Ted Eytan, MD

e-Health. Patient empowerment. Washington, DC.

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:

OnCall Brands


Why is this interesting? Because it’s doable - this ambulatory record system communicates using an XML platform, and has been doing so since 1996. XML, as I mentioned in a previous post, is an uber-industry standard for moving data across systems outside of health care, and is now getting traction in health care. Having it as a foundation for an electronic health record system back to 1996 has some advantages, like the one you can see above. Different types of care can access the same data differently.


In my usual LEAN way, I asked if I could see OnCall in action, and so I shadowed Henry Chueh, MD during his clinic day (with each patient being asked for their consent before I entered the room). I found the interface to be very user centric, with lots of modern AJAX-y touches, as one would expect for an EHR that is being continually improved by a team of physicians that practice medicine regularly. Back to the XML though, the happiness is not that the user experience is good, it’s that it can be improved perhaps easier than another system because the data is moved around in standard ways. It’s almost like the team could create a patient version of the same record using a style sheet - which is something of a holy grail in patient access, in my opinion.


OnCall is going to be used as the basis for the Ambulatory Practice of the Future, also being designed at MGH. The idea is that a practice that can continuously improve will do best with an electronic system that can do the same, quickly.


There isn’t yet a patient portal attached to OnCall, but one is being worked on under the leadership of Henry and JeanHee Chung, MD, MS, a practicing internist and member of the LCS team. They showed me an early prototype of a patient front end and system named “ACCORD” (Ambulatory Care Compact to Organize Risk and Decision-making) which takes a personal health record one step farther than I have seen, by connecting patients and physicians to agreements around treatment plans. There’s a short summary of the project here at the AHRQ Web Site. I think this would be an exciting development for an electronic system and I was delighted to meet the parents of the OnCall system and get a glimpse into the future of a personal health record that uses data to model patient-centeredness.


Thanks to MGH and the Lab of Computer Science team for the warm welcome. LCS is sort of legendary in Informatics circles in terms of the vision it brought to medicine around the use of computers, and it was good to see in the flesh.

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Photo Friday: With Susan Edgman-Levitan, PA

Ted and Susan

This week’s photograph is of myself, with Susan Edgman-Levitan, PA, Executive Director of the John D. Stoeckle Center for Primary Care Innovation. Susan invited me as a guest to the Center to learn about the primary care practice of the future being envisioned at Massachusetts General Hospital, as well as the work under way at the famous Lab of Computer Science.

I enjoy working with Susan because she knows how to laugh. And in advocating for patients in her friendly style, she’s kind of like this…


Small Army

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I am posting this presentation that I created, commissioned by the California Healthcare Foundation, and supported by the Center for Information Therapy and indirectly, Group Health Cooperative.

It is the presentation that created the need for me to define Health 2.0. It is also the last presentation I will give as as a Group Health employee, and the only time I will be able to give it, due to my my career change.

It’s in slide show format, so feel free to click on any of the images and page through. I had a lot of fun putting it together because it allowed me to reflect on what I learned and how much I have changed in my thinking in just the past year. May the same trend continue.

I would like to extend special thanks to Crosskeys Media, producers of the excellent show “Remaking of American Medicine,” for allowing me to use portions of the content in the interest of supporting patient centered care. I encourage anyone interested in this topic to view or purchase the show. There is an educational license available that allows for use in teaching (as a whole piece, not intended for editing by users). It’s worth it.

Feedback and comments welcomed.

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Sites Visited

Thad Schilling, MD, and Caroline

Challenges with Patient Adoption

This seemed to be the hallmark of the multispecialty groups we visited, all with different organizational structures. Harvard Vanguard is a private multispecialty group, has an existing patient portal, MyHealth Online, as does Partners Health Care, in Patient Gateway. John Muir Physicians have chosen the RelayHealth platform, but have not yet implemented it across all care sites.

In observations at the practice level, we noticed an enthusiasm for PHRs in both HVMA and Partners, and both organizations are putting some effort toward promoting adoption. For example, brochures at nurses stations.

At the same time, the messages at times seemed ambiguous at the level of the patient. For examples, physicians in practices served by Patient Gateway are communicating with patients outside of the Patient Gateway environment, using electronic mail. Partners has a Physician Leader accountable for Patient Gateway’s success. Harvard Vanguard Medical Associates does not. There was not a consistent approach among physicians at sites we visited (both Boston organizations) with regard to explaining the benefits of these tools to patients. We also noticed signs like the one pictured here, which describe a workflow that makes less sense in the presence of a personal health record system.

Attention - Now using PHR!

Independent acts of adoption were visible, however, at several sites, such as Masschussetts General Beacon Hill Primary Care, where Administrative Manager Richard Perrotti has worked with medical staff to integrate Patient Gateway into the care experience. In addition, practices that we observed were interested in ideas to promote adoption from others engaged in PHR use in practice, which leads us to believe that there is receptivity to a consistent message about benefits.

Data in a recently published article demonstrates flat adoption curves (see: Halamka JD, Mandl KD, Tang PC. Early Experiences with Personal Health Records. J Am Med Inform Assoc 2008;15:1-7) for other institutions local to HVMA and Partners, most notably Beth Israel Deaconess Medical Center. This is despite the fact that these organizations do not charge additional fees for use of these services.

Internal, External, Technical Factors?

When on site in Boston, organizations we spoke with acknowledged that hurdles to promoting adoption originated in internal prioritization of multiple initiatives, as opposed to external factors. This may be prevent the application of resources to developing a coordinated approach to adoption.

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This blog post, by Andrew Dreyfus, the executive vice president for health care services at Blue Cross Blue Shield of Massachusetts and former president of the Blue Cross Blue Shield of Massachusetts Foundation, caught my eye.

Commonhealth » Blog Archive » A NEW AND DIFFERENT WAY TO PAY FOR CARE by Andrew Dreyfus

At the level the information is presented it sounds promising - that delivery systems might have more lattitude to use all of the tools available today to coordinate care (including patient access to their records online). The details are not listed, though. I wonder what about the plan would enable a more patient centered approach to implementing health information technology. Would a delivery system under this plan be spurred to promote personal health record adoption?

As we found when we visited Boston recently, adoption of relatively robust patient access systems has been less than desired, especially compared to systems where incentives are aligned. Maybe this might help?

I’m posting this as a trackback to the blog post to see if more information might be shared about this, either here or on the original blog. How does this new payment methodology stimulate patient access to health information technology and non-visit based care?

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PCHIT links for December 26th through December 27th:

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PCHIT links for December 18th:

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PCHIT links for November 9th through November 13th:

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Health Plan Perspective; Cambridge Health Alliance, Boston

My journey in Boston was completed with a visit to one of the large health insurers in the region, and to Cambridge Health Alliance, which serves Cambridge, Somerville, and Boston’s metro-north communities.

While in the area, I did manage to make a visit to the LEAN Enterprise Institute, where I was thrilled to meet James Womack, the author of several works that have shaped much of the work underway at Group Health and other health institutions. While at LEI, we talked about the penetration of LEAN into the health care space. Organizations in Boston are lucky to have access to this teaching and research resource so close by.

Health Plan Perspective: I visited with a physician in one of the region’s largest health insurers to learn more about the financing environment and its relationship to patient centered HIT work. As people in the field are aware, Massachusetts is home to the nationally recognized eHealth Collaborative, which is bringing 34 member organizations and pilot communities to support adoption of EHRs statewide. As the MAeHC web site, states, this is a $500 million proposition. In the discussion I participated in, two key questions arose from the plan perspective: 1. Who owns the personal health record? and 2. How and if will it be adopted? These are very helpful questions to keep in mind as we talk about innovations that require participation from a whole system (providers, patients, financing) to be successful. As I come from an environment where all are aligned within the same organization, it’s good to know what the key issues are. There will tension between interventions where ownership has been reasonably well established, such as disease management, and for which outcomes can be measured. Everyone wants to make investments that directly support beneficiaries. A recent article I read pointed out that there is much experimentation going in in the health plan sphere. The challenge, therefore, may be around focusing strategy toward PCHIT. The key questions mentioned may need to be answered to get us there, which is helpful to know.

Cambridge Health Alliance: The practice: My guide on my visit was Hilary Worthen, MD, Director of Medical Information Systems for CHA, and primary care practitioner for 25 years. Hilary and I did the thing I enjoy so much - walking through the community to understand it better, which brought us to Union Square Family Health and its Medical Director, Rachel Wheeler, MD. Cambridge Health Alliance, like East Boston Neighborhood Health Center, is fully electronic, using the EpicCare electronic health record.

The pictures (click on any to see full size):

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