EHR pilot project provides FPs some playtime
Several AAFP members have been spending quite a bit of time playing in the sandbox lately. Not at the park, not playing with the neighborhood kids. These folks are in their medical offices tinkering with a new electronic health records system.
Last fall, the AAFP asked for volunteers for a pilot project to learn what it takes to implement an EHR system in a family medicine setting. Six physicians from across the country, along with technical support teams from MedPlexus Inc., Hewlett-Packard and Siemens Medical Solutions Health Services Corp., have been immersed in that project since January. The companies are partners in AAFP's EHR initiative, Partners for Patients.
Sandbox learning
AAFP Board member John Sattenspiel, M.D., of Salem, Ore., and the other five participants are currently in "sandbox mode." Sattenspiel has created four imaginary patients, including Mickey and Minnie Mouse. "This mode is a place where we can play with the software," said Sattenspiel. "I can generate notes, enter patient information and basically play around with it to my heart's content."
The sandbox period gives physicians a chance to learn the system, practice the flow and make mistakes before going into a live production mode, said Denny Koch, MedPlexus vice president of operations.
But the sandbox doesn't last forever. In the next few weeks, all the physicians will have to make their technology go live. "When they do, they're seeing real patients and using the system," said Koch.
To make sure they'll be ready, the physicians and support teams have regular phone conferences. The physicians can also access a private online site where they address problems and discuss solutions.
"Our family physicians are working together with some of the very best and innovative information technology companies to help design a low-cost, standards-based EHR option that could be used by many thousands of practices eventually," said David C. Kibbe, M.D., director of AAFP's Center for Health Information Technology.
Exploring the system
The EHR system being tested in the pilot is a work in progress. When a physician encounters a software glitch, the MedPlexus support team finds a fix, then supplies an upgrade via the Internet. "People are really responding to our needs. Every significant upgrade that MedPlexus has provided has been a dramatic step forward," said participant John Wilson, M.D., of Daly City, Calif.
Wilson can't wait for his EHR system to go live this month. "My only frustration is that I want the process to move even faster," he said. Wilson will start by entering every new patient he sees into an electronic chart. If that goes well, he'll add complicated patients who have long medical histories and medication lists. The final tier will be other established patients.
Equipment bells and whistles
The physicians realized early on in the pilot that built-in templates would save them time. "We came up with our most common diagnoses and created templates, and now we've got a small library to get started with," said Wilson.
The EHR system features an extensive internal messaging system, an HP Tablet PC TC1100 which is a pen-based tablet computer system that also allows for free-text entry into a note, and a powerful voice recognition engine "that will allow me to simply speak to my tablet and capture the fine nuances of the clinical visit," said Sattenspiel.
One of Sattenspiel's favorite components is the prescription-writing module. "I can generate a refill prescription with a couple of pen taps on my tablet," said Sattenspiel. The prescription is automatically faxed to the local pharmacy.
Hewlett-Packard provided nearly 30 computers -- Tablet PCs and D530 Business Desktops -- for the pilot. At the project's end, the physicians will have the option to buy their computers at a discounted rate.
Work-flow issues
One big question remains unanswered. How smoothly will implementation go?
"How much is it going to slow us down?" said Sattenspiel. "Docs are afraid of making a big change like this because even though we're drowning in charts with our current system, we're still able to do enough work each day to keep our practices financially viable."
The physicians in the pilot all share a concern about the time required for making the shift, said Sattenspiel. "So far, we all believe it's going to work."
The pilot project will conclude by the end of 2004. The information generated will then be compiled into a final report.
Other physicians involved in the pilot are Kenneth Bertka, M.D., of Holland, Ohio; Michael Peterson, M.D., of Herriman, Utah; Desiree Butter, M.D., of Pittsburgh; and Ronald Hughes, M.D., of Whitakers, N.C.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
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