As the subject of the post states, these awards, what some consider the Oscars of e-Health, have been published.

In the interest of creating the best person/user/patient/consumer experiences, the awardees listed provide a nice reference point for those looking to talk with organizations who serve their customers well online.

Three of the partners of the PCHIT Initiative, Group Health Cooperative, Kaiser Permanente, and California Healthcare Foundation were distinguished with Platinum and Gold Awards in several categories.

I know that both organizations spend a considerable amount of effort in involving their members in the usability of their web sites, and caring that they are usable. Maureena Moran is the Executive Director of Web Services and Enterprise Information Management at Group Health Cooperative, and she allowed me to share the kudos she gave teams at Group Health:

Kudos to the entire web team, including Web Services and ISD’s Web Development and Systems Integration Groups, in particular, for their undying commitment to defining, designing, and developing the best online services for Group Health’s customers!

We also won the top design award — Best Site Design — for a Medical Practice/Clinic. Kudos to Judy Hucka and her team, including our lead web designer Stacy McCauslin, and the entire User Experience team for their commitment to using the best internet design standards for ease-of-use and simple navigation.

I think having a web services team of any size is one of the most potent drivers of patient-centered care processes across all aspects of a practice. The skill and talent they bring to understanding what patients want when they are physically present as well as when they are not is priceless.

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).

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At Susannah Fox’s suggestion, I took the Pew Internet & American Life Project Internet Typology Quiz, and I came out as a Connector.

This is one step below an Omnivore, and I think based on the fact that I don’t watch TV shows on anything other than a TV (who has the disk space for these things). I certainly fit in the demographic described.

I can relate this to my sabbatical experience in that as I have visited new places (or even familiar places), people refer to me someone who’s a bit of a technophile (or even “geek doctor”). None of the words are meant in a pejorative way, and all are from people with whom I share mutual respect. In actuality though, technology doesn’t really excite me, or even impress me the way that improving systems and people’s ability to do things does.

In much of the work I have been doing around the Toyota Management System, there’s been a great emphasis on only using tried and true technology. Paper is a great way to organize one’s self, and I am finishing up the paper-based visual system for my work here. It’s great, and I’ll be posting it soon. My workplan focuses very little on installing technology and more on transforming care.

How I do relate to technology is that I want to understand everything it does, and I enjoy mastering it, so that I can have access to the most useful tools around. That’s more change agent than it is technophile, I would say, so I’ll substitute “Connector” in conversations from now on:

Connectors combine a sense that information technology is good for social purposes with a clear recognition that online resources are a great way to learn new things.

If you are reading this, take the quiz yourself and post your Internet type here as a comment….

This Vietnam Veterans Memorial turns 25 years old this year. There are so many experiences available here that enhance perspective, and this is one of them.

I wouldn’t normally devote a whole blog post to one feature of Mac OS X Leopard, but this one really deserves it.

Data detectors is a huge innovation and something I would love to see in all kind of systems. The blog below beat me to laying out how they work. They really are incredible, though. Imagine having these in an electronic health record, where an abnormal finding or the result of a patient’s entry into a health risk appraisal could be detected automatically and advise on next steps based on evidence.

Marc Liyanage - Blog - Mac OS X - Leopard: Data Detectors - Awesome!

• The Changing 20s - Brookings Institution - Information / data about being in your 20’s in the 2000’s
• Lean Manufacturing Blog, Kaizen Articles and Advice | Gemba Panta Rei - Toyota places emphasis on facts learned at the Gemba.
• Life as a Healthcare CIO: The Tyranny of the Urgent - John Halamka, MD, posts his 1 year and 5 year plan on his blog. Way to be transparent.
• Modern Healthcare Online: Patient Safety Institute Closes Its Doors - YAR (yet another rhio….)
• CDC Reports Rise In EMR Usage - Slightly more physicians are using comprehensive EMR’s - but still at 12%

Our first new Co-Author is Mark Groshek, MD, from Kaiser Permanente, Colorado. He’s a leader nationally in tackling one of the most interesting issues in PCHIT, adolescent care. His first post follows this one and he will be a regular contributor about his experiences.

This blog is an experiment. It’s the chronicle of a journey of discovery around patient centered health information technology. Josh Seidman and I have been witnessing experiences at the practice level in health care organizations and talking about them here. This blog is not about Josh and Ted’s journey, alone, though.

What we also wanted to do was have the organizations themselves talk about their own experiences over time, with us. Therefore, as I have gone to each site, I have asked for a volunteer leader from each to blog with us. The leader can be a physician, nurse, any care provider. It can be a patient. This is a person that would talk about their experiences supporting patient-centered health information technology - including Personal Health Records and Information Therapy - the good times, the we wish things were better times, and the “what do we do now?” times. This is the benefit of the blog platform - it is not good at describing perfection - it’s great at describing a little bit of improvement every day.

Why do this?

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Charles Milligan, Jr., is the Executive director of the Center for Health Program Development and Management, University of Maryland, Baltimore County. I have to insert here that Chuck is also an alum of the University of Calfiornia, Berkeley School of Public Health…

The Center’s Mission is “…to work with public agencies and nonprofit community-based agencies in Maryland and elsewhere to improve the health and social outcomes of vulnerable populations in a manner that maximizes the impact of available resources,” and Chuck brings his experience here as well as experience supporting diverse populations in California in the areas of health care law and policy.

Chuck stimulated a very key conversation that resulted from a little confusion of my part (as I have now surmised). We talked about “PDCA cycles” and the idea that in the Toyota Motor Company, 80% of time is spent on planning, 20% on execution, the opposite of some American Companies. In our discussion these concepts seemed at odds, because as Chuck pointed out, policy makers benefit from quick movement from planning to execution so that they have something concrete to work off of.

Chuck also provided guidance on consumer involvement, that as we look to readily available sources of input, we should also look for not-so-readily available sources of input, because community boards and the like may not be truly representative in every case.

As Maryland’s leading public applied research organization for Medicaid Managed care, the Center is working on appropriately adjusted outcomes measurements that support reimbursements, or as Chuck stated, “report cards that are fair.” His group is also working on an electronic health risk appraisal and the impact on utilization before and after.

With UMBC itself, Chuck alerted us to a forum on behavioral health issues on campus, that will touch on issues of confidentiality and safety, which will happen on November, 27.

The Adjust: I couldn’t wait to resolve the issue regarding “P” from PDCA and “Planning,” and referred that question out to some experts in the LEAN world, which is detailed on the DailyKaizen blog in this post. The adjust, therefore, is in my opinion to keep going by rapidly improving what we do, and the 80% time planning spent happens in the P, C, and the A parts of the cycle. In that respect, Josh and I are doing regular checks on what we are doing. I am also working on setting up a visual system for the work (I will post the picture here, of course).

Chuck is one of the experts on our group regarding reimbursement and care of vulnerable populations, so as with other members of the group, we would like to check on what is happening in this arena. We are already doing that a bit based on the guidance by working to arrange discussions with payers in communities we are visiting. We did this in Boston, and are working to do this in California, our next stop.

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.