Health Information Technology Initiative

REPORT OF COUNCIL ON PRACTICE MANAGEMENT SERVICES

CPMS Report 2-A-07
Subject: Health Information Technology Initiative
Presented by: David Fleeger, MD, Chair

Since January 2006, TMA's Health Information Technology Department has operated with funds provided by the Physicians' Foundation for Health Systems Excellence (PFHSE) to the TMA Special Funds Foundation (SFF). The goal of this project is to contribute to enhanced patient safety through accelerated physician adoption and use of clinically-focused health information technology in their office practices.  This activity is overseen by TMA's Ad Hoc Committee on Health Information Technology, which reports to the Council on Practice Management Services.

Significant accomplishments thus far include building an infrastructure to ensure continued success of this project as well as delivery of numerous strong, tangible products and services to Texas physicians, including seminars, tools, publications, and consulting services.

Demand for health information technology and services and knowledge is rapidly increasing. This acceleration makes the need and urgency for this project even greater. TMA's programs already have reached tens of thousands of physicians through multiple venues. In addition, TMA has freely shared its knowledge and resources with other medical societies and HIT stakeholders, leveraging grant dollars across state lines.

As this project has progressed, activities have fallen into three major areas as driven by physician need and market and government forces. These three areas of focus are:

In-Office Support - Activities are developed to help physicians successfully select, implement, and utilize information technology in their practice. The objective is to be a trusted advisor to the physician's practice, and the go-to source for unbiased information.  A full spectrum of services are available that meet the varying health information technology needs of Texas physicians, including using technology to improve quality of care and patient safety.  

HIT Policy - Momentum continues to build as policy is established at the federal and state levels.  President Bush continues the push for health IT through his executive order.  Gov. Rick Perry issued an executive order encouraging health care stakeholders to use interoperable electronic health care information systems. The HIT team is actively participating in local, state, and national health information conferences and meetings to monitor and influence policy developments related to HIT and patient safety.  

Health Information Exchange and Regional Health Information Organizations - Establishment of the technological infrastructure for community connectivity required to confidentially share clinical information across providers is a vital step to promoting efficiency and quality of care. TMA's goal is to ensure that physicians play an integral role in the development of these health information exchanges. TMA is monitoring and providing access to resources for physician groups across the state as they seek to learn about and participate in local RHIO initiatives.

The following highlights activities of TMA's HIT project:

1.   Identified physician leaders and key stakeholders to drive the initiative: The Ad Hoc Committee on Health Information Technology has been operating since fall 2005. The committee is chaired by Joseph Schneider, MD, MBA, from Dallas, and reports to this council, chaired by David Fleeger, MD, of Austin.  The committee meets formally three times a year and conference calls are scheduled as needed.

Specific actions of the committee include:

• Oversight of HIT Policy
  • Three committee members served on Texas' Health Information Technology Advisory Committee (HITAC), formed in response to 2005 legislation. All committee members reviewed draft reports of the committee;
  • Drafted TMA policy on health information exchange;
  • Dr. Schneider serves Gov. Rick Perry on the Southern Governor's Task Force on Emergency Preparedness, which is addressing health information exchange across communities.
• Involvement in RHIO Development
  • Directed staff to monitor development of RHIOs across the state;
  • Directed staff to convene stakeholders involved in RHIO development to help ensure standards and interoperability.

2.   Established Department of Health Information Technology: The Health Information Technology Department operates within the Membership Development and Physician Services Division. The department establishes new and coalesces existing and planned HIT activities. Priorities of staff include:

A.  Performed a baseline survey to identify knowledge gaps:  The TMA survey on HIT was completed in February 2006.  Results of the special survey have been widely distributed and utilized by the HIT community and other stakeholders, such as state government. Some of the statistics from the survey were cited in the Governor's Health Information Technology Committee's (HITAC) recommendations to the Texas State Legislature. The survey has been used to guide the development of TMA's services, educational content, and appropriate message to encourage adoption of EMRs.  A second survey is planned for fall 2007 to measure progress of the HIT project.

Key findings:

• Only 27 percent of physicians currently use an electronic medical records system. TMA staff believes this is an exaggerated response - an anomaly resulting from the majority of survey responses being received electronically versus mailed paper;
• Almost half of all physicians (46 percent) are planning an EMR implementation;
• More than a third (36 percent) of physicians who have implemented an EMR are extremely satisfied and another half (48 percent) are somewhat satisfied;
• Physicians who do not plan to implement an EMR report that the cost is prohibitive and they would need a grant in order to reconsider that decision. 

B.   Developed Self-Study Programs:  There are two separate self-study programs.  One is the EMR implementation guide which was recently finalized.  The other was the July issue of Texas Medicine .  Both allow for continuing medical education credits for physicians completers. Both are designed to give practical information to physicians and educate them about steps needed for successful EMR adoption. 

C.   Produced EMR Implementation Guide:  The EMR implementation guide was sent to Texas physicians in direct patient care and requesting nonmember physicians.  This guide is specifically designed to help physicians with pragmatic solutions to encourage EMR adoption to improve patient safety within a practice.  Physician leaders specifically asked that case studies be included.  Four physicians agreed to share specific experiences and processes that led to successful EMR adoption.

Physicians who complete this self study are eligible for continuing medical education credits and a Texas Medical Liability Trust insurance premium discount. 

D.  Disseminated Texas Medicine HIT Symposium Issue:  The July 2006 issue of Texas Medicine included a symposium section on health information technology.  It was comprised of six articles that covered issues about accepting change, embracing EMRs, understanding pay for performance, and avoiding pitfalls in the adoption of electronic technologies.  Physician completers are eligible for two AMA PRA Category 1 credits.

E.   Developed Web Resources:  TMA's Web site averages 140,000 unique monthly visitors. A portion of the Web site is dedicated to health information technology. Following is a sampling of current HIT resources available on TMA's Web site:

• Needs and readiness assessment checklists;
• Calculator to determine return on investment;
• Comparative vendor data - TMA negotiated a contract with KLAS, an online database, to compare functionality and performance of various EMR vendors, to allow free access to Texas physicians;
• 25 questions to ask your software vendor;
• Sample vendor contract noting problem clauses;
• Guidelines for financing requests;
• Links to low-cost funding options;
• HIT project management checklist;
• Financial benchmarking data specific to Texas;
• Online network for sharing best practices;
• Unique tools identified by HIT advisory group; and
• Baseline survey.

F.   Mobilized TMA Media:  TMA utilizes its primary communication vehicles to educate physicians on how EMRs can improve office efficiency, patient safety, and clinical quality.  In addition to the special issue of Texas Medicine , there have been four Texas Medicine articles specifically related to HIT.

In addition, E-tips, TMA's monthly electronic practice management newsletter, Action, and News of Interest carry HIT information to physicians and office staff. Topics include:

• TMA special EMR survey results;
• Vendor comparison resources;
• HIT glossary;
• Ways an EMR can increase productivity;
• Stark relaxation;
• EMR certifications;
• TMA's office technology online community.

G.   Held Statewide Seminar Series:  A key component of sharing the HIT message is physician education.  Working with TMA's Office of Conference Management, two seminar series were conducted in 2006.   There will be two HIT sponsored seminars during 2007.  One will focus on EMR selection and implementation, while the other will be paired with another topic, such as pay for performance or e-prescribing. 

Summer 2006 Seminar Series:  Electronic Medical Records (EMRs):  Straight Answers, Practical Advice, and Best Practices.
TMA completed a four-city seminar series on electronic medical records in June and July in Austin, San Antonio, Dallas, and Houston. The agenda consisted of presentations on how to select an EMR, realistic expectations, and legal issues related to contract negotiation, as well as two demonstrations and case studies by physicians already using an EMR in their practice. CME credits were offered. In addition, participants were able to visit with up to seven EMR vendors during breaks.  The four seminars were attended by 99 physicians and 74 office staff.

Fall 2006 Seminar Series :  Defensive Documentation:  Risk Management, Quality Improvement, Technology.
This seminar series was taken to ten Texas cities during October and November 2006.   In addition to offering the seminar in major metropolitan areas, rural areas of the state, such as Abilene, Corpus Christi, El Paso, Lubbock, McAllen, and Tyler, were included. The premise of the seminar is medical record documentation with an emphasis on how EMRs can help improve documentation and clinical outcomes.  Total attendance reached 419 of which 317 were physicians.  Vendor exhibits were available for the attendees to visit.  

H.  Participation in County Medical Society Meetings/Physician Forums:  TMA holds in high regard the relationships with its grassroots county medical societies. Part of TMA's support to these societies includes help with educational programs.  By request, TMA will provide a speaker for CMS meetings to help physicians realize the resources and tools provided by the health information technology department. 

The HIT Department sends an e-newsletter monthly to keep county medical society staff and leadership abreast of current issues surrounding health information technology. There are opportunities for participation in local technology expos and forums. 

I.    Implementation of HIT Helpline: TMA installed a "helpline" with dedicated toll-free number to provide a service to physicians who have specific questions related to selection and implementation of an EMR.  In conjunction with installation of the helpline, a dedicated e-mail address is available for HIT specific questions. The phone number and e-mail address are provided on all printed materials and special business cards are distributed providing the contact information.  As demand for information builds and word of TMA's programs spreads, this resource will be more heavily used. The slow building of demand seen during 2006 has allowed TMA to build a solid foundation to meet increased demand by Texas physicians.

J.    Develop Programs and Services for Quality Improvement:  Nancy Bieri, RN, BSN, started Oct. 9, 2006, as Quality Improvement Coordinator.  She is charged with developing resources and tools to assist physicians to implement quality indicators as they adopt HIT. These tools will range from simple checklists to guide quality improvement methodologies during HIT adoption to more complex data aggregation to meet pay-for-performance criteria. As economic credentialing gains momentum, TMA will play a vital role in educating physicians and helping them utilize measures to improve clinical quality. 

K.  Support for RHIOs/Community Data Warehouses: TMA's goal is to ensure that physicians play an integral role in development of community connectivity required to confidentially share clinical information across providers. To help physicians take a leadership role in this endeavor, TMA is supporting local, regional, and statewide health information exchange projects, forums, and summits. 

TMA has developed relationships with an inclusive group of stakeholders, including legislators, large employers, payers, hospitals, and state agencies. These relationships are invaluable as TMA cultivates stakeholder support for health information exchange projects throughout the state.  

TMA is working closely with county medical societies and offering support for health information exchange (HIE) projects and stakeholder events on a local level. These projects and events also include various stakeholder groups and focus on the unique local issues surrounding health information exchange.  TMA also focuses on bringing stakeholders together from various RHIOs to ensure broad interoperability as exchanges expand from regional to statewide. 

L.   Established an Online Peer-to-Peer HIT Community:  The online peer-to-peer community was launched in May 2006 and provides an interactive forum for physicians and their office staff to post questions and engage in discussion.  The Office Technologies Community, moderated by Joseph Perkinson, MD, allows physicians, office staff, and county medical society staff to seek and post information and resources on topics such as electronic medical records, electronic insurance claim filing, electronic billing, and scheduling software. With 2,183 hits since May, the community has 226 members and contains tools, resources, and links helpful to physicians and office staff looking for information on adopting electronic medical records in their practice.

TMA House of Delegates: TexMed 2007