PCHIT links for November 29th through December 4th:

• How to talk to a doctor - USATODAY.com - I wonder how much if the burden being placed on patients is necessary in the era of PCHIT?
• Delivering a new kind of care | IndyStar.com - Patient centered HIT starts with patient-centered care, from Indiana
• Benefits of Electronic Health Records Seen as Outweighing Privacy Risks - WSJ.com - Poll by WSJ/Harris: Consumers want interaction with their care providers online. Less agreement on reimbursement.

One of the greatest things I heard from a CEO of a health care company I really admire was, “Sometimes I go back to my office and ask myself what the heck I am doing.”

And, sometimes I go back to my office and ask myself what the heck I’m doing.

I am just finishing up a week (more or less) of visiting a total of four different health care organizations, in the San Francisco Bay Area. It was a great week. I never know what I’m going to see or learn when I do this, and I learn a lot. The reason for this is that I do shadow - asking to go into the exam room with patient and physician (after proper consent). I typically don’t sit down with people at meetings, and instead talk to them on the fly, in the context of patient care. Sometimes I will give a presentation, on request, which I am happy to oblige.

It’s a bit of an unusual way to learn, and it can be challenging to get there in the first place. This includes everything from knowing my tuberculosis status (to protect patients I may come in contact with) to understanding privacy practices and protecting the security of medical information.

When I visit a practice, there is invariably a conversation that starts with, “who are you and why are you here?” I have a bit of an elevator speech that I’ve developed over time. The reality is, that in medicine, it’s not the “norm” to perform quality improvement a little at a time. People are used to data-driven quality, which can take months to compile and more months to release as people discuss methodology. They don’t really watch each other practice and critique and improve on the fly. So, I sometimes find myself in a situation where I have to represent my value very quickly.

The good news is that I have been uniformly welcomed, even by busy clinicians, which has been so impressive to me. Some of the clinicians I am following are not having the smoothest days, and some may not be having the smoothest weeks or smoothest months. And, that’s okay. I’m a visitor serving them, not the other way around.

In a health care system where quality happens every day, a bit at a time, it would be more likely that a physician (or nurse) would be shadowed by a colleague, and so my presence wouldn’t be a novelty. But that’s not the case, so every new request to shadow is going to bring a challenge with it. It would be much easier to acquire information by setting up meetings, but I think the quality of information would be inferior. So, I’m not going to do that, but I will set myself up for disappointment and maybe even failure, if an organization or practice feels that there isn’t a need to have me observe what they do.

The reason why it’s okay, to do this more complicated thing, is because of all of the things I have seen and heard, the moments of “the heart of family practice” that I have had in every place I’ve been. Maybe one day all patients will expect to see another physician in the exam room with their own who is working to help their colleague to be a better doctor.

Such is the life of the change agent….

PDF: Web 2.0 for Planning, Communication and Change Management, Ted Eytan, MD

Given at California Healthcare Foundation’s new headquarters, Oakland, CA

It was a busy week in California, starting with a visit to the California Healthcare Foundation’s new headquarters in Oakland, California. I was honored to lead a discussion on the use of “Web 2.0″ (mostly focusing on blogs) in health care. This blog itself is an experiment, partially funded by the Foundation. I think the basic message is “If you don’t, they will,” and “being transparent and accountable as a health system can inspire confidence.”

I first gave this presentation with Andy Wiesenthal, MD, who leads the Kaiser Permanente HealthConnect project, at a User Group meeting for Epic Systems clients, later within my own health system, Group Health Cooperative, and now this public version.

I am a bit of an evangelist now of using Web 2.0 in Healthcare, and consider myself “very available” when it comes to the opportunity to give this presentation to other audiences. It’s been a great journey, as you can see in the slides.

We had a nice discussion about the value of blogging and transparency in different environments. The presentation is meant to be informational, without any particular recommendation for the philanthrophy community. Of interest, though, was a question posed about how to move to Web 2.0 in a large organization. My answer was, “Slowly” and “not to shock the system.”

What was really great was that Holly Potter, the Director of Communication for the HealthConnect project was in attendance, and her response was, “It would be nice to have the luxury of being that deliberate. We don’t have that option anymore.” Holly’s team supports a project that touches millions of lives. She related her experience as the person accountable for ensuring that the communities that are touched by this project have the most accurate information about it, all the time. It was very powerful to have Holly present in the discussion, in my opinion.

Council of Accountable Physician Practices (CAPP)

Speaking of accountability, I was also fortunate to meet Nancy Taylor, the Executive Director of CAPP, which is an affiliate of the American Medical Group Association. The medical group I belong to, Group Health Permanente, is a member of CAPP, and these are the medical groups that are working to promote a health care system that is “more accountable to patients, consumers, and purchasers.”

I actually didn’t know about CAPP before I started this work, but as I look at the roster, it’s a who’s who of innovators in the personal health record / patient-centered care world.

This is not to say, though, that CAPP groups are the only ones innovating. As I discussed previously on this blog, there is a lot going on in smaller practices supported by the American College of Physicians and the American Academy of Family Physicians. At the same time, this consortium represents another nice touchpoint for those who ask, “Who can I talk to about implementing patient centered health information technology?”

Of course, in the shadow of the talk I had just given, I thought about which of these medical groups have blogs where they are communicating their work to the public. I don’t know the answer to that question (and if any of them are reading this, please post your comments here about that). I hope at some point to interact more with the Council and maybe discuss the opportunity to be even more transparent using Web 2.0 technology

I am wrapping up my time in California, with just a few more posts to go, and I wanted to again thank the California Healthcare Foundation and The Council of Accountable Physician Practices for their support of patient centered health information technology.