TransforMED: Talk, Planning Turn to Action

An Academy dream several years in the making became reality June 2 when representatives from 18 family medicine practices around the country converged in Kansas City, Mo., to begin the hard work of delving into the TransforMED national demonstration project that could change the course of family medicine.

During the next two years, AAFP leadership; staff members from TransforMED, the Academy's practice redesign initiative; and trained facilitators and consultants will guide project participants as they begin implementing the tenets of family medicine envisioned in the 2004 Future of Family Medicine Report. Their efforts will identify what changes are feasible in a family physician's office and how to implement those changes for a profitable, patient-centered practice that delivers high-quality health care.

AAFP EVP Douglas Henley, M.D., started off day one of the two-day meeting -- dubbed "Journey to the Future" -- with a rousing and emotional delivery to the 60-plus participants gathered together for the first time in one room.

Calling the assembled group of practices "the chosen 18," Henley told the group they were taking on a huge burden but an informed risk. "You're embarking on a journey," to define this model and build a roadmap to make it a reality for other practices, said Henley. "We're going to learn from you."

"We know that family medicine delivers better health outcomes in terms of mortality, morbidity, medication use, patient satisfaction and per capita expenditures," said Henley. "We also know that all of those indicators reverse in a subspecialty based system. How do we take that message to lawmakers and policy-makers so they'll begin to invest in family medicine?" he asked. "We need people to pay attention (to the data), and you'll help us to get there."

Henley noted that a total of 36 practices were selected for the project. He also acknowledged the dedication of the 18 practices not present at the Kansas City meeting. Although those practices will move through the two-year project at their own speed without the help of facilitators, Henley noted that their efforts would be equally beneficial to the project, especially when it comes to measuring the value of facilitation. Profiles of all 36 participating practices -- and details about the project -- are available on the AAFP Web site.

Practice Profiles Show Diversity

As physicians around the room rose to introduce themselves and their practices, the diversity of the group -- and their reasons for signing on -- quickly became clear.

Joel Jarvis, M.D., of Muskegon, Mich., said his nine-provider practice has been using an electronic health record for 11 years. "We've already implemented a lot of the measures" in the Future of Family Medicine report, he said.

On the other end of the spectrum, Richard Rajewski, M.D., of Hays, Kan., said his practice would present the biggest challenge during the next two years "because we've adopted the least number of pre-existing attributes. There will be lots of opportunity for us to learn," he said.

One physician reminisced about the past. Barbara Saul, D.O., of Troy, Mich., said she remembered filling out her application to medical school 35 years ago and answering a question about what she wanted out of medicine. "This (the description of the new model of care) is what I wrote," she said.

Susan Wilder, M.D., of Scottsdale, Ariz., said her practice is "trying to be to medicine what Starbucks is to coffee. We're trying to make primary care a privilege, not a chore," she added.

Susan Nelson, M.D., of Memphis, Tenn., runs a full-service practice that features extras such as a wellness center, acupuncture and massage therapy. Even so, she said the thought of experimenting with patient e-mail was "a little scary," and she's concerned about her practice's bottom line. "I want to learn how to make my practice sustainable," she said.

Sue Andrews, M.D., of Murfreesboro, Tenn., an early adopter and outspoken proponent of EHRs, said, "We had our first online visit yesterday, but how do we charge for it?"

There's diversity even within practices, as was demonstrated by Jonathan Siegel, M.D. of Cromwell, Conn., when he described his physician partners. "Some want no part of change -- no e-mail, no fax -- and others are enthusiastic and energetic."

Consultants Share Expertise

Project consultants, such as L. Gordon Moore, M.D., of Rochester, N.Y., founder of Ideal Micro Practices, gave glimpses of the know-how he and others will share with physicians during the next 24 months.

With blunt humor, Moore drove home some points on open-access care. “We can call it open access, advanced access, same-day access, today's work today, just in time. Call it whatever you want -- just get rid of the barriers," said Moore.

"We should be saying to patients, 'We're here, you have a need, let's get to work,'" said Moore. Unfortunately, too often, physicians get hung up on discussions about urgent versus routine care.

"Why do patients 'no-show'?" asked Moore. "We (physicians) think it's about the ride, day care, or they forgot to put the appointment in the 'Palm Pilot.' It's really much more about delay and (lack of) access," he said, because patients interpret those as a lack of respect for their time and their priorities. "When we put up barriers to access, kids are a little less likely to be brought in for their immunizations before age 2," said Moore.

Sue Houck, M.B.A., president and CEO of Houck & Associates, shared some tips about EHRs. "You have to get your arms around your workflow before you implement an EHR. Who's doing what when," she said. If your EHR has you leaving work at 11 p.m., you've got workflow issues. "Remember, we're not just taking the tablet (computer) into the room and replacing the paper chart. It's certainly a lot more complex than that," she said.

When is your practice ready to implement an EHR? The answer lies in leadership, said Houck. "If two-thirds of your leadership is not actively supporting EHR implementation, I'd wait."

Henley closed his portion of Friday morning's agenda with a reference to Star Trek, of television and motion picture fame. He noted that in the fictional universe in which Star Trek is set, the Starship Enterprise was staffed with one family physician and an appropriate medical team to care for the entire onboard community.

Adapting a tag line from the show, Henley said, "You're taking family medicine where family medicine has never gone before. And that is so exciting."