Adding performance data to EMRs shows payoff

The costs of using electronic medical records and the paperwork burden of documenting physician adherence to performance measures are often cited as obstacles to putting either into widespread practice.

Now, however, Michael O'Toole, MD, is capturing the medical community's attention by showing proof of the multiple benefits of integrating the performance measures developed by the AMA-led Physician Consortium for Performance Improvement into an electronic health record system. These benefits include improving patient care and saving money by avoiding hospitalizations. And, because the collection of data is woven into the normal practice of a typical doctor's office visit, the process does not add more paperwork.

Dr. O'Toole, an internist and cardiologist, serves as the director of medical informatics for Midwest Heart Specialists, a practice with 60 cardiovascular physicians in 15 offices -- most in suburban Chicago. He has given a briefing on his work to Health and Human Services Secretary Tommy Thompson and also presented his findings at a meeting of the Physician Consortium last month in Chicago.

Dr. O'Toole showed that, after one year of integrating the consortium's coronary artery disease measures into its practice, MHS was able to report 78 fewer deaths among its 2,368 patients, 158 fewer heart attacks, 38 fewer strokes and $3 million to $5 million saved in hospitalizations, compared with results for similar patients in published studies. This year, MHS adopted the consortium's measures for hypertension and heart failure.

The presentation drew an overwhelmingly positive response. National Committee for Quality Assurance Executive Vice President L. Gregory Pawlson, MD, called it "breathtaking."

"He was able to identify the areas of his practice -- like management of cholesterol levels -- where they were not achieving the level of patient care that he and his colleagues felt they could achieve," he said. "He was also able to identify the specific patients who fell into the group that was not doing well in this regard."

Data can be byproduct of care

Bruce Bagley, MD, medical director for quality improvement for the American Academy of Family Physicians, agreed.

"Dr. O'Toole's presentation was a nice capsule of our vision about how a doctor's office ought to work," Dr. Bagley said. "The principles he used about collecting improvement data -- not as a separate task but as a byproduct of care -- are just as doable in a two- to three-doc office as long as the data collection burden is near zero."

Dr. O'Toole admitted that when he speaks to other groups "there is a little more hesitancy about what this is going to mean" and there is concern about another layer of paperwork.

"The biggest point is that the collection of this data has to be part of good clinical care and not part of an additional mandated paperwork burden," he said. "It's not just giving people a [handheld], it's building a system that involves changing almost every form, every procedure. Don't computerize what you currently do."

He explained that the idea is to change the physician's role from data collector to information analyzer, and the use of the consortium's performance measures is helpful because it creates a standard set of information to gather rather than collecting dozens of slightly different sets from a variety of health plans.

AMA EVP Michael Maves, MD, addressed the consortium meeting and said that establishing a standard that everyone can use was a high priority. "Every time we meet with insurance companies, we urge them to adopt our performance measures instead of cooking up their own," he said.

Robert Galvin, MD, director of global health for General Electric and a board member of The Leapfrog Group, echoed Dr. Maves on the importance of establishing a standard, consensus-driven set of measures. "It will be insane if every different payer has a different set of measures."

In addition to standard measures, consortium co-chair Bernard M. Rosof, MD, senior vice president for corporate relations and health affairs for North Shore-Long Island Jewish Health System in Great Neck, N.Y., said it's important that the measures are developed by physicians. "That really is a focus of what we're doing."