Q&A With Steven Waldren, M.D.

Quest for EHR Usability, Interoperability Fuels AAFP's Technology Team

October 08, 2014 11:30 am Sheri Porter

Earlier this summer, the Academy signaled a shift in its health information technology (IT) focus by announcing a new moniker and a new focus for its decade-old Center for Health IT -- that center has transitioned to become the AAFP's Alliance for eHealth Innovation.

Steven Waldren, M.D., director of the AAFP's new Alliance for eHealth Innovation, looks forward to seeing family physicians embrace health information technology products as indispensable support systems in their practices.

Recently, AAFP News sat down with the alliance's director, Steven Waldren, M.D., to discuss the change, what it means and where the AAFP is headed in terms of future health IT endeavors.

Q: What is the significance of the new name?

A: The task before us encompasses more than the AAFP can do alone. As an organization, we need to partner with others on this important work, thus the term "alliance."

The Academy purposely chose the term "ehealth" to indicate that the technology itself no longer will serve as the driver. For instance, health IT is not about patient portals, but it is about communicating with patients and empowering them to participate in their health care.

With the word "innovation," the AAFP acknowledges that the current crop of health IT products and services are not at the usability and interoperability levels that family physicians need. The alliance will work to close those gaps in functionality.

Q: You've recently brought a new staff person onboard. What does Talley Holman, Ph.D., the AAFP's new senior ehealth systems analyst, bring to the table?

A: With more than 10 years of experience in applying industrial and systems engineering to health care, Talley brings a new perspective to our work. We see a future where all of the important aspects of running a practice and delivering health care to patients will be supported by health IT with a focus on effectiveness and efficiency. Adopting a broader approach that incorporates engineering principles will enable us to ensure that health IT can be more readily integrated into health care systems.

The scope of our work here in the alliance is comprehensive; our primary target is health care quality, and our goal is to give family physicians the tools, techniques and concepts that will empower them to evaluate and improve their practices with health IT.

Q: How will your day-to-day work change?

A: Our activities will expand to include a new focus on workflow and the human factors that affect the reliability and usability of health IT. If we can articulate those needs, then the AAFP can work with vendors within the industry to build better products. Our work in helping to create interoperability standards is ongoing. And, of course, we will assist the AAFP as it continues advocacy efforts at the federal level and on various health IT industry fronts.

Q: How will this new effort help family physicians make the best use of their electronic health record (EHR) systems?

A: Physicians want their EHR systems to, at a minimum, do one of three things: Save them time, eliminate hassles or increase revenue. For instance, medication reconciliation is just one small piece of a family physician's clinical day. Data about a patient's medications should be in the EHR system, and the system should spot drug overlaps and inconsistencies and then provide a summary.

When a physician can confidently rely on his or her EHR to perform that task, then the system saves the physician considerable time and hassle. Our job is make sure that EHR functionality improves to the point that tasks of that sort are routine and just one more piece of an efficient practice process.

Q: What are the biggest issues facing health IT users today?

A: Usability and interoperability. Both of these are big challenges. And again, we became an alliance in recognition of our need to partner with others to make real improvements in these two areas. Ultimately, we hope to change physicians' perception of health IT by improving the technology to the point that they'll view it not as an intrusive barrier to care but rather as an indispensable system that supports their efforts to keep patients healthy.

Q: How is the Academy helping overcome these tough obstacles?

A: AAFP leaders continue to advocate for requirements that demand interoperability from health IT vendors. The Academy also has been working on several fronts for standards around the delivery of secure email in health care settings. At the same time, the AAFP has been advocating against EHR requirements that have spurred the sort of "check-the-box" system of implementation that isn't helpful to physicians or their patients.

Our new efforts focused on industrial engineering will position the AAFP to help in the development of products and services that will drive the usability and utility of health IT not only for family medicine but for all of primary care.

Q: The AAFP is set to unveil its long-awaited clinical data repository (CDR). What is this new product, and how will it help family physicians?

A: The Academy will fully launch a new CDR product in the first quarter of 2015 that will help practices leverage clinical data to gather insights about their practices. We think it also will provide solid evidence in support of primary care and help refute the arguments of those who misuse clinical data to the detriment of primary care. The CDR also will help family physicians improve patient care and increase practice revenue.

Q: How can members learn more about and participate in using this new CDR technology?

A: Getting family physicians involved in data collection and analysis gets us closer to a data set capable of providing global- or population-level solutions. Data is the key to moving forward, and I will keep family physicians abreast of how they can participate as this product is rolled out next year.

Q: How would you sum up the AAFP's work in the realm of health IT and EHRs?

A: Health IT is poised to serve as the foundational support of our health care system. The Academy has long encouraged family physicians to implement EHRs in their practices and continues to help and advise physicians as they make their EHR systems fully functional. Although the AAFP has been a leader on this front for the past decade, we're a long way from saying "mission accomplished." We've made much progress, but we're far from finished.

Q: So much has changed with health IT in just 10 years. Take a look in your crystal ball and tell me what you see coming in the next decade.

A: The biggest barrier to usable and interoperable health IT is the nation's current fee-for-service business model that stresses volume rather than value. The system we have now is all about getting widgets out the door. But in this case, those widgets are real live people who depend on their family physicians to provide quality care.

It takes time and energy to do quality improvement in a busy medical practice. But moving to a value-based payment system can set the stage for a revolution in health IT that will move us from automating the business of health care to automating the delivery of that care.

The scope of this process is enormous, so we need to plan well, start small, and build on our successes.

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