Online information and resources presented at the 2005 AMIA Spring Congress

Dr. David J. Brailer, national health information technology coordinator, opened the conference by addressing the national EMR adoption gap and citing the ability of market forces to help physician groups implement electronic records.

Dr. Jerome H. Carter, editor of

Electronic Medical Records: A Guide for Clinicians and Administrators

, and chief executive officer of NT&M Informatics, outlined key strategies that successful organizations use (and avoid) in implementing an EMR.

Dr. Mark Leavitt, chair of the Certification Commission for Health Information Technology, described the background, scope, and future plans of the organization tasked with certifying EMR products.

Dr. Blackford Middleton, chair of the Center for IT Leadership at Partners HealthCare System in Boston and program committee chair of the 2005 AMIA Spring Congress. Middleton discussed the value of implementing an EMR and the surprising finding that physicians and providers are missing out on the lion’s share of EMR financial benefits and savings.

Rep. Patrick J. Kennedy (D-RI), co-chair of the 21st Century Health Care Caucus, discussed current federal healthcare IT initiatives, including an upcoming bill he co-crafted with Rep. Tim Murphy (R-PA) that would address major elements of creating electronic healthcare systems, including protection of patient privacy and drive IT adoption.

Plenary reactor panel consisted of Dr. Blackford Middleton; John Glaser, vice president and chief information officer of Partners HealthCare System; Dr. Larry Garber, medical director for informatics at Fallon Healthcare System; and Dr. John Blair, president and chief executive officer of Taconic IPA. Panelists provided their reactions to the plenary session presentations and the workshop group synthesis presentations.

Implementing an electronic medical record is a complex process that involves both cultural and organizational changes. From informative plenary sessions to workgroup brainstorming to online resources for EMR topics, the American Medical Informatics Association’s Spring Congress delivered an assortment of information that anyone contemplating the adoption of an EMR will find invaluable.

‘Best of Best’ Presentations Pinpoint What Works, and What Doesn’t, in EMR Implementations

The 2005 American Medical Informatics Association Spring Congress was a working meeting. Attendees participated in two days of intensive workshops covering a variety of topics related to the electronic medical record. Workshops were divided into several topic groups in which attendees discussed their experiences with EMR implementations. After a synthesis period, workshop facilitators compiled a “best of the best” list of information and data gathered from the brainstorming sessions. 

Increasing EHR Value with Ambulatory Care Physician Order Entry

Workshop Co-Captains: Dr. Blackford Middleton and Dr. Eduardo Ortiz

The highest priority for attendees was order entry/clinical decision support for medications. Participants agreed that it is much more challenging to implement computerized physician order entry in the ambulatory setting because it is less protocol-driven than the inpatient setting. The workgroup called on the AMIA to assess knowledge resources and databases. In measuring and deriving value from an ambulatory care physician order entry system, it is important to first understand what is most valuable to various users, including physicians, nurses, patients, the organization, and insurers.

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EHR Implementation

Co-Captains: Dr. Jerome A. Osheroff and Dr. Michael Krall

Implementing an electronic medical record is a large, unwieldy, and often daunting task. Workshop participants divided the implementation process into three areas:

• People/process

• Software/configuration

• Hardware

The idea that EMR implementation is first and foremost a culture change and not an IT project formed the foundation for much of the workshop discussion. Viewing the task as a culture change enabled attendees to highlight the importance of early, careful workflow analysis, identifying both champions and detractors of the project, and emphasizing long-term communication and training.

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Increasing EHR Value with Population Management

Co-Captains: Dr. Kevin Johnson and Dr. Charles Jaffe

Busy physicians and hospital organizations don’t just treat individual patients; they also treat populations of patients. Attendees at this workshop examined how electronic medical records can be used to facilitate population and chronic disease management by outlining:

• key components of a population management process

• the ways in which each stakeholder group benefits from population management

• potential barriers and facilitators in a successful population management program

• the role of an EMR in population management

• the ways in which a practice should operationalize population management using EMRs

• the way population management programs should be evaluated

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PowerPoint Presentations at the 2005 American Medical Informatics Association Spring Congress

Plenary Presentations

Healthcare informatics experts, including senior executives, physicians, and legislators, tackled a variety of issues surrounding the implementation and use of electronic medical records in the U.S. PowerPoint presentations provided by the speakers will be available at the American Medical Informatics Association Web site for 30 days.

Market Driven Chasm Crossing: Will EHRs Ride the Tide?

Presenter: Dr. Thomas H. Lee, network president, Partners HealthCare System

Lee presents a plethora of factors, including market forces, that may drive implementation of electronic medical records. He cites EMR adoption stars such as Harvard Vanguard, which, through a culture of quality and prevention, have achieved 100% EMR adoption. The carrot may be failing in persuading physicians’ offices to adopt EMRs, Lee said, and it could be time to consider the stick method. The Vanguard organization was able to implement an EMR and provide registries for following patient populations with chronic diseases without resorting to physician incentives directly tied to such quality measures.

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EHR Implementation Successes and Failures: What Have We Learned?

Presenter: Dr. Jerome H. Carter, chief executive officer of NT&M Informatics

Electronic medical records are complex software implementations, and, according to Carter, as many as 50% of these types of complicated implementations fail. Carter discusses a series of studies on failed implementations and highlights surefire characteristics of those failures, including vague objectives, bad planning, and poor vendor performance.

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In Sickness and in Health: Development Tools for the Electronic Health Record to Support Population Care Management

Presenter: Dr. Paul Wallace, executive director of the Care Management Institute, Kaiser Permanente

With headquarters in Oakland, CA, the nonprofit HMO organization Kaiser Permanente serves the healthcare needs of members in nine states and Washington, DC. Wallace, calling on his experience at the large healthcare organization, outlines the functions needed to support population-based care and explains how the electronic medical record can fill the gaps in the information needed for such a large task.

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The Time is Right: Making the Health IT Revolution

Presenter: Rep. Patrick J. Kennedy (D-RI), co-chair of the 21st Century Health Care Caucus

Kennedy addresses the problem of a healthcare system that is not designed to ensure the best possible outcomes for patients at the lowest possible cost. The Murphy-Kennedy 21st Century Health Information Act is Kennedy’s attempt to put IT in physicians’ hands. The goal of the bill is to enable sustainable, secure, interoperable health information networks with broad provider participation and the capacity to transform the practice of medicine.

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The Certification Commission for Healthcare Information Technology (CCHIT) Overview and Update

Presenter: Dr. Mark Leavitt, chair of the Certification Commission for Healthcare Information Technology

With President Bush promoting the use of electronic medical records by 2014, health IT product certification is key to overcoming physicians’ lack of confidence in the technology, according to Leavitt. He details the background, mission, organization, and scope of the private-sector organization, which plans to have a pilot certification process in place by this summer.

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Additional Online Resources from the American Medical Informatics Association Spring Congress EMR Workshops

Selecting an EMR for Your Practice

Research report:Electronic Medical Records: Lessons from Small Physician Practices

About 70% of practicing physicians in California work solo or in small groups of 10 or fewer physicians, yet little has been published on their experience using EMRs. Understanding EMR use in solo/small practices can also help policymakers in government, employer coalitions, and public and private funding agencies to better craft policies that will hasten EMR adoption.

This study was based on interviews with EMR physician champions in 20 solo/small practices between May and December 2002. The 27-page report was prepared by the California HealthCare Foundation, an independent philanthropy committed to improving the way healthcare is delivered and financed in California.

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Online EMR evaluation tool: EMR Evaluation Tool and User Guide

Many hospitals struggle to make sense of the hundreds of EMR products on the market. The California HealthCare Foundation has developed a Web page that contains two downloadable files: an EMR evaluation tool, which is an Excel spreadsheet compressed as a Zip file; and a five-page PDF user guide that offers instructions for using the tool.

Note: According to the Web site, the tool is optimized for the Windows operating system. Macintosh users might not be able to activate some functions of the spreadsheet.

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Increasing EMR Value with Population Management

Research report: Disease Management Concepts Applied to Children in a Michigan Medicaid Population

During fourth quarter 2002, the Institute for Health Care Studies at Michigan State University initiated a collaborative project with the Michigan Department of Community Health and three Michigan Medicaid managed-care plans. The purpose of the project was to apply a disease management approach to a population of healthy children. Project goals were:

• to improve rates of well child examinations and immunizations received by children enrolled in the participating plans, and

• to assist the participating plans in understanding, developing, and implementing disease management strategies within their organizations.

Because disease management has been shown to be an effective model to complement primary care efforts and improve the health of populations with chronic conditions, project developers believed that a similar model could be developed to meet the varying needs of well children within a Medicaid health plan population.

Two plans were successful in increasing rates of well child care/immunizations for children who were case managed, compared with children who were not case managed. The other plan experienced no statistically significant differences in rates. The report covers 20 pages.

View the entire report in PDF file format

Research report: Stretching State Health Care Dollars: Care Management to Enhance Cost-Effectiveness

This 25-page report examines state-level innovative disease management strategies for Medicaid populations. It includes a section on initiatives to watch, extensive footnotes, and a list of related publications. The report was prepared by the Commonwealth Fund, a private foundation that supports independent research on health and social issues and makes grants to improve healthcare practice and policy.

View the entire report in PDF file format

Links to news reports from the 2005 American Medical Informatics Association Spring Conference

Certification group struggles against vendor-driven reputation

The Certification Commission for Healthcare Information Technology is combating the notion that it is driven by vendors and may not have the healthcare provider’s best interests in mind.

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Asymmetric benefits hinder EMR adoption

Overall penetration of the electronic medical record is relatively low in the U.S. And the gap in its adoption between large, well-financed organizations and smaller, cash-strapped physician practices is even larger, according to presenters at the American Medical Informatics Association meeting in Boston.

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White papers and online articles are included in an appendix of the 2005 American Medical Informatics Association Spring Congress Program

White paper: Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan

With the advent of electronic medical records, physicians have access to their patients’ latest medical information. Clinical decision support continues to evolve as it is incorporated into more practices. The AMIA’s Clinical Decision Workgroup classified advances in clinical decision support into four areas: the state of the knowledge base, necessary database elements to support clinical decision support, operational features to promote usability and measure performance, and organizational structures to help manage and govern current and new clinical decision support interventions.

Based on these advances, the workgroup outlined a series of proposals and recommendations that should be considered by those developing criteria for certification of electronic prescribing systems and implementations.

The March 2005 31-page report was compiled by the Joint Clinical Decision Workgroup.

View the entire report in PDF file format

Executive Preview: The Value of Computerized Provider Order Entry in Ambulatory Settings

Research has confirmed that the adoption of ambulatory computerized provider order entry can significantly improve quality, cut costs, and enhance the bottom line for organizations that adopt it. In this 16-page executive preview, the Center for Information Technology Leadership, chartered by Partners HealthCare and supported by the Healthcare Information and Management Systems Society, provides a comprehensive analysis of the potential for physician order entry systems to help transform U.S. healthcare.

While much attention has been focused on inpatient care, this report looks at ambulatory care as the lever with which providers can best apply clinical evidence at the point of care.

View the entire report in PDF file format

Journal Article: A Consensus Statement on Considerations for a Successful CPOE Implementation, Journal of the American Medical Informatics Association 2003;10:229-234

In May 2001, 13 experts on computerized provider orderentry from around the world gathered at a two-day conferenceto develop a consensus statement on successful CPOE implementation. The experts employed a qualitative research approach to generate and validatea list of categories and considerations to guide CPOE implementation.

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Journal Article: The Barriers to Electronic Medical Record Systems and How to Overcome Them,  Journal of the American Medical Informatics Association 1997;4:213-221

From the federal government to private citizens to healthcare organizations, everyone is clamoring for electronic medical record systems. But these systems are difficult to construct, and the existence of legacy data and information systems compound the implementation problems.

In a 1997 viewpoint paper, Dr. Clement J. McDonald of the Regenstrief Institute for Health Care at Indiana University School of Medicine said that acceleration of  EMR adoption requires physicians to focus on the interfaces instead ofon the EMR system. While interface solutions are already available in the formof standards (IP, HL7/ASTM, DICOM, LOINC, SNOMED), the healthcare community simply needs to embrace them, according to McDonald.

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