Us­ing doc­tors to sell in­for­ma­tion tech­nol­ogy to other doc­tors

Or­ga­ni­za­tion uses on­line tools to pro­mote value of the tech­nol­ogy

Modern Healthcare - - FRONT PAGE - Mau­reen Mckin­ney

At last year’s meet­ing of the Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety, held in Fe­bru­ary in Or­lando, Fla., a small group of well­known 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.

At the time, most physi­cians were un­easy about the de­mands posed by the fed­eral gov­ern­ment’s elec­tronic healthrecord 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.

Serv­ing a need

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 coun-

try 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.

Ad­vice from prac­tic­ing physi­cians

“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.”

Dr. Peter Basch is one of sev­eral physi­cians fea­tured in videos on the role of IT in the prac­tice of medicine.

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