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Tuesday Jul 18, 2017

AAFP's eHealth Initiative Aims to Make Health IT Work for FPs

"Progress is man's ability to complicate simplicity."
-- Thor Heyerdahl

I recently was introduced to a new product/service that was described as "the disruptive innovation that would change health care for millions of people." This is a phrase that I have heard often and am quick to dismiss.

[Physician using holographic computer interface]

However, this one struck me for a couple of reasons. First, it was a simple idea powered by 21st century technology and, second, it is the type of product that tends to raise concerns among physicians.

I have been wanting to write about the work the AAFP is doing in electronic and digital health, and this was, in my opinion, a good jumping off point for that conversation. So here we go.

When we hear the term "innovation" or "disruptive innovation," most of us think about products and applications such as the iPhone, iTunes, Facebook, Google, Uber, Thumbtack, Venmo, Spotify, and, of course, Twitter. These and countless other technologies have entered our life since the late 1990s, changing how we communicate, travel, and interact with each other. The pace of innovation is astonishing with each generation of these technologies rendering previous generations nearly obsolete.

Although health care has experienced its fair share of innovation and disruptive innovation, it is widely speculated that the generation of transformative innovation in health care is just starting. This is both exciting and horrifying. How will it impact patients? How will it impact family physicians and their practices? Will we all be replaced by robots? Will the Cubs finally win the World Series? … Wait, that actually happened.

These are serious questions. Technology disrupts industries -- remember Kodak? So it is fair to ask what will happen to our health care system and what will patients expect from their family physician in an age of transformative innovation in health care.

Maybe these questions have never crossed your mind, but they have crossed ours -- several times. In 2014, the AAFP launched the Alliance for eHealth Innovation, or the Alliance. Steven Waldren, M.D., director of the Alliance, summarized the transition this way: "This new name will reflect our mission to move beyond the EHR and toward the automation of care delivery. This new direction focuses more broadly on eHealth." Many of you may not be aware of the Alliance, so let me give you a quick introduction and overview.

The Alliance didn't appear out of nowhere. It is a product of evolution. In 2003, the AAFP formed the Center for Health Information Technology (CHIT). At the time, the formation of the CHIT positioned the AAFP as a national leader on health information technology, a position we continue to hold today. For more than a decade, the CHIT led the AAFP's effort to drive the adoption and implementation of electronic health records (EHRs) in family medicine. By all measures, they were extremely successful. Today, nearly 90 percent of family physicians use an EHR in their practice.

I will note that the percentage of family physicians who are happy with their EHR is not 90 percent. Clearly, there is a decisive delta between utilization and satisfaction, which leads me to the focus of this post.

The Alliance will continue to be the hub of our policy and advocacy work around EHR functionality and interoperability. This work remains a top priority for the AAFP, and we continue to work with the Office of the National Coordinator for Health Information Technology, as well as the industry, to improve the performance of EHRs and slash the onerous regulatory environment that dictates how they must be used in medical practice.

However, the Alliance also will engage in broader work around eHealth, digital health and other technologies that are transforming care delivery. This is important work, and it is critical that the AAFP's leadership in these areas be strong and visible.

As technology is invented and rolled out for implementation, it often lacks physician input or oversight on how it will be, or could be, utilized at the point of care. Often, a great idea leads to a new product, service or application that is intended to improve quality, increase efficiency, and save money for individuals and payers; but the reality is, many times something goes horribly wrong between the development phase and the implementation phase and the product turns out to cost more than anticipated and detracts from quality care, frustrates patients and makes physician practices less efficient. Case in point: EHRs.

This gap that occurs between the development of an innovative product and its implementation in a family physician's practice is one of the reasons that we transformed the CHIT into the Alliance. As noted in our press release at the time, "the Alliance will represent a cooperative effort to align with innovative AAFP member physicians and industry leaders to improve workflows and address gaps in needed functionality for members." The Alliance focuses its work in four areas:

  • Discovery -- identifying and evaluating new technologies and products, and evaluating best practices for how they can be used in a family medicine practice
  • Deployment -- sharing information and best practices with AAFP members and the primary care community
  • Development -- working with industry partners to provide a physician perspective during the development phase of current information technology products and new innovations under development
  • Data -- provide analytics to demonstrate and improve the quality and cost-effectiveness of family medicine

You may be curious to learn what the product/service that I mentioned in the opening sentence actually is. It's UberHealth(uberhealth.co). There is an interesting explanation of the product and the motivation behind its launch on the UberBlog(medium.com). If you are really moved by this post, you may want to check out the work of Clayton Christensen, M.B.A., D.B.A., M.Phil.(www.claytonchristensen.com), the Harvard professor who coined the term "disruptive innovation."

Primary Care Innovation Fellowship

Are you interested in working with the AAFP on these issues? If so, you should check out the Primary Care Innovation Fellowship. The fellowship will support projects that improve the usability and utility of health IT for family medicine as the health care system makes the transition to value-based care. Additionally, this fellowship aims to foster the next generation of family medicine leaders with an understanding of how to think about systems design and human factors, and to expose advanced industrial and systems engineering students and experts to the opportunities in family medicine and primary care. This is a great opportunity! If you have any questions about the fellowship or the application process, please contact us at allianceforehealth@aafp.org.

Wonk Hard

On July 11, the Patient Centered Primary Care Collaborative(www.pcpcc.org) published its annual review of evidence: The Impact of Primary Care Practice Transformation on Cost, Quality and Utilization(www.pcpcc.org). The report was supported by the Millbank Memorial Fund with the research and analysis being completed by the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

This is an excellent report, and I urge you to at least review the executive summary. In my opinion, this is the operative finding: "As this year's evidence report reaffirms, the patient-centered medical home has demonstrated improved outcomes in terms of quality, cost and utilization, but not uniformly."
 

Posted at 09:50AM Jul 18, 2017 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.