Primary care gets short shrift in health IT standards push, doctors say

By Nancy zz_Ferris
Wednesday, January 09, 2008

The national push for better and more widely used e-health records is suffering from a lack of focus on the doctors who provide the bulk of health care — primary care physicians — in the view of doctors affiliated with the American Academy of Family Physicians.

“We had concerns that the largest platform for health care in the country, where more than half a billion visits are made every year, … is being left behind in the health IT standards development process,” Dr. Robert Phillips, director of AAFP’s Robert Graham Center for policy development, said at the November meeting of the National Committee for Vital and Health Statistics.

Phillips told a reporter recently that he has made similar pitches to leaders of the other federally supported organizations in the national push for health information technology, but he fears his concerns are not being heeded.

“I would challenge you to find a use case right now in development or published about the physician-patient visit, particularly in the primary care setting,” Phillips said to the NCVHS, an advisory committee to the Health and Human Services Department.

In the federally guided health IT standards process, use cases are health care scenarios that serve as frameworks for identifying which standards apply to specific activities and where there are gaps.

Phillips said the clinic where he practices uses one of the most popular e-health records systems, and he cannot use the system for some basic functions, such as compiling registries of patients with particular diseases or determining who the patient considers his or her personal physician. “We’ve had to retrofit it using our own coding to even get to patient registry.”

Phillips and a colleague, Dr. Michael Klinkman, who teaches medicine and practices at the University of Michigan, argued that the building blocks are missing for the idea of a medical home, an office or clinic where the patient is known and his or her care is coordinated. It is a promising concept for improving primary care, but requires IT systems that give a complete picture of the patients, they said.

Besides primary care use cases, they are seeking two other elements of an IT infrastructure for primary care: a classification scheme that ties information together in episodes of care, and a data management platform to enable decision support and other creative uses of the stored information.

For a classification scheme, Phillips and Klinkman are suggesting the International Classification of Primary Care, which is widely used in Europe and elsewhere but not well-known in the United States.

Several NCVHS members agreed there may be a need for high-level standards to organize the patient information that might be available through a nationwide health information network and to aggregate data about patient populations.

Asked to comment on the allegation that primary care standards have not been a priority, the national health IT coordinator, Dr. Robert Kolodner, said much remains to be done, but the question is whether “we have products and standards that are good enough to get started.”

Dr. Karen Bell, director of the Office of Health IT Adoption in Kolodner’s office, said the American Health Information Community may be asked to authorize work on a use case to support the medical home concept later this year.

Bell drew a distinction between IT standards, which have been the focus of considerable work to date, and functions such as data management, which may need to be tackled somewhat differently.