March 7th through March 11th:

• Frist Advocates Higher Medicare Payments for Doctors Who Use EHRs - iHealthBeat - An idea to promote network preference among physicians who adopt HIT.
• Marissa Mayer’s 9 Principles of Innovation | Fast Company - I love number 5
• The Curious Genius of Twitter - Evan Williams - Tweet | Fast Company - Will Twitter go the way of friendster? I think there could be applications of Twitter in Health Care (really)
• Area Tap Water Has Traces of Medicines - washingtonpost.com -
• Farm Workers Service Wheel - Services for farm workers in Sonoma County. Showing that the Internet can serve everyone

Imagine that you were working internationally and had a serious stomach ache and needed to see a doctor. When you went into the medical clinic, the doctor asked you what medicines you were taking and what the status of your medical conditions were. What if you didn’t know or couldn’t tell them because you were in so much pain or you had seen a doctor but they didn’t give you a copy of your medical record. What if you lived in that same community for 5 years, but weren’t sure if you needed any medicine or treatment to prevent illness, and no one was keeping track. What if it felt like you didn’t belong….

While in California, I was honored to be invited to visit with the principals of MiVia, based in Sonoma, California. Here’s a short history of the system

MiVIA™ (My Way) was designed as a collaborative effort of Vineyard Worker Services, St. Joseph Health System- Sonoma County and Community Health Resource & Development Center in 2002. Since then, these community based organizations have worked closely to help improve the quality of life and health conditions of farm workers living and working in the Sonoma Valley and beyond.

Today I will post about my experience with the health care associated with MiVia. Tomorrow, I’ll post a virtual tour of the system.

I arrived at the MiVia headquarters in Sonoma, a humbly-appointed, former OB-Gyn practice, where I was greeted by Cynthia Solomon and Heidi Stovall. Heidi offered me the choice of an overview of the work before heading over to the mobile health units. Of course I chose to go to where the work happens, and Heidi told me the story along the way. During our ride, I learned that MiVia was born out of a personal family need for members with significant health conditions to have their medical information available at all times. Then, in looking at the community, for them to have this access as well. What Cynthia and Heidi did was take their experience managing private medical practices, and apply it to community clinic settings, and ultimately in the care of this population (farm workers without ready access to care), and I am so glad I got to see it from this perspective.

We arrived at La Luz Community Center, where the St. Joseph’s Mobile Medical Clinic was parked, and I was introduced to Jessica Alcantar, one of the “Promotores de Salud,” and Jackie Williams, the Supervisor of the Clinic. Jessica showed me how she brought families into the care system by signing them up for MiVia first. The Promotores program is an innovation of this health system, and is essential to the use of the personal health record system. It allows anyone to have access to MiVia, and the team also does educational sessions about the use of the Internet for this population. Jessica told me that as an exercise, she taught the use of Google Earth to show people how they could find their nearest library. I asked about the value of the Internet in this population, and Jessica said, “They know the advantage of being able to connect with people back home.” A great demonstration of the shattering of conventional wisdom that the Internet is only useful for some and not all.

MiVia was developed in collaboration with the people it serves, and one of the unanticipated “wins” of the system was the MiVia ID card (see pictures). These can be printed on demand off of the Web, and are also issued to members as laminated card. For the people being served, this is often the only identification they have, their only tangible “belonging” to this community. The card is not just identification…more on that tomorrow.

In La Luz, a healthy cooking class was taking place as patients were being seen in the mobile clinic.

Here are my pictures from the visit, click on any to see full size, and then the “continue” link below to read on….

Read the rest of this entry »

This article is very interesting to me, because I seem to be living the statistic:

In the air, health emergencies rise quietly - USATODAY.com

I have been on several flights in the last 2 years with medical emergencies on them. On the last one, there were so many doctors on the flight, that the flight attendants actually turned people away from assisting. On two I have been on, I was the only physician on the flight, but not the only allied health professional (nurses are as important as physicians in these situations).

I’m glad this is being reported on, because I think that this issue should be recognized and there are some opportunities for us to do some things:

1. Establish helpful guides for patients deciding whether to fly or not. For example, a person recently discharged from a hospital with a new medication regimen may be at risk on a transcontinental flight
2. Establish helpful guides for airline personnel for working with in-flight physicians and nurses. This includes seeking out the right expertise, and maybe a 30 second coaching session on procedures like using the air to ground radio and what is available and not available on board (and there’s usually a medical kit with a lot of useful things on board).
3. A guideline about intervening on a flight plan. One thing that was confusing for me in the times I assisted surrounded landing a plane in an emergency - this is the kind of thing I don’t want anyone to be guessing about. If a patient is critically ill, there should be an option to order a plane down to get help, and maybe scripting that goes with this. What’s possible though - how long does it take to land a plane and is it better to continue on and bring medics on board? Sometimes, it’s the humane thing to do to get help quicker.
4. A guideline for medical providers to prepare documentation and work with flight crew to maximize their talents in an emergency. Maybe an introduction as to who has medical experience and what they can do (perhaps as part of the 30 second orientation I spoke of).
5. Maybe, a guideline for patients and providers. In an in the air emergency, people encounter very intense moments and form something of a bond. I think it is therapeutic in some cases for the provider to connect with the patient/family after the incident is over, or with the patient’s regular provider in some cases. I did this with one family and it was really special.

I also have to make a broader societal call for our profession to engage in making medication reconciliation a norm in all parts of care, and in involving patients in their care by giving them access to all of their medical information (as I did in this blog post about a medical emergency I attended to on the ground). Informing and empowering patients throughout the process of care prevents a devastating outcome in these situations. None of us wants a family member in distress in a situation where they do not have accurate information about their health care regimen that they can either tell someone or have written down from their physician.

An in-air medical emergency is both an intense time and a time when people come together to do the best they can to help another person. I am a big fan of creating a process where everyone can maximize their talent and minimize their anxiety during a life or death situation.

If anyone else has attended on an emergency or seen one in the air, let me know your thoughts. Comments are open.