Latinos Online: Summary chart, Pew Internet & American Life Project

We held a successful Advisory Group Meeting of the PCHIT initiative yesterday (and will post about that shortly), and one of the many pearls we received was from Susannah Fox, regarding the characterization of Internet access among populations. Through her research, she characterizes Internet access as a “dimmer” rather than an “on/off” switch.

She presented a visual example to us in a “thermometer” diagram that she created as part of her report on Latinos Online, published in March, 2007. She is planning to produce similar data on Internet access as characterized by device (e.g. cell phone) as well. She’s given us permission to reproduce the visual here.

Ending the use of the term “Digital Divide”

The approach of the Pew Internet and American Life Project seems useful moving forward as we think about bringing patients and their families of all backgrounds into the care experience. With that in mind, I am going to discontinue the use of the term “Digital Divide.” I don’t think it accurately describes Internet access across populations in the United States.

Your comments on this are welcome, of course!

Today is the second meeting of the PCHIT Advisory Group (Click here to see their picture and biographies). We have nearly 100 % participation, with the exception of Chuck Milligan, who is out of state right now.

This blog is as much about PCHIT as it is about working on PCHIT, and the Advisory Group component has been very important. Our meetings have created opportunities to stop and ask “Why?” for everything we are doing.

This particular meeting has a defined purpose, which is to assist Josh and I finalize a piece of work we are putting together for this effort, called “PCHIT Personas” (And maybe the group will help us if the name isn’t quite right, either). This borrows from a concept of user-centered design where professionals create personas around the individuals they are designing for. Our personas are not people, but entities, such as safety net providers, health plans, multispecialty groups, and integrated delivery systems. We want to assemble our experience so we can know what each entity is about and what their influencers are. We are also learning about what our influencers are, as well. We then want to take that information to frame our next three months in terms of what we will “do” to support PCHIT, since this is about doing, after all (within the framework of PDCA though….).

Reflection is great. And to have help from experienced and bright individuals like this makes it even better. We’ll post the outcome of our discussion, happening at the Center for Information Therapy World Headquarters in Bethesda, tomorrow. Wish us luck!

Charles Milligan, Jr., is the Executive director of the Center for Health Program Development and Management, University of Maryland, Baltimore County. I have to insert here that Chuck is also an alum of the University of Calfiornia, Berkeley School of Public Health…

The Center’s Mission is “…to work with public agencies and nonprofit community-based agencies in Maryland and elsewhere to improve the health and social outcomes of vulnerable populations in a manner that maximizes the impact of available resources,” and Chuck brings his experience here as well as experience supporting diverse populations in California in the areas of health care law and policy.

Chuck stimulated a very key conversation that resulted from a little confusion of my part (as I have now surmised). We talked about “PDCA cycles” and the idea that in the Toyota Motor Company, 80% of time is spent on planning, 20% on execution, the opposite of some American Companies. In our discussion these concepts seemed at odds, because as Chuck pointed out, policy makers benefit from quick movement from planning to execution so that they have something concrete to work off of.

Chuck also provided guidance on consumer involvement, that as we look to readily available sources of input, we should also look for not-so-readily available sources of input, because community boards and the like may not be truly representative in every case.

As Maryland’s leading public applied research organization for Medicaid Managed care, the Center is working on appropriately adjusted outcomes measurements that support reimbursements, or as Chuck stated, “report cards that are fair.” His group is also working on an electronic health risk appraisal and the impact on utilization before and after.

With UMBC itself, Chuck alerted us to a forum on behavioral health issues on campus, that will touch on issues of confidentiality and safety, which will happen on November, 27.

The Adjust: I couldn’t wait to resolve the issue regarding “P” from PDCA and “Planning,” and referred that question out to some experts in the LEAN world, which is detailed on the DailyKaizen blog in this post. The adjust, therefore, is in my opinion to keep going by rapidly improving what we do, and the 80% time planning spent happens in the P, C, and the A parts of the cycle. In that respect, Josh and I are doing regular checks on what we are doing. I am also working on setting up a visual system for the work (I will post the picture here, of course).

Chuck is one of the experts on our group regarding reimbursement and care of vulnerable populations, so as with other members of the group, we would like to check on what is happening in this arena. We are already doing that a bit based on the guidance by working to arrange discussions with payers in communities we are visiting. We did this in Boston, and are working to do this in California, our next stop.

Deven McGraw is the Chief Operating Officer of the National Partnership for Women and Families and brought terrific community-centric perspectives to the discussion, through her work with the Partnership and also through her expertise on health information technology issues.

She serves on the Privacy, Confidentiality, Security Workgroup of the American Health Information Community and is our link to that organization. She is working on defining what the best privacy and security protections are for consumers. She is also active in policy issues and specifically empowering consumer groups to impact ways that systems are shaped. This includes access, and also beyond access to issues related to the quality of care once access is achieved. New developments for her work include work to provide technical assistance to state-based organization.

The Adjust: Deven talked with us about creating “workable models in a community where people enjoy what they have.” This was key in that the measure of success will come from the people who are being served rather than the care providers, and this is what a federal system can point to and scale. With this in mind, we are going to gather information about community and consumer involvement as we work with organizations. As we just got back from Boston, we already started bringing this into the conversation. It is critical because when adoption of PCHIT by patients is at issue, it is relevant to look at their involvement. Another adjust at this point is to think about how this work will support policy activities - we really have not defined that at this point (and purposefully, from my perspective, to get experience at the practice level). From here, though, we should begin investing in awareness of the work of the National Partnership and other policy experts to shape this work for that audience.

Continuing where I left off last week, with feedback and adjustments from members of the PCHIT Advisory Group:

Susannah Fox is an Associate Director at the Pew Internet & American Life Project, whose work has been very influential in describing people’s use of the Internet.

Susannah just published a report on patients with a Disability or Chronic Disease that we mentioned here previously.

Upcoming work that we will take note of includes work around PHR’s and EHR’s (Susannah is currently a contributor to e-patients.net), and a research agenda that will go beyond measuring simple Internet use. She describes this as “Attitude, Actions, Assets” and is looking at information ecosystems and people. Within these reviews, she will focus on 2 key populations: Latinos, and Teens. Within the teens group, she will be taking a look at gaming, and teens and writing.

It goes without saying that we follow Susannah’s work in a very dedicated fashion. I have been subscribing to the RSS Feeds offered by their site since I started using RSS. The forthcoming reports will offer an important view on PCHIT, especially now that I have returned from Boston and was able to observe care given in leading edge medical centers serving Latino patients, among others.

Key health care leaders are saying the time for PHRs are now. Based on the Boston visit, I am saying the time for multilingual and culturally relevant PHRs is now. We’ll be therefore eagerly awaiting these two new reports on the Pew web site.

Speaking of the Pew web site, Susannah is also managing its redesign, to make the information more modular and accessible, while incorporating the latest Web 2.0 feature. At least that’s our expectation. Given Pew’s current work in informing builders of Internet services for patients, we’ll look forward in how they inform the builders of the communication tools of those builders.

PCHIT Advisory Group - Slides

This post is first in a series will summarize our status and input from our Advisory Group (Blogs are about a little information at a time). Both the Group and this audience are welcome to comment. Our goal is to make any adjustments necessary, now, and continually improve our process as we do this.

The summary comes in the form of an “A3″ document and a short set of slides. The slides are published here.

A reminder that an A3 document really just outlines a story. It’s probably best for this medium for me to discuss the work of each Advisory Group member (with the exception of Patricia Flatley Brennan, who could not be with us this first time) and the impact on adjusting our work.

To also keep this manageable, I’ll do it over the course of the week, one each day.

Michael Barr, MD, MBA, FACP: Michael, as Vice President of Practice Advisory and Improvement for the American College of Physicians, is leading the Medical Home work of the College. This includes establishing the “systemness” of the Medical Home, as well as understanding the economics of the Medical Home. He is working with payers to establish the benefit to patients and ability of Medical Home to address self-management goals. As currently devised, this model is most effective in practices where there are longitudinal relationships, such as primary care, but also in specialty care in certain circumstances. Several demonstration projects are set to begin in 2008. The College’s Center for Practice Innovation has been working with small practices to transform them, in line with Medical Home principles. The ACP is heavily involved in technology issues, at the level of some delivery systems. Finally, we are alerted to the publication of a white paper in the Annals of Internal Medicine on payment methodologies.

Adjustment: The impact of Medical Home discussions locally and nationally is very clear, and observations in PCHIT should be connected to Medical Home principles. Ted Eytan is presenting at the CPI conference in Washington, DC, on November 17 and will be spending time with CPI staff and practices as part of this involvement. The ACP white paper will be reviewed by us as well for implications for PCHIT.