Retrieving and validating patient data stored in far-flung legacy systems using different technologies has never been easy. Nevertheless, the American Medical Group Association (AMGA) is making steady progress in just such an effort. The Alexandria, Va.-based group has been aggregating and analyzing comprehensive patient data from nearly 300 AMGA member organization who serve more than 50 million patients and represent about 75,000 physicians in 42 states.

Dr. Donald W. Fisher, president and CEO of AMGA, has been leading these efforts through the development of AMGA’s National Collaborative Data Warehouse. He hopes that one day, physicians, pharmaceutical companies, and patients will all use this database productively. Fisher spoke with Digital HealthCare & Productivity about the database initiative and how AMGA is generally moving forward in health information technology.

DHP: What’s the status of electronic health record (EHR) adoption among AMGA members?

Fisher: About 84 percent of our members have already made the investment [in EHRs] and most of them are fully implemented.

DHP: How have your members been able to afford this investment?

Fisher: It’s a matter of establishing priorities; many of the large medical groups have retained earnings that they put aside each year just for investing in the infrastructure. The medical groups are finding significant financial returns from EHRs as well as incalculable returns in patient and provider satisfaction.

DHP: What about physician resistance we keep hearing about?

Fisher: There has been some resistance by specialty. Some have unique documentation needs that make it difficult to get up and running on EHRs. Often there is a lot of customization required, particularly in areas like ophthalmology and orthopedics and other specialties. But there are always the 20 percent who are the early adopters; the 60-to-70 percent who say, ‘Well, if it works, I’ll jump on the bandwagon;’ and the 10-20 percent who are resistant to any kind of change. EHRs, after all, do have a learning curve, add another step to the care process, and change the workflow process.

DHP: Tell us about the AMGA/Anceta National Collaborative Data Warehouse, which provides groups with access to comparative healthcare data.

Fisher: We’re trying to create an aggregate database upon which treatment effectiveness and outcome studies can be done. It’s not only for medical groups to get comparative data, or benchmarks, but also actually provides them with the tools they need to identify best practices. By the end of 2008 or 2009, we also hope to enable a portal for patients so they can go into the data warehouse through their physician portal and find ways to control or manage their disease conditions. We’re not there yet, and the limiting factor is the number of patients we have by disease conditions.

DHP: What’s the business model and value proposition for this collaboration?

Fisher: We have about 10 medical groups who are engaged in the data extraction, loading, and transformation process. For these first groups, we’ve provided this service at no cost; the next 10 groups will pay at cost, and we’re hoping to keep it at cost for every medical group we add thereafter. The revenue for the company (Anceta) will come from making the totally identified, HIPAA-compliant data available to third parties, for outcomes research, clinical trial identification of patients, and effectiveness research.

This data is longitudinal at the patient level, and pharma and device companies can look at inclusion and exclusion criteria. We’ll be able to shorten the time it takes to recruit patients for clinical trials because we’ll have real patients with real data that fit the clinical trial protocol. We also see part of the revenue coming in from patients as well as for medical groups who may want to do some drill-down exploratory analysis of the data and consultations so they can learn how to use the data for quality improvement and re-engineering care process.

DHP: What are the most pressing challenges that you’ve faced in developing this data warehouse?

Fisher: There are been four challenges: Establishing comprehensive privacy practices at the patient and provider level was the first and most difficult challenge, because we actually started the data warehouse before the HIPAA regulations were published. And it wasn’t just overcoming the regulatory process but it was overcoming what I call ‘HIPAA fear.’ We were able to overcome the fear by AMGA owning the data, aggregating it, and then licensing the data to our for-profit subsidiary, Anceta.

The second challenge was establishing an efficient data loading process. The loading process needed to minimize the burden on the medical groups, because these medical groups have limited IT resources and have constraints and all kinds of compelling internal initiatives they have to deal with.

It’s also been challenging to get a robust data validation and reconciliation process among the medical groups. This data stored in different ways, and when you extract it, you have to transform, standardize, and load it in a common format, and agreeing what that would be was difficult.

The other thing we are working on and hope to finish by the end of the December is developing analytics that would serve the needs of not only the medical groups but also our commercial customers. We’re looking at specific measures around disease conditions that will present themselves in dashboards for the medical groups and then they’ll be able to develop some exploratory analysis around those dashboards.

DHP: Will you be involving others outside AMGA?

Fisher: Absolutely. The reason the company doesn’t have AMGA’s name all over it -- it’s called Anceta -- is that we really have a multi-organizational model that will involve other associations. We believe that other associations in the provider community -- like the American College of Physicians, American Hospital Association, and others -- could serve the same trusted intermediary role that AMGA serves for its members. So any of these professional societies could aggregate their data and then license it to Anceta. The data could be compartmentalized within Anceta but could be co-mingled if desired. So we look to expand this, and this could include insurance companies and others.

DHP: As far as public healthcare policy, what is your organization’s perspective on key health IT issues?

Fisher: Our first and highest priority is the Senate bill introduced recently, the Wired for Healthcare Quality Act. While we’re not optimistic it’s going to go anywhere in this Congress, this legislation does some important things: it creates quality reporting organizations like Anceta that can store healthcare data, and develop the ports that would be designed to improve quality and safety. It would also extend the privacy requirements to the operators of these databases, which right now the privacy acts don’t do.

DHP: What’s the status of e-prescribing among AMGA members?

Fisher: We’re a strong supporter of mandating e-prescribing by date-certain. We just wrote a letter to Secretary Leavitt of HHS indicating that we think the proposal for having e-prescribing mandated for Medicare Part D pharmaceuticals by 2010 is the right way to go.

We think it’s a matter of patient safety and efficiency, and if you mandate it and say to physicians across the country that by date-certain if you haven’t gotten to the position where you can e-prescribe, you won’t be able to bill Medicare -- that’s a really strong statement about driving the safety agenda through the payment mechanism. We think the requirement to e-prescribe combined with financial incentives is really the way to go to get physicians to move into 21st-century healthcare.

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