We are three months into the PCHIT initiative, and we would like to add additional sites that are local to the Center for Information Therapy, to establish a longitudinal relationship of proximity to care systems.

One such care system is the Baltimore Medical System, which I toured with Chief Medical Officer Kyu Rhee, MD yesterday. We went to the Belair-Edison site and the Middlesex site.

I have to say here that the day was a very interesting one for me, as I spent the morning at a Kaiser Permanente medical center in a nearby community, and the contrasts were very striking. Both organizations are working hard to improve their service in admirable ways, even if their service challenges are vastly different.

BMS is undergoing a significant transition, into the electronic age. It is also undergoing a leadership transition, with Kyu accepting a new position at the National Institutes of Health, where he will further pursue his interest in reducing disparities in health. Our tour was a little bittersweet because of this, as Kyu bonded with colleagues at the two medical centers we visited.

Kyu has been Chief Medical Officer of BMS for 2 years, with previous experience as a medical center Medical Director and internal medicine/pediatrics physician in a safety-net medical system in Washington, DC. BMS serves about 55,000 patients at 11 sites (as of 2006), and it funded acquisition of its EHR, manufactured by Misys, on its own, which is remarkable for an organization like this. As the data that Kyu pointed out, 8% of community health centers have EHRs. This puts BMS in the 92nd percentile. It also frames my work a bit, as I have been tending to visit the early adopters - having an EHR is far from being the norm.

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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.