an EMR to implement Choosing Wisely is the best way to go, other options exist; they just require more self-discipline. Baylor Scott and White adopted Choosing Wisely about a year ago and used handwritten protocols at first. “It can be done. I have to take medi- cines for my kidney stones, and I use my watch or alarm clock or computer to set reminders. But without those, I have to rely on myself to do it,” Dr. Wesson said. Similarly, “I can do [Choosing Wisely] in handwritten protocols [that remind] providers to get it done, and it works reasonably well. But it works much bet- ter if I have structural reminders that make it more of a routine. Having an EMR allows you to do this with less thinking because when you are engaged in a patient encounter, it provides the structural assist.” Realizing the process can get un- wieldy as specialty societies continue to join the campaign or add to their “not-to-do” lists, the Choosing Wisely
campaign also is working to simplify the program, Dr. Wesson adds. “After a while, these lists could end up with 200 to 300 things, and that can be compli- cated. So we are trying to come up with a conceptual message clinicians can use versus a specific list of things to do, like: Am I doing this because it’s a part of a protocol, or because in this instance, it’s going to give me information that will help me with this patient?”
Contributing value to patient care
However physicians choose to start, the most important step is identifying gaps in care so physicians know where to improve, says Garland family physi- cian Cliff Fullerton, MD, chief medical officer of the Baylor Quality Alliance and a member of TMA’s Health Care Qual- ity Council. Making those improvements may not be easy at first, he cautions, but they are worthwhile. “There isn’t a financial positive to quit
doing some of these things. And it does cost doctors time to talk to patients in- stead of sending them out the door with an antibiotic,” he said. The latter also could negatively impact patient satisfac- tion rates in the short term if they don’t get the drug or test they think they need. “But it’s hard to justify saving money or saving time for yourself at the expense of your patients. By engaging in these activities, you are creating a safer envi- ronment for your patients.” That will pay off in the long run, he says, especially as commercial and state quality initiatives put more emphasis on value-based care. “The better we [phy- sicians] do, the more appealing we are to payers and employers. And some- where down the road, patients are going to look at our quality and cost of care. So we want to be doing well when that time comes.” Already, the Texas Institute of Health
Care Quality and Efficiency is consider- ing Choosing Wisely as a possible recom-
TMA Member Services at Winter Conference Physician Education and Practice Help
• See the latest CME in the TMA Education Center • Learn how TMA’s expert consultants can assist your practice
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Information and Advocacy
• Ask questions and get answers with the TMA Knowledge Center
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• Ease your transition to ICD-10 with TMA’s Complete ICD-10 Implementation Solution
Stop by the TMA Member Services Booth at Winter Conference or visit
www.texmed.org/benefits.
January 2014 TEXAS MEDICINE 53
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