At last year's meeting of the Healthcare Information and Management Systems Society, held in February in Orlando, Fla., a small group of well-known health information technology leaders from the public and private sectors met to discuss the need to create a resource for physicians who were struggling to implement IT systems in their practices.
Docs helping docs embrace IT
Organization uses online tools to promote value of the technology
At the time, most physicians were uneasy about the demands posed by the federal government's electronic health-record incentive program, says Dr. Peter Basch, an internist with Washington (D.C.) Primary Care Physicians and medical director of ambulatory EHR and health IT policy for nine-hospital MedStar Health, Columbia, Md.
“The voice of physicians at that time was focused on what was wrong with the program,” Basch says. “We were doing what we as physicians—and I include myself in that—do very well, which is complain about details and minutiae.”
With funding for meaningful-use payments still uncertain amid political bickering and fiscal constraints, Basch and others worried that physicians' negative response to the program could make it an easy target for budget-cutting.
Also, they felt strongly that physicians needed to take the lead in demonstrating to one another how best to meet the program's requirements.
“Our sense was the legislation was never meant to dictate exactly what you should do and how you should optimize your systems for quality, safety and value,” Basch says of the incentive program. “That would and should come from doctors standing up and saying, ‘We've got this one.'”
From that small group of experts—which included Basch; Dr. William Bria, chief medical information officer of 20-hospital Shriners Hospitals for Children, Tampa, Fla.; Dr. Michael Zaroukian, professor and CMIO at Michigan State University, East Lansing; and Dr. Farzad Mostashari, then deputy national coordinator for programs and policy in HHS' Office of the National Coordinator for Health Information Technology, and now head of the agency—the idea for Doctors Helping Doctors Transform Health Care was born.
“We felt like there was an enormous opportunity during this time of transition,” Basch says. “With the vast majority of physicians set to make the move from paper-based passive records to an IT-based infrastructure, we thought, wouldn't it be great if we could create a vehicle to channel the expertise and insights of physicians as they made the journey?”
Launched in December, Doctors Helping Doctors is a not-for-profit organization whose website features instructional videos, blog posts, personal stories and other health IT-related information produced by physicians for their colleagues.
The need for such a resource is great, Bria says. Although the ONC announced in January that EHR incentive payments had topped $2.5 billion, many physicians—particularly those in small practices—are still struggling to meet meaningful-use attestation requirements. And some as-yet-uninitiated doctors, deterred by the legislative complexity, are delaying EHR implementation altogether.
“There is still confusion and prejudice about the requirements,” Bria says. “If physicians don't understand that adoption of these systems means practicing the best medicine, incentive dollars won't even get you to first base. We want to make it obvious to physicians that the use of health IT is part and parcel of the modern-day practice of medicine.”
Doctors Helping Doctors is still in the early stages. The project has no-strings-attached grant funding from the Optum Institute for Sustainable Health, Siemens and the Chan Soon-Shiong Family Foundation, which makes up the bulk of its $500,000 budget for 2012, says Janet Marchibroda, chair of the Health Information Technology Initiative for the Bipartisan Policy Center's Health Project, and initial executive director of Doctors Helping Doctors.
The organization's 15-member advisory board includes Basch, Bria, Zaroukian, Marchibroda and others. Resources on the site will explore topics such as e-prescribing, maximizing the value of clinical decision-support, managing problem lists and leveraging EHRs for information-exchange efforts, Bria says.
“We deeply want to have as many folks involved kicking the tires as possible,” he adds. “This is not about a Pollyanna approach. We want to know about problems and how people overcame them, or at least started to.”
The website contains several video testimonials taped last July at the annual meeting of the Association of Medical Directors of Information Systems, in Ojai, Calif., says Bria, president of AMDIS.
The planners of Doctors Helping Doctors recorded hours and hours of video at the AMDIS meeting, later editing the footage into shorter vignettes. Dr. Howard Landa, CMIO of 387-bed Alameda County Medical Center, Oakland, Calif., was featured in one, discussing the importance of EHRs for improving quality and efficiency.
“I talked about some of the challenges I had faced, how to overcome them and how to embark on this type of journey,” Landa says. “It's very daunting to make large investments in IT systems, especially when many physicians have had negative experiences with them in the past. Many of them look at it as a weight that will be placed on them versus something that can help them to improve care.”
More videos are coming, Bria says.
The site's blog also will include guest contributions, the first of which, posted Feb. 3, came from Dr. Christopher Tashjian, a family physician who practices in Ellsworth, Wis., a rural village of a few thousand residents in the far western part of the state.
At 7:35 a.m. on April 18, 2011, Tashjian became one of the first physicians in the country to complete the meaningful-use attestation process. He credits his success to diligent planning, communication with his practice's vendor and frequent use of his regional extension center. RECs are charged by the government with helping providers implement and successfully use EHRs.
For instance, in Ellsworth—which, as Tashjian is quick to point out, is known as the Cheese Curd Capital of Wisconsin—there are no IT security professionals available. Tashjian instead relied on help from his REC, the Madison-based Wisconsin Health Information Technology Extension Center, to help meet the program's privacy and security requirements.
“If they hadn't helped me, I don't think I could have got it done,” he says.
His early attestation caught the attention of government officials, who asked Tashjian to speak on a panel at ONC's annual meeting in November. Basch was on the same panel and the two became friends.
“We're both doctors in small practices; he's in the big city and I'm in the country,” he says. Soon after the ONC meeting, the organizers of Doctors Helping Doctors approached him to serve on the organization's advisory board and he accepted.
“I'm not an academic, I don't work for a big system, I'm just a practicing physician who sees patients every day,” Tashjian says. “That's what I bring to the table.”
In his recent blog post, Tashjian discussed his office's implementation of the after-visit summary, a document provided to patients at the end of their visit, which includes height, weight, body-mass index, medication lists, problem lists, future appointment times, laboratory results and other information. Providing an EHR-generated clinical visit summary to more than 50% of patients within three business days is a requirement for Stage 1 meaningful-use certification.
“This helps families of our geriatric population who are eager to learn what transpired at the office visit of their parents,” Tashjian wrote in his blog post. “Just as importantly, this is a great benefit for our newborns as all of the important baby information is given in a clear, legible format, including immunizations given at the well-child visit.”
Basch wrote a companion post, also published to the site Feb. 3, praising the after-visit summary requirement as a good idea, but also listing some of the improvements he thought could be made.
Most important, Basch wrote, physicians are concerned that the government does not mandate the inclusion of patient instructions in the summary. Adding that information to an “already bloated document” could overwhelm patients, he says.
“My wish for the clinical visit summary in stages 2 and 3 of meaningful use (is) to learn from the experience of physicians and more importantly from patients,” Basch wrote. “Let's include what works and what patients find useful. Let's also consider removing or making optional what doesn't work.”
Doctors Helping Doctors is now actively soliciting blog posts from physicians who want to showcase lessons learned, according to Basch, who says new content will be added to the site on a weekly—and perhaps daily—basis.
“So many of us have been busy with our own meaningful-use submissions,” he says. “Now is the time to take a deep breath and reflect on what we've learned and what it means.”
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