If you’ve been considering the purchase of an electronic health record for your practice but have been turned off by the price tag, AAFP has a deal for you. Actually, they have quite a few deals. In November, the Academy announced several strategic business alliances it calls the Principled Group Purchasing Agreements to provide electronic health record (EHR) technology to medical practices. The alliances are with GE Medical Systems Information Technologies; HP; MedPlexus, Inc.; MedPlus, Inc.; NextGen Healthcare Information Systems, Inc.; Physician Micro Systems, Inc.; Siemens Medical Solutions Health Services Corporation; and Welch Allyn, Inc.

“The EHR systems the AAFP and its partners are developing will help ensure patients receive the most timely, appropriate and efficient medical care possible,” says AAFP President Michael Fleming, M.D. In a small- or medium-sized medical practice, an EHR system is the central nervous system for clinical patient management. Via computer, Internet and personal data assistant, EHR systems help physicians and staff members view, chart and interact with patients’ health information in a timely and accurate manner.

Proponents of health technology have said for years that electronic record systems could enable physicians’ offices to gather and integrate patient information, medical resources and patient education resources, and that they could improve the efficiency of health care by reducing medical errors and duplication of services. But the cost of purchasing a system and making the switch from paper to computers has kept many clinics out of the market. According to preliminary results from TAFP’s recent member survey, 34 percent of TAFP members use EHRs in their practices.

Companies participating in the agreements are offering hardware and software to AAFP members at discounts from 15 to 50 percent. Director of the Academy’s Center for Health Information Technology, David Kibbe, M.D., thinks these discounts should help remove some of the barriers that have prevented physicians from taking the electronic plunge.

“The most impressive price breaks are from the companies whose products are the most expensive,” Kibbe says. “The first tier costs for a single family practice office use of GE Medical Centricity product has been decreased from something around $25,000 to $6,000.” The price difference could be more or less dramatic depending on how the system is configured.

Kibbe is quick to point out that these agreements do not amount to endorsements from the AAFP for these products. Also, the Academy is not making any money on the deals. The goal is to align AAFP members who are ready to purchase with a range of options for EHRs and hardware that will meet their needs for affordability and standards.

The participating companies have agreed to four principles developed by AAFP: affordability, compatibility, interoperability and data stewardship. These principles guide the strategic alliances and serve as the foundation for the adoption of health information technology by family physicians.

While the price reductions will grab headlines, efforts to establish interoperability may be the real scoop. “I think everybody understands interoperability who is old enough to remember when Word and Word Perfect were not interoperable,” Kibbe says. Users of one of the two most popular word processing programs couldn’t open documents created with the other. While most other information technologies have long since worked out these problems, health care information systems have not. “The fact that you can’t take your health information from a doctor to another doctor’s office or from one hospital to another except in paper format has really become a huge problem. It’s a problem of quality, it’s a problem of safety, it’s a problem of convenience, it’s a problem of waste and it creates enormous inefficiency.”

To achieve interoperability, software creators must agree on standards and protocols. Within AAFP’s strategic partnerships, this process starts with the continuity of care record. Kibbe says this will be an interoperable XML document that summarizes the patient’s encounter. It will contain a core set of data about the patient including personal demographic data, a diagnosis list, a medication list, allergies and more.

If successful, the standards for interoperability defined by AAFP and its partners could catch on throughout the health care universe. It won’t be necessary to have an EHR to display documents like the continuity of care record. Kibbe says the data should be displayable as Adobe PDF documents, Word documents or electronic spreadsheets.

“If the public begins to demand this kind of simple interoperability, it could take off very quickly,” Kibbe says. “We’re hoping it will.” Several pilots and demonstrations are scheduled for 2004.

A handful of physicians have already made purchases under the new agreements and Kibbe expects that many more will soon join them. “I think this is the great American electronic health record sale of 2004. Family physicians who’ve been interested in electronic health records should go out and buy one, and then stay in touch with us, because we want to know how they’re doing.” Plans are in place to have a spot on the AAFP Web site where physicians who have purchased hardware and software packages through the strategic partnerships can post reviews and experiences.

Participation is expected to increase on the other end of the partnerships as well. According to a recent statement by Dr. Fleming, “Already, other information technology companies are beating a path to AAFP’s door.” The companies involved in the partnership so far are:

• GE Medical Systems Information Technologies, maker of one of the leading ambulatory electronic health record systems, will offer AAFP members cost-effective physician office EHR software solutions.

• HP, a leader in health-care information technology solutions, will offer AAFP members discounts on technology and resources through a Web site specially configured for AAFP.

• MedPlexus, provider of innovative practice management and EHR solutions, is working closely with the AAFP to improve features and functionality of the EHR system and will provide discounted software and services to AAFP members.

• MedPlus, Inc., a wholly-owned subsidiary of Quest Diagnostics Incorporated, is a provider of information technology and products to the healthcare industry, will offer discounted interface software and data management services to AAFP members.

• NextGen, a leading developer and provider of computer-based practice management and electronic medical record systems, will provide discounts on EHR and practice management packages to AAFP members.

• Physician Micro Systems, Inc., makers of products for the ambulatory medical environment, will offer AAFP members discounted EHR and practice management software packages.

• Siemens, a leader in medical engineering solutions, will assist the AAFP with engineering expertise and managed hosting.

• Welch Allyn, Inc., designers of instruments that provide physicians with better methods to diagnose patients, will provide medical devices for electronic measuring and transfer of patient data and interface software to AAFP members.

To peruse the deals being offered through the partnerships, visit AAFP’s Center for Health Information Technology online at www.aafp.org/centerforhit.xml. Click on “Current Projects,” then “Principled Group Purchasing Agreements.” Links to the participating companies are listed there. You’ll have to enter your AAFP ID to access the sites. Happy shopping.

GUIDING PRINCIPLES FOR STRATEGIC PARTNERSHIPS

1. Affordability – Recognizing the limited capital available to family physicians in small medical practices, the AAFP’s partnering firms will discount their prices and work with the AAFP to increase the volume of their sales for software and hardware.

2. Compatibility – Compatibility will be achieved through efforts to standardize connectivity interfaces between office-based systems, such as the EHR, and key information resources for electronic prescribing, laboratory result reporting and hospital information systems.

3. Interoperability – Interoperability standards, such as the continuity of care record, will be jointly developed by the AAFP and partnering companies to permit seamless data exchange among physicians, other providers and patients.

4. Data stewardship – Data stewardship will become an increasingly important challenge as ever-larger amounts of physician-generated health information are collected, stored and managed in systems and databases across the country. These data must be protected, kept secure and used only for ethical purposes that support the highest values of the medical profession.