Jonah Froelich, MPH, California Healthcare Foundation’s resident expert on health information technology sent this along to me and I wanted to post it. It shows the spirit of health professionals who are changing the way they practice because they want to perform better for their patients. Scenes like this are happening all over the United States. Thanks and congratulations to West County Health Centers and (again) to the Redwood Community Health Coalition for sharing their enthusiasm with patients everywhere.

While at Massachusetts General Hospital last week, as a guest of The Stoeckle Center for Primary Care Improvement, I was invited to meet the team at the Laboratory of Computer Science based at MGH. The Lab of Computer Science produces the OnCall series of clinical web portals, which are a front end to the Computer Stored Ambulatory Record medical record system.

The reason it is a “series” and not “a front end” is because this system actually has brands that are specific to the specialties and care that it supports. Here’s a picture from a computer screen that shows them:

Apple’s newest advertisement. It’s sort of a metaphor for health care, if you watch closely….

The PCHIT blog is moving to its new home at the Center for Information Therapy next week.

We’ll post a link to the new blog here, and then automatically redirect all traffic to the new site.

This blog was started along with the initiative in October, 2007, and will, as planned, move to a site hosted by the Center for Information Therapy. Josh and the IxCenter will maintain things there, including the 141 posts and 155 comments that resulted from this effort.

The new blog will continue to discuss important developments at the intersection of HIT and patient-centered care and build on related work going on at the IxCenter.

Ted will continue to write about his own experiences in health information technology, patient empowerment, reducing disparities, and physician (and patient!) leadership at http://www.tedeytan.com/.

We learned so much from the committed organizations we visited, all of which involve practitioners dedicated to promoting patient-centered care. We also learned, as one medical director colleague once said, that we are living in a hailstorm of innovation. We thank all of the organizations and the people who support them, for their time and interest in their patients and communities.

We also thank the supporters of this work

Imagine that you are going to launch a new program, like patient access to their medical record online, and a visitor from another institution asks for a tour of the work in progress. Then imagine that it isn’t a member of the staff that does the demo - it is one of your patients. I think this idea would sound foreign to most organizations. It’s pretty normal here, and Christine did a great job, on her own, without any oversight or hand holding. This is the level of trust that exists here.

Images, click any to see larger

I have actually never had a patient demonstrate their own access to the electronic health record to me. This was the first time in my career. I am so used to doing the demos and describing what patients want, and this was so different because it included the things that worked best, but also the hopes and dreams for using this tool to be involved in care. Christine not only did the demonstration for me, but also 3 Medical College of Georgia Students, and part of the research team on a funded project to introduce patient access into hypertension care.

In the hopes and dreams part, Christine talked about uses of the system that we might consider concerning as medical professionals, such as writing messages that conveyed a significant level of concern about her condition (she lives with MS), but when she explained it, it made sense, and it became not so concerning.

This was a theme throughout the visit - the normalcy of patient and family involvement in care. This was very evident in the 3W Neurosciences unit and Ambulatory clinic. Countertops are reduced or eliminated. The layout is open. There is no such thing as “visiting hours.” Signage is welcoming and participation is encouraged. There are alcoves for family conferences, and even computers set up for families to use. There is guest wireless throughout the hospital.

As you watch the Remaking of American Medicine show and look at the data associated with this tranformation, it’s very clear this is not only good for families and patients (and society), it’s good for business. Quality is up, mortality is down, patient satisfaction is up, profits are up - all the right trends for a hospital serving a vital population like this.

This organization of course is part of a health care system with many challenges - physicians and nurses have significant time challenges, and even the physicians in training here are at risk in terms of their future enjoyment of the profession. I casually ran my idea of a 4th year rotation on patient-centered care (which would include elements of LEAN such as process flow, physician leadership, and service and access methods) with our student hosts, and they provided a little balance to the concept and assistance with messaging. Matt, Kim, and Brandi reminded me about the immediate needs of physicians in training and the way that they learn about and commit to new training experiences. I’d therefore like to propose a rotation on success in practice beyond the diagnosis - enjoying work, life, and balancing both successfully. Being patient centered guarantees that this is the outcome for any physician, in my opinion.

The thing I am super interested whenever I meet people who have done exceptional things is, “Why?” I noticed that in the PBS show, Medical College of Georgia was an institution in which their transformation was not set off by a patient tragedy. So I asked Pat about this and here’s what she said:

What started this and kept it going and I may have told you this in a way is that we developed a value around the inclusion of the patients voice in our work from the beginning of the design process for the new childrens hospital. I personally was a senior executive back then and I was utterly transformed by the power of the patient’s (in this case, parents and children) perspective on what mattered most in care and I could see that this was a strength that we were denying ourselves as executive leadership. We also had very good mentors way back then in Bev Johnson and the Institute for Family Centered Care and I think we were just open to learning. Because I became so committed and over time could show the hard results in terms of outcomes so did the rest of our leadership. I think it is really that simple….just persistence over many years, Ted.

I think this is very remarkable - Pat and the Medical College of Georgia did not wait for a patient to be hurt to transform their system. I keep reading and hearing about organizations that transform only after a tragedy. We’re health care, we cannot wait for a tragedy, right?

When we were touring 3West, Pat, Roslyn, and Bernard showed me a plaque, signed by every staff member that represents their commitment to patient and family centered care. The first thing I did was look at the date that it was first signed, and of course wondered if it was up to date. As I did that Roslyn said, “Whenever we get new staff, they add their signatures, too. We haven’t had new staff in a long time, though, because people stay here.”

I can’t wait to see the innovation that will come from Medical College of Georgia in the launch of their patient access system. This will take Patient and Family Centered Care beyond their physical buildings and wherever patients and families live, work, and play.

With thanks again to the patients, families, staff, physician and leadership at MCG for being great teachers, so that every patient and family can be involved in their care, whether or not they are fortunate to be supported by the MCG Health System.

And, I am not going to consider patient access to their medical record successful until a patient does the demo.

The quote in the post comes from Roslyn Marshall, RN, Nurse Manager of the 3West Inpatient (Neurology and Neurosurgery) unit at Medical College of Georgia, in Augusta.

Images: Click on any to see larger

Just as with several other organizations I have visited, I did not imagine that I would be heading to Augusta, Georgia to learn about how to involve patients and families in their care, but I’m glad I did. This is a place where so many things that are seen as abnormal in the rest of health care, are normal (see this paper for a description of patient centered care, with a focus on MCG). In an environment like this, it’s okay to ask “why?” when it comes to issues of involving patients and families in their care.

The occasion of my visit is related to a grant that Medical College of Georgia has received to study the use of a personal health record to improve hypertension care. With respect to the idea that being as close to the patient as possible is important, Ms. Pat Sodomka, Senior Vice President of Patient and Family Centered Care, hosted my visit on behalf of the organization.

Part of my study included watching the excellent program, The Remaking of American Medicine, which featured Medical College of Georgia in its last hour, and it was amazing to see how much has been accomplished both in involving patients and their families, and in transforming the organization.

Today, I’ll post about what I saw clinically. Tomorrow, I will post about what I saw systematically in this leading edge care system.

I began in Family Medicine and Internal Medicine, where practitioners and patients are both busy, and integrating one or two electronic health records in the care that they use. This is what I observed when shadowing family medicine specialist Bill Phillips, MD.

Besides data from their own organization, they need to integrate the needs of patients working to stay healthy in a system with an affordability crisis. In my own practice, I had not had to think about which big box retailer offers which drugs for $4 , or even free, as a loss leader. However, this is a big issue for patients. I reviewed the formulary for Wal-Mart’s $4 program - it’s extensive.

I was able to shadow the Director of the Osteopathic Medicine Program, Julie Dahl-Smith, DO, who is also board certified in Family Medicine, as she performed a manipulation visit and acupuncture visit for a family. This made me think about the value of patient involvement through a personal health record. The treatments that Dr. Dahl-Smith provides are distinct from the allopathic treatments that I have been trained to do. There’s an opportunity for patients to become more knowledgeable about the treatments that work best for them through patient access.

I spent time with Shilpa Brown, MD, who manages her own faculty practice as well as a residency practice and extensive student teaching. Patients in each have distinct needs. I also observed some key differences in workflow between private practice and academic practice. Faculty are ultimately accountable for 1, 2, 3 or more residents’ care, whether that care is provided in person or virtually. There is much that MCG will contribute in this area as an innovative academic medical center.

In between, I visited with the Neurosciences Interdisciplinary Rounding Team, which includes nurses, pharmacists, students, residents and attendings, led by Dr. David Hess. This is a unit, 3W (which I will talk more about tomorrow) that serves patients and families not just locally but regionally. What would it be like if a family member who is based far away from Augusta could connect with their family’s care team electronically? The team was open to this idea.

This organization is unique in my travels because it is a full academic medical center with many top notch training programs, which include a family medicine residency and an osteopathic residency. It is also special in the way it involves patients and families in the care, through its advisor program. The program reaches all the way into undergraduate medical education, and every new program seeks involvement. Patient advisors are free to visit MCG facilities and talk to patients and families about their care.

As I was being guided to the Internal Medicine clinic by Bernard Roberson, Director of Family Services Development, we passed by one of the “commons” (a different way of thinking about a waiting room that’s more patient centered) and a patient waiting to be seen said to us, “Tell me more about patient and family centered care.” It turned out it was one of MCG’s Patient Advisors, and I think we both saw it as a welcome sight. That’s how things are different here.

Tomorrow, a post about the system-ness of Patient and Family Centered Care at Medical College of Georgia.

It’s interesting that it worked out the way it did, but the last organization I am visiting on my PCHIT journey is the organization I started at, Institute for Family Health. I didn’t plan it this way, it just happened. This time, though, things are different. IFH now has a physician champion for its online patient access to the medical record, Adam Szerencsy, DO, who is also the Medical Director of the Urban Horizons Medical Center in Bronx, NY.

Pictures, click on any to see full size

I give the leadership of IFH credit - when I first met Neil Calman, MD, literally on the first day of my sabbatical, he said that they would be launching patient online access in Spring, 2008, and here it is, happening. Spring, 2008 seemed like a long time for patients to wait at the time.

In the interim period, I have worked with Neil and Adam and their superstar developer Jonah some, but they have done all of the work. My visit was a bit of a graduation day for me, and it was terrific. At the end of every patient visit, Adam excitedly told every patient that they, too, would be able to share in the access to their own medical records. I really loved the way he inquired, too. He would start with, “Do you have a computer at home?” Some patients said, “No,” but he did not stop there. He then asked, “Do you have access to the Internet?” And guess what, I think every answer to that question was a “Yes.” The best part for me was to watch Adam talk to patients about how he would be there for them in this new way.

As with every other innovative organization I have visited, I learned of a new application of the patient access system - in a community where primary care / specialty care communication is at a premium, Adam will use this system to support doc to doc communication, by keeping patients informed and involved in their care. They will have access to a secure web site with their medical information (using a system manufactured by Epic Systems, Inc.), and will be able to print or show this information to referral physicians. In a sense, they will become human information exchanges. It’s important to know that they are already serving in this role - this will add accuracy to it and empower patients with their own medical information.

One other little thing that I hadn’t considered that Adam pointed out to me was the work of documenting in English on the electronic health record at the same time he was having a spanish conversation with the patient. He has mastered this now, but it’s another consideration for our field (Informatics) to have as we support culturally competent care. The record is in English, the conversations are not. What’s best for our patients?

After shadowing Adam in his clinical morning, we had lunch at a local eatery in the Bronx, and talked about the future. Adam has done a lot of work to support his physician colleagues in adopting this technology and as an adopter himself, and the Medical Director of his medical center, I think he’s put together the winning recipe - enthusiasm, energy, accountability, leadership, for the patient and for the community. When Institute for Family Medicine is successful, they will have a wonderful story to tell health care about how every patient in every health care system deserves the best health care available anywhere.

After talking about our digital futures, I asked for the check, and it came as a reminder of the past - a written piece of paper. I took a picture of it for this blog and captioned it with Adam’s word when it was handed to us. He said, “Authentic.”

Moving to a new blog

This is the last post of my journey here with PCHIT. I’ll be continuing at http://www.tedeytan.com, as this blog moves over to the Center for Information Therapy. I’ll post more on that soon.

In Augusta, Georgia, a national epicenter for Patient and Family Centered Care, as featured on “The Remaking of American Medicine.” It’s a really impressive place. I’ll be blogging more about it soon. Nothing provides more energy than patient empowerment.

When I found out that Sal Volpe, MD, Mat Kendall, and the PCIP team were going to be talking about their work in the community where Sal practices, I knew I wanted to come and experience it.

We started with Sal allowing me to experience the trip from Manhattan to Staten Island, which can take up to 2 hours by car as it did this day. This says something about Sal’s commitment to this work. He makes this commute regularly to support New York in rolling out this program, at the same time he supports his family and Internal Medicine/Pediatrics/Geriatrics practice on Staten Island. On the way over, he told me how the electronic health record has changed things for him. Prior to having an EHR, he used to take his sons for a walk to his office, where he would catch up on charts for a bit, and then walk with them home. Since that time, they don’t have to stop at the office anymore - they just walk longer together. This is not to say that the EHR has reduced the workload, it has allowed Sal to integrate it better with his family.

We arrived at Richmond University Medical Center and began with an overview of the PCIP program by Mat Kendall, the Director of Operations. It really is impressive to think that here is a Department of Health actively engaged and interested in community providers having better tools to take care of patients first.

Sal then came on and presented his experience, and I think his experience is important, given that he manages his own practice and accepts the risk of the business decisions he makes. With the data showing that EHR’s are more prevalent in group practices, Sal’s story is important in the conversation. He included his experience with the patient portal that comes with the system he uses, which is manufactured by eClinicalWorks. He then spoke about the fact that since he turned on the system, he has given every patient a copy of his physician’s progress note. When asked about this, he said, “What’s wrong with giving them a copy?” I thought that was a great question to ask of all physicians everywhere.

I was given a ride back by Mat Kendall and the rest of the PCIP team. Spending time with Mat reassures me that optimism is infectious - usually I am the most optimistic person in the room but when I am around Mat, this is not the case. It’s always nice for me to have optimism radiated in my direction. We had a nice conversation about the future of the program and of the patient portal in it. Mat has 4 years’ worth of experience managing a Federally Qualified Health Center, so he has a good idea about how to be successful with patient access, and I believe him. Despite the challenges of a visit-based reimbursement model, there’s the idea that patient access will improve access to good health care and promote better use of the system among patients who do not know their risks. Mat also points out that the data to date about visit reduction comes from commercial health plan settings. The PCIP team is well aware of data about Internet use in the population it serves and the potential benefit from giving them access to data contained in EHR systems. Right on.

I left the conversation and the evening as optimistic as I ever have about patient access to health information technology. Before I started this journey, I didn’t forsee that one of the most innovative practices I would discover would be in Staten Island, NY, or that a Department of Health could steward health information technology adoption for a whole community. I did and they are.

The quote in the title is from Mark Snyder, MD, Associate Medical Director, Information Technology, Mid-Atlantic Permanente Medical Group, who once again, volunteered to demonstrate how Kaiser Permanente improves medical care for patients using the latest technology. This happened at Kaiser Permanente North Capitol Medical Center, which takes great care of a community that includes the United States Capitol.

Mark was demonstrating the After Visit Summary, in this case, to a group of leaders from the District of Columbia Primary Care Association, which is currently undertaking an impressive program to implement health information technology in safety net medical centers in Washington. Senior Project Specialist Lauren Mardirosian was in attendance, along with Tracy Knight, NW Social Services Director from Bread for the City, and Deborah Parris, Health Information Manager from Family and Medical Counseling Services.

I set up the visit, with Kaiser Permanente’s help, because I am excited by the fact that our members’ experience can help patients in every care system, locally and nationally. It’s a virtuous circle - sharing our experience brings other experience back that we can use to do even better, and the cycle continues. I have really learned the reinforcing power of sharing in this journey. It’s even more enjoyable when I get to work with colleagues like Mark and Medical Center Chief Doug VanZoeren, MD, who willingly give their time alongside me.

What about the After Visit Summary? Mark showed that by involving the patient in its development, he makes the creation as important as the delivery in achieving its goals - involving patients and families in their care. In an era where we talk about Web2.0, Health2.0, and focus on user generated content, I think this is a great example - we create the record of what happened today, together.

DCPCA is implementing a modern electronic health record system, manufactured by eClinicalWorks, that has this capability. A care system that I visited in Sonoma, California, is already generating these for patients. Sometimes a piece of paper (albeit one that is also available on the Web in real time, on Kaiser Permanente’s personal health record, kp.org) can be as revolutionary as the people who put it together.

Thanks again to DCPCA, Mark, Doug, and Kaiser Permanente North Capitol Medical Center members and staff for their interest in helping patients everywhere.

Pictures: Click on any to see larger. Note: The patient displayed is a test patient. No actual patient information was demonstrated during the visit.