Special CME Issue - West Virginia State Medical Association

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platform on which more advanced data management, preventive care/quality improvement practices, and information sharing is facilitated and advanced at the individual practice level. Our experience in assisting practices with quality improvement and outcome measurement parallels the experiences described by Langley and Beasley. 19 In their visits to many primary care settings, the authors concluded that most primary care practices are engaged in two distinct types of clinical improvement activities: (1) those attainable through the direct application of information technology to improve operational processes and care documentation (e.g., billing, e-prescribing, computerized physician order entry and identification of drug interactions); and (2) those attainable only through systems that allow continuous measurement and ongoing improvement to a system of care, (e.g., planning and delivering care to a population and whole patient views for comprehensive individual care). The rapid saturation and expansion of Health IT has had some unintended consequences. Some primary care practices have been left to sort through redefining and improving internal operational processes on their own. Vendor support is limited, costly and not necessarily sensitive to, or focused on, the practitioner’s clinical customization needs. Most reported studies derived from the practice level reflect the focus on process improvements, including the incorporation of care standards and automation of clinical protocols. Taplin et al. eloquently describe the process for translating cancer screening into practice using the EHR. 20 Measurement of process and health outcomes is far more complex from a clinical perspective – and each EHR system structures, captures, and processes this data differently. At the same time, national and state professional debates indicate the need for more pragmatism in the definition of population attribution and the development of evidence-based protocols to assure “apples to apples” comparisons. Discussion Many experts believe there is overwhelming support for integrated, intelligent and aligned health system changes to assure the provision of high quality, safe, affordable and accessible care to patients. 21 In this regard, medical professionals clearly share common ground with government, payers, and the general public. The major barriers preventing practitioners from optimal use of Health IT, especially for improving health outcomes and managing populations, are less about the use of technology and more about a shift in how physicians will function in a changing health system. Fortunately, there is more opportunity than ever to be actively engaged in shaping that role and defining how technology will be used to support it. Active, ongoing participation in EHR selection/implementation/ optimization processes at the practice level is a good start. Membership in local or state medical/professional societies, contributions to requests for comments on key rule making and legislation, and discussions with peers through educational forums on optimal use of EMR’s are examples of how physicians can get involved. The WVRHITEC and WVMI provide channels for physician input and expertise to advance HIT in practice. Primary care practitioners continue to face significant shortages of resources (financial, expertise, and personnel) to manage the numerous changes in the care environment and advocacy is essential to guide the change process. In West Virginia the vast majority of medical practice takes place in small practices with less than 4 practitioners. The typical staffing arrangement is comprised of an office manager, one or two office assistants, and the physician. EHRs are complicated systems that require hands on clinical and technical expertise and management from the point of selection to implementation and beyond. Most practices lack the technical expertise or clinical time resources to successfully navigate the change process on their own. In some cases, and at significant costs, some practices have hired additional full time staff to “manage” achievement of Meaningful Use. Our role is to assist primary care practitioners and other providers to meet important HIT and QI outcomes, but more importantly, Join WESPAC Now! West Virginia State Medical Association’s Political Action Committee Visit www.wvsma.com or Call 304.925.0342, ext. 25 52 West Virginia Medical Journal
to build the capacity to effectively demonstrate practice performance improvements. In the past, this role has included participation in many collaborative efforts to promote HIT use and providing expertise and resources to practitioners in order to facilitate practice-level advances in exchange of information (Accenture Project), information technology adoption (Doctor’s Office Quality- Information Technology – DOQ-IT, WVRHITEC), e-prescribing, privacy/ security (Health Information Security and Privacy Collaborative – HISPC), and consumer engagement. The capability to translate science from peer reviewed studies into evidence-based practice varies greatly among EHR systems. The clinical optimization of practicebased systems does not begin when the systems are implemented. Most certified systems have standard features and capabilities that can quantify and track the provision and outcomes of certain preventive health services. However, the time lag for engaging practitioners in more advanced levels of clinical optimization usually begins after (at least) a year of experience with the EHR and stabilization of internal work flow processes. The first glimpse at performance data often is enough incentive to stimulate a practitioner’s drive to enhance and improve the system of care. Conclusion Although impressive, the financial incentives offered through the ARRA probably are not the most significant drivers of the technology transformation of health care in West Virginia. Achieving the goals put forth in the ARRA/ HITECH legislation is far more complex than acquiring and using electronic technology meaningfully. Most physicians and health care practitioners are challenged to adopt and integrate technology into the daily care of patients while mitigating the unintended consequences resulting from heightened security/ privacy requirements, limitations of systems interoperability, vendor limitations/costs, legal and safety issues impacting important functions (e.g., e-prescribing), and the considerable resources necessary for data analysis, quality improvement, patient engagement, and population management. The knowledge we have gained regarding practice resource needs, the changing EHR vendor markets, and the effect of the health care reform legislation, has led to a clearer understanding of the ongoing technology and support needs of Helping West Virginia pHysicians take the right path… …in litigation, privacy and security compliance, certificate of need, medical staff and professional disciplinary matters, credentialing concerns, complex regulatory matters and business transactions. health care practice group Ryan A. Brown Robert L. Coffield Alaina N. Crislip J. Dustin Dillard Sam Fox Michele Grinberg John D. Hoffman Amy R. Humphreys Charleston Justin D. Jack Richard D. Jones Edward C. Martin Mark A. Robinson Amy L. Rothman Don R. Sensabaugh, Jr. Salem C. Smith Morgantown Stephen R. Brooks Stacie D. Honaker Wheeling David S. Givens Phillip T. Glyptis Robert C. James Edward C. Martin, Responsible Attorney | tedm@fsblaw.com | www.fsblaw.com | (304) 345-0200 | (800) 416-3225 THE ART, SCIENCE AND ETHICS OF PREVENTION | Vol. 108 53
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Page 5: contents Volume 108, No. 3 Special
Page 8 and 9: President’s Message Ethics and Ra
Page 10 and 11: Special Issue Commentary Losing the
Page 12 and 13: Special Issue Commentary A Tale of
Page 14 and 15: Commentary Article | Special Issue
Page 16 and 17: Falls and Dilemmas in Injury Preven
Page 18 and 19: Table 1. Demographics and Location
Page 20 and 21: Table 3. Injury Distributions Diagn
Page 22 and 23: 1993-2003 and 2001-2005. MMWR Morbi
Page 24 and 25: Immunizations for Adults and Childr
Page 26 and 27: Figure 1. Cumulative cases of selec
Page 28 and 29: Table 1. Recommendations for Routin
Page 30 and 31: Recently, the US Court of Federal C
Page 32 and 33: Screening Children for Hyperlipidem
Page 34 and 35: Figure 1. Proportion of “yes” r
Page 36 and 37: espect to specific patient populati
Page 38 and 39: Interdisciplinary Treatment of Adol
Page 40 and 41: can be prescribed at mealtime to su
Page 42 and 43: medicine and psychiatry, WVU psycho
Page 44 and 45: Possible Prevention and Treatment o
Page 46 and 47: vigorous activity could slow the pr
Page 48 and 49: substantially reduce cancer-related
Page 50 and 51: Using Health Information Technology
Page 52 and 53: Table 1. Meaningful Use Objectives
Page 56 and 57: small group practices, if the effor
Page 58 and 59: Extraskeletal Effects of Vitamin D:
Page 60 and 61: Cancer risk is decreased when level
Page 62 and 63: directly associated with insulin se
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Page 67 and 68: to psychiatrists or psychiatric nur
Page 69 and 70: to treatment, and facilitates a ref
Page 71 and 72: Ear, Nose and Throat Medical and Su
Page 73 and 74: Table 1. Meta-analysis of mammograp
Page 75 and 76: Table 3. Breast Self Exam and Clini
Page 77 and 78: lowered women’s stroke risk (RR 0
Page 79 and 80: What’s Good for Them Is Good for
Page 81 and 82: concern regarding the opinions of p
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Page 85 and 86: Table 1. Summary of Medicare Covere
Page 87 and 88: homosexual men, and residents of in
Page 89 and 90: specifically discussed above and li
Page 91 and 92: Lifestyle modification is an often
Page 93 and 94: 4. Varkey E, Cider A, Carlsson J, L
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Page 97 and 98: References 1. Alzheimer’s Associa
Page 99 and 100: found to occur in 80% of fatal ATV
Page 101 and 102: Table 3. Injury Patterns of Helmete
Page 103 and 104: can promote and contribute to these
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SPECIAL WESPAC SUPPLEMENT 2012 Supr
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West Virginia Medical Insurance Age
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Marshall University Joan C. Edwards
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West Virginia University Healthcare
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Please copy and fax both pages to C
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WV Prevention Research Center Putti
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West Virginia Medical Journal P.O.
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Special CME Issue - West Virginia State Medical Association

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