Chicago can get really really cold.

I found this out when I braved what I would call a challenging travel experience, along with several other HIT experts, to attend a new Joint Commission Public Policy Roundtable, addressing the creation of a nationally interconnected Health Information Technology System.

It was both worth the effort and I left welcoming the Joint Commission’s leadership and support. And since I originally hail from Phoenix, Arizona, I am apt to exaggerate the harshness of winter travel, anyway.

If you are not familiar with The Joint Commission, it is an organization with an important mission and positioned to “Help Health Care Organizations Help Patients.” I’ve encountered The Joint Commission’s work in my Informatics leadership role and it has definitely shaped improvements in quality, safety, and affordability of care. There is a lot of respect there.

Convening a roundtable like this is part of a larger process that includes an expert panel, the creation of a white paper, and conferences to influence policy. This roundtable covered a nice cross section of the HIT landscape, with sections on:

• Realizing the Benefits of HIT
• Creating Incentives to Spur HIT Adoption
• Overcoming Implementation Barriers
• Achieving Interoperability

Further, the attendees represented a core group of some of the most dedicated individuals to furthering a better health care system through technology. What was useful for me was the fact that most of the experts talking about HIT are from institutions which have viable PHR’s, or are working to build them. These are groups that understand the realistic promise in this area.

The most striking pieces of data to me were around adoption of HIT by physician practices, still in a range that we find disheartening - 14% by one definition, and by another, even lower at 4%. While patient centered HIT doesn’t require an EHR, it’s certainly easier to support it with an EHR. There was also an excellent overview by Dr. David Blumenthal from Massachusetts General Hospital of the different factors supportive of HIT adoption in different countries - everything from public support, to the presence of certified products, to peer support.

In terms of input I provided, it was to keep the patient at the center of the discussions, to promote patient adoption of HIT as well as physician adoption of HIT, and that transformation using HIT is really an element of an organization’s continuous improvement strategy. HIT doesn’t make this happen, but it makes improvement happen much more beneficially.

How did I leave this roundtable? Overall, very enthusiastically.

On the way to the airport from the meeting, I was able to share a ride with Don Detmer, MD, who is to me something of an Informatics hero, and a person who I believe has even more energy than I do. Don talked about the idea that there is a role for everyone to play, and we shouldn’t get seduced by the concept that there is one stakeholder responsible for forward movement. This is really important for us on the PCHIT initiative as we take our experience and put together some key attributes in our Personas work (coming soon). The other thing he did was recount some of his experience to me, which had a common thread throughout - the work of an inspired leader changed attitudes and then behavior to a different status quo.

I think we should look forward to the publication of the Joint Commission’s white paper on Creating a Nationally Interconnected Health Information Technology System and I am glad that this organization is applying resources to supporting our health system in this way.

I received this insert in the mail recently. No better time like the present than to start blogging. It’s from The Department of Health Policy News, which is described as follows:

The Department of Health Policy at Jefferson Medical College is committed to conducting research and education programs that will contribute to the quality, safety, and cost-effectiveness of health care. The Department’s activities are meant to inform decisions made by government policy makers, providers, payers, and other health system stakeholders about how best to deliver and finance care in order to improve the health of the public.

I support blogging by health system leaders to support a conversation with the people we serve. Of course I subscribed to the RSS feed.

PCHIT links for January 14th through January 29th:

• FreeMD? Your Virtual Doctor - A guided diagnostic tool for patients. There is limited record keeping that comes with this.
• California Could Be Health IT Model, Medicare Official Says - iHealthBeat - PHRs, they haven’t arrived.
• New York Insurers Launch Pilot To Test Medical Home Model - iHealthBeat - PHRs, have they arrived?

January 16th through January 29th:

• Operator of Walk-In Clinics Shuts 23 Located in Wal-Mart Stores - New York Times - Does this mean that traditional health care delivery systems will begin to explore partnerships in retail?
• Partnering with Your Doctor for Better Healthcare - DrGreene.com - Another discussion of the Dr. Haig article by Dr. Greene.
• Report Brief - Institute of Medicine - National Clinical Effectiveness - The IOM proposes a national clinical effectiveness assessment program. It would be wonderful if this was produced in tandem with standardized decision support for EHR AND PHR systems
• Johns Hopkins Informatics Seminars - A nice collection of presentations from leading edge speakers
• IndustryWeek : How To Practice Hoshin Kanri - Information about Pascal Dennis’ work - very useful

I became interested in this book as the story of a profession that started from scratch in the 20th Century, whose ranks grew from a population of a social minority - women in the workplace. In many ways, the story of flight attendants parallels the stories of other health professionals, including physicians and nurses. In my own medical school, which opened for business in 1967, you could walk along the “wall of fame” and at a glance see how the number of women in each class grew from year to year. It was only in the year after mine that there were as many women as men in the entering school class.

I have also grown up in the Jet age, and in an era where a lot of legal rights that minorities now have, have been in place. I recently visited the National Partnership for Women and Families, where I saw legislation that that group helped to enact, including the Pregnancy Discrimination Act and the Family Medical Leave Act. When I saw the physical representation of these laws, and the years that they were enacted, it was a powerful reminder to me that a lot that we take for granted today took a lot of work by dedicated individuals to make them part of society.

It was with this interest that I learned about the history about the flight attendant profession.

Read the rest of this entry »

I am back from my Internet holiday (highly recommended!), which means a return to regular publishing on this blog. We are planning our next trip to New York City, publishing of our PCHIT Personas Special Report, and a final trip to California, stay tuned, and please add to the discussion. Comments are now turned back on for your interaction pleasure.

In the meantime, I ran across this commentary from Joerg Schwarz, the Director of Healthcare & Life Sciences at Sun Microsystems, about the value of the PHR in health care. My presentation at the Northern Calfornia HIMSS in December was useful in that I learned about the role of technology companies, both as experts in supporting a great customer experience online, and as purchasers, in promoting personal health records. Endorsements like Joerg’s below make a difference in fostering adoption across the industry.

Norcal HIMSS chapter - PHR Workshop : Joerg Schwarz on Health Care

I am going on a planned Internet holiday (more information is here), which will reduce the publishing schedule for this blog. Comments on previous posts are closed, but these will reopen in about a week. Thanks for reading!

My second planned Internet Holiday begins tomorrow. The idea came to me from Author Timothy Ferriss, as did the parable that I posted shortly before my last Internet Holiday.

It’s still a useful read. I will be freezing comments in the meantime. Be back in touch in about a week.

Woman aircraft worker, Vega Aircraft Corporation, Burbank, Calif. Shown checking electrical assemblies (LOC), originally uploaded by The Library of Congress.

The Library of Congress has begun uploading an incredible collection of photographs to Flickr, like this one. It seems most have no restrictions on publication. This photo taps into the interest in diversity in the workplace and the contribution that everyone makes to a better society.

PDF: Key HIT Terms, Definitions and Characteristics (nahit.org)

The answer to the question, of course, is a lot. I sat in on a Definitions Forum held today in Washington, DC, to review work in progress around defining and characterizing key HIT terms. These include ones we use and see a lot: EHR, EMR, PHR, RHIO and HIE.

I sensed from the experience that there is potentially (potentially) much at stake in the definition of these terms, because definitions reflect culture. Indeed, Dr. Karen Bell, who opened the session stated that “culture eats technology for lunch.” In my own work, I have learned something similar - “culture eats strategy for lunch.”

Even though the acronym “PHR” is discussed at the beginning of the presentation, the discussion centered mostly on RHIO, HIE, and EHR, and I focused my attention mostly on the last acronym. What I appreciated about the emerging definition of EHR (see page 20 of the presentation) is that it is more aspirational than I have seen in the past. Still, there was some interesting discussion on two specific topics. One, the role of health plan as an actor in collecting and accessing data from an electronic health record. I stated in the discussion that this connection requires further discussion, in my opinion. At the current time, the definition says “collected from and accessible by all providers.”

I think a bigger issue is the role of the patient in the definition. It’s not there. This was brought up, and our moderator, Dr. David Longnecker from the Association of American Medical Colleges, posed an interesting question about this. He wondered if adding patient input to the EHR was similar to listserv’s he has operated where the moderated variety have been more successful than the unmoderated variety. This was a great time to add the experience of Group Health Cooperative, which has shown that patients are very respectful of their care team and of their health record, even now that they are allowed to write to it via the online health appraisal.

Comments (rather than definitions) are still being accepted through the Web site, at this link. The definitions are set to be completed on March 28, 2008.