PCHIT links for November 9th through November 13th:

• JAMA: Soliciting the Patient’s Agenda: Have We Improved?, January 20, 1999, Marvel et al. 281 (3): 283 - Data often cited and here’s the source: patients redirected an average of 23 seconds while providing their history.
• The Center For Health Design Research - Pebble Project - Center for Health Design supports evidence based design of health environments. Have they done work in PHR/EHR enabled institutions?
• Life as a Healthcare CIO: Personal Health Records - John Halamka, MD, supports the idea that PHR adoption is not a technology issue. Consistent with my findings on our recent trip to Boston.
• A Model for Health Care That Pays for Quality - New York Times - NYT Reports on Patient Centered Primary Care Model promoted by ACP, IBM, and others
• E.H.R. Home - HL7 announces balloting for PHR standards

Whenever I think about what my professional purpose is (the 3 x 5 card exercise), I say that it is to reduce disparities among vulnerable populations. It’s why I became a doctor. This study highlights the challenges of an important vulnerable population.

Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War. Jama 2007;298:2141-8.

Here are some thoughts I had on how to help:

1. Involvement of family. I have used the after visit summary to inform family members who aren’t or can’t be in the care environment about what happened in the clinical encounter. I note that this is a challenge of the military system, that families cannot be involved as they would like.

2. Destigmitization. I did not know that behavioral health care is not confidential in the military as opposed to civilian life. The paper indicated that the screening in and of itself is a form of Information Therapy. Is there an opportunity to make the fact that this is a medical condition more clear to commanders and patients.

3. Longitudinal management. The paper indicated that those who entered treatment did worse than those who did not. This is explained in many ways, but most interesting is the explanation that the visits are just points in time, with no continuous engagement or self-management. It seems that many improve on their own, and is there a role for information along the way to speed up that improvement so people can return to achieving their life goals?

As you will see from Photo Friday this week, there are very tangible reminders in this community about what this means for the people we serve as health professionals, as they serve us.

Deven McGraw is the Chief Operating Officer of the National Partnership for Women and Families and brought terrific community-centric perspectives to the discussion, through her work with the Partnership and also through her expertise on health information technology issues.

She serves on the Privacy, Confidentiality, Security Workgroup of the American Health Information Community and is our link to that organization. She is working on defining what the best privacy and security protections are for consumers. She is also active in policy issues and specifically empowering consumer groups to impact ways that systems are shaped. This includes access, and also beyond access to issues related to the quality of care once access is achieved. New developments for her work include work to provide technical assistance to state-based organization.

The Adjust: Deven talked with us about creating “workable models in a community where people enjoy what they have.” This was key in that the measure of success will come from the people who are being served rather than the care providers, and this is what a federal system can point to and scale. With this in mind, we are going to gather information about community and consumer involvement as we work with organizations. As we just got back from Boston, we already started bringing this into the conversation. It is critical because when adoption of PCHIT by patients is at issue, it is relevant to look at their involvement. Another adjust at this point is to think about how this work will support policy activities - we really have not defined that at this point (and purposefully, from my perspective, to get experience at the practice level). From here, though, we should begin investing in awareness of the work of the National Partnership and other policy experts to shape this work for that audience.