Archive for May 15th, 2008

The 100,000,000th Electronic Order – Results reviewed by patient online :)

May 15th, 2008 | Popularity: 9%
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Two proud health information technology leaders from Group Health Cooperative, Terri Boehm, Director of Web Services, and David Kauff, MD, let me know of an important milestone, relayed by another great technology leader, Emily Hull, Associate Director of Clinical Informatics:

Subject: 100,000,000 orders in EpicCare!

Reaching the 100 millionth order placed in EpicCare gives us a wonderful opportunity to focus on the shared accomplishments of many parts of Group Health. Even better, this order represents many of the value-added features of care at Group Health: the order was placed by a hospitalist working in Lidgerwood Family Practice, the test was processed by PAML, and the patient has already reviewed the results on MyGroupHealth.*

To translate a bit – the order was placed electronically in an Eastern Washington Medical Center, it was transmitted securely to an outside laboratory, and results were simultaneously transmitted back to the patient (via the web portal) and the physician (via the electronic health record), securely, at the same time.

After 100,000,000 orders, what used to be abnormal (patients being involved in their care) is now normal, and the staff that manages the electronic health record system considers the patient as important a stakeholder in the use of the technology as those who care for her/him. This is the positive transformation that awaits other organizations who design and implement systems with patients at the center.

*A reminder that staff do not have access to patient health record information in the example above, just the information that messages were delivered.

Internal Medicine 2008: Focus on the Practice

May 15th, 2008 | Popularity: 23%
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Yesterday I had the privilege of speaking at the pre-course for Internal Medicine 2008, American College of Physicians annual conference, in Washington, DC. The topic of the pre-course was the focus on the individual practice, and was facilitated by the great team at the Center for Practice Innovation, including Michael Barr, MD, MBA, FACP, Paula Woodward, MPH, BSN, RN, and Maria Rudolph, MPH.

I really like working with this group first of all because Michael and Paula assemble entertaining and fun experts, like Gordon Moore, MD, Rodney Hornbake, MD, and Peter Basch, MD. All of these physicians, and fellow panelist, Maria Rudolph, are “current” in the field and honest and passionate about improving patient care, which includes being able to stage agreement and disagreement. It’s sort of East Coast, and I like it.

The second reason I like this group is because they represent the overwhelming majority of care environments for patients in the U.S. (over 90% get care from small practices). In terms of promoting patient-centered care for every patient in every system, these are the physicians who have both the ability to innovate and the fiduciary responsibility to make it work for their practice. Putting those two together makes for a perspective that is supportive of HIT and patient centered HIT (that’s what I observed) that succeeds for patients, and those who care for them. I think that’s what we want.

We were asked to provide some parting words for this group, and honestly, I feel a bit awkward being a teacher to this group of practitioners. In many ways they see a lot more of healthcare than I do. In any event, my parting words were that when it comes to HIT, they know more than they think they know, and are well suited to ask, “how will this work for my patient?” That and they should ask every patient if they access the Internet.

ACP enters the blogosphere this week with ACP Internist. A great move for this specialty society, in my opinion.

My visit was capped with a trip to see my colleague David Kauff, MD, from Group Health Cooperative. I have to say that I had to make my way through quite a bit of product placement (more than I would expect to see in 2008), and I wasn’t allowed to take pictures in the exhibit hall, but it was well worth the trip to meet up with one of my favorite internists.

The Case for Hypertension and Health 2.0: California

May 15th, 2008 | Popularity: 33%
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This is simply a redrawing of yesterday’s graphic, based on California population data. This site has an excellent overview of the impact to California. It understates prevalence because it speaks of patients who have had hypertension diagnosed and does not include undiagnosed Californians.

I found a more recent article and updated proportions accordingly ( see, I did find something wrong with the previous diagram )

Click on the images to enlarge

I added a new source, #3 below, since yesterday. This paper has newer control data with a more optimistic point of view:

The prevalence of hypertension has not increased significantly since 1999. At the same time, there has been increasing control rate of hypertension, especially in Mexican American men, elderly, and obese people – Ong, et. al (see below)

(formatted for Zotero):

1. Fang J, Alderman MH, Keenan NL, Ayala C, Croft JB. Hypertension Control at Physicians’ Offices in the United States. Am J Hypertens. 2008;21(2):136-142. Available at: http://dx.doi.org/10.1038/ajh.2007.35 [Accessed May 8, 2008].

2. Rosamond W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics–2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-146. Available at: http://circ.ahajournals.org [Accessed May 7, 2008].

3. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999-2004. Hypertension. 2007;49(1):69-75. Available at: http://hyper.ahajournals.org/cgi/content/abstract/49/1/69 [Accessed May 15, 2008].

Tomorrow, a look at costs, direct and indirect, for the nation and California.