September 04, 2008By Mary C. Labanowski, MD
President, Board of Directors
Rochester Individual Practice AssociationIn 2001, the
Institute of Medicine released
"Crossing the Quality Chasm" as a challenge to the
United States' health care system to transform delivery systems to ensure that patients
safely receive the care they need at the right place, when they need it. While national
coordination of quality measures and standards of care are essential to that transformation,
it is becoming increasingly clear that action at the local and regional level holds the
greatest promise to realize true changes to care. Our health care community holds great
responsibility in leading that change.
Over the years, our regional hospital systems and insurers have developed active, successful quality improvement programs. But meaningful change must involve the physician community in a more central role. One important component of a quality improvement initiative is a
community or region-wide feedback system that lets health care practitioners objectively
know how they are doing relative to published, clinically accepted national standards as
well as their community peers. Providing accurate, meaningful data about underuse and
overuse of services in our community, regardless of a patient's insurance status, would allow practitioners to consider and develop the practice design needed to ensure the highest
quality of care.
With that responsibility in mind, the Rochester Individual Practice Association Board of Directors, at its May 31, 2008 planning retreat, voted to capitalize on our prior experience and move forward as a leader in creating a community wide healthcare quality improvement
program. This collaborative would seek to pool data from payer and provider sources, and
develop feedback tools across payers and health systems allowing practitioners access to a
single source of information across their entire patient population. We have repeatedly
heard frustration from our members that scorecards and reports from multiple sources on
sub-segments of patient populations do little to identify consistent, actionable information that can help with quality improvement.
Several regional quality improvement collaboratives are already operating effectively throughout the country including
Massachusetts Health Quality Partners "a broad-based coalition of physicians, hospitals, health plans, purchasers, consumers, and government agencies working together to promote improvement in the quality of health care services in Massachusetts." MHQP was first established in 1995 by a group of Massachusetts health care leaders who identified the importance of valid, comparable measures to drive improvement. The
Pittsburgh Regional Health Initiative "was the first regional consortium of medical, business and civic leaders to address healthcare safety and quality improvement as a social and business imperative. Turning its own community into a demonstration lab, PRHI strives to accelerate improvement and set the pace for the nation." Links to additional collaborative websites are provided below.
Regional quality improvement has also been the subject of some excellent publications. The
California Healthcare Foundation published "It Takes a Region: Creating a Framework to Improve Chronic Disease Care" in 2006. And
the Commonwealth Fund published "Physician Organization in Relation to Quality and Efficiency of Care: A Synthesis of Recent Literature" in April 2008. Each of these papers provides excellent and thorough background on the vital components for success of community-wide quality improvement collaboratives. These can help the Rochester/Finger Lakes region develop a "roadmap" as we come together and build momentum to develop this collaborative effort. You are encouraged to visit these websites to download these articles. In addition, we have developed a list of
"Frequently Asked Questions." We will periodically update this information so please check back.
The RIPA Board of Directors and its many specialty advisory committees have a long history of developing innovative approaches to sharing meaningful, clinically relevant feedback with
practitioners. We are excited to provide the impetus that we hope will lead to development of a valuable and ongoing resource that can help to continuously improve our healthcare system.
July 03, 2008Rochester RHIO, our community's regional health information organization, is up and running with an extended pilot. The original participants - 26 physicians from five different practices - are continuing to test the RHIO's full "virtual health record" (VHR) capability, viewing insurance eligibility, test results, medication history and other patient information electronically. The VHR pilot is also being expanded to additional specialist practices, nursing homes, and home healthcare settings.
Many more physicians are using the exchange today to receive electronic test results and for e-prescribing. Any physician with a computer and internet access can receive lab results electronically, within a week of signing up for the exchange.
Organizations providing data to the RHIO exchange today include ACM Medical Laboratories, Elizabeth Wende Breast Clinic, Excellus BlueCross BlueShield, Preferred Care, Unity Health System and University of Rochester Medical Center. Many others will be added in the coming months, including Clifton Springs Hospital, Lakeside Hospital, Nicholas H. Noyes Memorial Hospital, Thompson Health, United Memorial Medical Center, and ViaHealth.
The state health department recently gave Rochester RHIO two of the largest grants in the state to expand services, under the Health Efficiency and Affordability Law of New York.
•$6.7 million will help 75 independent practices to purchase EMR hardware and software, with implementation support from Monroe County Medical Society.
Physicians interested in EMR adoption through the MCMS EMR Service Bureau may contact Nancy Adams at 585-473-4072.•$6.1 million to improve continuity of care by expanding RHIO access to EMS providers, emergency departments, and long term care facilities. RHIO will also use this grant to provide direct links to Medicaid patient information, and to develop a portal that will allow patients to view their records online.
Deployment will continue and a public advertising campaign are expected to begin in the fall. Rochester RHIO will provide all participating offices materials to educate office staff and support their efforts to manage the patient consent process.
Specific information regarding costs, technology, the consent process, security and more can be found at http://www.grrhio.org/pat_providers.shtml. Physicians interested in joining Rochester RHIO may call Jessica Hasler at 877-865-RHIO (7446). For more information, visit
www.grrhio.org December 20, 2007Community practice guidelines can now be viewed and downloaded at the Monroe County Medical Society website. Guidelines were developed as part of the Rochester Community-Wide Clinical Guidelines Initiative, an initiative currently facilitated by the Monroe County Medical Society with representation from Aetna, Excellus BlueCross BlueShield, GRIPA, Kodak, The Monroe County Health Department, The Monroe County Medical Society, The Monroe Plan for Medical Care, Preferred Care, RIPA, Thompsonhealth, University of Rochester Medical Center/Strong Health, Unity Health System and ViaHealth.
To view and download the guidelines, visit the Medical Society's website guidelines area at
http://cwcg.mcms.org