Health IT Still Needs Work, Say FPs During White House Meeting

During a recent White House event, AAFP members and other family physicians emerged as a powerful and unified voice on the importance of health information technology (IT) and the need for interoperable and user-friendly health IT systems.

Chaired by Farzad Mostashari, M.D., M.S., the national coordinator for health information technology, the June 19 meeting brought together more than 140 physicians from around the country to share ideas and experiences about the use of health IT in medical practices. Participants included AAFP members, several of whom asked questions or commented on the uses of health IT and the challenges that still exist with the technology.

"There were a lot of folks from different backgrounds and different specialties and subspecialties," said AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., shortly after the two-hour meeting adjourned. "There was tremendous representation from family medicine."

The meeting relied on a panel discussion followed by a question-and-answer period. Family physician and AAFP member James Johns, M.D., a solo physician from Canton, Ohio, served as one of the four physician panelists. He explained how the Health Information Technology for Economic and Clinical Health (HITECH) Act enabled him to purchase a health IT system for his practice.

In particular, the regional extension centers (RECs), created by the HITECH Act to help practices research and purchase health IT systems, helped Johns negotiate contracts and obtain low interest loans for the purchase of a health IT system. "Because of that, I was able to go electronic," said the owner of Little Flower Family Practice Inc. "It would have been really, really hard to do it on my own."

According to Stream, two main issues emerged during the meeting: usability of health IT systems and interoperability of the systems.

Physician participants said many of the systems are not necessarily easy or intuitive to use and that they are geared more to capturing documentation for billing than to collecting and maintaining patient care information, Stream said.

"Even after you make the effort to get your office on electronic health records (EHRs), it is difficult to exchange information with other sources of care," Stream added, citing concerns voiced by other physicians at the meeting.

Eugene Heslin, M.D., owner of Bridge Street Family Medicine in Saugerties, N.Y., told AAFP News Now he expounded on that point during the meeting by calling for "streamlined delivery of information" from one system to another.

Heslin said he also urged the Office of the National Coordinator for Health Information Technology (ONC) to develop a good breach policy for health IT, saying that someone eventually will figure out how to break into these systems, making the development of a breach system imperative. "I also talked a little bit about sustainability -- of needing to be nimble and understand that payer resources will change over time," he added.

Family physician Tiffany Nelson, M.D., owner of Desert Ridge Family Physicians in Phoenix, said she concentrated on the usability of EHRs being much improved by payment system reforms that reward value instead of volume. Physicians need to be able to electronically document what they need instead of being required to check boxes and verify codes for insurance purposes, said Nelson.

She described the meeting as a "great opportunity for people who have been leading health IT to come together and discuss their success and the barriers they still face."

"I think it was great feedback for the ONC -- to let them know how they have been helping us, and to let them know how much more needs to be done," Nelson said.

The meeting took place the same day the federal government announced that more than 110,000 health care professionals now are using EHR systems that meet federal standards. At the end of May, more than $5.7 billion in EHR incentive program payments had been made overall. That figure includes more than $3 billion in Medicare incentive program payments made since the program first started in May 2011 and more than $2.6 billion in Medicaid program payments since that program began in January 2011.

In addition, more than 133,000 primary care providers and 10,000 subspecialists were working with their local RECs to implement and effectively use their EHR systems as of May 31.

Stream said, however, that not all practice settings have been able to obtain the incentive payments because of the way they bill Medicare, a fact that came out during the meeting.

"I know that is true for rural health clinics," Stream said.

According to Stream, one physician participant at the meeting said her free clinic is grant funded and sees patients who do not have insurance. As a result, the clinic does not bill Medicare, making it impossible for the clinic to qualify for the incentive payments.