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Wednesday Mar 19, 2014

Academy Tools Could Ease EHR Burdens

Editor's note: During the AAFP's Scientific Assembly in San Diego, a panel discussion on practice transformation generated far more questions than the panelists could answer in the time allotted. This is the fifth post in an occasional series that will attempt to address the issues members raised -- including challenges associated with electronic health records systems -- during the panel.

Two years ago, my practice implemented an electronic health record (EHR) system. The initial results weren't pretty. Transitioning from paper to electronic files takes time, and my productivity plunged.

But I worked at it, learned the system and my productivity has improved. Although my patient volume has not yet returned to pre-EHR volumes, my clinic is running much smoother than it did initially because my staff and I have adapted. We have embraced this change, and the benefits have been numerous.

  • We qualified for meaningful use stage one incentive payments, and we are working on stage 2, including the launch of a new patient portal. Those incentive payments helped offset the investment in the EHR and that initial dip in clinic volume.
  • My practice previously had one full-time equivalent devoted to pulling and filing paper charts. Now, that information is at my fingertips whenever I need it.
  • Our clinic system is spread across three communities, so one of the big benefits of the electronic system is being able to access records -- including labs and X-rays -- securely from any location, including our ER.
  • A medication reconciliation process has made us more aware of what drugs patients are taking, which helps us avoid medication errors, interactions and duplications.
  • We are developing disease registries that will allow us to track our patients, improve follow-up care and provide better care for patients with chronic conditions.

Health care isn't going back to paper records. This is where we are headed, but qualifying for meaningful use incentive payments can be challenging. That's why the Academy has included a step-by-step guide to meaningful use stage one in its new PCMH Planner, an affordable, subscription-based web tool designed to help practices -- particularly small practices -- transform to the patient-centered medical home model. A guide to stage two is expected be available in the PCMH Planner by the end of March.

The Academy created the PCMH Planner at the request of small practices that were asking for help with practice transformation. I recently saw a demonstration of the Planner, and it is an effective, evidence-based way to start the process of transforming a practice. The Planner also includes Practice Foundations for PCMH, a step-by-step guide to quality improvements and other tasks that should be completed before you begin practice transformation. PCMH 101, which covers the basics of becoming a medical home, will be available later this month, and PCMH 201, which offers more advanced topics, is expected to be available later this spring.

What else is the Academy doing to make EHRs easier to use and more effective? The Congress of Delegates has asked the AAFP to create a clinical data repository that would provide data to family physicians in way that is clinically relevant.

In a 10-practice pilot, we've created registries related to diseases, procedures, medications and lab results and provided the participating practices with analytics and comparison data against their peers. The system is capable of identifying potential gaps in care and patients who should be prioritized for outreach. It also provides revenue and cost efficiency metrics.

Although this is only a pilot, evidence to date indicates that it is working. We have found that the clinical data repository is technically feasible and capable of generating value for practices. The repository also could act as a national specialty registry, which would ease the reporting burden on family physicians by allowing us to report data to a single source.

A decision on how this concept might be rolled out to Academy members as a product likely will happen this summer.

And what about interoperability? When our patients leave our practice and go to another -- for a subspecialist consultation, for example -- my EHR won't necessarily be able to communicate with the subspecialist's EHR. This is a major flaw in our health care system, and the Academy continues to push the Office of the National Coordinator (ONC) for Health Information Technology and EHR vendors on this important issue. Unfortunately, vendors have little motivation to fix it because they want customers to buy their proprietary, unique products. It doesn't help that large health care systems aren't in the habit of sharing information with competing health care systems. Thus, interoperability likely remains at least five years away.

Meanwhile, the Academy is one of the sponsors of the nonprofit DirectTrust, which accredits services that allow physicians to exchange encrypted patient information through secure servers. You can read more about the direct exchange process here

The AAFP is working to develop resources that save us time and money and reduce our reporting burdens. I'll keep you updated on our progress in these efforts.

Robert Wergin, M.D., is President-elect of the AAFP.

Posted at 11:50AM Mar 19, 2014 by Robert Wergin, M.D.

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