Primary care ignored in health IT standards push

PCPs often get ignored for health IT. Source: Portsmouth Regional Hospital

As states across the U.S. move closer to better and more widely used EHRs, doctors who provide the bulk of healthcare in the country—primary care physicians—are being lost in the shuffle, according to doctors affiliated with the American Academy of Family Physicians (AAFP).

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

Phillips said he has made similar pitches to leaders of the other federally supported organizations in the national push for health IT, but he fears his concerns are not being heeded.

“I would challenge you to find a use case right now in development or published about the physician-patient visit, particularly in the primary care setting,” Phillips said to the NCVHS, an advisory committee to the Health and Human Services Department. A use case is a healthcare scenario that serves as a framework for identifying which standards apply to specific activities and where there are gaps.

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

Phillips and a colleague, Michael Klinkman, MD, who teaches medicine and practices at the University of Michigan, argued that the building blocks are missing for the idea of a medical home, an office or clinic where the patient is known and his or her care is coordinated. Besides primary care use cases, they are seeking two other elements of an IT infrastructure for primary care: a classification scheme that ties information together in episodes of care, and a data management platform to enable decision support and other creative uses of the stored information.

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

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

In response to allegations that primary care has not been a priority, Robert Kolodner, MD, national health IT coordinator, said much remains to be done, but the question is whether “we have products and standards that are good enough to get started.”

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

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