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
Overview

Driving Forces

IT related to Future of Family Medicine

AAFP EHR Initiative
 Member
 Center
Survey
for Health Information Technology
 Current
Projects
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Why use an EHR?

Personal Reasons
 Efficiency
 Decreased
 Improved
costs
quality of life
 Technophile

Other Forces to drive adoption
 External
 Internal
to the profession
to the profession
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External Forces

Institute of Medicine http://www.iom.edu/topic.asp?id=3718

Leapfrog Group http://www.leapfroggroup.org/

Government

Physician Focus Quality Initiative – CMS
http://www.cms.hhs.gov/quality/pfqi.asp

Doctors Office Quality-IT (DOQ-IT) -CMS
http://www.doqit.org

National Health Information Infrastructure
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
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Internal Forces


AAFP Board of Directors Resolution
2000

All AAFP members using the Internet
by 2003

Half of AAFP members using EHRs
by 2005
Future of Family Medicine Report

All FP residencies with EHRs by
2006
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Electronic Health Records as a Core Technology
for the Future of Family Medicine

Integration of health information across providers and sites

Continuous, real-time access to important patient health
information

Secure messaging and communication with colleagues and
patients

Coupling/linking of knowledge/evidence with specific patient
health information

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.
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What The AAFP is Doing!
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What Percentage of AAFP
members* Use An EHR?
• May over represent use
of EHRs
• A large majority of our
members are currently not
using an EHR
* 5,517 AAFP members surveyed who had e-mail and web connectivity, early Jan 2003
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Of Those Who Don’t Currently Use an EHR, How Many
Have Considered Purchasing a System?
•The vast majority of nonEHR users would like to have
an EHR
•92% plan on implementation
within 2 years
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What Are the Top Reasons for Not
Purchasing an EHR?
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Center for Health Information
Technology
Mission:
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.
http://www.aafp.org/centerforhit.xml
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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)
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CHiT Current Projects

New and interactive web site

Workshops and Seminars

Partners for Patients Initiative

Pilot Project (Medplexus, Siemens, & HP)

Continuity of Care Record, CCR

Doctors Office Quality -- IT (DOQ-IT)
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Partners for Patients (P4P)

Declaration of support for the four principles
from vendors

A forum to drive efforts toward those principles

A mechanism to help vendors better address
family physicians’ and other ambulatory
physicians’ needs
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P4P – Core Companies
some of the core group companies
Electronic Health Records and
Practice Management Systems
A4 Health Systems
Medical Devices
Welch-Allyn
Laboratory and Testing
Services
DOCS, Inc. (SOAPware).
GE Medical/Centricity (Formerly
MedicaLogic/Logician)
Medplus
Medplexus
Hospital Information
Systems
NextGen
Physician Micro Systems, Inc..
Siemens Medical Solutions
Hardware, Netware, Peripherals
Hewlett-Packard
E-Prescribing
RxHub
SureScripts
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P4P – Supporting Companies
some of the supporting companies

MedcomSoft, Inc.

MedicWare

Allscripts Healthcare Solutions

Cerner Corporation

CHARTCARE, Inc.

MediNotes Corporation

ChartWare, Inc.

Meditab Software, Inc.

Clinix Medical Information Services

Meridian EMR, Inc.

DocSite, LLC

Midmark Diagnostics Group

eClinical Works, LLC

Misys Healthcare Systems

Noteworthy Medical Systems

OmniMD (A Division of ISM, Inc)


e-MDs, Inc.
Integrated MD Solutions
http://www.aafp.org/x26745.xml 

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PowerMed Corporation
Praxis® EMR
EHR Pilot Project

Study implementation in small practices

Study and foster partnership between EHR
vendor, Hospital/ASP vendor, Lab vendor, and
hardware vendor

Identify needs and barriers specific to small
ambulatory practices
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Continuity of Care Record (CCR)

Standard for health information exchange during
transfer of care

Sponsorship along with The Mass. Medical
Society, HIMSS, and others

Development of a reference implementation
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Doctors Office Quality-IT (DOQ-IT)

funded by the Centers for Medicare & Medicaid
Services

endeavors to lead the way in assisting small- to
medium-sized physician offices in migrating from
paper-based health records to EHR systems

California Quality Improvement Organization in
partnership with CHiT
http://www.doqit.org/doqit/jsp/index.jsp
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They are coming!

There are many forces driving HIT

Physicians must be a strong force

The future of medicine is information

Without tools to manage this information, we will never
achieve the highest quality of health care

“Family physicians will rely increasingly on information
systems and electronic health records” –Future of Family
Medicine Report
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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
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