Future of Family Medicine and the EHR Initiative

Steven E. Waldren, MD, MS

Assistant Director

Center for Health Information Technology

American Academy of Family Physicians

swaldren@aafp.org

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Overview

Driving Forces

IT related to Future of Family Medicine

AAFP EHR Initiative

Member Survey

Center for Health Information Technology

Current Projects

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Why use an EHR?

Personal Reasons

Efficiency

Decreased costs

Improved quality of life

Technophile

Other Forces to drive adoption

External to the profession

Internal to the profession

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External ForcesInstitute of Medicine http://www.iom.edu/topic.asp?id=3718

Leapfrog Group http://www.leapfroggroup.org/

Government

Physician Focus Quality Initiative – CMS http://www.cms.hhs.gov/quality/pfqi.asp

Doctors Office Quality-IT (DOQ-IT) -CMS http://www.doqit.org

National Health Information Infrastructure http://aspe.hhs.gov/sp/nhii/

“The goal I set is most people ought to be covered within a 10-year period” - President Bush http://www.whitehouse.gov/news/releases/2004/04/20040427-5.html

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Internal Forces

AAFP Board of Directors Resolution 2000

All AAFP members using the Internet by 2003

Half of AAFP members using EHRsby 2005

Future of Family Medicine Report

All FP residencies with EHRs by 2006

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Electronic Health Records as a Core Technology

for the Future of Family Medicine

Integration of health information across providers and sites

Continuous, real-time access to important patient health information

Secure messaging and communication with colleagues and patients

Coupling/linking of knowledge/evidence with specific patient health information

Secure aggregation of data for quality and performance reporting and analysis

Future of Family Medicine Project Leadership Committee. The Future of Family Medicine: A Collaborative Project of the Family Medicine Community Ann Fam Med 2004 2: S3-S32.

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What The AAFP is Doing!

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What Percentage of AAFP members* Use An EHR?

* 5,517 AAFP members surveyed who had e-mail and web connectivity, early Jan 2003

• May over represent use of EHRs

• A large majority of our members are currently not using an EHR

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Of Those Who Don’t Currently Use an EHR, How Many Have Considered Purchasing a System?

•The vast majority of non-EHR users would like to have an EHR

•92% plan on implementation within 2 years

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What Are the Top Reasons for Not Purchasing an EHR?

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Center for Health Information Technology

To promote and facilitate the adoption and optimal use of health information technology by AAFP members and other office-based clinicians, for the purposes of improving the quality and safety of medical care, and to increase the efficiency of medical practice.

Mission:

http://www.aafp.org/centerforhit.xml

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The Four “Acid Test” Principles

Affordability

Office-based IT should be affordable to family physicians and other office-based clinicians who face very challenging economic environments and decreasing reimbursement

Compatibility

Physicians should not have to replace entire systems when purchasing a component, nor be locked into vendor products due to proprietary interfaces or predatory pricing tactics, and systems should work in concert with other systems

Interoperability

Data exchange schema should facilitate data transfer, import, and export among different vendor systems, in different settings such as office to office, to hospital, to nursing home, and to patient/patient home.

Data stewardship

Physicians reserve the right to choose the repository and guardians of their data, and the uses to which the data are put, within a framework of privacy and security mandated by federal/local regulations (HIPAA)

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CHiT Current Projects

New and interactive web site

Workshops and Seminars

Partners for Patients Initiative

Pilot Project (Medplexus, Siemens, & HP)

Continuity of Care Record, CCR

Doctors Office Quality -- IT (DOQ-IT)

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Partners for Patients (P4P)

Declaration of support for the four principles from vendors

A forum to drive efforts toward those principles

A mechanism to help vendors better address family physicians’ and other ambulatory physicians’ needs

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P4P – Core Companiessome of the core group companies

Electronic Health Records and Practice Management Systems

A4 Health Systems

DOCS, Inc. (SOAPware).

GE Medical/Centricity (Formerly MedicaLogic/Logician)

Medplexus

NextGen

Physician Micro Systems, Inc..

Hardware, Netware, PeripheralsHewlett-Packard

Medical DevicesWelch-Allyn

Laboratory and Testing Services

Medplus

Hospital Information Systems

Siemens Medical Solutions

E-PrescribingRxHub

SureScripts

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P4P – Supporting Companiessome of the supporting companies

Allscripts Healthcare Solutions

Cerner Corporation

CHARTCARE, Inc.

ChartWare, Inc.

Clinix Medical Information Services

DocSite, LLC

eClinical Works, LLC

e-MDs, Inc.

Integrated MD Solutions

MedcomSoft, Inc.

MedicWare

MediNotes Corporation

Meditab Software, Inc.

Meridian EMR, Inc.

Midmark Diagnostics Group

Misys Healthcare Systems

Noteworthy Medical Systems

OmniMD (A Division of ISM, Inc)

PowerMed Corporation

Praxis® EMR

http://www.aafp.org/x26745.xml

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EHR Pilot Project

Study implementation in small practices

Study and foster partnership between EHR vendor, Hospital/ASP vendor, Lab vendor, and hardware vendor

Identify needs and barriers specific to small ambulatory practices

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Continuity of Care Record (CCR)

Standard for health information exchange during transfer of care

Sponsorship along with The Mass. Medical Society, HIMSS, and others

Development of a reference implementation

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Doctors Office Quality-IT (DOQ-IT)

funded by the Centers for Medicare & Medicaid Services

endeavors to lead the way in assisting small- to medium-sized physician offices in migrating from paper-based health records to EHR systems

California Quality Improvement Organization in partnership with CHiT

http://www.doqit.org/doqit/jsp/index.jsp

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They are coming!

There are many forces driving HIT

Physicians must be a strong force

The future of medicine is information

Without tools to manage this information, we will never achieve the highest quality of health care

“Family physicians will rely increasingly on information systems and electronic health records” –Future of Family Medicine Report

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Questions?

It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system, for the initiator has the enmity of all who would profit by the preservation of the old institution and merely like warm defenders in those who would gain by the new ones

- Machiavelli, The Prince, 1513