- When Does a Social Media Policy Go Too Far? Ask the Associated Press – Associated Press is criticized for a too-far-reaching social media policy for its employees.
Archive for June, 2009
Group Health Cooperative: Reinventing Primary Care by Connecting Patients with a Medical Home
June 30th, 2009 | Popularity: 5% 0 comments | Leave a reply- Group Health Cooperative: Reinventing Primary Care by Connecting Patients with a Medical Home – Report from Commonwealth Fund on Group Health Medical Home
What’s Needed Next: A Culture of Candor – HBR.org
June 30th, 2009 | Popularity: 4% 0 comments | Leave a reply- What’s Needed Next: A Culture of Candor – HBR.org – We’ll tackle upward communication first. Consider the results of an intriguing, relatively obscure study from the 1980s, in which organizational theorists Robert Blake and Jane Mouton examined NASA’s findings on the human factors involved in airline accidents. NASA researchers had placed existing cockpit crews—pilot, copilot, navigator—in flight simulators and tested them to see how they would respond during the crucial 30 to 45 seconds between the first sign of a potential accident and the moment it would occur. The stereotypical take-charge “flyboy” pilots, who acted immediately on their gut instincts, made the wrong decisions far more often than the more open, inclusive pilots who said to their crews, in effect, “We’ve got a problem. How do you read it?” before choosing a course of action.
Accelerating toward veteran-centered health care at the Department of Veterans Affairs
June 29th, 2009 | Popularity: 4% 0 comments | Leave a replyI was honored (truly) to represent The Permanente Federation as a guest last week at a summit held by Veterans Health Administration Primary Care in Washington, DC, to review work done to date inside and outside of VHA, for the purpose of continuing to provide the best overall care for our veterans.
The summit included a review of the latest efforts of the Patient Centered Medical Home, given personally by Paul Grundy, MD, from IBM, and Michael Barr, MD, from the American College of Physicians, as well as information given by VHA experts in primary care leadership operations, quality, and across disciplines, including physicians and nurses.
The day and a half-summit included a healthy (in my opinion) amount of introspection that included the best results for our veterans, as well as areas for improvement. As I expected, this group of nursing and physician leaders are incredibly bright and committed to understanding the strengths and weakness of the system they support, to a humbling degree.
This is impressive to see in a system (VHA) that is regarded by many in health care as an example to others as what world class health care should be, and at the same time what I am familiar with in systems like this – an ongoing, healthy dissatisfaction with the status quo.
What I could also relate to in my role is the serious interest, especially in a highly-regarded system, in making sure that primary care is all that it can be, not just in medical offices but wherever patients/people/veterans live, work, and play (and I learned about the existence of the care coordination services – telehealth program). And, as at Kaiser Permanente, the VHA has a commitment to a robust internet portal for veterans, MyHealtheVet. I think the era of the personal health record is a great one for primary care, and vice versa.
In terms of connection to the patient centered medical home, I really liked how this concept was used not so much as a bar to reach, but as a guide and stimulus to create a whole new bar. Systems like VHA and Kaiser Permanente by virtue of their emphases on whole-body, total care, may be more likely to experience challenges faced by primary care across our profession(s) (nursing and medicine) sooner than the rest of health care and therefore be faced with the urgency of solving those challenges sooner as well. Both systems also support multi-specialty care, so there’s good understanding that great specialty care goes hand in hand with great primary care – both are necessary.
My hope is that the solutions they create for veterans will support strong primary care for all Americans, and I am confident that they will. Thanks to the primary care leadership, physicians and nurses alike, for allowing me to observe their work on behalf of our veterans.
Photo Friday: DC Clinovations at Work, in the #Epicenter
June 29th, 2009 | Popularity: 4% 0 comments | Leave a reply 
This week’s photograph was taken at a regular gathering of some of Washington, DC’s most thoughtful health information technology professionals, known collectively as Clinovations. The group gets together to share cross-disciplinary expertise in implementation, policy, and local and national approaches to promoting a better health care system through technology. On this evening, we were briefed on the efforts of Chesapeake Regional Information Systems for our Patients , based in Maryland.
The venue in which the gathering was held, is unique to Washington, DC – it’s the Edward Marc Chocolatier sales office, which is opened to community organizations for events (a little chocolate was included…).
From left to right, top photograph: Joel Selz, Ike Brenner, John Kontor, Anita Samarth, Jeremy Wong, Luana Lewis, Jamie Marraccini, Steve Zlotkus, Gaurov Dayal, Brenda Wright
From left to right, bottom photograph: Jeremy Wong, Luana Lewis, Jamie Marraccini, Steve Zlotkus, Danny Rosenthal
Meaningful Meaningful Use
June 26th, 2009 | Popularity: 7% 7 commentsA little while ago, I wrote about the experience of a patient, Fred Holliday, whose wife Regina Holliday stimulated a discussion about patient access to recorded health information. Fred Holliday died on June 17, 2009 .
On June 16, 2009, the HIT Policy Committee produced its first recommendations of what Meaningful Use should be. I of course am looking at the proposal from the perspective of patient and family involvement in care, and I think in many ways it is impressive.
It’s useful to think about the HIT Policy Committee recommendation in the context of what the law as written says, which is as follows (page 355-356):
‘(2) MEANINGFUL EHR USER.— ‘‘(A) IN GENERAL.—For purposes of paragraph (1), an eligible professional shall be treated as a meaningful EHR user for an EHR reporting period for a payment year (or, for purposes of subsection (a)(7), for an EHR reporting period under such subsection for a year) if each of the following requirements is met: ‘‘(i) MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.—The eligible professional demonstrates to the satisfaction of the Secretary, in accordance with subparagraph (C)(i), that during such period the profes- sional is using certified EHR technology in a meaning- ful manner, which shall include the use of electronic prescribing as determined to be appropriate by the Secretary. ‘‘(ii) INFORMATIONEXCHANGE.—The eligible profes- sional demonstrates to the satisfaction of the Secretary, in accordance with subparagraph (C)(i), that during such period such certified EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as pro- moting care coordination. ‘‘(iii) REPORTING ON MEASURES USINGE HR.—Subject to subparagraph (B)(ii) and using such certified EHR technology, the eligible professional submits information for such period, in a form and manner specified by the Secretary, on such clinical quality measures and such other measures as selected by the Secretary under subparagraph (B)(i).
That’s the complete definition in the law.
With that in mind, the thinking of the HIT Policy Committee is inclusive of a policy priority they call “Engage patients and families,” with a fairly reasonable (based on what I know the technology can do) set of objectives and measures for 2011-2015. The way I interpret the thinking in this set, it is that in 2011, patients will begin to read their records online, in 2013 they will begin to write their records online, including via secure messaging with their providers, and in 2015, there will be full real-time access to a personal health record populated with their data.
The measures in 2011 include the use of an after visit summary, which I’ve written about previously, and is relatively easy to measure (and produce, in my opinion).
I think the measures are a nice compromise between what leading edge health care systems can do today versus where all health care systems should be in the future. I’ll also say that this component of meaningful use is likely to help all of the other components be more successful, because they will cause health care systems and providers to see the impact of what they do, through patient reaction. To the patients out there, what do you think?
Photo Friday: Check the Accuracy of Your Message – Have it Drawn For You
June 19th, 2009 | Popularity: 11% 1 comment
While speaking at the Institute for the Future’s Health Horizons’ Spring 2009 Conference (LiveTweets here and more organized here) about Combinatorial Innovation, with William Ruh, Vice President, Cisco Systems, Larry Tessler, from 23andMe, and Mike Liebhold, Senior Researcher from IFTF, I had a great opportunity to have my words documented graphically, by a very talented visual recording artist.
You could look at the product and get a sense of what I was speaking about on behalf of Kaiser Permanente – member/patient as the hub of health care, engaged doctors with their patients, moving ahead together in the interest of those they serve.
Seeing the documentation is also a great check on accuracy – and in fact, it showed an error in my discussion – the “$5 billion Project” attributed to Kaiser Permanente HealthConnect is actually $4.2 billion, which is a big difference in discussing the investment of a non-profit health system in leading edge technology.
I think (and thought) this was a great opportunity. How can a person tell what the audience feels after they tell a story about something like patient empowerment using technology? Extrapolating to the patient-physician encounter, how does a patient know if their physician understood the significance of their story? Seeing the documentation is very powerful, and a visual check on creating the right impression of the work is very innovative, in my opinion.
Thanks a ton to Institute for the Future for hosting a great discussion, and for allowing me to touch base again wtih two of my favorite leaders in the universe, Karl Hoover and Diana Elser, both from Group Health Cooperative, and as of the date of this discussion, now on Twitter (Follow them here: @kmhoover @dlelser and please encourage them to share their experience in this medium…) Welcome aboard!
