Given that evaluation and management starts with gathering information about a patient’s history and condition, information management has to be one of the fundamental skills of the family physician – at least information management on the level of the patient visit.
Still, the idea that “family practice is information management” struck me as radical when I first encountered it. Although I can’t be sure, I believe this is a claim born of the computer age. Certainly, the earliest articulation of it that I have found (without looking too hard) occurs in a 1990 article by Stephen J. Spann, MD, arguing that family practice medical records should be completely computerized.1
What connects computers and the assertion that family practice is nothing but information management is the recognition that information management on a scale larger than the single visit can produce better results. For instance, by making it easy to access previous test results, to display them in flowsheet format or even to graph them, the electronic record equips the physician better to deal with current results.
More, the electronic record represents only the first step on the road to the integrated information management that (I hope) represents the family practice of the future. Just as the electronic patient record facilitates seeing the patient as a whole rather than one visit at a time, the patient registry helps you see whole populations with similar needs – all your patients with diabetes, say. And the practice management system, while not giving you the whole picture, does begin to allow high-quality information management at the level of the whole practice. But why stop at the practice? In principle, successive levels of integration can take us as far beyond the practice as we care to go.
Wait a minute
Let’s stop before we get into the blue sky, though. I’d like to stick with the level of the practice, since my purpose in bringing all of this up is to point out that, without really trying to, we have made this practically a special issue on information management. Two of the main articles have to do with organizing information at the level of the practice and the third has to do with protecting it.
While only the article by Floyd “Tripp” Bradd, III, MD, (page 37) delves at all deeply into computer technology, all three articles are products of the information age we find ourselves in. Bradd argues that you can (and probably should) develop your own practice intranet. No getting away from computers there.
Scott Endsley, MD, MSc, argues in our cover story (page 43) that you can (and probably should) develop a “clinical instrument panel” as a way of getting a well-rounded picture of how your practice is doing. It’s perfectly possible to create this instrument panel with a pencil and a few pieces of graph paper, but the computer makes it a lot easier both to collect the data and to display it.
Finally, Jennifer Bush offers forms you may find helpful in complying with HIPAA privacy regulations (page 29). And while the solution she offers is a paper one, the problem is computer generated, so to speak.
Getting it together
I’d like to draw your attention in particular to the first two of these articles, because both offer you ways of taming the torrents and floods and seas of information you’re swimming in – without much investment of time, energy or money.
Given my introduction, I need to emphasize that neither article presupposes that you have an electronic medical record system. Both articles emphasize starting small. Your intranet need be no more than a menu created with a word processing program, for instance.
I know it’s reductionistic and deliberately provocative to equate family practice with information management. Family practice is more than that. One thing is true, though: If you aren’t a world-class manager of information, you’ll find it next to impossible to be a world-class family physician.