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
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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 Forces Institute 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 EHRs by 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, Peripherals
Hewlett-Packard
Medical Devices Welch-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