P4P in Physician Group Practice

CMS recently published interim findings on the use of Information Technology to achieve measurable improvements in the quality of care for patients with chronic diseases. They have 29 measures for Diabetes, Coronary Artery Disease, CHF and preventative care. The results are very strong; the participating practices consistently achieved improvements. In the first year, all the practices achieved benchmark or target performance on at least 7 out of 10 diabetes clinical quality measures. Similar results are posted for subsequent years.

Other bloggers have written about it as well.

Having the data available really works; the trick is to get people to recognize that the pain of implementation and the challenge of change are worth it.

High Tech and High Touch

Kaiser Permanente recently published an interesting study. They did a two year trial of patients with prior coronary artery disease. Approximately half the patients got their intense follow up program (including regular direct calls to the patient from a specialty pharmacist). The other half got electronically generated reminder letters to schedule the blood checks on their cholesterol.

The fascinating result was that both of these groups showed dramatically better results that patients without any reminder system. The difference between the "high touch" version and the simply "high tech" version was not very high. But the difference between nothing and either reminder system was very high, meaning the cheaper solution was highly effective.

Most institutions are not yet at the point where their EMR could be generating the reminder letters that Kaiser did. But it appears that processes like this may be where the meat of the cost savings promised by Healthcare IT will come from.

Real doctor using an EMR and building a PHR

I really like what Stasia Kahn, MD, had to say about Electronic Medical Records.

She is now "exporting PDF Healthcare files to my patients for the purpose of populating an untethered personal health record (PHR). I believe that a patient-directed PHR that has been pre-populated with authoritative data from a primary care physicians’ electronic medical record is the quintessential, longitudinal health record..."

See my earlier post about how hard it is to enter the data yourself. People should begin to see the value added from practitioners that will contribute to the record for them and let those become the more popular providers.