Attachment J -- Public Comment from TMA

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December 19, 2012
Doris Lefkowitz
Reports Clearance Office
Agency for Healthcare Research and Quality
[email protected]
Dear Ms. Lefkowitz:
The Texas Medical Association (TMA) appreciates the opportunity to provide commentary on the proposed
information collection project: “Using Health Information Technology in Practice Redesign: Impact of
Health Information Technology on Workflow.” TMA has a keen interest in health IT and agrees that the
research on health IT workflow impact in small ambulatory practices is lacking. Our specific comments are
as follows:
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When practices are selected, please ensure that different EHR systems are used. Some EHRs are
more “workflow-friendly” than others and this will have an impact on the findings. For example, an
evaluation of EHRs in the past two years by pediatricians on “Ease/Methods of Data Entry…” found
scores that ranged from 1 to 4.25, with an average of 3.35 (source: www.aapcocit.org/emr).

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TMA understands the study will focus on primary care practices. Please be sure that all primary
care specialties are studied (i.e., pediatrics, internal medicine, family medicine, and obstetrics and
gynecology) as each has its own challenges and requirements. For example, the common
pediatrician needs to retrieve a sibling’s chart during a child’s visit because the parent remembers a
sibling’s problem is not a workflow typically found in internal medicine.

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There is mention of “small practices” in the proposed project. TMA thinks the focus should be on
practices of 1 to 5 physicians as a significant number of patient visits occur in this setting.

TMA is a private, voluntary, nonprofit association of Texas physicians and medical students. TMA was
founded in 1853 to serve the people of Texas in matters of medical care, prevention and cure of disease, and
improvement of public health. Today, our maxim continues in the same direction: “Physicians Caring for
Texans.” TMA’s diverse physician members practice in all fields of medical specialization. On behalf of the
almost 47,000 member physicians and medical students, TMA submits these comments and looks forward to
seeing the final report. Should you have any questions, they may be directed to Shannon Vogel, TMA’s
Director of Health Information Technology, at (512) 370-1411.
Sincerely,

Joseph Schneider, MD, MBA
Chair, TMA ad hoc Committee on Health Information Technology
TEXAS MEDICAL ASSOCIATION

401 WEST 15TH STREET AUSTIN, TEXAS 78701-1680 (512)370-1300 FAX (512)370-1630

WWW.TEXMED.ORG