1. Future of Family Medicine and the EHR Initiative Steven E. Waldren, MD, MS Assistant Director Center for Health Information Technology American Academy of Family Physicians swaldren@aafp.org

2. 2 Overview v Driving Forces v IT related to Future of Family Medicine v AAFP EHR Initiative  Member Survey  Center for Health Information Technology  Current Projects

3. 3 Why use an EHR? v Personal Reasons  Efficiency  Decreased costs  Improved quality of life  Technophile v Other Forces to drive adoption  External to the profession  Internal to the profession

4. 4 External Forces v Institute of Medicine http://www.iom.edu/topic.asp?id=3718 http://www.iom.edu/topic.asp?id=3718 v Leapfrog Group http://www.leapfroggroup.org/ http://www.leapfroggroup.org/ v Government  Physician Focus Quality Initiative – CMS http://www.cms.hhs.gov/quality/pfqi.asp http://www.cms.hhs.gov/quality/pfqi.asp  Doctors Office Quality-IT (DOQ-IT) -CMS http://www.doqit.org http://www.doqit.org  National Health Information Infrastructure http://aspe.hhs.gov/sp/nhii/ http://aspe.hhs.gov/sp/nhii/  “ The goal I set is most people ought to be covered within a 10-year period” - President Bush http://www.whitehouse.gov/news/releases/2004/04/20040427-5.html http://www.whitehouse.gov/news/releases/2004/04/20040427-5.html

5. 5 Internal Forces v AAFP Board of Directors Resolution 2000  All AAFP members using the Internet by 2003  Half of AAFP members using EHRs by 2005 v Future of Family Medicine Report  All FP residencies with EHRs by 2006

6. 6 Electronic Health Records as a Core Technology for the Future of Family Medicine v Integration of health information across providers and sites v Continuous, real-time access to important patient health information v Secure messaging and communication with colleagues and patients v Coupling/linking of knowledge/evidence with specific patient health information v Secure aggregation of data for quality and performance reporting and analysis Future of Family Medicine Project Leadership Committee. The Future of Family Medicine: A Collaborative Project of the Family Medicine Community Ann Fam Med 2004 2: S3-S32.

7. 7 What The AAFP is Doing!

8. 8 What Percentage of AAFP members* Use An EHR? * 5,517 AAFP members surveyed who had e-mail and web connectivity, early Jan 2003 May over represent use of EHRs A large majority of our members are currently not using an EHR

9. 9 Of Those Who Don’t Currently Use an EHR, How Many Have Considered Purchasing a System? The vast majority of non- EHR users would like to have an EHR 92% plan on implementation within 2 years

10. 10 What Are the Top Reasons for Not Purchasing an EHR?

11. 11 Center for Health Information Technology To promote and facilitate the adoption and optimal use of health information technology by AAFP members and other office-based clinicians, for the purposes of improving the quality and safety of medical care, and to increase the efficiency of medical practice. Mission: http://www.aafp.org/centerforhit.xml

12. 12 The Four “Acid Test” Principles Affordability  Office-based IT should be affordable to family physicians and other office-based clinicians who face very challenging economic environments and decreasing reimbursement Compatibility  Physicians should not have to replace entire systems when purchasing a component, nor be locked into vendor products due to proprietary interfaces or predatory pricing tactics, and systems should work in concert with other systems Interoperability  Data exchange schema should facilitate data transfer, import, and export among different vendor systems, in different settings such as office to office, to hospital, to nursing home, and to patient/patient home. Data stewardship  Physicians reserve the right to choose the repository and guardians of their data, and the uses to which the data are put, within a framework of privacy and security mandated by federal/local regulations (HIPAA)

13. 13 CHiT Current Projects v New and interactive web site v Workshops and Seminars v Partners for Patients Initiative v Pilot Project (Medplexus, Siemens, & HP) v Continuity of Care Record, CCR v Doctors Office Quality -- IT (DOQ-IT)

14. 14 Partners for Patients (P4P) v Declaration of support for the four principles from vendors v A forum to drive efforts toward those principles v A mechanism to help vendors better address family physicians’ and other ambulatory physicians’ needs

15. 15 P4P – Core Companies some of the core group companies Electronic Health Records and Practice Management Systems A4 Health Systems DOCS, Inc. (SOAPware). GE Medical/Centricity (Formerly MedicaLogic/Logician) Medplexus NextGen Physician Micro Systems, Inc.. Hardware, Netware, Peripherals Hewlett-Packard Medical Devices Welch-Allyn Laboratory and Testing Services Medplus Hospital Information Systems Siemens Medical Solutions E-Prescribing RxHub SureScripts

16. 16 P4P – Supporting Companies some of the supporting companies v Allscripts Healthcare Solutions v Cerner Corporation v CHARTCARE, Inc. v ChartWare, Inc. v Clinix Medical Information Services v DocSite, LLC v eClinical Works, LLC v e-MDs, Inc. v Integrated MD Solutions v MedcomSoft, Inc. v MedicWare v MediNotes Corporation v Meditab Software, Inc. v Meridian EMR, Inc. v Midmark Diagnostics Group v Misys Healthcare Systems v Noteworthy Medical Systems v OmniMD (A Division of ISM, Inc) v PowerMed Corporation v Praxis® EMR http://www.aafp.org/x26745.xml

17. 17 EHR Pilot Project v Study implementation in small practices v Study and foster partnership between EHR vendor, Hospital/ASP vendor, Lab vendor, and hardware vendor v Identify needs and barriers specific to small ambulatory practices

18. 18 Continuity of Care Record (CCR) v Standard for health information exchange during transfer of care v Sponsorship along with The Mass. Medical Society, HIMSS, and others v Development of a reference implementation

19. 19 Doctors Office Quality-IT (DOQ-IT) v funded by the Centers for Medicare & Medicaid Services v endeavors to lead the way in assisting small- to medium-sized physician offices in migrating from paper-based health records to EHR systems v California Quality Improvement Organization in partnership with CHiT http://www.doqit.org/doqit/jsp/index.jsp

20. 20 They are coming! v There are many forces driving HIT v Physicians must be a strong force v The future of medicine is information v Without tools to manage this information, we will never achieve the highest quality of health care v “Family physicians will rely increasingly on information systems and electronic health records” –Future of Family Medicine Report

21. 21 Questions? It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system, for the initiator has the enmity of all who would profit by the preservation of the old institution and merely like warm defenders in those who would gain by the new ones - Machiavelli, The Prince, 1513