BY SHERI PORTER
Seeing is
believing. If you're still waffling about whether an electronic health record
system can work for your practice, go see a successful one in action. Spend a
few hours with an FP reaping the rewards of a paperless office. You'll likely
come away a believer.
Take, for example, FP Susan Andrews, M.D., who was turned on to an electronic health record system in October 2000. Since then, Andrews and her three partners (including her husband, FP Randall Rickard, M.D.) have successfully used the EHR system to deliver medical care in Murfreesboro, Tenn., a town of 80,000 residents.
FP Report visited Andrews' practice and found it running seamlessly. This story -- the second in a series on the new model of care proposed in the Future of Family Medicine report -- shows how an EHR system can revolutionize patient care.
Lights, camera, EHR in action
 With her computer on her lap and her eyes on her patient, Susan Andrews, M.D., left, conducts an animated interview with patient Gloria Daniel. |
It's just after lunch on a hot July day, and Andrews prepares to see her first afternoon patient. Sitting at her desk, she glances at her computer and learns a nurse has entered the patient's vital signs and clicked on the purpose of the visit, "physical." Andrews chooses a template (she's set them up by patient age) and pulls up the patient's medical record.
Now Andrews has right in front of her all the recommended screening tests for this particular patient. Is she past due for a tetanus shot? Red flag. Is it time for a mammogram or cholesterol screening? If so, another red flag. This quick and thorough overview of the patient's chart is done before Andrews ever enters the exam room.
She scoops up her laptop and swings down the hall to check on her patient. "It's just second nature," she says of the computer held in the crook of her arm.
When she enters the exam room, the patient isn't surprised to see Andrews toting a computer. In fact, patient Gloria Daniel appreciates the health care she receives from Andrews, care Daniel says is enhanced by an EHR system.
"It's an excellent way to keep accurate records," says Daniel, who has a long history with Andrews. "There's no question from one time to the next about what's in my medical record because she has everything right in front of her." Translation: Forget the bulging paper chart with randomly inserted telephone notes and test results.
In the exam room, Andrews types patient notes right into Daniel's chart. The conversation is fluid and intimate with good eye contact. "I get most of my notes done in the room with the patient," says Andrews. Translation: Gone is the stack of charts waiting for completion at 5 p.m.
Andrews' computer screen displays a list of Daniel's current medications. Andrews asks about each and every one: "Do you still need this? Are you still taking that?" Refills are a snap. So are medication changes.
"I can write prescriptions quickly with a few clicks, and the prescription goes into the note automatically," said Andrews. After the visit, the prescriptions are waiting at the printer for Andrews to sign.
That's not all of the exam room magic. Andrews' office is wireless, meaning she has Internet access without being tied to a cord in the wall. So, when a patient shared plans about an upcoming trip to China recently, Andrews instantly went to the CDC Web site to gather vaccination information.
Patient education sites are readily available; handouts, just a keystroke away, can be picked up along with those prescriptions waiting at the printer. Ditto for form letters patients need, such as a physician note excusing a work absence. Fill in the blanks on the form letter template and hit print.
Translation: Every task completed before the patient leaves the office is one less task to do later.
Different strokes for different folks
Each of the four physicians in the practice can tweak the system's templates to fit their styles. And while Andrews prefers to complete patient notes in the exam room, her husband's work style is different. "I'm a procrastinating documenter," says Rickard, found sitting in the medical office's tiny kitchen entering the morning's patient notes into his computer.
Rickard stops his work to show off the system's graphing element. "I use the graphing fairly liberally to show trends and connect information for patients," he says. In fact, he had used graphing that morning to illustrate a patient's weight and cholesterol trends.
With the patient by his side, Rickard positioned two graphs side-by-side on his computer screen and asked, "Do you see a correlation between the rise in your weight and the rise in your total cholesterol?"
The overweight male -- who had repeatedly turned a deaf ear to Rickard's requests for him to lose weight -- had an "aha" moment. "Oh, yeah. I need to come back on my weight," he said. Point made, patient education battle won. Translation: Rickard may see a healthier patient in the future.
"The EHR system has improved care," says Rickard.
"It's made me more passionate about being a family physician," says Andrews. "It's added a little excitement after doing the same thing for 19 years. I feel like I have the tools to do a better job."
To reach writer Sheri Porter, e-mail sporter@aafp.org.
Why are so many physicians stuck in the EHR starting gate? Perhaps because there are so many products to choose from.
When FP Susan Andrews, M.D., and her colleagues decided to go paperless in June 2000, she became the EHR point person. She forged ahead and had the system up and running by October.
 This 80-year-old cottage houses the high-tech family medicine practice of Susan Andrews, M.D. |
Her advice to family physicians: Pinpoint your needs. Look for an EHR system that offers what your practice can't live without. "I only looked at systems that included billing, scheduling and records," she said.
While some folks don't mind testing out the new kid on the block, Andrews wanted a stable, profitable company with dedicated support staff. She talked to colleagues around the country about their experiences with various companies and finally requested a long-distance online demonstration with Physician Micro Systems Inc.'s Practice Partner software.
"For three hours, I watched everything the technician did (on the screen)," said Andrews. The demo won her over.
What about her practice's bottom line? "Profits have increased since 2000; all four physicians are making more money," said Andrews. The total initial investment was $100,000, and the system paid for itself in a year, she added.
It took about six months to get old information into the EHR system. "Add five minutes a day per patient," said Andrews. "Then it starts paying off."
Part of the savings came in reducing staff. "We used to have six people; now we have 4.5, even though we brought billing back in-house," said Andrews. The physicians also stopped using transcription services, which saved a chunk of money.
"We've added software programs and purchased some new equipment," said Andrews, but there's no additional charge for software upgrades. Andrews and her colleagues continually tweak templates.
Andrews said she's always looking for ways for the EHR system to help her do a better job. She added, "It's an evolution."
Note: Go to http://www.aafp.org/centerforhit.xml for health IT information from the AAFP.
Insurance specialist Sheila Richards has worked in the front office for FP Susan Andrews, M.D., for nine years. She's been through the transition from paper records to an electronic health record system with Andrews and crew, and she knows all about the dreaded learning curve.
"It was very scary at first," said Richards. "The information I needed was in the computer. I had to learn the system to access it."
Remarkably, Richards said it took her just six weeks to feel "fairly comfortable and knowledgeable." She said the temporary drop in the practice's cash flow created several months of uneasiness.
The challenge of going electronic was more than just learning how to navigate the EHR system; the entire office work flow changed, said Richards. "I learned new ways of doing everything."
Now a seasoned veteran, Richards said the best part about going paperless was having faster access to the doctors. Before the practice adopted the EHR system, staff carried notes to the FPs. "Now (with internal messaging), I can send the doctors a message anytime about anything a patient or I might need," said Richards. "And they can respond immediately."
No files to pull, no files to put back. It means less hassle for the staff and prompt service for the patient.
How would Richards feel about going back to paper charts? Her eyes widened at the question and she paused before saying, "No, please no!"
"Yesterday, I must say, was the high point of my vacation," wrote FP Bruce Burton, M.D., of Corydon, Ind., in a summer thank-you note to Susan Andrews, M.D.
Burton had recently returned home from a two-hour road trip to visit Andrews' paperless practice in Murfreesboro, Tenn. "I came away with some knowledge ... and inspiration," wrote Burton. "For that I am very grateful."
In a recent phone interview, Burton called himself a "theoretical" electronic health records supporter. He admitted his solo practice was totally tied to paper. He said he knew he wanted to invest in an EHR system but hadn't made the move because of economics.
"It's not that I can't afford it," Burton said. "I can't afford to make a mistake."
Burton said he went to Murfreesboro because he wanted to see a battle-tested EHR system in action in an FP's office. Andrews' practice "truly is paperless," marveled Burton. "The charts she had were in a back room, neatly stacked on the shelves. You would tell they hadn't been molested in years."
Burton read about Andrews' electronic successes on an AAFP EHR e-mail discussion list. Subscribe at http://www.aafp.org/myacademy/. Log in with your Academy ID number, then click on "My Subscriptions."
What Burton would like to see next is an AAFP listing, by location, of members like Andrews. "I'd like to know who are using what systems and if they'd be willing to share their offices and their expertise with a visitor," said Burton. The AAFP is working to make this happen.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
BY TONI LAPP
In the year since Americans in Motion debuted at the 2003 AAFP Scientific Assembly, many FPs have watched in admiration as President Michael Fleming, M.D., of Shreveport, La., torqued up his activity level and shed 45 pounds. Fleming has been the spokesman for this AAFP program.
Now it's time for other FPs to take the next step in the AIM fitness initiative. Step two, "The Healthiest Family Medicine Office in America," will debut at the 2004 Assembly Oct. 13 - 17 in Orlando, Fla. This step involves encouraging and facilitating staff within FP offices to participate in successful health initiatives, including increased physical activity, balanced nutrition and improved emotional well-being.
You don't need to attend the Assembly to register, however. Beginning Oct. 14, go to the AIM Web site at http://www.aafp.org/aim.xml to register your office or institution in a six-week fitness program.
Prizes -- from microwaves to fitness equipment -- will be awarded for both groups and individuals meeting personal goals during the program. Winners will be announced May 18, coinciding with National Employee Health and Fitness Day.
Also in Orlando, AIM researchers will present results from the "How Fit Is Our Specialty" study, which collected health and fitness data from FPs at the 2003 Assembly.
In August, HFIOS researchers sent a survey to the original cohort of participants from 2003 who received pedometers and agreed to let their health data be collected. Of those who responded to the survey, 35 percent of the FPs said their patients had noticed or made reference to their improved level of fitness.
Even more gratifying to AIM organizers were some of the comments the survey takers offered. "It's been easier for me to talk about healthy lifestyle choices to my patients, and they seem more receptive because I have gone through it and been successful," said one participant, echoing the goal of AIM.
"Members are excited about ‘How Fit Is Our Specialty,' said AIM Director Sarah McMullen. "They want it repeated."
Thus, each FP attending the Assembly this month can have his or her body mass index plus two new measurements -- grip strength and waist circumference -- collected as part of the next HFIOS study, and will receive a pedometer.
BY J. MICHAEL BRODIE
The AAFP Board of Directors has given its stamp of approval for the Academy to "support legislative proposals that allow importation of drugs." The Board's action was based on two conditions. First, the drugs distributed in the United States -- including drugs imported from Canada and countries in the European Union -- should come from FDA-approved plants and be manufactured in FDA-inspected facilities. Second, an FDA approval and inspection system should supersede the current HHS safety certification process.
| "Whether drug
reimportation is debated now or in the next session, we believe these issues
must be fully explored." --James Martin, M.D. |
"The Academy Board wrestled with the development of a policy that would address both the costs to our patients and the safety and efficacy of life-saving pharmaceuticals," said AAFP Board Chair James Martin, M.D., of San Antonio. "Whether drug reimportation is debated now or in the next session, we believe these issues must be fully explored."
The AAFP Board's decision, made in August, comes in the midst of hot debate about drug importation across the nation. Senate leaders at press time were deciding whether one or both of two bills had sufficient support to force a vote. The bills are S. 2493, the Safe IMPORT Act, or the Safe Importing of Medical Products and Rx Therapies Act, written by Senate Committee on Health, Education, Labor and Pensions Chair Sen. Judd Gregg, R-N.H., and the Pharmaceutical Market Access and Drug Safety Act of 2004, S. 2328, sponsored by Sen. Byron Dorgan, D-N.D., and Sen. Olympia Snowe, R-Maine. The Dorgan-Snowe bill would open the way for the U.S. to import FDA-approved prescription drugs from 20 countries, including Canada.
The House of Representatives last year passed a drug importation bill (H.R. 2427, the Pharmaceutical Market Access Act of 2003), by a vote of 243-186.
Pharmaceutical industry leaders have taken a stand against importation because, they say, it allows for the potential introduction of unsafe drugs or phony and ineffective substitutes.
Senate Majority Leader Bill Frist, M.D., R-Tenn., himself a staunch opponent of drug imports, has expressed doubts the measures would get voted on before the November elections.
Meanwhile, the governors of three states asked Frist on Sept. 10 to let the Dorgan-Snowe bill reach the Senate floor for a vote before legislators returned to their districts in early October.
Democratic Gov. Rod Blagojevich of Illinois, in a Sept. 10 statement, said that nearly three million of his state's residents currently have no prescription drug coverage, which forces them to go without needed medicine, take smaller doses than their physicians prescribe, or go without food or other essentials in order to pay for their medicines.
"No one should be forced to make those choices," said Blagojevich. His statement mentioned the letter from himself, Republican Gov. Craig Benson of New Hampshire and Democratic Gov. Jim Doyle of Wisconsin and said, "We're doing what we can at the state level to help our citizens get their medication at a price they can afford -- even if that means buying them in places like Canada and Europe where they cost half as much."
Easing physician jitters about investing in pricey health information technology products could help persuade FPs to purchase them. To help dispel physicians' fears and uncertainties, a commission created last summer will soon begin work on health IT product certification.
On Sept. 1, the Certification Commission for Healthcare Information Technology appointed Academy EVP Douglas Henley, M.D., and 11 other commissioners to serve one-year terms on the CCHIT.
"I am excited to represent the AAFP on this important commission," said Henley. "Our members have enthusiastically taken advantage of our Partners for Patients program and our Center for Health Information Technology as they move to adopt electronic health record technology in their practices. However, physicians need the added assurance that these technologies meet the criteria necessary to be compatible and interoperable, and that is the goal of this certification effort."
The 12 commissioners represent three primary stakeholders: providers that purchase health care IT products; vendors that develop, market, install and support these systems; and purchasers or payers that will offer incentives and support for health care IT adoption.
The formation of a certification process for health IT products was publicly encouraged by HHS Secretary Tommy Thompson at a July 21 IT summit in Washington. Thompson expressed a strong desire to see such a process rise out of the private sector rather than the federal government.
CCHIT was the brainchild of the American Health Information Management Association, Healthcare Information and Management Systems Society, and the National Alliance for Health Information Technology. These organizations are providing the initial funding and staffing for the certification effort.
In its September news release, the commission said it hoped to "reduce the risk of IT investment by health care providers" and ensure interoperability of local and national health information infrastructures. The commission aims to have initial certification requirements and processes ready for testing by next summer.
More than eight in 10 (84 percent) of the respondents to the 2004 Member Attitude Survey said they were satisfied or very satisfied with the AAFP compared with other organizations.
Nearly six out of 10 respondents (59 percent) said the Academy's performance had improved in 2004 compared with the past.
In addition, 92 percent of survey respondents said they were kept well-informed about major actions and programs of the AAFP. The majority of members said they received that information through American Family Physician (81 percent) and the Academy Web site (55 percent). Many members also said they obtained the information from Family Practice Management, Academy mailings, FP Report and AAFP This Week.
The respondents gave these rankings to these AAFP products and services:
Seventy-three percent of respondents said family physicians provided higher-quality health care now than 10 years ago. Ninety-four percent said outside regulations were making it more and more difficult to practice medicine.
Some areas within AAFP were not rated quite as highly as in the past. Sixty-four percent of respondents (compared with 73 percent in 2003) said AAFP did a good job representing family medicine to the public and patients, and 57 percent (compared with 65 percent in 2003) said the Academy was doing a good job representing family medicine to government.
BY PAULA BINDER
Why do you read FP Report? If you're like most AAFP members, you want news about the specialty and about AAFP's advocacy efforts in Washington. You want analysis -- of news affecting your practice and trends influencing the specialty. Finally, you want to know what AAFP is doing on your behalf, in addition to its advocacy in Washington.
The most recent FP Report reader survey, conducted earlier this year, gave us this information -- and more:
Results gleaned from the survey are helping us in the most important endeavor of all: fine-tuning AAFP's news reporting to better meet your needs.
To reach writer Paula Binder, e-mail pbinder@aafp.org.
BY LESLIE CHAMPLIN
Family physician preceptors have an enhanced tool for encouraging students to consider family medicine as their specialty. The tool, the Family Medicine Interest Group Web site at http://fmignet.aafp.org, has a new look and -- more important -- new content that provides an accurate picture of life as a family physician.
Family medicine preceptors applaud the updated site.
"Anything we can do to support students going into family medicine is great," said Linda Stone, M.D., predoctoral education director at Ohio State University College of Medicine and Public Health. "Our students have so many choices, and we want them to know about the specialty that we have loved. They are making huge personal and professional choices during medical school, and I believe family medicine is often the answer if they just knew more about it."
Amanda Keerbs, M.D., part-time family medicine faculty adviser who teaches an introductory preceptorship course for first- and second-year medical students at the University of Washington, Seattle, agreed.
"The virtual FMIG page has content that is useful for students who want to explore family medicine as a career choice and those who have already decided on family medicine and are looking for information on residency applications and leadership opportunities," she said.
With a completely new, easily navigated format, the site offers:
Overall student reaction to the revised Web page has been positive, said Jay Fetter, AAFP manager of student interest, adding, "They liked the look of the site. Several said they were surprised that the scope of information, such as the new clinical resources section, was bigger than they had expected."
This year's update of the virtual FMIG site is the first major revision since the site was first launched in 2001.
WEB EXTRA!
To the Editor:
I find it extremely ironic that the article, "Why Medical Students Lose Interest in Family Medicine," in the July issue of FP Report was followed by the article, "Learners, Faculty Need Not Reinvent EBM Wheel, Say Educators." The first article confirms my observation that family medicine residents tend not to read the literature, are not up on the important latest studies and tend to take a cavalier approach to academics. In the second article, three family medicine educators promote this level of incompetence by encouraging family medicine residents and practicing physicians to eschew reading research studies and other important literature directly; instead, they encourage readers to depend on the simple opinions of other better-read physicians -- who have read summary reports and position stands.
I think the position of the second article confirms the first and is very revealing. Family medicine will never have the respect it should have until residency education steps up quite a few notches and demands better performance from the residents. This may, in fact, even require failing some residents.
David Weldy, M.D., Ph.D.
Ravenna, Ohio
WEB EXTRA!
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The AAFP supports the concept that all physicians should obtain privileges in accordance with their individual qualifications. If you have concerns about privileging issues, turn to a new Academy resource, "Privileging Crash Cart." This CD-ROM contains two documents and a monograph. Review "Protocol for Handling Hospital Privilege Problems," with instructions for resolving privileging disputes; "Procedural Privileges Legal Opinion," a review of applicable case law; and Family Medicine in Hospitals: Strategies for Strength, a monograph that will help you make informed decisions when applying for clinical privileges. Order the CD-ROM (item #309, $20) directly from the online catalog at http://www.aafp.org/shop/309. The two documents can also be downloaded at no charge at http://aafp.org/29067.xml. |
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Proven value: Order the Physician Office Laboratory Microscopy Atlas, second edition (item #725, $105) for your office lab. The atlas contains more than 145 photographs of cellular elements, each with a matching description and clinical association. Recently updated Clinical Laboratory Improvement Amendments regulations are also included. Use this resource for training, continuing education and as a reference tool in your lab. For easy online ordering, go to http://www.aafp.org/shop/725. |
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Proven value: Use AAFP Placement Services' online database to help match qualified family physicians to available positions. Search for professional opportunities or for qualified candidates for your practice based on geographic, demographic and professional factors. This service is free to FPs searching for positions and is available at a discounted rate for members listing job opportunities. Go to http://www.aafp.org/placement to learn more. |
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Proven value: With the cold and flu season fast approaching, take advantage of two patient education brochures from the AAFP Family Health Facts series. Use the online catalog to order "Flu & Colds: Tips on Prevention and Feeling Better" at http://www.aafp.org/shop/1557 and "Sore Throat: Easing the Pain of a Sore Throat" at http://www.aafp.org/shop/1531. A packet of 50 brochures of the same title costs $12.50. These brochures are packed with easy-to-read information and have been reviewed by physicians, patients and the AAFP Foundation Health Education Program. |
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A shipping fee may apply; Kansas residents pay a 7.525 percent tax. |
WEB EXTRA!
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FP Report is published by the
AAFP News Department.
Copyright © 2004 by
American Academy of Family Physicians.
