HHS Targets Communities for EHR Pilot Project

HHS Secretary Michael Leavitt convened a group of health care stakeholders, including AAFP President Jim King, M.D., of Selmer, Tenn., here on Jan. 31 to launch a five-year federal initiative designed to increase physician use of electronic health records, or EHRs.

The initiative, which will include a national EHR demonstration project, has a budget of about $150 million, according to Leavitt. That money will go to physicians participating in the program who

According to Leavitt, physicians' upfront investment in EHR technology, which often ranges from $30,000 to $40,000 for an individual system, is the biggest barrier to implementing EHRs. "We need to change the macroeconomic equation so that doctors who make the investment share in the financial benefit," he said.

Practices chosen to participate in the demonstration project will use EHRs to perform specific functions, such as clinical documentation and electronic prescribing. Core incentive payments will be based on performance on quality measures, and a bonus will be paid based on how well physicians use their EHR systems to manage patient care.

Leavitt's announcement about the demonstration project came as he awarded Chartered Value Exchange status to Healthy Memphis Common Table, a nonprofit collaborative working to improve the health and health care of people living within a 150-mile radius of Memphis.

Chartered Value Exchanges represent an outgrowth of HHS' community leaders project, which encourages communities across the country to pull together employers, health plans, providers and consumers to support value-driven health care. Healthy Memphis Common Table, which is the first organization to be named a Chartered Value Exchange, now will have access to Medicare information on health care quality and can use that information to foster value-based purchasing decisions.

But Memphis is just the beginning, said Leavitt.

"I have 12 flags I'm going to plant someplace in America, and with those flags come 100 smaller flags," said Leavitt, referring to the 100 small- and medium-size physician practices he wants each of the communities designated as Chartered Value Exchanges to recruit to the EHR demonstration project.

Ultimately, up to 1,200 physician practices from various regions of the country -- all affiliated with Chartered Value Exchange communities -- will be chosen to participate in the pilot.

During the Memphis event, King described his practice's robust EHR system. "I'm one of the 37 percent of family doctors who have EHRs in their offices; and another 13 percent are coming on this year," said King, referring to findings from the AAFP's most recent EHR member survey.

King also said HHS' EHR demonstration project should focus on recruiting family physician practices because FPs provide patient-centered medical homes. Family physicians "have the data that you want," King told Leavitt. "We're also the group -- because our profit margins are so narrow -- that needs the financial help" to implement EHR systems.

However, just implementing an EHR is not enough. Physicians "have to use the information," the system provides, such as red-flagging patients who need particular tests or vaccines, said King.

Then there's the issue of safeguarding medical records.

Hurricane Katrina "taught us we have to be able to protect our information," said King. He noted that his practice had its "own little Katrina," when a satellite office in Adamsville burned to the ground one Sunday in 2006. The two FPs based at that office were able to see their patients -- as scheduled -- the next morning in the Selmer office because the practice's EHR system had successfully secured the patients' records.

King, however, lamented the lack of connectivity between his practice and area hospitals. "If I send a patient to Memphis to go into the hospital, I may get discharge papers back in about two months," he told audience members. "But the patient comes back to me in seven days, and I have no record of what went on in the hospital."

Leavitt stressed the need for a U.S. health care system that thrives on competition but is based on value and driven by quality. "We want to get fair and accurate information into the hands of the doctors, consumers, insurance companies and employers," said Leavitt. The key to accomplishing that goal is through

The EHR early-adoption phase is about over, warned Leavitt. "We're rewarding use of EHRs right now, but at some time, it will become a condition of doing business with CMS," said Leavitt. "We're very close to the time when some part of physician reimbursement will be conditioned upon having an EHR."