March/April 2006

CLEVELAND PAcademy HYSICIAof Medicine of Cleveland/Northern Ohio Medical Association • March/AprilN 2006 Volume 91 www.amcnoma.org No. 2 INSIDE Riding the Wave of Change IN THE PRACTICE OF MEDICINE THIS ISSUE From e-prescribing to the best laid plans of pay- place with regard to EMRs for-performance, the 2006 annual seminar of The and P4P, but also what Physician Advocacy Academy of Medicine Cleveland/Northern Ohio technologies and payment Page 7 Medical Association was as topical in subject mat- systems to expect in the ter as it was engaging to the many health care coming years. As prom- professionals in attendance. ised, the conference Legislative Update Physicians and residents, registered nurses and addressed such issues as practice managers from all over Northeast Ohio why practice-based elec- Pages 8 & 9 were on hand Feb. 17 to garner the volumes of tronic health records are information made available to them during this essential to quality meas- year’s event, aptly entitled “Riding the Wave of urement, and related to Public Health Change in the Practice of Medicine.” programs such as pay-for- Dr. Kikano offers his wel- Each of the presenters, widely respected as performance; why infor- coming remarks to atten- Page 14 dees at the onset of the experts in their respective positions, fielded a mation technology is a day-long “Riding the Wave bevy of questions from the audience,making con- key enabler of quality of Change in the Practice nections between their offered material and the improvement; how such of Medicine” seminar. Practice real-world experience of physicians in active payment experiments Management/ practice. Punctuated by comments from AMC/ will continue to expand as reimbursements and Legal Issues NOMA President Dr. George Kikano acting as quality of care become more formally linked. Pages 16 & 17 program moderator, the day’s schedule was like- In sum, the 2006 annual seminar of the wise bolstered by a timely legislative update pro- AMC/NOMA proved a successful interim step vided during the luncheon hour by AMC/NOMA toward a fuller understanding of the issues pre- Medical Records lobbyist Michael Wise. sented therein, as well as an opportunity for all Jointly sponsored by the AMC/NOMA, the manner of area health care practitioners to come Update Academy of Medicine Education Foundation and together, share their ideas and concerns with col- Page 19 St.Vincent Charity Hospital, the seminar in aggre- leagues from around Northeast Ohio, and come gate was intended to inform attendees not only away with a more comprehensive grasp of the on what policies and initiatives have already taken program’s content. By all accounts, including Member Matters exemplary summary evaluations by attendees, Page 18 “Riding the Wave of Change in the Practice of Medicine” concluded as a most worthwhile and informative event for those gathered. President’s Corner How Information Technology is Page 15 Linked to Quality Improvement C. Martin Harris, MD, Chief Information Officer and Chairman of the Information Financial Technology Division of The Cleveland Clinic Management Foundation began the day’s program with his From physicians and residents to practice managers and presentation, in general terms, on the new face of Page 11 registered nurses, this year’s seminar drew a wide variety of NE Ohio health care professionals. consumerism in health care. He termed it a challenge, in light of the “sheer volume” of medical information available today both to the patient and the practitioner. He used the example of AMC/NOMA direct-to-consumer advertising in print and elec- 6000 Rockside Woods Blvd. tronic media that does not always best serve the Ste. 150 doctor-patient flow of communication. For Cleveland, OH 44131-0999 instance, he demonstrated an Internet search of the term “diabetes” that elicited some 13 million articles. Oftentimes a patient will come into the ADDRESS SERVICE REQUESTED examining room armed with information, yes, but (Continued on page 3) ++'%*,0%(,)' nnn%DXj\iXk`f]:c\m\cXe[%Zfd 00 9ifX[nXp 9\[]fi[ F? ++(+- 7KHVH &DUV 5LS ++'%*,0%(,(, nnn%8jkfeDXik`e:c\m\cXe[%Zfd 00 9ifX[nXp 2 Cleveland Physician I March/April 2006 9\[]fi[ F? ++(+- ANNUAL SEMINAR not necessarily the most accurate or tion relative to the actual electronic appropriate for their personal medical health market today and the practical needs, he said, thus presenting an addi- application of the varied new technolo- tional challenge to the physician who gies for the practicing physician. From must then distill much of this volumi- his experience and the results of the nous information for his/her patients. associations’ pilot program of wide- Couple this with the exponentially spread implementation, Dr.Waldren was increasing amount of scientific informa- able to offer many suggestions and solu- tion made available to physicians, (from tions to the sometimes overwhelming approximately 100 seminal published process of “going paperless” for the typi- articles in 1970 to more than 10,000 per cal physician office. This experiment annum in these first years of the 21st also identified through trial and error century), Dr. Harris said a new set of Seminar attendees were taken on a virtual tour both the common pitfalls and measura- tools was required, then, to manage this of e-clevelandclinic by C. Martin Harris, MD, ble successes of those who have imple- new knowledge and disseminate it prop- where access made available to patients and mented a standards-based integrated erly and efficiently from doctor to physicians is streamlining the practice of medi- system to their business. He began by patient and back again. He then “walked” cine in many ways. deconstructing the harmonization of the audience through a virtual tour of the Another level or example of these “value- standards, the inherent obstacles to e-ClevelandClinic Web site and its associ- added”services includes CCF’s DRConnect defining them and identified physicians, ated online applications and services. program, which facilitates specialty refer- health plans and vendors as the three Included in this were demonstrations of rals in a way traditional phone calls and major stakeholders in their eventual the ease with which physicians are results by mail could never accomplish development. Beyond that, he addressed already electronically managing prescrip- so effectively. He went on to outline how adoption of these new tools will “fit tions and alterations in medication via more benefits of this burgeoning tech- into a new model of care.” That is, keep- direct links with the emails of patients nology, including the many benefits it ing the needs of your patient population and participating retail pharmacies. He will hold for chronic medical conditions, met during and after such a major transi- cited statistics of a “typical practice” in maintenance and controls managed on a tion for yourself and your entire front which 30% of incoming patient calls macro level across a practice or institu- relate to prescription renewals or med- tion. Dr.Harris concluded his presentation ication adjustment. The EMR system vir- by touching on the subject and the chal- tually eliminates the need for such, as lenges in light of these developments, of patients initiate the process, a message is what is known as interoperability — the sent to the doctor, and in seconds the exchanging and sharing of these elec- renewal and a notice of it are emailed to tronic medical records among practition- both the pharmacy and the patient. He ers — as well as the inherent security noted the ease of this process is catching and privacy issues such sharing brings on nationwide and that e-prescribing with it. He noted the “good news” that seems to be the first electronic transac- Northeast Ohio was granted one of only tion doctors will see the benefit of and six awards across the country — money utilize. Dr.Harris then described an inter- to begin building such an exchange infra- action in the exam room in which the structure. The major healthcare institu- President George Kikano, MD, moderates a lively question-and-answer session following the presen- functionality of the EMR was not only a tions in this area will carve out a model tation by Dr.Steven Waldren, Asst. Director of CHIT useful clinical tool, but also how the for electronic health records’interchange for the American Academy of Family Physicians. technology allows the physician to assess and place our area into “the forefront of if the patient’s insurance will cover a the information exchange highway as it’s and back office. Dr.Waldren stressed the screening test, for example, that the doc- built.” He then ended by offering a hope- critical importance of pre-planning, of tor is about to order and can discuss with ful look into the future of the “consumer- getting staff on board with an upcoming the patient right then if it were to be driven model of healthcare,”wherein the implementation “as close to 100% as pos- their responsibility to pay — thereby tools technology will offer must be har- sible,”and understanding that an incre- streamlining the administrative end of a nessed to provide value-added services mental transition into new technology medical practice. He went on to detail to the patient, where a fundamental shift seemed to work best for offices of all the MyConsult program, already in use in thinking about the delivery of services sizes and scope. In light of this, an for 100 life-altering diagnoses, which will need to occur, and where patients acceptance of the fact that productivity offers patients an online second opinion will receive the best in their personalized will decrease for months, on average, within 48 hours, typically by a team of care “when they want it, anytime or any- while technology is installed and physicians weighing in on the electronic where.” upgraded,tested and modified in practice, records submitted.

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