Electronic health records raise doubt – The Boston Globe – Our very own e-patient Dave is profiled in the Boston Globe about his experience porting records to Google Health. The experience demonstrates the importance of accuracy as close to the patient-physician interaction as possible.
The story has apparently now been elevated to a full blown crisis by ZDNet.
I admit, that maybe, once or twice in my past, I may have used convening and convener in less than flattering terms, much like I used to use “process” in unflattering terms. I learned through LEAN, though, that process isn’t bad, bad process is bad. And so I have learned the same thing about convening, now that I have done it a couple times this summer, with the California Healthcare Foundation.
The most recent time was yesterday, when Veenu Aulakh, MPH, and I brought together Safety Net health care organizations, and national experts in patient online access and social impact of the Internet to talk about (you can guess…) “Patient Online Access in the Safety Net.”
These being the first convenings I have co-led, rather than participated in, I have learned a ton, and have gotten a good understanding of doing this for a purpose, which both situations have had. In the event we hosted yesterday, in Oakland, I put together an A3 document before we invited anyone, which included the background, the goals, and most importantly, the “why?” we were doing this in the first place. It was really helpful to have created agreement around the “why?” – I referred to this many times in the planning.
At the event itself, I got a new perspective that I had not had as a participant previously. It was one of listener/observer – even when I was doing the talking, I was interested to see reactions and learn what people and organizations are capable of. It made me think that when I have been a participant in convenings in the past, this is what my hosts were doing – learning what myself or my organization was capable of doing to solve a problem, as much as they might have tapped me as an expert. Interesting to have this happening in my brain.
Sharing information happened, too, courtesy of some of the most innovative organizations in the U.S., including Cambridge Health Alliance, University of California, San Francisco’s Positive Health Program , New York’s Primary Care Information Project, Institute for Family Health, and Kaiser Permanente.
In addition to all of this, there were a few nice moments of recognition for people’s work, such as when Jim Kahn, MD, thanked Kate Christensen, MD, and her team at Kaiser Permanente for their support and assistance in the launch of the myHERO patient portal for HIV patients cared for at San Francisco General Hospital.
…and a little something for me, a follow-up conversation with Hilary Worthen, MD, from Cambridge Health Alliance, about his study and pathway to discover and implement LEAN in primary care at CHA. He told me that for him, this is a transition from thinking about exam rooms and staff to “work that you need to get done, defined by doctor and patient.” I love hearing about how people apply their creativity and copy the thinking of LEAN to do exceptional things for their patients.
This being the second time I have done this, I don’t know if it was perfect. We tried a lot of things I’ve not done in meetings before, and I am still working to integrate social media before, during, and after. I am definitely sold on my philosophy of supporting any and all technology use (“if you need or want to use your device, use it”) - I have not, in my conveningness, come around to the “turn your devices off” philosophy, as I have written about previously.
Oh, and I learned that a 60″ table seats 8 people.
Here are a few images from yesterday. I’ll follow up with my slides in a separate post. Click on any to see larger size.
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:
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…
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.
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.
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.
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.
» Read more: PCHIT Personas: Mutispecialty Group Practice
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?
PCHIT links for December 26th through December 27th:
PCHIT links for December 18th:
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):
» Read more: Health Plan Perspective; Cambridge Health Alliance, Boston
Massachusetts General, Beacon Hill Primary Care
Today was spent at two practices at within Massachusetts General primary care, part of Partners Health Care. Another new addition to the process was the fact that Jonathan Wald, MD, the Physician Lead for Partners’ Patient Gateway, also shadowed with us. I thought shadowing with both Josh and Jonathan was great. Both should be posting their experience here, so I will let them do that.
We actually started the day at the Stoeckle Center for Primary Care Innovation, hosted by Susan Edgman-Levitan, PA, its Executive Director. Susan is a hero for patient-centered care in my (and many individuals’) eyes and kindly introduced us to some of the innovation in primary care that’s happening here. And it’s great to hear about innovation in primary care. I honestly had to do a soft reboot during our discussion because there’s more happening here than I could glean prior to our visit. So, we’re coming back for more, and this is why it’s good to come in the first place.
First, the pictures, and then a description of the practices. Click on any to see them full size:
» Read more: Building Adoption – PCHIT at Partners Health Care
Thad Schilling, MD, and Caroline, Harvard Vanguard Medical Associates
These were the words of Caroline, who’s Thad Schilling, MD’s, Medical Assistant at Harvard Vanguard Medical Associates‘ Medford Medical Office. She was commenting on the fact that Thad uses a whiteboard when he teaches patients about their health. This has the impact of involving his team in understanding the patient’s condition as they support the care.
Yesterday, Joshua Seidman and myself shadowed practices at the Medford office (Dr. Schilling) and at the Kenmore office (Dr. Kate Koplan). We went to see what was happening at Harvard Vanguard because they have an established PHR, MyHealth Online, that’s produced by a very respected EHR manufacturer. I was interested in MyHealth Online because it’s a system very similar to the one that Group Health produced for its members in Seattle. However, patient adoption of this system has not been at the levels of Group Health. I wanted to get some insights on the issues at the exam room level.
This was also Josh’s first time shadowing in a medical center, as part of this project at least, so it will be good to read about his perspectives doing this along side me. Consent was obtained from each patient of course, and it actually worked out well to have us alternate shadowing experience. Thad had a relatively busy schedule and he has experience with people learning from his practice, so Caroline and his stewardship worked out really well.
First some pictures, and then the rest of the story:
» Read more: “When I walk in the room, it’s like going to medical school.” : PCHIT in Boston
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