The Digital Office...connecting your practice with the Electronic Medical Record is your source for timely, comprehensive coverage and analysis of use of the electronic medical record in independent physician practices. The Digital Office is a new complimentary resource for HIMSS members, physicians, the media and anyone involved and interested in the transformation of today’s medical practice through healthcare IT. The newsletter will be published on the second Wednesday of the month to keep you informed of the latest news on ambulatory care and the electronic medical record.

Keep The Digital Office Coming To You: The Digital Office is provided to readers at no charge, but only to those readers who sign up to receive the online publication. To permanently subscribe to this complimentary information source from HIMSS,
click here to register.

More on Ambulatory Care:
Ambulatory care has recently taken a front-and-center position on the national health information technology (HIT) agenda. Consider these statistics.

• The National Center for Health Statistics, in its National Ambulatory Medical Care Survey (NAMCS), estimates more than one billion doctor visits/outpatient encounters annually.
• The Institute of Medicine (IOM) 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, suggests an increased focus on longitudinal care, prevention, and management of chronic disease, all functions that take place in the ambulatory setting.
• More procedures now require only outpatient service instead of a hospital stay.

HIMSS is committed to the ambulatory HIT agenda and this new resource is just one example of that commitment. The Digital Office will provide the HIMSS perspective on

• Electronic medical record (EMR) implementation
• Value of an EMR in times of natural disaster
• Electronic prescribing
• Mobile technology
• Public policy/advocacy
• Vendor activity and practical application updates
• Quality improvement in conjunction with HIT
• Regional health information organization (RHIO) activity
• Many others...

Allow HIMSS to be your HIT educational resource to connect you with your fellow physician practices to learn the most effective strategies to glean the benefits from health information technology.

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Recognized leaders in their fields, two physicians have put together their respective expertise in practice performance improvement and information technology to write Medical Practice Transformation with Information Technology, a new book from HIMSS and the Institute for Healthcare Improvement (IHI).

With a this-is-now approach to medicine in the 21st century, authors Charles M. Kilo, MD, MPH, and Mark Leavitt, MD, PhD, FHIMSS, look at the medical practice as a system, one to retool and refocus on three critical functions that physicians must deliver:

deep, trusting relationships impeccable service highly reliable clinical care

Drs. Kilo and Leavitt explain that the medical practice for ambulatory care, the focus of this book, must be “specifically and thoughtfully designed” to follow through on these components. That philosophy is delivered throughout the book with the 11 chapters written by recognized and knowledgeable experts in the healthcare field.

For more information, visit the HIMSS Online Store. The book sells for $60 for HIMSS members and $75 for non-members, plus shipping.

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Kevin Fergusson, MD Family Practice Physician VitalTrust Physicians Richmond, Va.

Kevin Fergusson, MD, understands the value of time – time that his patients both value and want when it comes to their healthcare. He knows that an effective use of his time results in better care for his patients and improved revenue for the practice. Relying on that philosophy, he opened VitalTrust Physicians in November 2005 in Richmond, Va.

“This is a start-up practice and it will take some time to build the patient base,” he said in a phone interview with The Digital Office. He opened with an inexpensive EHR, selecting components that fit his practice design: an EMR, a free registry, adherence programs and an online communication tool.

“What is important to me is the ability to communicate with patients online in a private secure network.” He knows that patients like and appreciate the online follow-up for patient education, such as sending back exercises to a home email, as he has done.

As an out-of-network physician, he based the payment structure on time. “Most office visits are 10 or 20 minutes,” he explained. “If the patient wants to talk for an hour, we will do that.” Patients with chronic conditions set up a proactive partnership plan with Dr. Fergusson and follow a tiered payment structure.

While he does have the EHR in place now, this solo practice physician recognizes that technology and the technology needs of his practice will change. “I realize that what I have today is not what I will have four years from now. It will evolve and that is modern life.”

Contact Dr. Kevin Fergusson at www.vitaltrust.com

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Blackford Middleton, MD, MPH, MSc Chair/HIMSS Board of Directors – 2005-2006

Healthcare is in transition. Pressures to reduce healthcare cost escalation, reduce medical errors, improve healthcare quality and patient safety, and make the healthcare delivery system more efficient overall are all driving the adoption of healthcare information technology.

We are on the verge of another revolution in healthcare as well: our increasing understanding of the human genome and our ability to rapidly sequence the genome and correlate a patient's genetic profile with their responsiveness to targeted medicines and other interventions will dramatically increase our need for information technology and clinical decision-support. The average clinician will need clinical decision-support at his side to provide optimal patient care.

Much has been done already for in-patient care settings with the adoption of IT, but more needs to be done. In outpatient care settings, where most Americans receive most of their healthcare, healthcare information technology has had less of an impact to date. Increasingly, both inpatient and outpatient care settings will be supported by healthcare IT, and potentially securely sharing clinical information across regional healthcare information networks.

In The Digital Office, members of the HIMSS Ambulatory eNewsletter Task Force, other clinicians and information technology professionals will review and update readers on current activities in ambulatory practice and information technology used in outpatient care settings.

I look forward to reading this newsletter regularly. Please join me in sending thanks to the Ambulatory Healthcare Information Systems Steering Committee and congratulations on your inaugural issue!

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The arrival of Hurricane Katrina in late August 2005 was disastrous for the citizens of Louisiana, Mississippi and Alabama and the healthcare system that supported their well being. Hospitals, ambulatory practices and local clinics sustained severe to catastrophic levels of damage throughout the three-state area. Millions of pages of paper medical records were destroyed or lost in the flood waters. The struggle to recover is tremendous and on-going.

The HIMSS Katrina Phoenix Project, initiated in September 2005, is focused on aiding paper-based medical practices - decimated by Katrina - by rebuilding with EHRs. Key partners in the Katrina Phoenix Project include the American College of Physicians, American Medical Association, Louisiana Health Care Review (LA QIO), Information Quality Healthcare (MS-QIO), Health Level Seven (HL7), and the HIMSS EHR Vendor Association (EHRVA).

HIMSS is now accepting donations of EHR software, practice management systems, computer hardware and consulting services. Donations are currently being received by the HIMSS Foundation.

If you know of physicians whose practices have been severely damaged by Hurricane Katrina, or if you are a vendor who would like to participate, please contact HIMSS Ambulatory Healthcare Information Systems Manager David Collins via email or call 703.837.9817.

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Q. What is the difference between an electronic medical record and an electronic health record?

The electronic health record is a longitudinal electronic record of patient health information produced by encounters in one or more care settings. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician’s workflow. The EHR has the ability to generate a complete record of a clinical patient encounter, as well as supporting other care-related activities such as decision support, quality management, and clinical reporting.

This definition appears on the Electronic Health Record page of the HIMSS Web site. Pat Wise, RN, MSN, Vice President, HIMSS Healthcare Information Systems, provided additional commentary below.

An electronic health record -the EHR - has two components...an electronic medical record, the EMR, and a personal health component, often referred to as the PHR or personal health record.

An EMR belongs to and is owned by the hospital/practice/clinic that provides the patient with medical care. The patient is entitled to a copy of that information, but in reality, most patients probably don't want all the information, but just summary information.

An EHR, if it existed as defined above, would have a component where the patient could record data, such as diabetic management records. This would be daily blood glucoses, insulin requirements, activity, and diet. The patient would then share that data as appropriate with the healthcare provider to help determine best treatment options, etc.

For the most part, those PHRs that are in existence are stand-alone. In other words, informed consumers are beginning to aggregate medical data about themselves and keep it electronically. Most hospitals, practices and clinics are not prepared to provide an electronic copy of summary data to patients for their PHR.

Two years ago, the government realized there was no definition of an electronic health record. The Department of Health and Human Services (HHS) commissioned Health Level Seven (HL7), a standards development organization, for a standard definition, which is the HL7 EHR standard. In reality, that standard defines an EMR but calls it an EHR, which has resulted in additional challenge to streamline the definition. Work continues throughout the industry to review the terms and come to an accepted definition for the EHR and EMR. Watch for additional updates in The Digital Office.

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Look for industry updates in this column...information of interest to make EMR implementation easier and more efficient for the digital office.

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As physicians implement the EMR in their practices, the exchange of health information demands a collaborative effort for success. The HIMSS RHIO Federation, formed in October 2005, helps support and set realistic expectations for this exchange of health data.

What Is a RHIO?
A RHIO is a group of organizations with a business stake in improving the quality, safety and efficiency of healthcare delivery. The terms “RHIO” and “Health Information Exchange” or “HIE” are often used interchangeably.

What Is the Purpose of a RHIO?
The purpose of a RHIO is to electronically exchange health information in a secure format so that the receiver can use the information. Consider the RHIO as a local or state effort, actually the building blocks needed to help build the National Health Information Network (NHIN) by David Brailer, MD, and his team at ONC.

Visit the Website for more information on the HIMSS RHIO Federation.

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Cerner Corporation, headquartered in Kansas City, Mo., offers physicians in private practice Power Works, an EMR system designed to facilitate patient care with access to crucial health information anyway and any time.

PowerWorks is a full suite of clinical and practice management solutions designed to provide everything needed to run a doctor’s office. Delivered on a subscription basis PowerWorks is available for a low monthly fee and upfront costs. Cerner hosts the data for physician practices that use PowerWorks, keeping the information safe, secure and available.

A practicing physician since 1981, George A. Saleh, DO, admits he had been hesitant to implement the EMR. However, In September 2005, he introduced the Power Works system to his solo gynecology practice, Creekwood Women’s Care, LLC, in Kansas City, Mo.

“I can immediately see what is going on with my patients, said Dr. Saleh of the system now in place. “I am able to interact more effectively with patients than before because I can directly share lab results and other pertinent information, which is an indispensable asset in terms of patient safety,” he said.

For more information on Cerner’s PowerWorks, contact Cerner at 866-221-8877.

*The Vendor Update column offers a review of EHR solutions now in the marketplace. The companies featured in the Vendor Update belong to the HIMSS Electronic Health Record Vendors Association (EHRVA) and meet the EHRVA guidelines for an EHR vendor, which is defined as “a legally formed company in good standing that is a commercial vendor of EHR products to the United States of America healthcare market or a company that develops and markets its own proprietary EHR software.”

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It's all in a days work at the Troop Medical Clinic in Fort Richardson, Alaska, a clinic led by Major Mark Evans, RN, officer in charge, and chief nurse, and staffed by about 40 people. An ambulatory care site equipped with the EHR, the clinic relies on staff medics, one Army physician assistant provider, one civilian contract physician provider, and two registered nurses (Blanton Fortson and Major Mark Evans) to manage sick call for the almost 1,500 soldiers on base. Mr. Fortson is IMO, or Information Management Officer, for the clinic. In the photo, CPT Laura Vandermartin, RN, and SGT Luis Ayala demonstrate the delivery of patient care in one of the exam rooms. (Photo by Blanton Fortson, RN)

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