  |
November 2006 — Volume 1, No. 11 SPECIAL ISSUE of The Digital Office…a Look at the Ideal Micro Practice revolution — Different Doctors…Better Care Who Was Dr. Nicholas E. Davies Of The “Davies Award”
Be Part Of Davies Committee: Apply Now The HIMSS Nicholas E. Davies Award of Excellence will be accepting applications for new Committee members through Dec. 1. The Davies Award recognizes excellence in EHR implementation across three award types: Organizational, Ambulatory, and Public Health. Visit the HIMSS Web site to learn about the Davies Awards program. For further information, contact David Collins. The Davies White Papers: Read and Learn Take advantage of this new Davies resource, a culmination of the multiple Davies recipients across the Organizational and Ambulatory Awards looking at return on investment, leadership, lessons learned, and value derived. Many thanks to Pat Wise, HIMSS, VP Healthcare Information Systems for consolidating the award winning applications into these white papers for a valuable high-level review.
Consumer Spending on Outpatient Drugs: Learn more about US spending on prescription drugs in a new report from the Agency for Healthcare Research and Quality. The reports found that spending on prescription drugs in an outpatient setting nearly doubled from 1999-2003 to $141 billion for brand name drugs and $36.6 billion for generics. Smaller Practice Physicians & Information Technology Gaps: Find out what 12,000 physician respondents said in this study from the Center for Studying Health System Change in Washington. The study found that both large and small practices have increased access to information technology in five clinical areas with gaps in others, per the study design. Read more. Evidenced-based medicine: Evidenced-based medicine asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practice. Evidence-based medicine follows four steps: formulate a clear clinical question from a patient’s problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice. The term ‘evidence-based medicine’ was coined at McMaster Medical School in Canada in the 1980s to label this clinical learning strategy which people at the school had been developing for over a decade. Workflow (as in workflow optimization): 1. A process description of how tasks are done, by whom, in what order and how quickly. Workflow can be used in the context of electronic systems or people, i.e. an electronic workflow system can help automate a physician’s personal workflow. 2. A graphic representation of the flow of work in a process and its related sub-processes; including specific activities, information dependencies, and the sequence of decisions and activities. Source: HIMSS Dictionary of Healthcare Information, Technology Terms, Acronyms and Organizations, 2006, Healthcare Information and Management Systems Society Thanksgiving Week Special…Connecting Communities RHIO/HIE Forums Register between Nov. 20-27 and save $50 on the Connecting Communities RHIO/HIE Forums As regional health information organization (RHIO) and Health Information Exchange (HIE) initiatives ramp up for dynamic growth, plan to attend this CME-Accredited, one-day educational forum to gain key insights and practical advice on these state, regional and community based efforts. Significant Savings For this week only, take $50 off the regular registration fee of $235 for HIMSS and eHealth Initiative members and $265 for non-members. You've got all week to register for $185 if you are a member or $215 for non-members. Reserve your spot by Nov. 27 and save $50 on December forums. Visit the HIMSS Web site to register. Ideal Micro Practices – Different Doctors…Better Care On Sept. 28, the 1st Annual Convocation of Ideal Micro Practices met in conjunction with the 2006 American Academy of Family Physicians Scientific Assembly at the D.C. Convention Center. The keynote speaker for this gathering was Andrew Webber, President and CEO of the National Business Coalition on Health. Dr. Gordon Moore is the champion of this movement, accompanied by “Cohort 1” of 16 physicians who have joined the Ideal Micro Practice evolution to provide more patient-centric care while enjoying the fulfillment of practicing medicine on their own terms. Each of these 16 physicians participated in a panel and provided their perspective of their lessons learned, successes, and barriers to a packed room of approximately 100, many who were interested to model their own practice after the Ideal Micro Practice (IMP) design. The IMP project is funded in part by grants from The Physician’s Foundation for Health Systems Excellence and the Commonwealth Fund The Digital Office has previously featured two physicians participating in IMP:
Read on to learn just how these Ideal Micro Practices are “Different Doctors, Providing Better Care.” Going Solo: The Next Generation
Five and a half years ago, I left a salaried practice to go solo. I had many reasons for this counterintuitive move, but the root of it all came down to my realization that the current form of health care delivery made it very hard to practice the way I wanted. I was increasingly uncomfortable with the pace of work, number of patients per hour and time per patient necessary to generate the revenue we needed. All the forces working on my practice appeared likely to further exacerbate the situation, and no one seemed to have any solutions. I wanted to be able to deliver superb care to patients in a vital and sustainable practice. By “vital and sustainable,” I meant that I would have a reasonable balance between work and the rest of my like and that the income would be adequate to my needs. I started out in one room (rented from a specialist colleague) with a good computer and EMR. I learned the (very annoying) tricks of billing and figured out how to weld together various technologies to achieve a near-paperless office. My overhead was less than 20 percent of gross revenue. I wrote up my experience in Family Practice Management, available at http://www.aafp.org/fpm/20020200/29goin.html and had such an overwhelming response from other docs that I created a listserv to facilitate communication and dissemination of our work. I also captured my experience one-year after getting started http://www.aafp.org/fpm/20020300/25goin.html My practice is still going strong. I work with a nurse now (out of two rooms) as we pursue the best of patient-centered collaborative care (see below). Many of the participants on the listserv have themselves taken the leap and established their own Ideal Micro Practices (IMPs). We have a project funded by the Physician’s Foundation for Health Systems Excellence (www.idealmicropractice.org). In the project, we are measuring our outcomes and ways to disseminate the work so that others can join up. For example, see “The Emergence of Ideal Micro Practices for Patient-centered Collaborative Care,” (Moore LG, Wasson JH, Johnson DJ, Zettek, J., Journal of Ambulatory Care Management, Vol 29, No 3, pp. 215-221). Read about other physicians who have followed this path in this special issue of The Digital Office. A New Career with an Ideal Micro Practice
Nearing the end of my family medicine residency in Rochester, NY, I was becoming a bit despondent regarding the job options that were available to me. Even as a resident, being forced to see patients in 10-minute time slots left me disillusioned and questioning my career choice. A single afternoon visit to Gordon Moore's office opened my eyes to a whole new world. I opened my micro practice in September 2005 with just $6,000 of savings. I started renting a single room from a physical therapy office, purchased in an inexpensive EMR and a computer, and hung out a shingle. My practice started earning a profit in about four months. Word-of-mouth spread fast, and I had to temporarily close my doors to new patients after six months. Designing my personal micro practice is a never-ending, ongoing task. In fact, it has become my hobby and my obsession. Collaborating with other micro practice physicians makes me realize how wonderfully unique all of our practices are and how much we have to learn from each other. In December 2005, I added medical acupuncture to my practice, which once again has opened another whole new world. My current office design incorporates online appointment scheduling, guaranteed same-day appointments for acute issues, 24 hour/ seven days a week direct access by cell-phone, and, HIPAA-secure e-mail messaging and patient maintained personal health records. My new patient visits are scheduled for an hour and all other visits are scheduled for 30 minutes, which more often than not, still seems like too little time. Reaping the Benefits of Becoming an IMP Physician
Four years out of residency, I began to realize I was not allowed to be the comprehensive, compassionate, prevention-oriented doctor I had hoped to be. I was shackled with my typical high overhead, high productivity, hamster-wheel salaried position in a group with 60 doctors. I had little time for the non-doctoring aspects of my life and was rapidly heading for burnout with no hope of change in sight. Then I came across Gordon Moore’s articles, published in 2002 in Family Practice Management, and knew this was the answer for me. Three-and-one-half years ago, I left my salaried position and started a solo practice that embraced my dreams of ideal practice. After learning as much as I could about non-clinical advances in medical practice, I implemented as many as possible to improve efficiency and safety while minimizing overhead in a paperless office. I started in a two-room office with an EMR that allowed me to operate with minimal staff – an MA that does many functions: front office, back office, labs and posts insurance explanation of benefits or EOBs. I also wear many hats, including billing, ordering supplies, changing out the room, and cleaning - in addition to usual physician tasks. My office is also my exam room and has real-time Internet access for patient handouts, insurance information including providers and formularies, and evidence-based medicine resources. To achieve patient-centered collaborative care, I provide
To uncover patient needs, I use the How’s Your Health (www.howsyourhealth.org) an online survey, pharmaceutical software on my PDA, and a patient registry. As a result, my patient’s clinical outcomes have soared (e.g. 98 percent of patients with hypertension are at goal of BP<130/80); they are achieving the health they desire. And I am enjoying being a family physician again in a sustainable practice that prevents burnout and fills the soul. Same Day Appointments: Exploding the Access Paradigm http://www.aafp.org/fpm/20000900/45same.html Starting a Revolution in Office-Based Care: http://www.aafp.org/fpm/FPMprinter/20011000/29star.html?print=yes
The Certification Commission for Healthcare Information Technology (CCHITSM) announced on Nov. 20 that a newly formed board of trustees will assume fiduciary responsibility, one of the elements required for CCHIT to become a fully independent, nonprofit organization. The initial seven members of the board of trustees were appointed by the current Operating Committee composed of the three founding organizations – the American Health Information Management Association (AHIMA), the Healthcare Information and Management Systems Society (HIMSS) and The National Alliance for Health Information Technology (Alliance). The members of the new board of trustees are: Tom Fritz, CEO, Inland Northwest Health Services; The trustees will serve 3-year terms. The group will be joined by commission chair, Mark Leavitt M.D., Ph.D., and the executive director, Alisa Ray, in an ex-officio role. Visit www.cchit.org to read the entire announcement. MGMA Endorsement The Medical Group Management Association (MGMA) has officially endorsed CCHIT. In a letter dated Nov. 8, 2006, MGMA president and CEO William F. Jessee, M.D. wrote, “The Medical Group Management Association (MGMA) believes that the certification process undertaken by the Certification Commission for Health Information Technology (CCHIT) removes one of the significant barriers to increased EHR adoption. While medical practices must exercise their own due diligence in selecting an EHR product that fits their organizational needs, we believe they will benefit by beginning that process with the guidance of a credible, independent product certification body. MGMA is pleased to endorse the work of the CCHIT.” “We are proud to add MGMA’s endorsement to those already received from the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and the Physicians’ Foundations for Health System Excellence and Health System Innovations,” said Alisa Ray, CCHIT executive director. “Their endorsements and the volunteer contributions of their members have significantly added to the credibility and relevance of the certification program.” CCHIT announces new certified electronic health record products CCHIT has announced that 11 new products received CCHIT CertifiedSM status , bringing the number of certified products to 35. The new products achieved CCHIT Certified status after undergoing inspections that demonstrated their compliance with CCHIT's published criteria. Next application period for CCHIT certification opens November 1, 2006 Review the materials and process A total of 17 ambulatory electronic health record (EHR) products applied for certification status during the Aug. 1 - 14 application period. Eleven of those products passed the CCHIT certification process, while some applicants were disqualified, failed inspection, or postponed inspection until next quarter. A complete list of CCHIT Certified products can be found at www.cchit.org/cchit-certified. Internally Developed EHR Systems Eligible The next application period marks the launch of CCHIT certification for internally developed ambulatory EHR systems. Organizations with internally developed EHR that are interested in CCHIT certification should review the materials on CCHIT Web site for additional details. HHS Names CCHIT a Recognized Certification Body The Department of Health and Human Services (HHS) has designated CCHIT as a Recognized Certification Body (RCB). In August, the Department published two final rules providing an exception to the physician self-referral prohibition (commonly referred to as the Stark law) and a safe harbor under the anti-kickback statute. These provisions allow hospitals, health systems, health plans and others to donate interoperable EHR software to physicians and other healthcare practitioners under specified conditions, one of which is that the software must be interoperable. EHR software will be deemed interoperable under both rules if it has been certified within 12 months prior to the donation by a certification body recognized by the Secretary. Davies Award Winner Provides Newt Gingrich With Tour of EMR in Action
More than 80 representatives of healthcare organizations from across the Atlanta, Ga. area attended a recent event at the office of North Fulton Family Medicine, a 2005 Ambulatory Care Davies Award of Excellence winner (Read North Fulton's manuscript ). Attendees included Nancy Babbitt, HIMSS chair, Davies Ambulatory Care Committee and 2003 Davies Recipient; David Collins, HIMSS manager of the Davies Award program; UPS (the region's biggest employer); major regional medical groups; and hospitals. Newt Gingrich, former Speaker of the House, author Saving Lives and Saving Money and founder of the Center for Health Transformation (CHT), joined Dr. Jim Morrow and Dr. Thomas Bat on a panel discussion of the benefits of a mature EMR system. Before joining the panel, Speaker Gingrich took a private tour of the practice and EMR, and subsequently stated, "There is one reason I’m here today---Paper kills! If I could wave a magic wand and have each member of the House and Senate participate on this tour, they could fully see the benefit to the healthcare system of an EMR." During group tours, the audience learned more about North Fulton -- a HIMSS Davies 2004 Award recipient -- to better understand the workflow benefits to the patient and practice and affiliated cost savings, as well as an on-screen demonstration of the EMR. AllScripts, a HIMSS corporate member and EMR in use at North Fulton, sponsored this event.
Thinking About Adopting Health IT
What planning can be done from the time the decision to implement an EMR is made and the first productive use? Take the time to assign a dedicated project manager to begin the plan development. The project manager will consider all the typical activities, such as people resources, budget, system design, vendor role, contractual obligations, etc. The biggest consideration is operational impact; this can make a big difference in the success of an EMR implementation. Getting a good feel for the workflows associated with the following activities will prepare the project manager for how to get the organization ready to change.
Most providers are concerned about the impact on productivity the EMR can and does bring. Consider conducting a survey to identify the psychological and technical mindset of the providers. For example, if many providers rarely use a computer and do not feel the EMR is a good idea, the project manager will need to be sure to mitigate those risks. Marketing the EMR solution helps raise awareness, and if targeted to address the concerns raised in the survey, can serve a dual purpose. Knowing where the organizations falls on the technology adoption continuum is critical to EMR deployment planning. Project managers will be familiar with the balance of the preparation steps. They may include project team development, project scope, workflow optimization, system design, training plans, and deployment/live plans. Including the operational impact and understanding how people feel about the changes will increase chances for a successful EMR implementation. The Digital Office 20-Second Survey Curious to know where you stand compared to your industry peers? Each month, the HIMSS 20-second Survey will ask for your opinion with different survey questions on EMR implementation. Just complete the 8-question, 20-second survey and check the December issue for the answers. If you have suggestions for survey questions, please e-mail David Collins, dcollins@himss.org by the third Friday of the month. Already There…Implemented Health IT
Stasia Kahn, MD When asked how the electronic medical record has helped Fox Prairie Medical Group, Stasia Kahn, MD, says she “would never go back” to paper records. Dr. Kahn is one of three physicians that worked in and left a practice together to open in 2003 this new medical group in the Chicago suburbs. “If there was ever a time that a practice could transition to a paperless office, this was the time,” said Dr. Kahn. We wanted to open the doors with the EMR implemented.” With that basic objective in mind, they looked for space knowing that they did not need the extra room for a medical records department and would not waste resources scanning paper documents. Newly hired staff knew as well that they would be working in a digital office. The practice opened its door with two full-time nurses and two full-time administrators. Now, three years later, the staff has evolved to one full-time nurse and one full-time administrator with four part-time nurses and three part-time administrators. “We like to keep our staff happy by offering part-time positions.” The physicians have found it “very rewarding to have remote access to information from home. It speaks to lifestyle issues,” said Dr. Kahn. “Patients like the computer system as well. We can show them lab results in a graphic form; they can see the trends.” As for physicians in a small practice making that transition from paper to digital records, take just one year, rather than several years, to do so. “It focuses you – there are so many steps to go through that you can lose track along the way.” Fox Prairie Medical Group works with an information technology consultant, a step that Dr. Kahn suggested that clinicians consider: Why does the practice need an information technology consultant?
The HIT Dashboard The latest information on over 500 state, federal, and private HIT initiatives
|
||||||
Take a moment to learn more about Dr. Nicholas E. Davies, the physician whose name and ideals live on in the HIMSS Davies Award of Excellence. The 
|
|
The
Digital Office is a monthly online newsletter published by the Healthcare
Information and Management Systems Society (HIMSS). |