The Pri-Med Practice Solutions and the American Academy of Family Physicians Annual Scientific Assembly

The American Academy of Family Physicians Annual Scientific Assembly

September 28 - October 2, 2005, San Francisco, CA

Clinical Decision Making in Three Minutes or Less: Information Mastery at the Point of CarePresenter: Scott Strayer, MD, MPH

Overview: Tools and resources for keeping current with the best evidence-based medicine are essential in today’s practice; but how do physicians know they are using the best ones? At this year’s Assembly, Scott Strayer, MD, MPH, advised physicians on how to evaluate the validity and relevance of their information sources. Specifically, he discussed two types of essential information tools: “foraging” and “hunting” tools. While foraging tools alert users to newly available information, hunting tools allow them to find the information again when it is needed (at the point-of-care, for example). A hybrid hunting and foraging tool may be the best option, according to Dr. Strayer, but ultimately, you should be looking for a hunting tool that can provide the answer to a clinical question within minutes. His criteria for evaluating hunting and foraging tools are relevance, validity, bias, and timeliness. To ensure information validity, he recommended using the Cochrane Library’s collection of evidence-based databases and systematic literature reviews. And while they may be ubiquitous, Dr. Strayer said to avoid tools that offer abstracts—they lose points in the “timeliness” category, as one must wade through the abstracts in order to get to an answer. He also highlights the importance of patient-oriented evidence over disease-oriented evidence. Patient-oriented evidence that matters (POEMs) “matters to the clinician because, if valid, it will require a change in practice,” the speaker pointed out. Dr. Strayer warned against the “Trojan Horses”—information that is sponsored (and likely censored) by third parties. “You can have information ‘free’ and you can have it ‘uncensored,’ but you can’t have it both ways,” Strayer asserted. For more, visit www.aafp.org/x38684.xml

How Do You Find Someone to Run Your Computer Infrastructure?Presenter: Steven E. Waldren, MD

Overview: When selecting a consultant, according to Dr. Waldren, the key factors to look for are skill set, including knowledge of your business and industry certifications; comfort with their style and approach; outside financial interests; and references and professional organizations. The best places to seek out consultants, according to Dr. Waldren, are at local practices, local hospitals, EHR vendors, and health IT consulting firms. Once you’ve selected a consultant and are prepared to sign a contract, be sure to “explicitly define your core business function, explicitly define the scope of work; define the relationship between the IT consultant and vendor; define performance measures to gauge success of consultant; and sign a HIPAA business associate agreement,” which will iron out details like performance metrics, said Dr. Waldren. Finally, the presenter recommended joining the AAFP EMR discussion list.

Obtaining Affordable, Standards-Based EHR: An UpdatePresenter: David C. Kibbe, MD

Overview: In his discussion of the challenges that exist in establishing a core technique in family medicine, Dr. Kibbe identified the four components of the AAFP “acid test” for principles for health IT as affordability, compatibility, interoperability, and data stewardship. He revealed that the percentage of family physicians who use EHR systems has increased from 25% in 2003 to 46% in 2005, crediting the spike not to financial motives, but instead to a widespread frustration at “the lack of value in the current billing system and increase in discontent with system.” The barriers that initially stopped many physicians from considering switching to an EHR—namely cost and a decrease in productivity due to fewer patients—“have become less formidable in the last two years,” and are being outweighed by the benefits of EHRs in the form of more efficient workflow, easier access to patient records, management of e-prescribing, and better management of clinical documents.

Selecting an EHR for the Small PracticePresenter: Maggie Blackburn, MD

Overview: Given the ever-increasing demands put on today’s physician, an EHR makes sense; however, Dr. Blackburn recommends approaching the decision to go paperless with careful consideration of a number of factors. After prioritizing your wish list, follow the mantra “try before you buy.” Collect samples of software before purchasing anything, Dr. Blackburn recommends, and look for Internet demos. In order to make the most of free demonstrations of products, you may want to invest in some type of remote access software, such as PC Anywhere. Other considerations include a good tech support staff and the reputation of the vendor. Dr. Blackburn points out that an EHR is an asset; in addition to considering cost upfront, one must also consider cost over time. And if you can find an EHR system that will allow you to document a higher visit code, the product could be well worth its cost. While software and hardware costs could seem steep at first, you should be able to reduce your office staff and ultimately save money. Read more on how to purchase an affordable EHR system and access product reviews (requires AAFP id number).

Using Your EHR to Enhance Efficiency and ProductivityPresenter: John Bachman, MD

Overview: Dr. Bachman illustrated how, with products like Instant Medical History, doctors can manage patient encounters more efficiently, improve charting, and, ultimately, document higher visit codes. “Most clinicians do E4 work,” said Dr. Bachman. “Most code E3. Most document E2.” By allowing patients to enter their own history with products like Instant Medical History, physicians can garner useful information not typically elicited in a face-to-face encounter. Instant Medical History was able to elicit this type of information 40% of the time, according to Dr. Bachman. Because patients are able to control the length of the interview and may be more willing to divulge sensitive information to a computer than another person face-to-face, patient acceptance of automated history-taking is high. The physician and the patient are able to look at the content of the interview together, discuss it, and engage in shared decision making. As far as the physical exam, Dr. Bachman recommends Shorthand for Windows, software that allows creation of encounter note templates for conditions you see regularly.

Using Your PDA in the Office and the Bedside: A Medical Palm Pilot PrimerPresenter: Jeremy Golding, MD, FAAFP

Overview: With PDA use on the rise among physicians in recent years, Dr. Golding reviewed the practical applications of handheld computers in medicine and identified some of the best programs available. In comparing the capabilities of Palm OS devices versus those running Pocket PC, Dr. Golding stated that the Palm OS device is more compact, less expensive, and offers a wider selection of medical applications but cannot multitask as well as its counterpart. The five main types of PDA software, according to Dr. Golding, who provided top software recommendations for each category, are reference texts (Epocrates and Harrison’s Manual of Medicine), medical calculators (MedCalc, STAT Cholesterol), decision tools (Endocarditis Prophylaxis from MeisterMed), drug references (Johns Hopkins Antibiotic Guide from doctorsgadgets.com) and coding and billing (ICD Meister). Handheld devices, according to Dr. Golding, are “increasingly capable, versatile and easy to use;” they offer a “wide range of software;” and “you don’t have to be a techie to use it.”

Access audio recordings, video highlights, CME activities, and lectures from this year’s Scientific Assembly.

Pri-Med Practice Solutions:Integrating Technology to Enhance Patient and Practice Management (Mid-Atlantic)

October 6-7, 2005, Baltimore, MD

Pay-For-Performance: Perils and Pitfalls from a Practicing PhysicianPresenter: Patricia Roy, DO

Overview: “Those who ignore or are afraid to implement pay-for-performance (P4P) will lose out,” began Dr. Roy. In order to tackle P4P, one’s practice must have procedures in place and the appropriate personnel; the practice that can implement the process will ultimately win. “Earnings will be based on performance, whether it is accurate or not,” Dr. Roy warned. She also pointed out that doctors should “help the plan set the guidelines,” as following them may not always be good medicine. Ultimately, P4P is “an opportunity to make money by helping people; that’s why we’re in medicine,” the speaker noted. The physician needs to consider, however, if the cost of the manpower involved will offset the potential reward, where the money will come from, and if the data is accurate. The most important element of P4P to consider is the patient, for whom benefits are available if disease management improves their health and decreased cost filters down to them. “This is a big ‘if’” in non-tiered systems, explained Dr. Roy. All in all, P4P improves processes, may improve outcomes, and must be anchored in evidence-based medicine.

Improving Performance at the Point-of-Care Using the WebPresenter: Brian Alper, MD, MSPH

Overview: Dr. Alper explained that knowledge should inform action, turning research into practice and vice versa, and added that lectures, textbooks, original research in journals, and systematic reviews aren’t necessarily good sources for the best research evidence. The presenter defined the Usefulness Equation—relevance times validity, divided by work—which can be applied to studies, evidence sources, guidelines, and quality measures. If information isn’t relevant, “who cares if it’s valid?” said the speaker. “If it’s not relevant, why do the work?” Quality measures should represent quality care and accurately measure what they are supposed to measure, Dr. Alper stressed. “Evidence, guidelines, and quality measures are not interchangeable but interrelated,” he explained. Evidence can be misinterpreted, guidelines require evidence plus values, and inappropriate quality measures can result in inappropriate care. In regards to quality measures, “try to use data that’s already been captured,” Dr. Alper advised. When finding evidence, he directs physicians to his site for hundreds of useful patient care resources, DynaMed for rapid browsing of the best available evidence, the TRIP Database for links to free websites with evidence-based and/or medical content, and PubMed Clinical Queries for evidence-based Medline searches.

The New World of E-PrescribingPresenter: Salvatore Volpe, MD

Overview: E-prescribing can improve patient safety through the reduction of adverse events and compliance monitoring according to the Center for Information Technology; increase satisfaction and efficacy in care delivery; provide a positive return on investment; and make it more likely for patients to obtain the best medication, stated Dr. Volpe. The use of e-prescribing also cuts the steps involved when a prescription is too expensive, illegible, not on a formulary, or has drug—drug or drug–allergy interactions; communication with the pharmacy is available at the point of care. Dr. Volpe also explained that, at an average cost of $50 per month, e-prescribing software allows the physician to access a drug database, formulary reference, and patient medication history, as well as check potential interactions and receive daily news on such topics and medication recalls. The speaker’s take home message was that e-prescribing “can be your first step towards an electronic health record,” “in the long run will save you and your staff,” and “will permit you to take even better care of your patients.”

Dr. Strayer’s Recommended Foraging and Hunting ToolsForaging InfoPOEMs

Journal Watch

Medscape MedPulse

MDLinx

PeerView Institute

HuntingMedscape Daily News

DynaMed

InfoRetriever