Friday, August 17, 2007

Electronic Health Records - AAFP Committed to EHRs

In 2005 I interviewed Doug Henley, MD, EVP of the Academy of Family Physicians, for Voices of Health Reform (Practice Support Resources, 2005), a book consisting of 41 interviews with national health leaders. (My book concluded health reform would likely end in gridlock because any significant reform would gore the ox of powerful vested interests.)

Doug and the AAFP were wholly committed to the EMR concept as an efficiency, quality, and reform tool. Doug had this to say,

Back in 1998, the AAFP board was visionary when it set two goals: 1) we would have all of our members using the Internet by end of 2003; and 2) by the end of 2005, we would have ½ of our members using electronic health records. We met the first goal. It will be a significant challenge this year to meet the second goal.

Doug and AAFP set about organizing a systematic program to promote EHR use, setting up a Certification Commission to set standards and give a seal of approval to EHR vendors, developing attractive pricing packages for members, and preparing EHR adoption and readiness strategies for their 93,700 members consisting of four steps: preparation, selection, implementation, and maintenance.

An April 2007 spot survey of 459 AAFP members indicates AAFP is gaining ground towards achieving its goals:

•37% fully implemented
•26% plan to purchase
•25% do not plan to purchase
•13% in the process of purchasing.

Carrying out an organized and ambitious campaign to persuade FPs to adopt EHRs isn’t easy. As every IT health technology expert knows, physicians fall into categories when it comes to EHRs: visionaries, early adopters, mainstream adopters, late adopters, and resisters.

Some IY enthusiasts think physicians should be required to use EMRs and are bringing pressures to bear in the form of P-4-P programs, protocol compliance, and provider profiling that would make it difficult to function without EHRs.

The pressure became so great in 2006 that at the AMA’s Annual meeting, delegates adopted a policy saying that public and private payers should not require doctors to use EHRs. Certain benchmark Institutions – like Kaiser, Intermountain Healthcare, Brigham and Women’s in Boston, and the VA - require physicians to use EHRs, and other institutions are following suit.

But does this mean all physicians, 75% of whom practice in groups of 5 or less, should follow large institutions over the electronic cliff? Should independent physicians, who must choose commercial off-the-shelf software be mandated to install EHRs? Or will market conditions, including patient demand, and the need for market leadership, ultimately force the hands of physicians to install EHRs?

I don’t know, but I know I belong to the school that says no technology fits all situations, and that includes other technologies that can be used to spur efficiency and improve quality such as electronic scanning of paper documents, electronic and paper templates, combinations thereof, and other techniques for skinning the documentation cat.

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