The Shared Principles of Primary Care: A Multistakeholder Initiative to Find a Common Voice.

As America's health care system continues to transform, the foundational importance of primary care becomes more clear. The Joint Principles of the Patient Centered Medical Home are now more than a decade old. As delivery reform continues, the importance of seven essential shared principles have emerged from a dynamic, collaborative, and iterative process of consensus building across multiple stakeholders. These seven principles will help the public, policy makers, payers, physicians, and other clinical providers speak with a unified voice about these core principles that define the enduring essence and value of primary care. The seven shared principles of primary care consist of: (1) person and family centered, (2) continuous, (3) comprehensive and equitable, (4) team based and collaborative, (5) coordinated and integrated, (6) accessible, and (7) high value. When used together, these shared principles provide a solid platform on which to build all further health care reform.

Accelerating Momentum Toward Improved Health for Patients and Populations: Family Medicine as a Disruptive Innovation-A Perspective from the Keystone IV Conference.

This paper was prepared in follow up to the G. Gayle Stephens Keystone IV Conference by authors who attended the conference and are also members of the Family Medicine for America's Health board of directors (FMAHealth.org). It connects the aspirations of the current strategic and communications efforts of FMAHealth with the ideas developed at the conference. The FMAHealth project is sponsored by 8 national family medicine organizations and seeks to build on the work of the original Future of Family Medicine project. Among its objectives are a robust family physician workforce practicing in a continually improving medical home model, supported by a comprehensive payment model sufficient to sustain the medical home and enable the personal physician relationship with patients.

Beliefs of ambulatory care physicians about accuracy of patient medication records and technology-enhanced solutions to improve accuracy.

The continuing problem of inaccurate medication records and resultant harm from medication errors has prompted the Institute of Medicine and others to encourage information technology (IT) solutions to improve medication list accuracy. There are few studies on how ambulatory care documentation contributes to medication list inaccuracies and medication reconciliation failures. To address medication reconciliation issues in ambulatory care, office-based physicians in a region with a high adoption rate for electronic medical records (EMRs) were surveyed about current reconciliation practices, the need for redesigning reconciliation processes, and acceptable IT solutions for improving availability of medication information. Physicians selected from a list of potential IT platforms that would create a single reconciled record of prescription medications, nonprescription medications, and supplements accessible wherever patients go. The two most popular platforms were either an aggregated list within existing EMRs accessible by inpatient and outpatient providers regardless of their EMR system, or a web-based repository that was not integrated into an EMR. Respondents felt that implementation of such platforms would not require major changes to clinical workflow, perhaps due to the region's existing familiarity with health IT. Leveraging community acceptance of health IT could result in rapid implementation of universally accessible medication list platforms.

Trends in adoption of electronic health records by family physicians in Washington State.

OBJECTIVE: Electronic health record (EHR) adoption is encouraged by health plans, government agencies, and both the American Academy of Family Physicians and the Washington Academy of Family Physicians (WAFP), but rates of EHR adoption by family physicians in Washington were previously unknown. This study measured current rates of EHR adoption by family physicians in Washington State, as well as perceived barriers to adoption and what physicians identify as possible means to overcome those barriers. DESIGN: A survey of medical practices in Washington State was performed. One physician per practice was selected to respond on behalf of their practice for all practices where family physicians work and for which contact information was available in the databases of the Washington State Medical Association (WSMA) and WAFP. The survey was distributed either electronically or in print form depending on availability of an email address. MEASUREMENTS: Rates of EHR adoption, plans for adoption for those not yet using EHRs, perceived barriers to EHR adoption and perceived means to overcome those barriers. RESULTS: Response rate was 43.8%. EHR adoption by this group is relatively high at 57.9% and did not vary by practice location. Although solo practices had a relatively high rate of adoption (43.5%), EHR adoption remains strongly associated with practice size. Identified barriers to implementation are primarily financial, as are the means to overcome those barriers. If current trends continue, adoption will plateau at approximately 68% in the next four years. CONCLUSIONS: Adoption rate appears to have peaked in this group given current constraints and barriers. Increased outreach efforts and assistance programs will be necessary to achieve EHR adoption in the remaining practices, particularly solo and small group practices.