This statement is submitted to the Ways and Means Health Subcommittee hearing entitled “Health Care Information Technology,” on behalf of the 93,700 members of the American Academy of Family Physicians. Family physicians practice office-based primary care, predominantly in medical practices consisting of one to five physicians and often in underserved areas. In fact, slightly more than a quarter of family physicians work in single or two-person practices that provide health care to some 38 million patients every year. These small practices survive on extremely tight operating margins and usually are unable to capitalize new technology equipment, provide necessary training and support serious disruption of their practice. The primary care physicians who provide most of the health care in this nation do not have access to the finances and capital available to hospitals, academic health centers and other large institutions. Despite a strong interest in electronic health record (EHR) technology, the large up-front costs like the initial fees and licensing agreements are prohibitively expensive for these physicians.
Nonetheless, Academy members are convinced that patient safety, effective evidence-based care coordination and the reduction of duplicative and unnecessary care require EHRs. Therefore, the AAFP’s goal is to have at least half of its members using EHRs by 2006. As a result, the Academy has created a Center for Health Information Technology to improve the availability of health information technology products aimed at this segment of the physician market.
The Center’s mission is to promote the adoption and optimal use of health information technology by AAFP members, office-based physicians and allied health professionals, for the purposes of improving the quality and safety of medical care, as well as to increase the efficiency of medical practice. The Center is using a multi-faceted approach to realize this mission through advocacy, education, cooperation, and standardization. At the heart of these efforts is the EHR. The EHR enables family physicians to deliver the highest quality, most efficient, and safest care for their patients.
The following programs, currently ongoing through the AAFP Center for Health Information Technology, illustrate the facets of our efforts.
Statement for the Record to the House Ways and Means Health Subcommittee on Health Information Technology
June 17, 2004
Introduction
Partners for Patients
In October 2003, the Academy’s Center for Health Information Technology announced that it had negotiated purchasing agreements with a core group of software and hardware vendors around four principles. These joint purchasing agreements between the Academy and twelve information technology vendors is called, “Partners for Patients.”
The Partners for Patients initiative demonstrates our collaboration with the health information technology industry. It is also a forum to work with vendors on standards development. In addition, we are establishing best practices to address contracting, pricing, and technical support. Partners for Patients vendors have agreed to the following principles:
The Partners for Patients initiative demonstrates our collaboration with the health information technology industry. It is also a forum to work with vendors on standards development. In addition, we are establishing best practices to address contracting, pricing, and technical support. Partners for Patients vendors have agreed to the following principles:
- Affordability: the costs for the acquisition and use of health information technology should be within the budget of small- to medium-sized medical practices.
- Compatibility: adoption of health information technology should not require that clinicians and practices completely and routinely replace current systems when new components are needed. Information systems and their components should increasingly be based on standards that result in “plug and play” compatibility, similar to that found in the video and audio industries. There should be no “vendor lock” resulting from proprietary systems or interfaces.
- Interoperability: Data exchange schema and standards should permit data to be shared between clinician, lab, hospital, pharmacy, and patient regardless of application or application vendor.
- Data Stewardship: Clinicians who use health information technology should retain control of the data that are the product of their work, subject to the rights of patients to access their health information and control its release. Physicians should be entitled to choose an independent and unbiased third party to be a steward of the data on their behalf.
These principles address significant technological and financial barriers to the widespread adoption of health information technology in the ambulatory physician office. With the commitment of our partners, coupled with the support of 40 additional vendors, we believe that progress toward achievement of the principles is accelerating.
Continuity of Care Record
Until there is adoption of widespread interoperable data standards that are being used by every component of the health care system, the Academy will work to produce and promote the use of a patient summary content standard to allow patients access to an easily updated, portable copy of their pertinent medical history. This new standard is called the Continuity of Care Record (CCR).
Unlike other health information technology standards, the Continuity of Care Record (CCR) is designed from the start to facilitate communication from clinician to clinician and clinician to patient. This commonly shared method of exchanging this critical clinical information among clinicians is particularly important.
The CCR is a newly established patient summary content standard that can be accessed as a PDF, HTML or Word document with basic health information such as diagnoses, medication list, allergies, and recent procedures. Physicians can forward this document to subspecialists when a patient is referred and patients can carry it with them to promote continuity, quality, and safety of care. Having this information readily available at the time of care or in emergencies could significantly reduce duplication of lab tests or diagnostic procedures, as well as improve patient quality and reduce medical errors from faulty or incomplete information.
The CCR is being sponsored and developed by the AAFP, the Massachusetts Medical Society, and Healthcare Information and Management Systems Society, with input from many other individuals and organizations, under auspices of the standards development organization American Society for Testing and Materials. Balloting was completed in early 2004 and pilot projects are likely to start later this year.
The CCR is that digital file, produced by using readily available software like Microsoft Word, or generated from hospital and practice EHR systems when a patient leaves the ER, office, or is referred from a primary care physician to a subspecialist. Because the CCR is being designed to be a simple content standard, it will be possible for different EHR systems to both import and export the information contained in the CCR, and to update that information after each encounter or visit. Data in similar documents can be displayed in a variety of formats, such as HL7 messages, HTML (browser), PDF, and Word, and thus printed versions of the CCR will be available for patients who desire them. Adoption of the CCR by the medical community and information technology vendors will be a first step in achieving interoperability of medical records. To promote both the CCR and the dissemination of EHR technology, several medical specialty societies have formed a coalition of experts in health information technology. Because the CCR is a critical step toward interoperability right now, the federal government whole-hearted support of this standard is critical.
Unlike other health information technology standards, the Continuity of Care Record (CCR) is designed from the start to facilitate communication from clinician to clinician and clinician to patient. This commonly shared method of exchanging this critical clinical information among clinicians is particularly important.
The CCR is a newly established patient summary content standard that can be accessed as a PDF, HTML or Word document with basic health information such as diagnoses, medication list, allergies, and recent procedures. Physicians can forward this document to subspecialists when a patient is referred and patients can carry it with them to promote continuity, quality, and safety of care. Having this information readily available at the time of care or in emergencies could significantly reduce duplication of lab tests or diagnostic procedures, as well as improve patient quality and reduce medical errors from faulty or incomplete information.
The CCR is being sponsored and developed by the AAFP, the Massachusetts Medical Society, and Healthcare Information and Management Systems Society, with input from many other individuals and organizations, under auspices of the standards development organization American Society for Testing and Materials. Balloting was completed in early 2004 and pilot projects are likely to start later this year.
The CCR is that digital file, produced by using readily available software like Microsoft Word, or generated from hospital and practice EHR systems when a patient leaves the ER, office, or is referred from a primary care physician to a subspecialist. Because the CCR is being designed to be a simple content standard, it will be possible for different EHR systems to both import and export the information contained in the CCR, and to update that information after each encounter or visit. Data in similar documents can be displayed in a variety of formats, such as HL7 messages, HTML (browser), PDF, and Word, and thus printed versions of the CCR will be available for patients who desire them. Adoption of the CCR by the medical community and information technology vendors will be a first step in achieving interoperability of medical records. To promote both the CCR and the dissemination of EHR technology, several medical specialty societies have formed a coalition of experts in health information technology. Because the CCR is a critical step toward interoperability right now, the federal government whole-hearted support of this standard is critical.
Physicians' Electronic Health Record Coalition
The AAFP is one of the founding members of the Physicians’ Electronic Health Record Coalition (PEHRC), which recently formed to collaborate on issues of health information technology. The medical specialty societies that form the membership of the PEHRC agree that promoting workable information technology solutions for the health care system is too big for just one organization. PEHRC will be a strong physician voice in the health information technology sphere. The coalition will influence industry, government, and physicians to provide better health information technology that will achieve better efficiency, quality and safety.
Doctor’s Office Quality – Information Technology (DOQ-IT) and EHR Pilot Project
The following two projects in which the AAFP is involved, explore how to best implement EHR technology in physician offices. Both projects promise to reveal critical success factors for small- to medium-sized practices in preparing, choosing and implementing an EHR package.
The Doctor’s Office Quality Information Technology (DOQ-IT) project, funded by the Centers for Medicare & Medicaid Services, was awarded to California’s quality improvement organization (QIO) in partnership with the AAFP Center for Health Information Technology, in October of 2003.
The DOQ-IT project endeavors to lead the way in assisting small- to medium-sized physician offices in migrating from paper-based health records to EHR systems, storing health information electronically and utilizing computer-generated decision support tools, including preventive service reminders and clinical guidelines. This project offers an integrated approach to improving care for Medicare beneficiaries in the areas of diabetes, heart failure, CAD, hypertension, osteoarthritis, depression, and preventive care.
The DOQ-IT project will educate small- to medium-sized physician offices on EHR system solutions and alternatives as well as provide information on cost, risks, and benefits of IT adoption. Working closely with participating physician offices, the project will conduct a needs assessment, identifying an EHR system from multiple vendors that meets specific office needs. Technical and quality improvement assistance will be provided, including uploading data, acquiring reports, and reorganizing physician office workflow to integrate and optimize IT use, to ensure EHRs are used to their fullest capability to improve quality of care. Through comparative clinical quality measure reports, the project also will assist physician offices in identifying potential areas for quality improvement.
In May of this year, the Academy was awarded $100,000 from the Centers for Medicare and Medicaid Services to evaluate the implementation of an EHR Pilot Project. This project implements EHR technology in small- and medium-sized ambulatory care practices. This project operationalizes our collaboration with the industry. The AAFP and Partners for Patient vendors are moving from policy and agreement to action. Education of the AAFP members on EHR implementation in small- and medium-sized practices is an expected outcome of this project.
AAFP is leading this small-scale collaborative pilot project with Medplexus, Siemens Medical Solutions, and Hewlett-Packard to implement, study and promote the transition to use of EHR in small- and medium-sized family practices. Six practices have implemented EHR technology and are currently utilizing it as part of their clinical workflow. Participating practices consist of solo physician offices in California and Pennsylvania; two physician practices in Utah and North Carolina; a four physician practice in Ohio and a five physician practice in Oregon.
In June 2004 each office a six-month demonstration using the Medplexus XML- and Java-based EHR software application, at no cost to the practices. Siemens Medical Solutions, Hewlett-Packard, and Medplexus have generously committed to host the application, provide hardware and provide the software, training, and application management without charge to the participating practices. The Health Information Management Systems Society (HIMSS), the nation’s largest health IT industry membership organization, is co-administering the pilot with AAFP and has lent valuable assistance to the Center for Health Information Technology staff.
The pilot project’s main objectives are to intensively study the barriers and keys to success during the implementation process, and to combine this goal with a proof-of-concept for the applications service provider model of delivery of scalable electronic health record systems. An additional goal is to identify those special needs for small and solo practices and help Medplexus, and subsequently other vendors, address those needs in their EHR.
The Doctor’s Office Quality Information Technology (DOQ-IT) project, funded by the Centers for Medicare & Medicaid Services, was awarded to California’s quality improvement organization (QIO) in partnership with the AAFP Center for Health Information Technology, in October of 2003.
The DOQ-IT project endeavors to lead the way in assisting small- to medium-sized physician offices in migrating from paper-based health records to EHR systems, storing health information electronically and utilizing computer-generated decision support tools, including preventive service reminders and clinical guidelines. This project offers an integrated approach to improving care for Medicare beneficiaries in the areas of diabetes, heart failure, CAD, hypertension, osteoarthritis, depression, and preventive care.
The DOQ-IT project will educate small- to medium-sized physician offices on EHR system solutions and alternatives as well as provide information on cost, risks, and benefits of IT adoption. Working closely with participating physician offices, the project will conduct a needs assessment, identifying an EHR system from multiple vendors that meets specific office needs. Technical and quality improvement assistance will be provided, including uploading data, acquiring reports, and reorganizing physician office workflow to integrate and optimize IT use, to ensure EHRs are used to their fullest capability to improve quality of care. Through comparative clinical quality measure reports, the project also will assist physician offices in identifying potential areas for quality improvement.
In May of this year, the Academy was awarded $100,000 from the Centers for Medicare and Medicaid Services to evaluate the implementation of an EHR Pilot Project. This project implements EHR technology in small- and medium-sized ambulatory care practices. This project operationalizes our collaboration with the industry. The AAFP and Partners for Patient vendors are moving from policy and agreement to action. Education of the AAFP members on EHR implementation in small- and medium-sized practices is an expected outcome of this project.
AAFP is leading this small-scale collaborative pilot project with Medplexus, Siemens Medical Solutions, and Hewlett-Packard to implement, study and promote the transition to use of EHR in small- and medium-sized family practices. Six practices have implemented EHR technology and are currently utilizing it as part of their clinical workflow. Participating practices consist of solo physician offices in California and Pennsylvania; two physician practices in Utah and North Carolina; a four physician practice in Ohio and a five physician practice in Oregon.
In June 2004 each office a six-month demonstration using the Medplexus XML- and Java-based EHR software application, at no cost to the practices. Siemens Medical Solutions, Hewlett-Packard, and Medplexus have generously committed to host the application, provide hardware and provide the software, training, and application management without charge to the participating practices. The Health Information Management Systems Society (HIMSS), the nation’s largest health IT industry membership organization, is co-administering the pilot with AAFP and has lent valuable assistance to the Center for Health Information Technology staff.
The pilot project’s main objectives are to intensively study the barriers and keys to success during the implementation process, and to combine this goal with a proof-of-concept for the applications service provider model of delivery of scalable electronic health record systems. An additional goal is to identify those special needs for small and solo practices and help Medplexus, and subsequently other vendors, address those needs in their EHR.
Summary
The Academy has made promoting the dissemination and utilization of health information technology a strategic priority for the organization. We are committed to helping physician offices begin the process of transforming the ambulatory setting. This transformation will require physician offices to rely upon health information technology to achieve advances in chronic care management, quality improvement and improved patient safety.
However, so many individual factors can affect the choice of adopting technology in the small- to medium-sized practice that it would be counter-productive to mandate the immediate implementation of any EHR technology. The lessons learned through DOQ-IT and the AAFP’s EHR Pilot Project are expected to yield vital information for small- to medium-sized ambulatory physician practices. For example, physicians currently lack adequate information about how to ready their practice for an EHR, how to choose an appropriate technology package and how to quickly implement an efficient clinical workflow utilizing an EHR. These barriers to technology adoption exist beside the significant financial hurdles that currently prevent many practices from purchasing EHRs.
The Center for Health Information Technology has been pleased to work with Dr. David Brailer, National Health Information Technology Coordinator within the Department of Health and Human Services. The clear intersection of priorities between Dr. Brailer and the Center for Health Information Technology has lead to a close working relationship. No one entity can solve the problems that plague our health care system, yet collaboration to utilize health information technology among physicians, patients, technology vendors, insurers, and the federal government holds great promise. The AAFP has been leading collaborative efforts around health information technology, and we believe Dr. Bailer's work will break down barriers to collaboration and promote action.
The Academy appreciates the opportunity to submit this statement outlining the experience that the ambulatory physician’s office has had with EHR and looks forward to continue out work with the Ways and Means Committee on issues related to health information technology.
However, so many individual factors can affect the choice of adopting technology in the small- to medium-sized practice that it would be counter-productive to mandate the immediate implementation of any EHR technology. The lessons learned through DOQ-IT and the AAFP’s EHR Pilot Project are expected to yield vital information for small- to medium-sized ambulatory physician practices. For example, physicians currently lack adequate information about how to ready their practice for an EHR, how to choose an appropriate technology package and how to quickly implement an efficient clinical workflow utilizing an EHR. These barriers to technology adoption exist beside the significant financial hurdles that currently prevent many practices from purchasing EHRs.
The Center for Health Information Technology has been pleased to work with Dr. David Brailer, National Health Information Technology Coordinator within the Department of Health and Human Services. The clear intersection of priorities between Dr. Brailer and the Center for Health Information Technology has lead to a close working relationship. No one entity can solve the problems that plague our health care system, yet collaboration to utilize health information technology among physicians, patients, technology vendors, insurers, and the federal government holds great promise. The AAFP has been leading collaborative efforts around health information technology, and we believe Dr. Bailer's work will break down barriers to collaboration and promote action.
The Academy appreciates the opportunity to submit this statement outlining the experience that the ambulatory physician’s office has had with EHR and looks forward to continue out work with the Ways and Means Committee on issues related to health information technology.
2004 Archives
