1	NAPCI Update David Bates, MD, MSc NAPCI Chair
2	Overview Incorporation update National scene Massachusetts example Short-term NAPCI plans Other things NAPCI might do next
3	Framing Statement A serious problem exists in the use of information technology in caring for patients by primary care practitioners in the United States of America. There is currently no identifiable national strategy for the use of information technology and management in primary health care addressing this problem, and there is a critical need to establish and fund a centralized, coordinating group to provide strategic leadership in its development.
4	NAPCI Vision Statement “Every primary care provider will use information technology that includes electronic health records with the ability to access and communicate needed clinical information to achieve high quality, safe, and affordable health care.” Endorsed by all participants and the organizations Agreed to move forward
5	National Alliance for Primary Care Informatics (NAPCI) Premises The United States needs to deliver excellent primary care medical services This can only be accomplished by primary care use of electronic medical records
6	Overall Objectives of NAPCI: I Promote creation of an NHII that: Identifies and supports the unique needs of primary care providers Provides incentives for primary care providers to participate in NHII Document and report of use of informatics and IT in primary care, and promote primary care IT research Educate primary care providers in use of informatics and IT
7	Overall Objectives of NAPCI: II Facilitate work within NAPCI and between NAPCI and other organizations to present a unified coalition representing the interests of primary care To take part in and sponsor meetings, publications and other forums for the purpose of advancing the mission of NAPCI and its member organizations
8	Last Six Months Have in-kind support from AMIA Developed: Bylaws Articles of incorporation Business plan Strategic vision Set out requests for participation to key organizations in September
9	Formal Acceptances ACP SGIM AMIA ANA NONPF
10	Likely to Announce Soon STFM AAP
11	Still Waiting AAFP Ambulatory Pediatric Association NAPCRG
12	Backdrop Rate of EHR adoption appears to be increasing rapidly Many of concerns about making transition still not addressed New study coming out soon saying medication error rate in outpatient prescriptions very high
13	DOQIT National program sponsored by CMS to promote increased use of IT in ambulatory care California got lead role David Kibbe is one of experts Other states not yet identified OMB has said must be budget-neutral Current status?
14	IOM Recommendations Regarding EHR Content Developed in June Marc Overhage, Paul Tang, Ed Hammond, David Bates on group Report released this summer General format what EHRs should include at specific time Readily accessible, well received
15	HL7 Process on EHR Standard Round 1 this summer Many special interests represented Relatively few providers First standard highly detailed Roundly rejected Press misinterpreted Need for NAPCI and primary care overall to be much more involved!
16	AHRQ RFAs To be announced very soon Target community/rural hospitals ($26 billion) IT innovation more generally ($24 million) 4 months to respond
17	Continuity of Care Record Developed by MMS Started with plan to automate paper form used at time of transfer HIMMS, AAFP have partnered
18	Expanding Electronic Health Record Use in Massachusetts Proposal Structure Next steps General implications
19	Proposal for Massachusetts Chapter ACP-ASIM Goal: To improve the safety of patient care in every ambulatory provider office in Massachusetts Approach: Develop partnership among key stakeholders Program phases: Needs assessment Development Pilot and refinement Implementation Dissemination
20	Specific Aims Build a stakeholder coalition Collaborate with state and federal lawmakers around legislation Identify sources of Hardware Software Identify and recruit internists and physician groups Assist providers in acquisition and implementation through educational and support programs
21	Key Stakeholders Providers Purchasers Payors Vendors Software Hardware Malpractice insurers Patients
22	Key Alliances and Resources Governor Romney/administration Mass ACP Massachusetts Medical Society Department of Health and Human Services Massachusetts legislature/Harriet Chandler Mass Health Data Consortium/MassShare Massachusetts Coalition for Prevention of Medical Error Major insurers Malpractice carriers (ProMutual, CRICO) Large purchasers—GE, IBM/Leapfrog National Alliance for Primary Care Informatics Masspro
23	Components of Initial Proposal Build consensus among key stakeholders Identify vendors of computer hardware and EHR software interested in collaborating with Massachusetts Ideally 2-4 Identify purchasers or business groups willing to pay a premium to providers who are willing to make or have already made the transition to electronic records Identify incentive package that will make it attractive for providers to adopt
24	Current Activities Received $50,000 grant from Mass ACP Applying for support from HEI/eHealth Initiative--$450,000 Asking for $2.5 million from Mass stakeholders Summit January 8 Will apply under AHRQ RFA to do evaluation Working with Massachusetts legislature regarding key legal changes
25	Use of Funds Central coordinating group Identification of vendors Development of specifications Educational outreach Focus groups Extraction of quality data—Masspro Addressing key data exchange needs—Mass Health Data Consortium Drugs, labs, radiology Modeling of benefit—Center for IT Leadership
26	Short-Term NAPCI Plans Operational Finish incorporation Check in with AAFP, AAP File in DC Website launch, PR blitz
27	Short-term NAPCI Plans Primary care and NHII white paper Try to testify to NCVHS about primary care needs re NHII Seek other opportunities to talk about needs of NAPCI re NHII
28	Interaction with Other Groups Be active with HL7 and other similar initiatives Join EHR Collaborative eHealth Initiative HL7 Continue to work very closely with PCWG
29	Short-term NAPCI Plans: Educational/Consensus Meeting with spring AMIA on models for increasing EHR use including state-wide (Mark Weiner) Meeting along with MEDINFO on defining primary care working group sponsored primarly by this group Tool for individual provider to calculate ROI for their practice Practice type, practice size Survey other available tools/touch base with societies
30	Further Downstream Identify key areas in which standardization is needed in primary care Obesity Immunizations Drug decision support Growth Will be key to view through lenses of provider groups Seek vehicle to promote more support for primary care informatics training Legislative needs
31	Key Leverage Points HL7 EHR effort EHR Collaborative States NHII DOQIT Others?