Federal Health IT Standards Committee Seeks Physician Input

The federal government's Health Information Technology, or Health IT, Standards Committee recently formed an implementation workgroup charged with bringing practicing physicians' technology experiences to light. As part of that process, two AAFP members, Louis Spikol, M.D., of Allentown, Pa., and Tripp Bradd, M.D., of Front Royal, Va., participated in a providers panel during a public hearing of the workgroup on Oct. 29 in Washington.

The invitation to testify in Washington was a first for both physicians. Bradd told AAFP News Now that he felt it was his civic responsibility to provide testimony that would help other physicians who have already implemented -- or who will be implementing -- an electronic health record, or EHR, system.

Spikol said that he, too, felt compelled to testify in Washington because family physicians in small practices need representation.

Small physician practices provide medical care for the majority of patients in the United States, said Bradd, who implemented an EHR system as a solo physician in the early 1990s. Skyline Family Practice is now a three-physician practice with more than 12,000 patients.

"I spoke to the standards and interface issues my practice has been through and why it is so important to have a standards interface that is clearly written and can't be altered by people after the standard is released," said Bradd. He added that during the process he felt a kinship with Jimmy Stewart's character in the 1939 movie classic "Mr. Smith Goes to Washington," in which a man with no political aspirations tries to make a difference in Washington.

"I wasn't polluted by political bias. I just went there and spoke as a small-practice physician," said Bradd. "I was unvarnished … and I think the committee listened to me."

Spikol, who practices in a two-physician office that is part of a larger health care organization, said small-practice physicians worry that they'll invest in an EHR system and then discover it requires a costly interface process to communicate with labs and hospitals. "There are huge questions that really have not been answered satisfactorily over the past seven to eight years," said Spikol.

He asked the committee to develop standards that would be simple and affordable. "If I'm taking care of 20 patients a day, I just don't have time to ask, 'Well gee, how am I going to make these two systems communicate?'"

Spikol said he never would have believed back in 2000 that health IT standards would remain unwritten in 2010. He said it was absurd that two physicians in practices within five miles of one another -- and operating the same EHR system -- couldn't share patient records electronically.

In addition to their live testimony, both physicians also provided written responses to a series of questions posed by the workgroup in advance.

In his written testimony, Spikol described his EHR system as a means of providing safe, efficient and evidence-based care for his patients. His measure of success is good patient outcomes. "I am overjoyed if laboratory data, hospital data and information from other physicians sharing care of my patients with me can automatically populate my electronic health record," he wrote.

Health IT progress has slowed substantially during the past few years, noted Spikol.
Physicians are "maxed out" trying to take care of their patients and survive in the current economic environment.

In his written testimony, Bradd recounted how e-prescribing standards that are set, locked down and harmonized across EHR portals allowed him to catch a prescription error that occurred on the pharmacy side.

The pharmacy had inadvertently sold the patient quinidine sulfate, a drug used to control heart arrhythmias, instead of the quinine sulfate that Bradd had prescribed to control leg cramps. The medication error was discovered when the pharmacy e-mailed a refill request to the practice that didn't match Bradd's e-prescribing record.

Fortunately, said Bradd, no harm was done to the patient.

Physicians want and need a single standard without variations for clinical data interchange, wrote Bradd. Such a standard would lead to higher quality care.

"If we can keep physicians focused on their patients and delivering good medical care without having to worry about health IT interchange standards, our health care system will be better for it," he wrote.