1	A United States National Strategy in Primary Care Informatics: AMIA 2002 Symposium Infrastructure Strategy John A. Zapp, MD Chair, Primary Care Informatics WG Chair, National Alliance for Primary Care Informatics
2	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.
3	Primary Care Informatics WG Strategic Planning Problems identified by Dr. Mullins 1994 AMIA presentation: Primary Care: An Enigma in American Medical Informatics Efforts on Infrastructure White Paper begun by Dr. Mullins 1998 in PCIWG (then named the FP/PCWG) Strategic planning by PCIWG begun in 1999 with Infrastructure as one of four foundation elements
4	Infrastructure: The Question Do we need a new organization to move the United States Strategic Plan forward? If so, what do we need? How will we create the solution?
5	The Need: Diversity of Providers Primary Care in the US consists of many different and independent providers: Family Physicians General Internists General Pediatricians Gynecologists Nurse Practitioners And some specialists!
6	The Need: Diversity of Location Hospital Office Home Care and Hospice Nursing Homes Schools Academic Medical Centers Remote Rural communities
7	The Need: Diversity of Care Process Multi-tasking Problems rather than diagnoses Continuity of Care over sites
8	The Need: Lack of Vendor Cooperation No standards for primary care (each group is on its own, and often vendor requests are made at local levels) No consensus among providers on what we need and want No incentive to develop non-proprietary systems
9	The Need: Diversity of Payers No funding for technology purchase and implementation Payer documentation requirements, formularies, provider lists, and audits has created a paper nightmare HIPAA Standards (moving toward a solution or ?)
10	The Need: Bioterrorism Surveillance Early detection, essential for dramatically reducing causalities, must be made in the primary care arena Effective surveillance requires real-time collection of standardized clinical information for analysis at regional/national levels
11	The Need: Conclusion There is no “One Voice” for primary care providers in defining and developing IT&M No one medical specialty society speaks for the others AMIA’s PCIWG is a volunteer-driven organization with virtually no resources for ongoing “work” The PCIWG is a catalyst for change
12	The Solution: Create a “One Voice” organization for primary care informatics Create strategic alliances with major primary care provider organizations Commit to consensus development process on key issues with Providers Payers Vendors Government Consumers Fund and staff to “do the necessary work”
13	The National Alliance for Primary Care Informatics (NAPCI) November 2000 Summit American Academy of Family Physicians American Academy of Pediatrics Ambulatory Pediatrics Association Society of General Internal Medicine North American Primary Care Research Group Society of Teachers of Family Medicine Agency for Healthcare Research and Quality
14	November 2000 Summit (continued) American Medical Informatics Association Primary Care Informatics Working Group, AMIA International Medical Informatics Association Working Group V (Primary Care) WONCA
15	November 2000 Summit Vision Statement created: “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
16	NAPCI Next steps: Generate a white paper on The Need for Electronic Medical Records and Primary Care (done, accepted for publication in JAMIA; please also attend panel S57: The Need for Electronic Medical Records in Primary Care)
17	NAPCI Next steps (continued) Seek funding opportunities for a working “secretariat”. Attempted but unsuccessful beyond AHRQ meeting grant for the May 2002 Summit PCIWG budget funds for meeting expenses AMIA support with staffing and meeting facilities for summits
18	NAPCI Next Steps (continued) Publish the PCIWG’s White Paper “Funding the Infrastructure to Support Primary Care Informatics” - done in Informatics in Primary Care (2002) 10: 45-8, Mullins and Zapp
19	NAPCI Next steps (continued) Develop an organizational structure: NAPCI Summit May 2002 recommended creating a nonprofit organization of organizations within AMIA AMIA Board endorsed the concept at its meeting on May 21, 2002
20	NAPCI Next steps (continued) Define the Founding Organization Members and their responsibilities (e.g. Board Positions with vote) Identify additional categories of membership e.g. Vendors Payers Government Consumers Define the governing bylaws Achieve adoption Short term funding of the secretariat to move forward
21	NAPCI Next steps (continued) Define NAPCI’s short term and long term goals in support of primary care’s strategic initiatives: Clinical Educational Research
22	NAPCI and the future: The opportunity for bringing together our diverse sectors and needs is moving forward Only through consensus can we make national progress for primary care provider IT&M needs and for patient safety Developing an organization is harder than agreeing on a Vision