Small practices leading the way: ACP’s Center for Practice Innovation

Acp Online - Center For Practice Innovation - Clinical Metrics Data (20071119)

Center for Practice Innovation: Clinical Metrics show improvement

Information Therapy: No co-pay or formulary check required.

This was a big “a ha” for me while in attendance of the American College of Physisicans’ Center for Practice Innovations November Conference.

The title of the conference as “Focus on the Practice- Challenges, Choices and Change.” In complete honesty, my assumption was that I was going to learn about the challenges and difficulties of smaller practices in supporting the most current models of care. I did learn about some of that; however, my assumption was proven mostly faulty after seeing the presentations. What I learned about was about how smaller practices are actually not only getting there, but shining a light onto the rest of medical care through innovation.

I saw multiple examples of practices examining their care processes carefully and making improvements in the flow of information (even using LEAN-Toyota Management-waste reduction techniques).

I saw practices that are installing electronic health record systems, with sound economics, and using the data to improve the care of populations. I saw models of practice that I have not yet learned about, such as the Ideal Micropractice, where individual physicians, without additional staff, manage a population of patients. And throughout, there was attention paid to patient-centered principles, as practices are learning and teaching that this approach supports a more satisfying practice and is better for business.

I will let the CPI share the details of this work, through publication in the ACP Internist, and on the CPI web site. The CPI itself shows impressive gains in quality and from my perspective, was executed in a way that showed respect for the nature of the involved practices. They were visited in person by the CPI team (as close to the patient as possible), and goals were set in partnership. For all of these reasons, it’s worth taking a look.

For my part, I gave a presentation on the personal health record with a focus on patient-physician e-mail and transparency of the medical record through web portals, from the perspective of a large health system. And guess what, I didn’t get the sense that this was a scary concept to these leaders. In fact, some of them are already experimenting with these systems themselves, and have ideas to make them work within their financing environments.

Here were some key points that I took away as I thought about PCHIT:

  • Information Therapy: I saw so much angst about medication prescribing – connecting to pharmacies, arranging refills, checking formularies, managing Co-pays. Ix requires none of this – what a great way to introduce the concept in this environment!
  • EHRs and PHRs: Solutions that seem out of reach for large practices because they are not fully integrated or streamlined into other applications may really be in reach for small practices. A smaller staff can manage a little dis-integration in the interest of serving their populations
  • Interfaces: Corollary to the point above – small practices are willing to tolerate less integration if it means not paying $5000 for an interface between systems. This may not be a lot of money for a large enterprise-based EHR, but it is too much for a small practice. The question is whether pricing models developed with large enterprise clients may need to be revised to spur adoption in smaller groups.
  • PDCA: The ability of a small practice to innovate quickly and see results is significant. Sometimes we think of taking big system learning and applying it to smaller systems. Well, I should say that I do because I come from a big system. I need to think about working with smaller systems and applying the learning to big systems. We are both necessary. What a big system has in terms of resource and scale may be counterbalanced in terms of its challenge to manage and grow the raw materials of improvement – our patients, physicians, and staff ideas.

I really enjoyed interacting with this group of primary care physicians and their staff, and thank the ACP and staff at the Center for their time in allowing me to be present – Michael Barr, MD, MBA (also on the PCHIT Advisory Group), Paula Woodward, MPH, BSN, RN, and William Underwood, MPH.


Hi Ted:

I think you hit upon some critical points around innovation in heatlhcare delivery systems. I concur with your assessment that a lot of the innovation is plowing much further ahead in smaller, community practices/hospitals. In addition, many for-profit health systems are driving hard in these areas.

This makes sense to me from a management perspective given the focus patient care (perhaps more accurately stated as the lack of other foci of interest) and their core competencies of operational excellence.

Many of us in not-for-profit, larger systems can stand to learn a lot from the broader community.

Thanks for the post!


Ted Eytan, MD