This post is a continuation of my experience at La Clinica de La Raza in Oakland, California. As I mentioned previously, it was a great experience and I was welcomed by the staff and providers who serve this community.

I mentioned that most of the clinical work performed here uses a paper medical record. There is laboratory testing and medication look-up, as well as scheduling features. I asked both Steve Schiff, FNP, and Bina Patel, MD, their thoughts about going electronic, and even communicating with patients online. Because providers share a communal work space, I received additional perspectives. Patri Zayas, MD, the Medical Director, also stopped in to say hello and answer questions about the Medical Center.

Bina told me that when she looked to move to California, she interviewed at 7 safety-net medical organizations, and none of them had or were planning to get electronic health records. She hoped to use an EHR in her new clinical environment. I asked her about e-mailing with her patients. She said that she does some of this now, and would look forward to doing it more comprehensively. She trained in a location with an electronic health record and is very comfortable with the electronic tools she has access to here.

I also talked to Steve and his colleagues, and learned that many patients in this community don’t have good reading skills, and often, the individuals in the home that can read are children, and not at a level that is sufficient for translating health information. A real dilemma. It is not one PHR fits all. Many providers here do not have experience with electronic health records, except perhaps at patients at other systems, such as Kaiser Permanente. As I spoke with Patri, I understood that the clinicians here have a good sense of what the right clinical goals are for their patients, but it may be hard to conceptualize how to get there with an electronic health record right now. I felt the same way when we started our journey 5 years ago.

I was very kindly invited to the all staff meeting held on that day by Suzy Mejivar, the Manager of the Clinic, which was a celebration of a lot of hard work by the staff. La Clinica had passed a level of volume of encounters that had never been achieved before (and I recalled a comment made at another safety-net medcial centers that encounter numbers are essential in this environment to survival). Suzy individually thanked each staff group for all of their teamwork. She said, “Love each other, respect each other, and work together.” She even complimented one of her case managers when she said that she knew they were doing a good job because she was at her aunt’s house when her aunt received a call from La Clinica. This is a measure of the integration in the community that this organization has. Suzy did ask me to introduce myself to the group, which I did, and when I said, “Our practice has been fully electronic since 2004,” I got a sense of excitement from the staff present.

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I was able to attend this session of Informatics in Action yesterday, at the National Institutes of Health Campus, as it focused on consumer health information technology. The cast was truly all-star, including Bern Shen, MD, from Intel Digital Health, Adam Bosworth, from Keas, and Bill Crounse, MD, from Microsoft (and also from the home team in Redmond, Washington). The session was moderated by Steve Taplin, MD, from the National Cancer Institute. A videocast may be available on the NIH site.

I think the group as a whole did a very nice job of talking about the needs today, along with directions for the future. I jotted down a few quotes on my iPhone from Adam:

It would be better in general if the system worked more like Kaiser.

Consumers don’t want PHRs. They want help and advice.

Adam also discussed three priorities, which include consumers being able to control their health data “in computible form,” empowering health professionals, and providing an easy way for researchers to implement protocols.

On the computible form issue, I have definitely seen the impact of not having things in computible form, for example, in trying to reconcile medication lists, where there are a plethora of medication products and non-standard codes.

Bill talked about 5 significant trends in health care, and he has an experience that includes a lot of work with international organizations, as well a long connection with the practice of medicine, which makes him well suited to put things in perspective. He introduced some of the concepts of HealthVault, a platform for PHRs, rather than a PHR itself. I am a regular reader of Bill’s HealthBlog, where it’s quite likely you’ll see a writeup of this event there as well.

In my work so far, I am seeing evidence that health care and non-health care professionals alike are working to make things happen in patient-centered health information technology, whether they call it that or not, and it is good to see.