AAFP Medplexus Deal Off, VistA On?

It looks like the American Academy of Family Physicians deal with Medplexus is off. However, it looks like VistA might be in the running now: ‘…This rejection was a disappointment, but it did not dampen the AAFP members’ or leadership’s interest in EHRs. Momentum continued to build for a low cost, standards based EHR solution. During this periood between January and the present, –we received many hundreds of emails from AAFP members, as well a other specialists in both primary care and the subspecialties, in support of the AAFP’s activist approach and encouraging the AAFP to continue to seek a solution that would afford physicians greater access to EHR technology; –we established relationships with people in the Veterans Administration (VA), led by Gary Christopherson, VA CIO, and the Centers for Medicare and Medicaid Services (CMS), many of whom who share our interest in creating a breakthrough in EHR adoption among AAFP members and other primary care physicians. We now talk regularly with the people in charge of VistA (the VA’s excellent EHR systems) about its possible wider use outside the VA…’ Complete text of Dr. Kibbe’s announcement is within.

Dear Colleagues:
First, let me explain that your name is included in this e-mailing
because I believe you contacted me at one time about the AAFP’s EHR
project asking for information, and you are either an AAFP member or a
close friend of the AAFP.

If you do NOT want to receive information about AAFP activities to
promote low cost, standards-based health information technology (HIT)
for family medicine, or I have you on this list in error, please reply
informing me of that fact. In that case, my apologies. Everyone hates
spam.

Conversely, I encourage you to forward this news on to your friends and
colleagues in the AAFP and elsewhere who are interested in these
topics. If they email me, I will add them to the list.

Secondly, this email is going to be rather longish. I will try to make
subsequent memos shorter. But, as you’ll see, there is a lot happening
within the AAFP on the subject of EHRs and HIT generally.

A BRIEF RECAP — As most of you know, the AAFP Board of Directors passed
a resolution in January of 2003 supporting the establishment of a new,
non-profit organization (the Foundation) that would further develop and
distribute a low cost open source EHR. The effort was made possible
because a start-up company, Medplexus, which also has a HIPAA-ready PMS
product, offered to gift its EHR software product to the AAFP for this
purpose.

The impetus behind the AAFP’s decision to become more active in
promoting the use of EHRs among the membership was an earlier Board
resolution, passed in January of 2000, that set two goals: that all
AAFP members would use the Internet by 2003, and all would be using
EHRs by 2005, in their practices. The leadership within the AAFP feels
strongly that the future of family medicine is linked to FPs having
excellent information management skills and technology, and that these
are key to improving quality and safety of care.

While that first goal has largely been met, we are still a long way from
completing the second: only about 5-8% of AAFP members currently use
EHRs in their practices, although there is data suggesting that many
more of us would acquire and use EHRs if the barriers of high cost and
lack of standardization could be dealt with.

To address and reduce those key barriers directly, the AAFP Board of
Directors in January 2003 passed a resolution that directed the AAFP
staff,, to develop a business plan for the open source EHR, and also
committed money for the Foundation, PROVIDED at least three (3)
additional medical specialty societies could be recruited to join the
AAFP in this effort to produce a low cost EHR solution. The AAFP felt
the right thing to do was to make this a joint venture with other
medical specialty societies, and to share the leadership with them.

For about 6 months, the team led by Douglas Henley, MD, AAFP Exec. VP
and myself worked very hard to convince our medical specialty society
colleagues to join the AAFP. Speaking personally, this was a valuable
and educational experience, and I came to know many of the people in
the ACP, AAP, ACOG, AMA, and other societies quite well.

For a number of reasons, however, best left to the individual medical
societies to explain, we did not get their support for an open source
EHR or the new non-profit, shared-governance organization to distribute
it. In May of 2003, not getting the critical mass needed to carry out
the AAFP Board’s directive of Jan 2003, we withdrew the plan and
released Medplexus from our agreement with them. The AAFP did not
spend any monies, as the conditions mentioned above were not met.

MOVING ON — This rejection was a disappointment, but it did not dampen
the AAFP members’ or leadership’s interest in EHRs. Momentum continued
to build for a low cost, standards based EHR solution. During this
periood between January and the present, –we received many hundreds of
emails from AAFP members, as well a other specialists in both primary
care and the subspecialties, in support of the AAFP’s activist approach
and encouraging the AAFP to continue to seek a solution that would
afford physicians greater access to EHR technology; –we established
relationships with people in the Veterans Administration (VA), led by
Gary Christopherson, VA CIO, and the Centers for Medicare and Medicaid
Services (CMS), many of whom who share our interest in creating a
breakthrough in EHR adoption among AAFP members and other primary care
physicians. We now talk regularly with the people in charge of VistA
(the VA’s excellent EHR systems) about its possible wider use outside
the VA; –we met with Tom Scully, CMS Administrator, and his staff, and
with William Yasnoff, MD, director of the NHII office, about the
importance of family physicians in the establishment of a national
health information infrastructure (NHII), and to federal government
efforts to improve quality of care for patients with chronic illnesses;
–many software and IT firms, large and small, began to contact the
AAFP to discuss ways to collaborate with us. We have learned that
there is strong IT industry support for the AAFP’s stance on
affordability and standards for office-based HIT; –we received an
invitation from CMS to submit a proposal for a Pilot Project to
implement the EHR application in a small number of family practices
across the country, in part to study ways to make implementation
efficient and in part to incorporate quality measurements into the
routine of EHRs.

SPECIFIC PROJECTS and ACTIVITIES –The Pilot Project has received some
national attention, in part because in July the AAFP received the
backing and support of HIMSS, the largest IT industry membership
organization.

The Pilot Project is truly becoming a collaborative effort. The planning
of the Pilot Project is being worked on by a 12 member Steering
Committee that now meets every other week, while we await word on
funding from CMS. HIMSS staff are providing very valuable project
management skills and administrative services. Medplexus has continued
to work with the AAFP to improve its features and functionality, and
will provide its software to the Pilot Project practices at no charge.
Siemens has agreed to assist the AAFP with engineering expertise and
managed hosting for the Pilot Project, and a large national hardware
manufacturer has offered to provide computers to the participating
practices. We are hopeful that the Pilot Project roll out will occur
in early October. There is still time for practices who want to
participate in the Pilot Project to apply, and any who do should
contact me immediately.

In addition, we are now negotiating with a number of software and IT
firms to provide lower cost options for acquisition and use of EHRs,
and to encourage collaboration on standards, such as interfaces between
PMS and EHR software, that will make these systems more compatible and
less costly to own and maintain. We are encouraging vendors to commit
with us to the principles of affordability, compatibility,
interoperability, and data stewardship. We hope to announce the
results of several of these agreements later in the fall, and therefore
to make several new options available for our members who wish to
acquire EHRs.

One of the most important standards under development is the Continuity
of Care (CCR) document standard, which the AAFP is co-sponsoring with
ASTM, the Mass Medical Society, HIMSS, and others. This is an XML
document standard that will contain a core set of health information on
each patient — problem list, medications, allergies, etc. — and which
will be capable of being imported and exported from a number of
vendors’ software products, or carried by a patient on a smart card,
USB memory stick, or via secure email attachment. Think of the CCR as
a referral document or “face sheet” or mini-medical history, which is
able to be read by a universal reader, a browser, in PDF file format,
or in Microsoft Word 11. Several EHR vendors have already agreed to
use the CCR as the first step in EHR interoperability. I am seeking
AAFP member help with this standard, and would love to hear from any of
you who want to contribute your expertise. The AAFP is hosting a CCR
Consensus Meeting in Kansas City on October 23. Please contact me if
you have an interest in attending this meeting.

Finally, the AAFP is working with all of the major standards development
organizations, such as HL7, ASTM, and WEDI, to participate in EHR
definitional standards. We will play a role in these as the
opportunities arise to do so.

In summary, then, the AAFP will not be developing our own open source
EHR, nor doing so in concert with other medical specialty societies as
per the plan of several months ago, at least in the near term.
However, we will be working with many different vendors, the
government, with health plans, and national IT firms to help create a
breakthrough in price, service, and standards that will make it
possible for family physicians and others to acquire and use this
technology in their offices for the first time. And we will be making
additional AAFP resources available to our members to assist them in
selecting, implementing, and making good use of EHRs.

I hope you find this email helpful. If you’re going to be at the Annual
Scientific Assembly in New Orleans Oct 1-5, please make a point of
getting together with me. I’m very interested in your points of view.

With very kind regards, DCK

David C. Kibbe, MD
Director Health Information Technology
American Academy of Family Physicians

Chapel Hill, NC

919-929-5993 office
913-205-7968 mobile

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