Dr. Wilson’s patients are retired military personnel who receive treatment ranging from preventive to chronic disease services.

In 1999, Dr. Wilson began participating in a quality improvement consortium, Acceleration Translation of Research into Practice (ATRIP), sponsored by the Agency for Healthcare Research and Quality and designed to maximize physicians’ capacity to provide high-quality care through the use of information technology. ATRIP provides routine performance data and suggests ways to improve the use of templates and other features in the EHR. It also provides quarterly practice reports showing data trends in care for measures based on clinical practice guidelines. Dr. Wilson receives practice reports on more than 80 measures, including the following: diabetes, heart disease, stroke, asthma, infectious diseases, mental health, substance abuse, immunizations, and inappropriate prescribing for the elderly.

Dr. Wilson was using EHRs and developing his own quality measures when he joined the ATRIP consortium. One of the services provided by ATRIP is periodic site visits from staff members of the Medical University of South Carolina to help in implementing national practice guidelines. Assistance is provided in the development of templates, measurement structures, and patient information handouts. Computer hardware and software support is purchased locally on a contractual basis.

In 1994, Dr. Wilson purchased the electronic medical record, including hardware and software, for $24,000. He has received periodic upgrades to the software. In the last 6 months, he has spent $20,000 to upgrade the

Key Lessons Learned from an Internal Medicine Solo Practice

  • A solo physician can successfully introduce electronic medical records and a quality-of-care program.

  • Introducing electronic medical records is not simple and requires perseverance.

  • Gaining buy-in from staff and giving them routine feedback and encouragement are vital.

  • The physician and staff must remain very flexible in the face of unexpected technical problems.

  • A learning network such as ATRIP permits expansion of the capabilities of electronic medical records and performance measurement, allowing serial analysis and comparison with national benchmarks.

  • A consortium with similar practice guidelines and goals provides support to sustain enthusiasm.

  • Risk management is an important benefit of electronic medical records.

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