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Clinical Subcommittee Chair: Alan Zuckerman, M.D.
This section is devoted to the works of the Clinical Sub-Committee within PCIWG/AMIA.
Clinical Subcommittee: Strategic Plan
The Clinical subcommittee of the PCIWG exists to promote the incorporation of informatics applications to improve clinical practice in the ambulatory setting. The strategy of this group is to define the information technology needs of the practicing clinician, and to advocate for the development and implementation of tools for clinical practice. Over the course of the strategic planning period, the group has developed four goals:
1. To examine the practice of primary care in the ambulatory setting, and conduct a global “needs assessment” for information technology applications in clinical practice.
The subcommittee seeks to define the “activities of daily living” (ADLs) of the ambulatory clinician. This assessment will provide a practical springboard to the creation of applications to improve practice. The present summary of primary care ADLs which the group has compiled is included in Table 1.
2. To develop and implement point of care technology to meet the information needs of practicing clinicians.
The emergence of handheld and wireless computing in primary care has already begun to change ambulatory practice. A wide variety of clinical knowledge bases are available, and electronic prescribing is gaining widespread acceptance. (REFERENCES???) The Clinical subcommittee proposes to serve as an information conduit to assist in the development of point-of-care applications.
The objectives in reviewing point-of-care technology applications are as follows:
a. To catalog and publish existing resources of clinical information; b. To advocate a mechanism to endorse the reliability of clinical information (“seal of approval”) for point-of-care applications; and c. To examine the existing resources in the context of the primary care ADL’s, with the goal of defining the future information needs of the clinician in ambulatory practice.
3. To evaluate clinical vocabularies, such as SNOMED-CT, and progress toward better clinical coding strategies for ambulatory practice.
There has been a long-standing disparity between clinical diagnoses and billing codes, particularly in the ambulatory setting. The presence of a strong primary care voice in the ongoing development and implementation of clinical vocabularies will facilitate improvements in coding and billing, and lay the framework for a standardized vocabulary to support the evolution of an ambulatory electronic medical record.
4. To define and communicate the essential components, features and functions of an electronic medical record in primary care.
The electronic medical record (EMR) deployment on the U.S. is substantially behind that of many other countries. Many factors pose as obstacles to EMR utilization, especially in the ambulatory care setting. A number of these obstacles, identified by the clinical subcommittee, are outlined in Table 2. This list is by no means exhaustive.
The Clinical subcommittee proposes to provide a clinical voice to the EMR development process. The greatest stumbling block to the ambulatory EMR is not technological, but organizational. Primary care clinicians need to have a seat at the table in the design and implementation of EMR technology. Through its liaison with primary care organizations within NAPCI, the Clinical subcommittee will develop recommendations for vendors, funding agencies, and clinicians to address the fundamental and practical implementation issues surrounding the ambulatory EMR.
Table 1: Primary Care ADLs
Interview and Examine Patients
Retrieve Medical Knowledge
Document Care in the Medical Record
Review Information in the Medical Record
Write Prescriptions for Medications and Other Therapies
Order Lab Tests and X-Rays
Review Results of Lab Tests and X-Rays
Complete Billing Forms
Code Diagnoses and Procedures
Communicate With Patients
Communicate with Other Physicians
Referrals
Communicate with Providers / Payors
Patient Education
Practice Management
Population Management
Disease Surveillance
Guideline Compliance
GIS Epidemiology
Continuing Medical Education
Care of Patients On-Call
On-Call Signout to Other Physicians
Telemedicine
Table 2: Essential Components of the Ambulatory EMR
Technical Features
Usability Features
Functionality Features
Barriers to EMR Adoption
Vendor Accreditation Process
Security and Privacy Initiatives
Personal (Patient) Access
Cost-Effectiveness / Return on Investment
Legacy Systems
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