M. Alexander Otto

SEATTLE — After 2 years, a pilot medical home project in a Seattle suburb cut emergency department visits by 29% and hospitalizations by 6%, recouping $1.50 for every $1.00 invested.

“We thought it would take years to see savings,” but after 1 year, the pilot was “so successful that we've spread the model to all of our 26 primary care sites,” said Dr. Claire Trescott, primary care medical director at Group Health Cooperative, a nonprofit, Seattle-based health care system.

Patients involved in the pilot reported better doctor interactions, better care, and increased access to care, compared with those at other Group Health clinics, Dr. Trescott reported at the symposium.

Work life improved for physicians, too. Compared with colleagues at other clinics, those in the pilot had lower mean emotional exhaustion and depersonalization scores on the Maslach Burnout Inventory.

“Group Health's experience demonstrates that primary care investments in the form of the medical home can improve patients' experiences … and providers' work environment, and at the same time save money,” according to Dr. Robert Reid, a scientific investigator with the Group Health Research Institute and lead author on a review of the project (Health Affairs 2010 May [doi:10.1377/hlthaff.2010.0158]).

Group Health launched its medical home in 2007 at its Factoria, Wash., clinic. Managers “wanted to see if there really were savings and quality improvements from better primary care,” Dr. Reid said in an interview.

They also wanted to see if it would make the clinic a better place to work. The situation there had not been “favorable in terms of recruiting and sustaining the workforce. There was a large motivation to try something different,” Dr. Reid said.

Better staffing was the key change at Factoria. Managers hired additional physicians and nurses. They also hired more pharmacists, medical assistants, and licensed practical nurses, and increased their involvement in direct patient care.

As a result, physician panels at Factoria dropped from 2,300 to 1,800 patients per doctor. For every 10,000 patients, there were 5.6 physicians, 5.6 medical assistants, 2 licensed practical nurses, 1.5 physician assistants or nurse practitioners, 1.2 registered nurses, and 1 pharmacist.

To deemphasize rapid patient turnover, Group Health eliminated productivity incentives for Factoria physicians.

Patients in the pilot were assigned to care teams; nurses, pharmacists, and other staff helped them manage their conditions with personalized care plans, medication monitoring, test result updates, chronic illness workshops, and other measures. When patients called the clinic, they were connected directly with their team, instead of having to struggle through a phone tree.

It was no longer about “the physician being responsible to do everything,” but instead about team care led by the physician, Dr. Reid said.

Daily, short, all-team meetings helped to coordinate the efforts, distribute tasks, and troubleshoot problems. To help with the planning, medical assistants called patients before each appointment to learn the reason for their visit. The clinic's existing electronic health records system helped, too, enabling patients to access after-visit summaries, review lab results, and refill prescriptions. The system also sent health maintenance reminders and other alerts.

The changes led to a drop in patient visits during the pilot, but visit duration went from a mean of 20 minutes up to 30.

There were also 80% more e-mail exchanges between patients and providers, and 5% more telephone encounters, compared with those at other Group Health sites.

To assess the results, Dr. Reid and his colleagues compared the utilization and cost numbers for Factoria's 7,018 continuously enrolled adults with those of the 200,970 adults enrolled at Group Health's other clinics.

Primary care cost $1.60 more per member per month in Factoria, and specialty care there approximately $5.80 more per member per month.

But Factoria patients visited emergency departments and urgent care clinics less often, saving $4 per member per month, and had fewer inpatient admissions, saving $14.18 per member per month. Balanced against increased staffing and other costs, Factoria saved an estimated $10.30 per member per month.

The changes have had another benefit, as well: It's easier to fill positions at Group Health now.

“My suspicion is that being a physician here is being seen now as a doable job. The panel sizes are manageable, and you have a supportive team in place. It's the type of place many physicians would want to work in,” Dr. Reid said.

For those thinking of their own medical home project, Dr. Reid suggested making changes gradually, not all at once.

The pilot and review were both conducted by Group Health Cooperative. The investigators are employees and shareholders of Group Health Permanente, the physician group affiliated with the Group Health Cooperative.

SEATTLE — After 2 years, a pilot medical home project in a Seattle suburb cut emergency department visits by 29% and hospitalizations by 6%, recouping $1.50 for every $1.00 invested.

“We thought it would take years to see savings,” but after 1 year, the pilot was “so successful that we've spread the model to all of our 26 primary care sites,” said Dr. Claire Trescott, primary care medical director at Group Health Cooperative, a nonprofit, Seattle-based health care system.

Patients involved in the pilot reported better doctor interactions, better care, and increased access to care, compared with those at other Group Health clinics, Dr. Trescott reported at the symposium.

Work life improved for physicians, too. Compared with colleagues at other clinics, those in the pilot had lower mean emotional exhaustion and depersonalization scores on the Maslach Burnout Inventory.

“Group Health's experience demonstrates that primary care investments in the form of the medical home can improve patients' experiences … and providers' work environment, and at the same time save money,” according to Dr. Robert Reid, a scientific investigator with the Group Health Research Institute and lead author on a review of the project (Health Affairs 2010 May [doi:10.1377/hlthaff.2010.0158]).

Group Health launched its medical home in 2007 at its Factoria, Wash., clinic. Managers “wanted to see if there really were savings and quality improvements from better primary care,” Dr. Reid said in an interview.

They also wanted to see if it would make the clinic a better place to work. The situation there had not been “favorable in terms of recruiting and sustaining the workforce. There was a large motivation to try something different,” Dr. Reid said.

Better staffing was the key change at Factoria. Managers hired additional physicians and nurses. They also hired more pharmacists, medical assistants, and licensed practical nurses, and increased their involvement in direct patient care.

As a result, physician panels at Factoria dropped from 2,300 to 1,800 patients per doctor. For every 10,000 patients, there were 5.6 physicians, 5.6 medical assistants, 2 licensed practical nurses, 1.5 physician assistants or nurse practitioners, 1.2 registered nurses, and 1 pharmacist.

To deemphasize rapid patient turnover, Group Health eliminated productivity incentives for Factoria physicians.

Patients in the pilot were assigned to care teams; nurses, pharmacists, and other staff helped them manage their conditions with personalized care plans, medication monitoring, test result updates, chronic illness workshops, and other measures. When patients called the clinic, they were connected directly with their team, instead of having to struggle through a phone tree.

It was no longer about “the physician being responsible to do everything,” but instead about team care led by the physician, Dr. Reid said.

Daily, short, all-team meetings helped to coordinate the efforts, distribute tasks, and troubleshoot problems. To help with the planning, medical assistants called patients before each appointment to learn the reason for their visit. The clinic's existing electronic health records system helped, too, enabling patients to access after-visit summaries, review lab results, and refill prescriptions. The system also sent health maintenance reminders and other alerts.

The changes led to a drop in patient visits during the pilot, but visit duration went from a mean of 20 minutes up to 30.

There were also 80% more e-mail exchanges between patients and providers, and 5% more telephone encounters, compared with those at other Group Health sites.

To assess the results, Dr. Reid and his colleagues compared the utilization and cost numbers for Factoria's 7,018 continuously enrolled adults with those of the 200,970 adults enrolled at Group Health's other clinics.

Primary care cost $1.60 more per member per month in Factoria, and specialty care there approximately $5.80 more per member per month.

But Factoria patients visited emergency departments and urgent care clinics less often, saving $4 per member per month, and had fewer inpatient admissions, saving $14.18 per member per month. Balanced against increased staffing and other costs, Factoria saved an estimated $10.30 per member per month.

The changes have had another benefit, as well: It's easier to fill positions at Group Health now.

“My suspicion is that being a physician here is being seen now as a doable job. The panel sizes are manageable, and you have a supportive team in place. It's the type of place many physicians would want to work in,” Dr. Reid said.

For those thinking of their own medical home project, Dr. Reid suggested making changes gradually, not all at once.

The pilot and review were both conducted by Group Health Cooperative. The investigators are employees and shareholders of Group Health Permanente, the physician group affiliated with the Group Health Cooperative.

SEATTLE — After 2 years, a pilot medical home project in a Seattle suburb cut emergency department visits by 29% and hospitalizations by 6%, recouping $1.50 for every $1.00 invested.

“We thought it would take years to see savings,” but after 1 year, the pilot was “so successful that we've spread the model to all of our 26 primary care sites,” said Dr. Claire Trescott, primary care medical director at Group Health Cooperative, a nonprofit, Seattle-based health care system.

Patients involved in the pilot reported better doctor interactions, better care, and increased access to care, compared with those at other Group Health clinics, Dr. Trescott reported at the symposium.

Work life improved for physicians, too. Compared with colleagues at other clinics, those in the pilot had lower mean emotional exhaustion and depersonalization scores on the Maslach Burnout Inventory.

“Group Health's experience demonstrates that primary care investments in the form of the medical home can improve patients' experiences … and providers' work environment, and at the same time save money,” according to Dr. Robert Reid, a scientific investigator with the Group Health Research Institute and lead author on a review of the project (Health Affairs 2010 May [doi:10.1377/hlthaff.2010.0158]).

Group Health launched its medical home in 2007 at its Factoria, Wash., clinic. Managers “wanted to see if there really were savings and quality improvements from better primary care,” Dr. Reid said in an interview.

They also wanted to see if it would make the clinic a better place to work. The situation there had not been “favorable in terms of recruiting and sustaining the workforce. There was a large motivation to try something different,” Dr. Reid said.

Better staffing was the key change at Factoria. Managers hired additional physicians and nurses. They also hired more pharmacists, medical assistants, and licensed practical nurses, and increased their involvement in direct patient care.

As a result, physician panels at Factoria dropped from 2,300 to 1,800 patients per doctor. For every 10,000 patients, there were 5.6 physicians, 5.6 medical assistants, 2 licensed practical nurses, 1.5 physician assistants or nurse practitioners, 1.2 registered nurses, and 1 pharmacist.

To deemphasize rapid patient turnover, Group Health eliminated productivity incentives for Factoria physicians.

Patients in the pilot were assigned to care teams; nurses, pharmacists, and other staff helped them manage their conditions with personalized care plans, medication monitoring, test result updates, chronic illness workshops, and other measures. When patients called the clinic, they were connected directly with their team, instead of having to struggle through a phone tree.

It was no longer about “the physician being responsible to do everything,” but instead about team care led by the physician, Dr. Reid said.

Daily, short, all-team meetings helped to coordinate the efforts, distribute tasks, and troubleshoot problems. To help with the planning, medical assistants called patients before each appointment to learn the reason for their visit. The clinic's existing electronic health records system helped, too, enabling patients to access after-visit summaries, review lab results, and refill prescriptions. The system also sent health maintenance reminders and other alerts.

The changes led to a drop in patient visits during the pilot, but visit duration went from a mean of 20 minutes up to 30.

There were also 80% more e-mail exchanges between patients and providers, and 5% more telephone encounters, compared with those at other Group Health sites.

To assess the results, Dr. Reid and his colleagues compared the utilization and cost numbers for Factoria's 7,018 continuously enrolled adults with those of the 200,970 adults enrolled at Group Health's other clinics.

Primary care cost $1.60 more per member per month in Factoria, and specialty care there approximately $5.80 more per member per month.

But Factoria patients visited emergency departments and urgent care clinics less often, saving $4 per member per month, and had fewer inpatient admissions, saving $14.18 per member per month. Balanced against increased staffing and other costs, Factoria saved an estimated $10.30 per member per month.

The changes have had another benefit, as well: It's easier to fill positions at Group Health now.

“My suspicion is that being a physician here is being seen now as a doable job. The panel sizes are manageable, and you have a supportive team in place. It's the type of place many physicians would want to work in,” Dr. Reid said.

For those thinking of their own medical home project, Dr. Reid suggested making changes gradually, not all at once.

The pilot and review were both conducted by Group Health Cooperative. The investigators are employees and shareholders of Group Health Permanente, the physician group affiliated with the Group Health Cooperative.

SEATTLE — Social media are making inroads into medicine; doctors are blogging, engaging patients on Facebook, and using Twitter to keep up to date, panelists said during a discussion of the phenomenon.

A few panelists, like Dr. Jennifer Dyer, a pediatric endocrinologist at Nationwide Children's Hospital in Columbus, Ohio, are texting patients, too.

In a preliminary study, Dr. Dyer texted three of her teenage diabetes patients weekly reminders about glucose testing and mealtime boluses, and asked them about the frequency of their blood sugar highs and lows.

The approach had previously been shown to help Scottish teens with diabetes (Diabet. Med. 2006;23:1332-8).

At the end of 3 months, Dr. Dyer's teenage patients were missing only about three boluses a week, instead of nine or more, and their hemoglobin A_1c levels averaged 9%, instead of 11%, according to a hospital press release and a post by Dr. Dyer on the Diabetes Mine blog.

She plans to expand the study to include 50 patients. “The use of social media to help outcomes is powerful,” Dr. Dyer said during the panel discussion.

Social media help in other ways, too, panelists said.

“For me, [Twitter has] extended my colleagues and created an ability for me to keep up to date,” said Dr. Kent Bottles, a health care consultant based in Philadelphia and recent past president of the Institute for Clinical Systems Improvement.

Dr. Bottles, who blogs at Kent Bottles Private Views, said he tweeted recently about attending a health care meeting in Colorado. A nurse he had never met before but who followed his Twitter stream offered to pick him up at the airport and took him to a vineyard, because she also knew from his tweets that he's a wine aficionado.

In response to another tweet, a physician sent him a paper that helped at the meeting. Neither “would have happened without Twitter,” Dr. Bottles said.

Another panelist, Dr. Bryan Vartabedian, an assistant professor of pediatrics at Baylor College of Medicine, Houston, said his blog, 33Charts, has given him “a powerful voice” regarding the convergence of social media and medicine, the blog's topic, as well as other matters.

More than influence is at stake. Eventually, “being in the [social media] space will confer market advantage,” he said.

Dr. Dyer and the fourth panelist, Dr. Mike Sevilla, a family physician in Salem, Ohio, who blogs at Doctor Anonymous, both said they share some personal information on their Facebook pages, but are careful not to post anything they could later regret.

Dr. Dyer has friended four patients on Facebook; she said it helps them see she's a regular person, making her more approachable. Also, her teen patients don't like e-mail, preferring Facebook's messaging service, another reason she engages some of them on Facebook.

E-mail is also an increasingly important tool, panelists said.

Because of her hospital's policy, Dr. Dyer can't initiate patient e-mails, so she tells patients to e-mail her first for test results and other matters. She cuts-and-pastes exchanges into the electronic health record so colleagues know what transpired.

Although e-mail takes less time than trying to reach patients by phone, Dr. Dyer has office staff help with the messages so she's not overwhelmed.

That was a concern among all the panelists – dealing with the extra work social media bring.

Dr. Vartabedian said he knows colleagues who are “spending their evenings opening e-mails” from patients, and not getting paid for it. Social media also raise concerns about patient privacy and legal liability.

A robust digital presence has its benefits, Dr. Vartabedian said, including countering negative online reviews. But it also opens the possibility that offhand remarks could show up later in legal proceedings. “A lot of this stuff hasn't been tested in courts,” he said.

An audience member even noted that lawyers at her hospital banned physicians from engaging in social media.

Dr. Bottles acknowledged the concerns, but said that “you can never [completely] protect yourself against malpractice suits.”

“You have to do what's best for your patients, give it your best shot, and get over it. We have patients to take care of, lives to live, and pinot noir to drink,” he said.

SEATTLE — Social media are making inroads into medicine; doctors are blogging, engaging patients on Facebook, and using Twitter to keep up to date, panelists said during a discussion of the phenomenon.

A few panelists, like Dr. Jennifer Dyer, a pediatric endocrinologist at Nationwide Children's Hospital in Columbus, Ohio, are texting patients, too.

In a preliminary study, Dr. Dyer texted three of her teenage diabetes patients weekly reminders about glucose testing and mealtime boluses, and asked them about the frequency of their blood sugar highs and lows.

The approach had previously been shown to help Scottish teens with diabetes (Diabet. Med. 2006;23:1332-8).

At the end of 3 months, Dr. Dyer's teenage patients were missing only about three boluses a week, instead of nine or more, and their hemoglobin A_1c levels averaged 9%, instead of 11%, according to a hospital press release and a post by Dr. Dyer on the Diabetes Mine blog.

She plans to expand the study to include 50 patients. “The use of social media to help outcomes is powerful,” Dr. Dyer said during the panel discussion.

Social media help in other ways, too, panelists said.

“For me, [Twitter has] extended my colleagues and created an ability for me to keep up to date,” said Dr. Kent Bottles, a health care consultant based in Philadelphia and recent past president of the Institute for Clinical Systems Improvement.

Dr. Bottles, who blogs at Kent Bottles Private Views, said he tweeted recently about attending a health care meeting in Colorado. A nurse he had never met before but who followed his Twitter stream offered to pick him up at the airport and took him to a vineyard, because she also knew from his tweets that he's a wine aficionado.

In response to another tweet, a physician sent him a paper that helped at the meeting. Neither “would have happened without Twitter,” Dr. Bottles said.

Another panelist, Dr. Bryan Vartabedian, an assistant professor of pediatrics at Baylor College of Medicine, Houston, said his blog, 33Charts, has given him “a powerful voice” regarding the convergence of social media and medicine, the blog's topic, as well as other matters.

More than influence is at stake. Eventually, “being in the [social media] space will confer market advantage,” he said.

Dr. Dyer and the fourth panelist, Dr. Mike Sevilla, a family physician in Salem, Ohio, who blogs at Doctor Anonymous, both said they share some personal information on their Facebook pages, but are careful not to post anything they could later regret.

Dr. Dyer has friended four patients on Facebook; she said it helps them see she's a regular person, making her more approachable. Also, her teen patients don't like e-mail, preferring Facebook's messaging service, another reason she engages some of them on Facebook.

E-mail is also an increasingly important tool, panelists said.

Because of her hospital's policy, Dr. Dyer can't initiate patient e-mails, so she tells patients to e-mail her first for test results and other matters. She cuts-and-pastes exchanges into the electronic health record so colleagues know what transpired.

Although e-mail takes less time than trying to reach patients by phone, Dr. Dyer has office staff help with the messages so she's not overwhelmed.

That was a concern among all the panelists – dealing with the extra work social media bring.

Dr. Vartabedian said he knows colleagues who are “spending their evenings opening e-mails” from patients, and not getting paid for it. Social media also raise concerns about patient privacy and legal liability.

A robust digital presence has its benefits, Dr. Vartabedian said, including countering negative online reviews. But it also opens the possibility that offhand remarks could show up later in legal proceedings. “A lot of this stuff hasn't been tested in courts,” he said.

An audience member even noted that lawyers at her hospital banned physicians from engaging in social media.

Dr. Bottles acknowledged the concerns, but said that “you can never [completely] protect yourself against malpractice suits.”

“You have to do what's best for your patients, give it your best shot, and get over it. We have patients to take care of, lives to live, and pinot noir to drink,” he said.

SEATTLE — Social media are making inroads into medicine; doctors are blogging, engaging patients on Facebook, and using Twitter to keep up to date, panelists said during a discussion of the phenomenon.

A few panelists, like Dr. Jennifer Dyer, a pediatric endocrinologist at Nationwide Children's Hospital in Columbus, Ohio, are texting patients, too.

In a preliminary study, Dr. Dyer texted three of her teenage diabetes patients weekly reminders about glucose testing and mealtime boluses, and asked them about the frequency of their blood sugar highs and lows.

The approach had previously been shown to help Scottish teens with diabetes (Diabet. Med. 2006;23:1332-8).

At the end of 3 months, Dr. Dyer's teenage patients were missing only about three boluses a week, instead of nine or more, and their hemoglobin A_1c levels averaged 9%, instead of 11%, according to a hospital press release and a post by Dr. Dyer on the Diabetes Mine blog.

She plans to expand the study to include 50 patients. “The use of social media to help outcomes is powerful,” Dr. Dyer said during the panel discussion.

Social media help in other ways, too, panelists said.

“For me, [Twitter has] extended my colleagues and created an ability for me to keep up to date,” said Dr. Kent Bottles, a health care consultant based in Philadelphia and recent past president of the Institute for Clinical Systems Improvement.

Dr. Bottles, who blogs at Kent Bottles Private Views, said he tweeted recently about attending a health care meeting in Colorado. A nurse he had never met before but who followed his Twitter stream offered to pick him up at the airport and took him to a vineyard, because she also knew from his tweets that he's a wine aficionado.

In response to another tweet, a physician sent him a paper that helped at the meeting. Neither “would have happened without Twitter,” Dr. Bottles said.

Another panelist, Dr. Bryan Vartabedian, an assistant professor of pediatrics at Baylor College of Medicine, Houston, said his blog, 33Charts, has given him “a powerful voice” regarding the convergence of social media and medicine, the blog's topic, as well as other matters.

More than influence is at stake. Eventually, “being in the [social media] space will confer market advantage,” he said.

Dr. Dyer and the fourth panelist, Dr. Mike Sevilla, a family physician in Salem, Ohio, who blogs at Doctor Anonymous, both said they share some personal information on their Facebook pages, but are careful not to post anything they could later regret.

Dr. Dyer has friended four patients on Facebook; she said it helps them see she's a regular person, making her more approachable. Also, her teen patients don't like e-mail, preferring Facebook's messaging service, another reason she engages some of them on Facebook.

E-mail is also an increasingly important tool, panelists said.

Because of her hospital's policy, Dr. Dyer can't initiate patient e-mails, so she tells patients to e-mail her first for test results and other matters. She cuts-and-pastes exchanges into the electronic health record so colleagues know what transpired.

Although e-mail takes less time than trying to reach patients by phone, Dr. Dyer has office staff help with the messages so she's not overwhelmed.

That was a concern among all the panelists – dealing with the extra work social media bring.

Dr. Vartabedian said he knows colleagues who are “spending their evenings opening e-mails” from patients, and not getting paid for it. Social media also raise concerns about patient privacy and legal liability.

A robust digital presence has its benefits, Dr. Vartabedian said, including countering negative online reviews. But it also opens the possibility that offhand remarks could show up later in legal proceedings. “A lot of this stuff hasn't been tested in courts,” he said.

An audience member even noted that lawyers at her hospital banned physicians from engaging in social media.

Dr. Bottles acknowledged the concerns, but said that “you can never [completely] protect yourself against malpractice suits.”

“You have to do what's best for your patients, give it your best shot, and get over it. We have patients to take care of, lives to live, and pinot noir to drink,” he said.

SAN ANTONIO – Earning patient-centered medical home recognition from the National Committee for Quality Assurance can seem an insurmountable challenge.

Cari Miller, the New Jersey Academy of Family Physicians' director of advocacy and program operations, should know. She recently helped 32 primary care practices achieve patient-centered medical home (PCMH) recognition from NCQA.

After talking a few practices off the ledge as they struggled to meet NCQA's nine PCMH standards – and after being a PCMH coach in the past – she has some advice for others seeking recognition:

▸ Get it in writing. The biggest struggle for most was fulfilling the first standard, which requires written policies for patient access and communication, plus data to prove they're followed.

NCQA, for example, wants to ensure patients are seen mostly by their specific primary care provider. The group “is not saying [that has to happen] every single time, and we would recommend that your policy doesn't say that,” Ms. Miller said in an interview after her presentation at the conference.

“What we have practitioners do is write a policy that may say 80% of the time patients will be scheduled with their primary care provider, then generate reports that show the patients who called in, [and] the percentage of time they actually saw their specific primary care provider versus another provider within the practice,” she said.

▸ Open access isn't an informal option. Along similar lines, to meet NCQA's open access requirement for last-minute patients, “often, practices will say, 'We see [patients] that day, we just fit them in.'” But that's not going to fly with the accreditor. “NCQA is going to say that if you are just fitting people in, that's not meeting the intent,” Ms. Miller said at the conference, also sponsored by the American Academy of Family Physicians.

Instead, the group is looking for dedicated, unscheduled slots held open each day for last-minute patients, she said.

“We found we could work with practices to, on average, keep two slots open for every morning and two slots open for every afternoon,” Ms. Miller explained. That way, NCQA could see that, “in fact, if somebody called at 9 o'clock in the morning, there is always a 10:15 and 11:15 appointment” available, Ms. Miller said.

Staff should know what the process is so that there is no variation. “[NCQA is] trying to take the variation out of things,” Ms. Miller said.

▸ Don't underestimate the power of a “carrot.” Horizon Blue Cross Blue Shield of New Jersey funded the efforts of Ms. Miller and the NJAFP to speed the adoption of the PCMH model in that state. “We really believed there needed to be a really strong carrot” to motivate participation, Ms. Miller said.

The 32 practices she recently coached included large, small, single, and multisite practices. NCQA recognition made them eligible for a $15 per patient per month care-coordination payment for Horizon Blue Cross Blue Shield enrollees with diabetes, plus a portion of any money saved in treating those patients as a result of the PCMH efforts.

The practices all won NCQA's seal of approval by October 2009, after starting the process in March of that year. Most achieved level 1 status, while others achieved level 2 or level 3.

▸ Change requires follow-up. In general, practice transformation is “a 2- to 5-year process,” Ms. Miller cautioned. PCMH recognition is just the first step – after that, practices must make sure the changes remain and are effective.

That's not always easy.

For example, when Ms. Miller visited one practice working toward recognition, it was doing a great job logging lab results, a critical PCMH component. But then the logger took a vacation, and no one was designated to take her place. When she returned, she stopped logging results because she felt she had too many other responsibilities.

Ms. Miller revisited the practice and discovered the system had fallen apart. “There was no information on the logs,” she said.

Similar things happened in other practices. “One of the fastest things that can go right down the drain is the follow-up, monitoring, and tracking,” she said.

The solution is to cross-train staff, let them know why they are being asked to do what they are being asked to do, and check records to ensure they are being kept.

▸ Physicians can't do it all themselves. Although 32 of Ms. Miller's practices passed PCMH muster, 2 did not. The medical assistant at the first practice thought he'd rack up enough points addressing only some of the standards; he let the others slide. The second practice had a problem Ms. Miller saw several times: Physicians had a hard time delegating decision-making responsibilities when they remained accountable for what happened in their practice.

“Some of the real challenges we saw had to do with physicians letting go of some of the work that could be done by others,” she said.

The problem is that team-based care is a PCMH foundation concept; NCQA does not want physicians running around trying to do everything themselves, Ms. Miller said.

The 11 physicians in the practices simply weren't on board with the concept, “and it was clearly evident in the documentation they sent NCQA,” she said.

One approach is to divide out the tasks that need physician involvement from those that do not.

Nurses, for instance, could give pneumococcal shots to all patients older than 64 years under a standing order. The only thing the doctor would need to do is pull records periodically to make sure the shots are given, at least until they become automatic in the way that blood pressure checks are.

▸ You may have more documentation than you think. In working toward PCMH recognition, Ms. Miller also cautioned not to assume required documentation doesn't exist, especially in larger settings.

For example, one hospital-based residency practice was sure it couldn't meet NCQA's e-prescribing standard. After a little sleuthing, however, Ms. Miller discovered that the hospital pharmacy department had all kinds of e-prescribing practices and documentation in place, including alerts to prevent errors.

“The pharmacy department was able to take care of and coordinate that whole standard for the residency program,” Ms. Miller said.

“That was an eye-opener. Do not assume. You need to tell people [what you are doing],” she said.

SAN ANTONIO – Earning patient-centered medical home recognition from the National Committee for Quality Assurance can seem an insurmountable challenge.

Cari Miller, the New Jersey Academy of Family Physicians' director of advocacy and program operations, should know. She recently helped 32 primary care practices achieve patient-centered medical home (PCMH) recognition from NCQA.

After talking a few practices off the ledge as they struggled to meet NCQA's nine PCMH standards – and after being a PCMH coach in the past – she has some advice for others seeking recognition:

▸ Get it in writing. The biggest struggle for most was fulfilling the first standard, which requires written policies for patient access and communication, plus data to prove they're followed.

NCQA, for example, wants to ensure patients are seen mostly by their specific primary care provider. The group “is not saying [that has to happen] every single time, and we would recommend that your policy doesn't say that,” Ms. Miller said in an interview after her presentation at the conference.

“What we have practitioners do is write a policy that may say 80% of the time patients will be scheduled with their primary care provider, then generate reports that show the patients who called in, [and] the percentage of time they actually saw their specific primary care provider versus another provider within the practice,” she said.

▸ Open access isn't an informal option. Along similar lines, to meet NCQA's open access requirement for last-minute patients, “often, practices will say, 'We see [patients] that day, we just fit them in.'” But that's not going to fly with the accreditor. “NCQA is going to say that if you are just fitting people in, that's not meeting the intent,” Ms. Miller said at the conference, also sponsored by the American Academy of Family Physicians.

Instead, the group is looking for dedicated, unscheduled slots held open each day for last-minute patients, she said.

“We found we could work with practices to, on average, keep two slots open for every morning and two slots open for every afternoon,” Ms. Miller explained. That way, NCQA could see that, “in fact, if somebody called at 9 o'clock in the morning, there is always a 10:15 and 11:15 appointment” available, Ms. Miller said.

Staff should know what the process is so that there is no variation. “[NCQA is] trying to take the variation out of things,” Ms. Miller said.

▸ Don't underestimate the power of a “carrot.” Horizon Blue Cross Blue Shield of New Jersey funded the efforts of Ms. Miller and the NJAFP to speed the adoption of the PCMH model in that state. “We really believed there needed to be a really strong carrot” to motivate participation, Ms. Miller said.

The 32 practices she recently coached included large, small, single, and multisite practices. NCQA recognition made them eligible for a $15 per patient per month care-coordination payment for Horizon Blue Cross Blue Shield enrollees with diabetes, plus a portion of any money saved in treating those patients as a result of the PCMH efforts.

The practices all won NCQA's seal of approval by October 2009, after starting the process in March of that year. Most achieved level 1 status, while others achieved level 2 or level 3.

▸ Change requires follow-up. In general, practice transformation is “a 2- to 5-year process,” Ms. Miller cautioned. PCMH recognition is just the first step – after that, practices must make sure the changes remain and are effective.

That's not always easy.

For example, when Ms. Miller visited one practice working toward recognition, it was doing a great job logging lab results, a critical PCMH component. But then the logger took a vacation, and no one was designated to take her place. When she returned, she stopped logging results because she felt she had too many other responsibilities.

Ms. Miller revisited the practice and discovered the system had fallen apart. “There was no information on the logs,” she said.

Similar things happened in other practices. “One of the fastest things that can go right down the drain is the follow-up, monitoring, and tracking,” she said.

The solution is to cross-train staff, let them know why they are being asked to do what they are being asked to do, and check records to ensure they are being kept.

▸ Physicians can't do it all themselves. Although 32 of Ms. Miller's practices passed PCMH muster, 2 did not. The medical assistant at the first practice thought he'd rack up enough points addressing only some of the standards; he let the others slide. The second practice had a problem Ms. Miller saw several times: Physicians had a hard time delegating decision-making responsibilities when they remained accountable for what happened in their practice.

“Some of the real challenges we saw had to do with physicians letting go of some of the work that could be done by others,” she said.

The problem is that team-based care is a PCMH foundation concept; NCQA does not want physicians running around trying to do everything themselves, Ms. Miller said.

The 11 physicians in the practices simply weren't on board with the concept, “and it was clearly evident in the documentation they sent NCQA,” she said.

One approach is to divide out the tasks that need physician involvement from those that do not.

Nurses, for instance, could give pneumococcal shots to all patients older than 64 years under a standing order. The only thing the doctor would need to do is pull records periodically to make sure the shots are given, at least until they become automatic in the way that blood pressure checks are.

▸ You may have more documentation than you think. In working toward PCMH recognition, Ms. Miller also cautioned not to assume required documentation doesn't exist, especially in larger settings.

For example, one hospital-based residency practice was sure it couldn't meet NCQA's e-prescribing standard. After a little sleuthing, however, Ms. Miller discovered that the hospital pharmacy department had all kinds of e-prescribing practices and documentation in place, including alerts to prevent errors.

“The pharmacy department was able to take care of and coordinate that whole standard for the residency program,” Ms. Miller said.

“That was an eye-opener. Do not assume. You need to tell people [what you are doing],” she said.

SAN ANTONIO – Earning patient-centered medical home recognition from the National Committee for Quality Assurance can seem an insurmountable challenge.

Cari Miller, the New Jersey Academy of Family Physicians' director of advocacy and program operations, should know. She recently helped 32 primary care practices achieve patient-centered medical home (PCMH) recognition from NCQA.

After talking a few practices off the ledge as they struggled to meet NCQA's nine PCMH standards – and after being a PCMH coach in the past – she has some advice for others seeking recognition:

▸ Get it in writing. The biggest struggle for most was fulfilling the first standard, which requires written policies for patient access and communication, plus data to prove they're followed.

NCQA, for example, wants to ensure patients are seen mostly by their specific primary care provider. The group “is not saying [that has to happen] every single time, and we would recommend that your policy doesn't say that,” Ms. Miller said in an interview after her presentation at the conference.

“What we have practitioners do is write a policy that may say 80% of the time patients will be scheduled with their primary care provider, then generate reports that show the patients who called in, [and] the percentage of time they actually saw their specific primary care provider versus another provider within the practice,” she said.

▸ Open access isn't an informal option. Along similar lines, to meet NCQA's open access requirement for last-minute patients, “often, practices will say, 'We see [patients] that day, we just fit them in.'” But that's not going to fly with the accreditor. “NCQA is going to say that if you are just fitting people in, that's not meeting the intent,” Ms. Miller said at the conference, also sponsored by the American Academy of Family Physicians.

Instead, the group is looking for dedicated, unscheduled slots held open each day for last-minute patients, she said.

“We found we could work with practices to, on average, keep two slots open for every morning and two slots open for every afternoon,” Ms. Miller explained. That way, NCQA could see that, “in fact, if somebody called at 9 o'clock in the morning, there is always a 10:15 and 11:15 appointment” available, Ms. Miller said.

Staff should know what the process is so that there is no variation. “[NCQA is] trying to take the variation out of things,” Ms. Miller said.

▸ Don't underestimate the power of a “carrot.” Horizon Blue Cross Blue Shield of New Jersey funded the efforts of Ms. Miller and the NJAFP to speed the adoption of the PCMH model in that state. “We really believed there needed to be a really strong carrot” to motivate participation, Ms. Miller said.

The 32 practices she recently coached included large, small, single, and multisite practices. NCQA recognition made them eligible for a $15 per patient per month care-coordination payment for Horizon Blue Cross Blue Shield enrollees with diabetes, plus a portion of any money saved in treating those patients as a result of the PCMH efforts.

The practices all won NCQA's seal of approval by October 2009, after starting the process in March of that year. Most achieved level 1 status, while others achieved level 2 or level 3.

▸ Change requires follow-up. In general, practice transformation is “a 2- to 5-year process,” Ms. Miller cautioned. PCMH recognition is just the first step – after that, practices must make sure the changes remain and are effective.

That's not always easy.

For example, when Ms. Miller visited one practice working toward recognition, it was doing a great job logging lab results, a critical PCMH component. But then the logger took a vacation, and no one was designated to take her place. When she returned, she stopped logging results because she felt she had too many other responsibilities.

Ms. Miller revisited the practice and discovered the system had fallen apart. “There was no information on the logs,” she said.

Similar things happened in other practices. “One of the fastest things that can go right down the drain is the follow-up, monitoring, and tracking,” she said.

The solution is to cross-train staff, let them know why they are being asked to do what they are being asked to do, and check records to ensure they are being kept.

▸ Physicians can't do it all themselves. Although 32 of Ms. Miller's practices passed PCMH muster, 2 did not. The medical assistant at the first practice thought he'd rack up enough points addressing only some of the standards; he let the others slide. The second practice had a problem Ms. Miller saw several times: Physicians had a hard time delegating decision-making responsibilities when they remained accountable for what happened in their practice.

“Some of the real challenges we saw had to do with physicians letting go of some of the work that could be done by others,” she said.

The problem is that team-based care is a PCMH foundation concept; NCQA does not want physicians running around trying to do everything themselves, Ms. Miller said.

The 11 physicians in the practices simply weren't on board with the concept, “and it was clearly evident in the documentation they sent NCQA,” she said.

One approach is to divide out the tasks that need physician involvement from those that do not.

Nurses, for instance, could give pneumococcal shots to all patients older than 64 years under a standing order. The only thing the doctor would need to do is pull records periodically to make sure the shots are given, at least until they become automatic in the way that blood pressure checks are.

▸ You may have more documentation than you think. In working toward PCMH recognition, Ms. Miller also cautioned not to assume required documentation doesn't exist, especially in larger settings.

For example, one hospital-based residency practice was sure it couldn't meet NCQA's e-prescribing standard. After a little sleuthing, however, Ms. Miller discovered that the hospital pharmacy department had all kinds of e-prescribing practices and documentation in place, including alerts to prevent errors.

“The pharmacy department was able to take care of and coordinate that whole standard for the residency program,” Ms. Miller said.

“That was an eye-opener. Do not assume. You need to tell people [what you are doing],” she said.

SAN ANTONIO – When diabetes patients team up as mentors and mentees – with one coaching the other on how to best control the disease – a curious thing happens: Not only do those being coached do better, but the patients doing the coaching do better as well.

Mutual accountability is the reason, said Dr. Robin Eickhoff, who is a family physician helping to pilot the technique at WellMed, a San Antonio–based company specializing in medical care for people aged 65 years and over.

Mentors think, “If I am going to try to teach you to be a better diabetic, I should sing the same tune” as a role model, Dr. Eickhoff said during an interview. Mentors and mentees “tend to hold each other accountable. There's a certain accountability you have when you are working with somebody and setting goals,” she said.

In a project funded by an American Academy of Family Physicians grant, WellMed has paired 41 mentors with 113 mentees at 15 of its clinics since late 2009. Dr. Eickhoff explained that the idea sprang from the work of Dr. America Bracho, who has successfully used peer mentors at Latino Health Access in Orange County, Calif.

Patients at WellMed were paired up after they completed an 8-week introduction to diabetes course that taught them about medications, blood glucose monitoring, and healthy meal planning, among other things. By the end of November 2010, 246 patients had completed the course.

Though WellMed has only preliminary data on its peer-mentoring efforts, the results appear to show benefit for mentee and mentor alike. For instance, before the diabetes course, patients tested their blood sugar 4.4 times per week. After the class and 6 months of mentor-mentee partnerships, mentees reported checking an average of 6.5 times per week, while mentors checked 5.2 times. Compared with how they were doing before the course, mentors and mentees reported improved hemoglobin A_1c levels, exercising more, and eating less fat and more fruits and vegetables.

WellMed educators look for potential mentors during the diabetes introductory course, taking note of good listeners with a willingness to learn, Dr. Eickhoff said. Those selected get additional guidance on how to talk to other patients, and are then matched with mentees from similar backgrounds whose lab values indicate they need extra diabetes help.

Most patients accept the invitation to be mentors, Dr. Eickhoff said at the meeting, cosponsored by the AAFP.

The first mentor-mentee meetings occurred at WellMed's monthly diabetes group meetings so they could be supervised. WellMed staff wanted to ensure that mentors gave sound advice and that the relationships worked. Rarely, there's a problem, as when a mentor mentioned that she had stopped taking her diabetes medications and was doing fine on dietary supplements.

After the kinks are worked out, the relationships blossom. “We have seen so much positive feedback from both the mentors and the mentees,” Dr. Eickhoff said. “The enthusiasm from patients has been huge.”

Mentors and mentees interact at least 4 hours per month, part of it at the group meetings, and the rest by phone, over lunch, or however else they chose to interact, Dr. Eickhoff said. They might brainstorm problems together, give each other emotional support, share recipes, and compare lab values, among other things.

For example, one woman's family did not want to give up its high-fat, high-carbohydrate diet, which included mashed potatoes. Her mentor suggested mashed cauliflower; the family didn't even notice the switch, Dr. Eickhoff said.

Another woman, unable to do the grocery shopping, felt she had no control over what her daughter brought back to the house. Her mentor suggested giving the daughter a weekly shopping list. It helped.

“They tell each other things that they don't tell us as providers, but will share with someone in a similar situation,” Dr. Eickhoff said. Plus, physicians “don't necessarily have time to delve into [patients'] day-to-day lives, yet so much of their diet and their lifestyle are affected by their social [situations]. Mentors have the ability to talk about those things, because they've been through it,” she said.

SAN ANTONIO – When diabetes patients team up as mentors and mentees – with one coaching the other on how to best control the disease – a curious thing happens: Not only do those being coached do better, but the patients doing the coaching do better as well.

Mutual accountability is the reason, said Dr. Robin Eickhoff, who is a family physician helping to pilot the technique at WellMed, a San Antonio–based company specializing in medical care for people aged 65 years and over.

Mentors think, “If I am going to try to teach you to be a better diabetic, I should sing the same tune” as a role model, Dr. Eickhoff said during an interview. Mentors and mentees “tend to hold each other accountable. There's a certain accountability you have when you are working with somebody and setting goals,” she said.

In a project funded by an American Academy of Family Physicians grant, WellMed has paired 41 mentors with 113 mentees at 15 of its clinics since late 2009. Dr. Eickhoff explained that the idea sprang from the work of Dr. America Bracho, who has successfully used peer mentors at Latino Health Access in Orange County, Calif.

Patients at WellMed were paired up after they completed an 8-week introduction to diabetes course that taught them about medications, blood glucose monitoring, and healthy meal planning, among other things. By the end of November 2010, 246 patients had completed the course.

Though WellMed has only preliminary data on its peer-mentoring efforts, the results appear to show benefit for mentee and mentor alike. For instance, before the diabetes course, patients tested their blood sugar 4.4 times per week. After the class and 6 months of mentor-mentee partnerships, mentees reported checking an average of 6.5 times per week, while mentors checked 5.2 times. Compared with how they were doing before the course, mentors and mentees reported improved hemoglobin A_1c levels, exercising more, and eating less fat and more fruits and vegetables.

WellMed educators look for potential mentors during the diabetes introductory course, taking note of good listeners with a willingness to learn, Dr. Eickhoff said. Those selected get additional guidance on how to talk to other patients, and are then matched with mentees from similar backgrounds whose lab values indicate they need extra diabetes help.

Most patients accept the invitation to be mentors, Dr. Eickhoff said at the meeting, cosponsored by the AAFP.

The first mentor-mentee meetings occurred at WellMed's monthly diabetes group meetings so they could be supervised. WellMed staff wanted to ensure that mentors gave sound advice and that the relationships worked. Rarely, there's a problem, as when a mentor mentioned that she had stopped taking her diabetes medications and was doing fine on dietary supplements.

After the kinks are worked out, the relationships blossom. “We have seen so much positive feedback from both the mentors and the mentees,” Dr. Eickhoff said. “The enthusiasm from patients has been huge.”

Mentors and mentees interact at least 4 hours per month, part of it at the group meetings, and the rest by phone, over lunch, or however else they chose to interact, Dr. Eickhoff said. They might brainstorm problems together, give each other emotional support, share recipes, and compare lab values, among other things.

For example, one woman's family did not want to give up its high-fat, high-carbohydrate diet, which included mashed potatoes. Her mentor suggested mashed cauliflower; the family didn't even notice the switch, Dr. Eickhoff said.

Another woman, unable to do the grocery shopping, felt she had no control over what her daughter brought back to the house. Her mentor suggested giving the daughter a weekly shopping list. It helped.

“They tell each other things that they don't tell us as providers, but will share with someone in a similar situation,” Dr. Eickhoff said. Plus, physicians “don't necessarily have time to delve into [patients'] day-to-day lives, yet so much of their diet and their lifestyle are affected by their social [situations]. Mentors have the ability to talk about those things, because they've been through it,” she said.

SAN ANTONIO – When diabetes patients team up as mentors and mentees – with one coaching the other on how to best control the disease – a curious thing happens: Not only do those being coached do better, but the patients doing the coaching do better as well.

Mutual accountability is the reason, said Dr. Robin Eickhoff, who is a family physician helping to pilot the technique at WellMed, a San Antonio–based company specializing in medical care for people aged 65 years and over.

Mentors think, “If I am going to try to teach you to be a better diabetic, I should sing the same tune” as a role model, Dr. Eickhoff said during an interview. Mentors and mentees “tend to hold each other accountable. There's a certain accountability you have when you are working with somebody and setting goals,” she said.

In a project funded by an American Academy of Family Physicians grant, WellMed has paired 41 mentors with 113 mentees at 15 of its clinics since late 2009. Dr. Eickhoff explained that the idea sprang from the work of Dr. America Bracho, who has successfully used peer mentors at Latino Health Access in Orange County, Calif.

Patients at WellMed were paired up after they completed an 8-week introduction to diabetes course that taught them about medications, blood glucose monitoring, and healthy meal planning, among other things. By the end of November 2010, 246 patients had completed the course.

Though WellMed has only preliminary data on its peer-mentoring efforts, the results appear to show benefit for mentee and mentor alike. For instance, before the diabetes course, patients tested their blood sugar 4.4 times per week. After the class and 6 months of mentor-mentee partnerships, mentees reported checking an average of 6.5 times per week, while mentors checked 5.2 times. Compared with how they were doing before the course, mentors and mentees reported improved hemoglobin A_1c levels, exercising more, and eating less fat and more fruits and vegetables.

WellMed educators look for potential mentors during the diabetes introductory course, taking note of good listeners with a willingness to learn, Dr. Eickhoff said. Those selected get additional guidance on how to talk to other patients, and are then matched with mentees from similar backgrounds whose lab values indicate they need extra diabetes help.

Most patients accept the invitation to be mentors, Dr. Eickhoff said at the meeting, cosponsored by the AAFP.

The first mentor-mentee meetings occurred at WellMed's monthly diabetes group meetings so they could be supervised. WellMed staff wanted to ensure that mentors gave sound advice and that the relationships worked. Rarely, there's a problem, as when a mentor mentioned that she had stopped taking her diabetes medications and was doing fine on dietary supplements.

After the kinks are worked out, the relationships blossom. “We have seen so much positive feedback from both the mentors and the mentees,” Dr. Eickhoff said. “The enthusiasm from patients has been huge.”

Mentors and mentees interact at least 4 hours per month, part of it at the group meetings, and the rest by phone, over lunch, or however else they chose to interact, Dr. Eickhoff said. They might brainstorm problems together, give each other emotional support, share recipes, and compare lab values, among other things.

For example, one woman's family did not want to give up its high-fat, high-carbohydrate diet, which included mashed potatoes. Her mentor suggested mashed cauliflower; the family didn't even notice the switch, Dr. Eickhoff said.

Another woman, unable to do the grocery shopping, felt she had no control over what her daughter brought back to the house. Her mentor suggested giving the daughter a weekly shopping list. It helped.

“They tell each other things that they don't tell us as providers, but will share with someone in a similar situation,” Dr. Eickhoff said. Plus, physicians “don't necessarily have time to delve into [patients'] day-to-day lives, yet so much of their diet and their lifestyle are affected by their social [situations]. Mentors have the ability to talk about those things, because they've been through it,” she said.

SAN ANTONIO – Group visits aren't just for diabetes patients.

At the Maine Medical Center in Portland, they also help – along with other measures – to keep recently discharged patients from being readmitted, according to Dr. Ann Skelton, chief of the center's department of family medicine, who presented the findings at a conference on practice improvement sponsored by the Society of Teachers of Family Medicine.

Upon discharge from the Family Medicine Inpatient Service (FMIS) to the outpatient Family Medicine Center (FMC), patients are given the option of having their first follow-up visit with their primary care doctor, or in a group with other patients led by a team that includes an attending physician, a nurse, a social worker, a pharmacist, and a care manager, among others.

The slightly more than half who opt for the group find all of their hospital-to-home issues addressed at one time, in one place, and without delay, explained Mary McDonough, R.N., FMC practice administrator, who also presented the findings.

If a patient has trouble getting through to a specialist, for instance, the social worker is there to help. If a patient needs home care, the care manager can set up an appointment, maybe for the same day.

And there's no need to go elsewhere for the physical exam – a physician does them during the meeting.

Patients also bring in their medications for the pharmacist to review. Sometimes the dosages are wrong; other times patients are taking the brand and generic versions of the same drug, or taking drugs that should have been discontinued at discharge – omeprazole and hydroxyzine, for example. COPD inhalers, warfarin, and allopurinol, among other drugs, have had to be added to some patients' regimens, too, said Ms. McDonough, who led efforts to start the groups.

Overall, group visits are “a very effective way to do posthospital care. Bringing that team together makes it flow smoothly,” Dr. Skelton said following the presentation.

In a pilot project from June 2009 – shortly after the groups started – to November 2009, Dr. Skelton and her colleagues tracked outcomes for 175 patients admitted from the outpatient FMC to the inpatient FMIS, and then discharged back to the outpatient center.

The 30-day readmission rate among those who opted for the group was 2.4%; for those who opted for office follow-up, 9.4%. Overall, the 30-day readmission rate dropped from 14.2% to 12.6%, saving an estimated $158,884 on an annualized basis.

More recent data support the trend. From June 2009 to September 2010, the 30-day readmission rate for those who opted for the group was 6.7%. Among all FMC patients, those who attended the group following discharge and those who did not, the 30-day readmissions rate was 8.9%.

It is not known whether the patients who opted for the group had lower readmission rates because they were less sick to begin with, or if other confounding variables contributed to the results; that analysis has not been done, Dr. Skelton said.

However, patients polled said that they understood their medications and care plans better after the group visit; virtually all said they'd recommend the group to recently discharged patients.

The 2-hour group visits are offered at the FMC every Wednesday morning, so patients who opt for them can attend within 7 days of discharge. Usually about four, but sometimes up to seven, patients attend.

The team knows who is coming and can prepare for the visits because the FMIS and FMC have improved how they track recently discharged patients.

They share a common electronic registry of hospitalized patients; the system alerts staff on the outpatient side when a patient is admitted and discharged. Discharge summaries are almost always available within 24 hours. Nurses also call patients within 48 hours of discharge, making a note in the system of any issues.

The group visits and tracking upgrades are “catching things that used to fall through the cracks,” one physician said in a poll.

The annual cost of the efforts, due mostly to the care team's group visit time, is $30,212. That's offset by an annual gross revenue from the group visits of $30,368, billed under CPT code 99214, Dr. Skelton said.

“As long as you have more than a couple patients in any week” so discharge group visits recoup their costs, they “make sense,” she said.

There was no outside funding for the efforts, “just creative reallocation of human resources,” said Dr. Skelton.

SAN ANTONIO – Group visits aren't just for diabetes patients.

At the Maine Medical Center in Portland, they also help – along with other measures – to keep recently discharged patients from being readmitted, according to Dr. Ann Skelton, chief of the center's department of family medicine, who presented the findings at a conference on practice improvement sponsored by the Society of Teachers of Family Medicine.

Upon discharge from the Family Medicine Inpatient Service (FMIS) to the outpatient Family Medicine Center (FMC), patients are given the option of having their first follow-up visit with their primary care doctor, or in a group with other patients led by a team that includes an attending physician, a nurse, a social worker, a pharmacist, and a care manager, among others.

The slightly more than half who opt for the group find all of their hospital-to-home issues addressed at one time, in one place, and without delay, explained Mary McDonough, R.N., FMC practice administrator, who also presented the findings.

If a patient has trouble getting through to a specialist, for instance, the social worker is there to help. If a patient needs home care, the care manager can set up an appointment, maybe for the same day.

And there's no need to go elsewhere for the physical exam – a physician does them during the meeting.

Patients also bring in their medications for the pharmacist to review. Sometimes the dosages are wrong; other times patients are taking the brand and generic versions of the same drug, or taking drugs that should have been discontinued at discharge – omeprazole and hydroxyzine, for example. COPD inhalers, warfarin, and allopurinol, among other drugs, have had to be added to some patients' regimens, too, said Ms. McDonough, who led efforts to start the groups.

Overall, group visits are “a very effective way to do posthospital care. Bringing that team together makes it flow smoothly,” Dr. Skelton said following the presentation.

In a pilot project from June 2009 – shortly after the groups started – to November 2009, Dr. Skelton and her colleagues tracked outcomes for 175 patients admitted from the outpatient FMC to the inpatient FMIS, and then discharged back to the outpatient center.

The 30-day readmission rate among those who opted for the group was 2.4%; for those who opted for office follow-up, 9.4%. Overall, the 30-day readmission rate dropped from 14.2% to 12.6%, saving an estimated $158,884 on an annualized basis.

More recent data support the trend. From June 2009 to September 2010, the 30-day readmission rate for those who opted for the group was 6.7%. Among all FMC patients, those who attended the group following discharge and those who did not, the 30-day readmissions rate was 8.9%.

It is not known whether the patients who opted for the group had lower readmission rates because they were less sick to begin with, or if other confounding variables contributed to the results; that analysis has not been done, Dr. Skelton said.

However, patients polled said that they understood their medications and care plans better after the group visit; virtually all said they'd recommend the group to recently discharged patients.

The 2-hour group visits are offered at the FMC every Wednesday morning, so patients who opt for them can attend within 7 days of discharge. Usually about four, but sometimes up to seven, patients attend.

The team knows who is coming and can prepare for the visits because the FMIS and FMC have improved how they track recently discharged patients.

They share a common electronic registry of hospitalized patients; the system alerts staff on the outpatient side when a patient is admitted and discharged. Discharge summaries are almost always available within 24 hours. Nurses also call patients within 48 hours of discharge, making a note in the system of any issues.

The group visits and tracking upgrades are “catching things that used to fall through the cracks,” one physician said in a poll.

The annual cost of the efforts, due mostly to the care team's group visit time, is $30,212. That's offset by an annual gross revenue from the group visits of $30,368, billed under CPT code 99214, Dr. Skelton said.

“As long as you have more than a couple patients in any week” so discharge group visits recoup their costs, they “make sense,” she said.

There was no outside funding for the efforts, “just creative reallocation of human resources,” said Dr. Skelton.

SAN ANTONIO – Group visits aren't just for diabetes patients.

At the Maine Medical Center in Portland, they also help – along with other measures – to keep recently discharged patients from being readmitted, according to Dr. Ann Skelton, chief of the center's department of family medicine, who presented the findings at a conference on practice improvement sponsored by the Society of Teachers of Family Medicine.

Upon discharge from the Family Medicine Inpatient Service (FMIS) to the outpatient Family Medicine Center (FMC), patients are given the option of having their first follow-up visit with their primary care doctor, or in a group with other patients led by a team that includes an attending physician, a nurse, a social worker, a pharmacist, and a care manager, among others.

The slightly more than half who opt for the group find all of their hospital-to-home issues addressed at one time, in one place, and without delay, explained Mary McDonough, R.N., FMC practice administrator, who also presented the findings.

If a patient has trouble getting through to a specialist, for instance, the social worker is there to help. If a patient needs home care, the care manager can set up an appointment, maybe for the same day.

And there's no need to go elsewhere for the physical exam – a physician does them during the meeting.

Patients also bring in their medications for the pharmacist to review. Sometimes the dosages are wrong; other times patients are taking the brand and generic versions of the same drug, or taking drugs that should have been discontinued at discharge – omeprazole and hydroxyzine, for example. COPD inhalers, warfarin, and allopurinol, among other drugs, have had to be added to some patients' regimens, too, said Ms. McDonough, who led efforts to start the groups.

Overall, group visits are “a very effective way to do posthospital care. Bringing that team together makes it flow smoothly,” Dr. Skelton said following the presentation.

In a pilot project from June 2009 – shortly after the groups started – to November 2009, Dr. Skelton and her colleagues tracked outcomes for 175 patients admitted from the outpatient FMC to the inpatient FMIS, and then discharged back to the outpatient center.

The 30-day readmission rate among those who opted for the group was 2.4%; for those who opted for office follow-up, 9.4%. Overall, the 30-day readmission rate dropped from 14.2% to 12.6%, saving an estimated $158,884 on an annualized basis.

More recent data support the trend. From June 2009 to September 2010, the 30-day readmission rate for those who opted for the group was 6.7%. Among all FMC patients, those who attended the group following discharge and those who did not, the 30-day readmissions rate was 8.9%.

It is not known whether the patients who opted for the group had lower readmission rates because they were less sick to begin with, or if other confounding variables contributed to the results; that analysis has not been done, Dr. Skelton said.

However, patients polled said that they understood their medications and care plans better after the group visit; virtually all said they'd recommend the group to recently discharged patients.

The 2-hour group visits are offered at the FMC every Wednesday morning, so patients who opt for them can attend within 7 days of discharge. Usually about four, but sometimes up to seven, patients attend.

The team knows who is coming and can prepare for the visits because the FMIS and FMC have improved how they track recently discharged patients.

They share a common electronic registry of hospitalized patients; the system alerts staff on the outpatient side when a patient is admitted and discharged. Discharge summaries are almost always available within 24 hours. Nurses also call patients within 48 hours of discharge, making a note in the system of any issues.

The group visits and tracking upgrades are “catching things that used to fall through the cracks,” one physician said in a poll.

The annual cost of the efforts, due mostly to the care team's group visit time, is $30,212. That's offset by an annual gross revenue from the group visits of $30,368, billed under CPT code 99214, Dr. Skelton said.

“As long as you have more than a couple patients in any week” so discharge group visits recoup their costs, they “make sense,” she said.

There was no outside funding for the efforts, “just creative reallocation of human resources,” said Dr. Skelton.

LOS ANGELES – There is very little evidence – and in some cases none at all – to support common pharmacologic treatments for anorexia and bulimia nervosa, according to Michael Strober, Ph.D.

Eating disorders "are the black hole of pharmacotherapy in psychiatry. There’s not much at this point in time we have to offer," Dr. Strober, director of the eating disorders program at the UCLA Neuropsychiatric Institute and Hospital, reported.

For anorexia nervosa, evidence is stronger for family-based therapy in which families are taught to help a child eat and maintain weight.

Cognitive-behavioral therapy (CBT) is more effective than drugs for bulimia nervosa and remains its treatment of choice, said Dr. Strober, who estimated he’s treated more than 8,000 eating disorder patients during a career dating back to 1975.

Although selective serotonin reuptake inhibitors (SSRIs) are widely used to treat anorexia, "there is absolutely not a speck of evidence that these drugs, in the acutely malnourished state, are effective," or that they help maintain weight gain, said Dr. Strober, who also serves as director of the adolescent mood disorders program at the institute.

There is slight evidence for the atypical antipsychotic, olanzapine (Zyprexa).

In a trial funded by the drug’s maker, Eli Lilly, 16 anorexia patients were randomized to outpatient day treatment plus olanzapine, and 18 to day treatment plus placebo.

The mean body mass index was low-normal in both groups at the end of 13 weeks (19.66 kg/m2 in the placebo group vs. 20.30 in the olanzapine group). However, placebo patients started with a lower mean BMI of 15.93, compared with 16.39 among olanzapine patients.

Also, at week 13, 55.6% of placebo patients but 87.5% of olanzapine patients achieved the target BMI of 18.5 (Am. J. Psychiatry 2008;165:1281-8).

The differences were "not very dramatic," but were statistically significant, Dr. Strober said.

"We have no idea what the mechanism is. We don’t know if it’s mediated by improved psychological state or weight gain associated with olanzapine," he said.

Given the lack of data, Dr. Strober said that he and his colleagues typically refeed anorexia inpatients for a few weeks, and only then add atypical antipsychotics if they aren’t managing well.

"I generally think [they] have more of an effect than the SSRIs, although we have patients receiving SSRIs who report less anxiety and psychological discomfort with weight gain," Dr. Strober said.

In general, however, "I have never seen a robust clinical effect of these agents," he said.

For bulimia, antidepressants have been shown to help.

"Regardless of the antidepressant used, in the majority of published studies – we really don’t know how many unpublished studies have been buried – active drug separates from placebo," Dr. Strober said.

"What this means is that about 60%-65% of people randomized to active treatment report a response (defined as a 50% or greater reduction in the frequency of binge eating)," compared with placebo responses of about 35%-40%, he said.

"We get remission rates – which means no bingeing or purging the last 2 weeks of the trial – of about 10% on active drug, maybe 0%-3% on placebo," he said.

However, about 50% of responders "have a recurrence of their symptoms" within 5 months, "so these are not very effective drugs for the majority of patients," Dr. Strober said.

CBT does better: "After 12-16 weeks, we get response rates (defined in the same way) that are roughly 65%-70%. You get about 35%-38% that are fully remitted, and that response tends to be more durable," he said.

Evidence also supports family-based therapy (FBT) for anorexia nervosa.

In a recent study, 121 subjects aged 12-18 years with mild to moderate illness – the trial excluded patients below 75% of their ideal body weight – were randomized to either individual therapy or FBT.

At the end of treatment and at 12 months’ follow-up, body weights were normal in about half of FBT patients but only in about a quarter of individual therapy patients (Arch. Gen. Psychiatry 2010;67:1025-32).

"There’s a signal here, I think – a powerful signal," Dr. Strober said. "This is a meaningful difference."

Family-based therapy "is an important treatment. We don’t really know what the ingredient is; we just know that this has been helpful for a number of families, but you really have to be very skilled in working with these people," he said.

Dr. Strober said he has no disclosures.

LOS ANGELES – There is very little evidence – and in some cases none at all – to support common pharmacologic treatments for anorexia and bulimia nervosa, according to Michael Strober, Ph.D.

Eating disorders "are the black hole of pharmacotherapy in psychiatry. There’s not much at this point in time we have to offer," Dr. Strober, director of the eating disorders program at the UCLA Neuropsychiatric Institute and Hospital, reported.

For anorexia nervosa, evidence is stronger for family-based therapy in which families are taught to help a child eat and maintain weight.

Cognitive-behavioral therapy (CBT) is more effective than drugs for bulimia nervosa and remains its treatment of choice, said Dr. Strober, who estimated he’s treated more than 8,000 eating disorder patients during a career dating back to 1975.

Although selective serotonin reuptake inhibitors (SSRIs) are widely used to treat anorexia, "there is absolutely not a speck of evidence that these drugs, in the acutely malnourished state, are effective," or that they help maintain weight gain, said Dr. Strober, who also serves as director of the adolescent mood disorders program at the institute.

There is slight evidence for the atypical antipsychotic, olanzapine (Zyprexa).

In a trial funded by the drug’s maker, Eli Lilly, 16 anorexia patients were randomized to outpatient day treatment plus olanzapine, and 18 to day treatment plus placebo.

The mean body mass index was low-normal in both groups at the end of 13 weeks (19.66 kg/m2 in the placebo group vs. 20.30 in the olanzapine group). However, placebo patients started with a lower mean BMI of 15.93, compared with 16.39 among olanzapine patients.

Also, at week 13, 55.6% of placebo patients but 87.5% of olanzapine patients achieved the target BMI of 18.5 (Am. J. Psychiatry 2008;165:1281-8).

The differences were "not very dramatic," but were statistically significant, Dr. Strober said.

"We have no idea what the mechanism is. We don’t know if it’s mediated by improved psychological state or weight gain associated with olanzapine," he said.

Given the lack of data, Dr. Strober said that he and his colleagues typically refeed anorexia inpatients for a few weeks, and only then add atypical antipsychotics if they aren’t managing well.

"I generally think [they] have more of an effect than the SSRIs, although we have patients receiving SSRIs who report less anxiety and psychological discomfort with weight gain," Dr. Strober said.

In general, however, "I have never seen a robust clinical effect of these agents," he said.

For bulimia, antidepressants have been shown to help.

"Regardless of the antidepressant used, in the majority of published studies – we really don’t know how many unpublished studies have been buried – active drug separates from placebo," Dr. Strober said.

"What this means is that about 60%-65% of people randomized to active treatment report a response (defined as a 50% or greater reduction in the frequency of binge eating)," compared with placebo responses of about 35%-40%, he said.

"We get remission rates – which means no bingeing or purging the last 2 weeks of the trial – of about 10% on active drug, maybe 0%-3% on placebo," he said.

However, about 50% of responders "have a recurrence of their symptoms" within 5 months, "so these are not very effective drugs for the majority of patients," Dr. Strober said.

CBT does better: "After 12-16 weeks, we get response rates (defined in the same way) that are roughly 65%-70%. You get about 35%-38% that are fully remitted, and that response tends to be more durable," he said.

Evidence also supports family-based therapy (FBT) for anorexia nervosa.

In a recent study, 121 subjects aged 12-18 years with mild to moderate illness – the trial excluded patients below 75% of their ideal body weight – were randomized to either individual therapy or FBT.

At the end of treatment and at 12 months’ follow-up, body weights were normal in about half of FBT patients but only in about a quarter of individual therapy patients (Arch. Gen. Psychiatry 2010;67:1025-32).

"There’s a signal here, I think – a powerful signal," Dr. Strober said. "This is a meaningful difference."

Family-based therapy "is an important treatment. We don’t really know what the ingredient is; we just know that this has been helpful for a number of families, but you really have to be very skilled in working with these people," he said.

Dr. Strober said he has no disclosures.

LOS ANGELES – There is very little evidence – and in some cases none at all – to support common pharmacologic treatments for anorexia and bulimia nervosa, according to Michael Strober, Ph.D.

Eating disorders "are the black hole of pharmacotherapy in psychiatry. There’s not much at this point in time we have to offer," Dr. Strober, director of the eating disorders program at the UCLA Neuropsychiatric Institute and Hospital, reported.

For anorexia nervosa, evidence is stronger for family-based therapy in which families are taught to help a child eat and maintain weight.

Cognitive-behavioral therapy (CBT) is more effective than drugs for bulimia nervosa and remains its treatment of choice, said Dr. Strober, who estimated he’s treated more than 8,000 eating disorder patients during a career dating back to 1975.

Although selective serotonin reuptake inhibitors (SSRIs) are widely used to treat anorexia, "there is absolutely not a speck of evidence that these drugs, in the acutely malnourished state, are effective," or that they help maintain weight gain, said Dr. Strober, who also serves as director of the adolescent mood disorders program at the institute.

There is slight evidence for the atypical antipsychotic, olanzapine (Zyprexa).

In a trial funded by the drug’s maker, Eli Lilly, 16 anorexia patients were randomized to outpatient day treatment plus olanzapine, and 18 to day treatment plus placebo.

The mean body mass index was low-normal in both groups at the end of 13 weeks (19.66 kg/m2 in the placebo group vs. 20.30 in the olanzapine group). However, placebo patients started with a lower mean BMI of 15.93, compared with 16.39 among olanzapine patients.

Also, at week 13, 55.6% of placebo patients but 87.5% of olanzapine patients achieved the target BMI of 18.5 (Am. J. Psychiatry 2008;165:1281-8).

The differences were "not very dramatic," but were statistically significant, Dr. Strober said.

"We have no idea what the mechanism is. We don’t know if it’s mediated by improved psychological state or weight gain associated with olanzapine," he said.

Given the lack of data, Dr. Strober said that he and his colleagues typically refeed anorexia inpatients for a few weeks, and only then add atypical antipsychotics if they aren’t managing well.

"I generally think [they] have more of an effect than the SSRIs, although we have patients receiving SSRIs who report less anxiety and psychological discomfort with weight gain," Dr. Strober said.

In general, however, "I have never seen a robust clinical effect of these agents," he said.

For bulimia, antidepressants have been shown to help.

"Regardless of the antidepressant used, in the majority of published studies – we really don’t know how many unpublished studies have been buried – active drug separates from placebo," Dr. Strober said.

"What this means is that about 60%-65% of people randomized to active treatment report a response (defined as a 50% or greater reduction in the frequency of binge eating)," compared with placebo responses of about 35%-40%, he said.

"We get remission rates – which means no bingeing or purging the last 2 weeks of the trial – of about 10% on active drug, maybe 0%-3% on placebo," he said.

However, about 50% of responders "have a recurrence of their symptoms" within 5 months, "so these are not very effective drugs for the majority of patients," Dr. Strober said.

CBT does better: "After 12-16 weeks, we get response rates (defined in the same way) that are roughly 65%-70%. You get about 35%-38% that are fully remitted, and that response tends to be more durable," he said.

Evidence also supports family-based therapy (FBT) for anorexia nervosa.

In a recent study, 121 subjects aged 12-18 years with mild to moderate illness – the trial excluded patients below 75% of their ideal body weight – were randomized to either individual therapy or FBT.

At the end of treatment and at 12 months’ follow-up, body weights were normal in about half of FBT patients but only in about a quarter of individual therapy patients (Arch. Gen. Psychiatry 2010;67:1025-32).

"There’s a signal here, I think – a powerful signal," Dr. Strober said. "This is a meaningful difference."

Family-based therapy "is an important treatment. We don’t really know what the ingredient is; we just know that this has been helpful for a number of families, but you really have to be very skilled in working with these people," he said.

Dr. Strober said he has no disclosures.

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology.

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at prices lower than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology.

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at prices lower than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology.

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at prices lower than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren't [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems.

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic's database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft's health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China's going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers' prices, he said.

Microsoft's HealthVault allows consumers to store health information online for quick access wherever they're treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients' consent – across different EHR systems. It's also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients' medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic's data store [and] Cerner's data store and every other data store into a meaningful operational data asset. It's going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren't [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems.

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic's database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft's health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China's going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers' prices, he said.

Microsoft's HealthVault allows consumers to store health information online for quick access wherever they're treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients' consent – across different EHR systems. It's also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients' medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic's data store [and] Cerner's data store and every other data store into a meaningful operational data asset. It's going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren't [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems.

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic's database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft's health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China's going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers' prices, he said.

Microsoft's HealthVault allows consumers to store health information online for quick access wherever they're treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients' consent – across different EHR systems. It's also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients' medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic's data store [and] Cerner's data store and every other data store into a meaningful operational data asset. It's going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."

SEATTLE – True electronic health record interoperability, with seamless information transfer between systems made by different companies, is still years off, agreed panelists discussing health information technology at the Swedish Medical Center Symposium "Innovation in the Age of Reform."

They also agreed that when interoperability comes, it will quickly identify emerging public health problems, address outcomes disparities, and lead to new drugs and other treatments because connected systems will, in effect, function as a massive clinical database.

"We would be a failure as an industry if we weren’t [eventually] able to find problems with chloromycetin and thalidomide [for example] much earlier" using the new technology, said Judith Faulkner, founder and CEO of the electronic health records (EHR) company Epic Systems. "I would hope we can focus on things such as autism and figure out the causes."

The lack of EHR standardization stands in the way of such potential, panelists said. The tens of thousands of data elements in Epic’s database are different from the elements in the Cerner database, which are different from those in the AllScripts database, said Peter Neupert, corporate vice president of Microsoft’s health solutions group.

One of the reasons, he said, is that vendors have little economic incentive to share information and standardize their approaches.

If an interoperability solution is not found, however, "China’s going to figure it out and export it here, or India is going to export it here," said Mr. Neupert. Those countries are developing health information technology to sell at lower prices than U.S. developers’ prices, he said.

Microsoft’s HealthVault allows consumers to store health information online for quick access wherever they’re treated, among other functions. Amalga, another Microsoft product, allows organizations to aggregate and mine clinical data.

Epic is developing Care Everywhere, a system to transfer medical records – with patients’ consent – across different EHR systems. It’s also working on a Connect the Docs system to facilitate communication and expertise-sharing between physicians, Ms. Faulkner said.

The federal government is working on interoperability fixes, too, said panelists. The current incentives for physicians and hospitals to install EHR systems include the goal that they eventually will be interoperable.

Among other measures, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act funds the formation of regional health information repositories that can be queried by providers. The Office of the National Coordinator for Health Information Technology created by the act is developing a secure, e-mail–like system over which providers can exchange patients’ medical information.

HITECH , however, "is a start, not a finish," said Rep. Jay Inslee (D-Wash.), also a panelist. He agreed that the challenge remains in "making sure systems can work together."

Mr. Neupert expressed confidence. "Computing is going to get 1,000 times faster in the next 10 years. With cheap storage and 1,000 times the processing power, we can translate stuff in Epic’s data store [and] Cerner’s data store and every other data store into a meaningful operational data asset. It’s going to be really fabulous for individuals."