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.

While in the Bay Area, I had the opportunity to visit with Jason Cunningham, DO, at the Sebastopol Community Health Center in Sonoma, California. The Sebastopol Community Health Center is part of the Redwood Community Health Coalition, which is embarking on an ambitious electronic health record project, using the eClinicalWorks application.

Jason is a Board Certified Family Medicine specialist practicing a full spectrum of the specialty, including OB, pediatrics, and inpatient care. Unfortunately, I came to see the Center after he had finished seeing patients for the day, so I was unable to shadow. However, Jason embraced the idea of a walking meeting, so I could say I shadowed in the community as opposed to the medical office as we put steps on the pedometer.

Jason’s health center is designed to pilot an advanced medical home model, facilitated with a complete electronic health record. There are less patients receiving care at this brand new center while different approaches to care are tested in the practice. Specifically, there is more involvement of support staff in panel management, and a focus on excellent primary care provision, with a goal of creating a sustainable approach across the community. What I was really impressed by is the fact that this work is being done with the current reimbursement system as it is; in other words, the team is working to demonstrate better outcomes and affordable care through a focus on comprehensive primary care, within a safety-net, federally qualified health center system that emphasizes in-person visits. They are not waiting for a change in reimbursement approach to do this work.

In terms of the layout of the medical center itself, you can see from the images below that there is a focus on bringing the patient into the care experience. The patient sits across from the physician, and the computer, a tablet PC, is arranged so that both physician and patient have access to the information being used. Jason is also using after visit summaries with his patients, as shown in the image (test data shown), so that they leave with a written description of the visit and next steps. I of course think this is a key part of patient centered health information technology.

The surrounding community is both beautiful and also working diligently to provide access to regular, quality, primary care across the population.

Images, click on any to see full size

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As part of our visit last week, Josh and I made sure to stop in at New York City’s Primary Care Information Project. As today’s press release indicates, PCIP is demonstrating success in promoting electronic health record use among New York City physicians.

There is a component of this work that involves implementation of the personal health record, and we spent time with Melinda Jenkins, Ph.D., FNP, and Joslyn Levy, RN, to learn more about this part of the project. We were given a demonstration of the patient portal that comes bundled with the eClinicalWorks product. As I have seen at the installation in Washington, DC, eCW has relatively robust integration within the EHR for patient access. I have not yet seen this in action personally, but I did speak with Sal Volpe, MD, a user of both the eCW EHR and PHR (see this post for that conversation).

The success that PCIP has achieved has come from focusing on the build for the provider side of the system. We learned that the patient access component is coming with the “Cycle 2″ portion of the project, which was scheduled to be kicked off the day after we visited (good timing!). In the meantime, Melinda and the team have been working on improvements to the out-of-the-box portal to promote self-management and longitudinal care.

Since Melinda is a contributor to this blog (see her posts here), we’ll let her continue to fill in the readership on her work. So far, the news is good from New York that health information technology can be implemented in our care system, even for the most vulnerable populations.

We stopped in to say hi to Mat Kendall, MPH, PCIP’s Director of Operations, and second to none (even including myself, I think) in the optimism department. Mat is a pro at creating visual systems in his office, which he graciously allowed me to photograph and display here, as great examples. Students of the Toyota Management System will appreciate the impact of keeping this work visible. Keep up the great work, New York!

Click on any image to see it full size

A little bit behind on blogging this week, and a little out of order because we’re back in New York City, working with some of the stars we began our journey with.

The quote comes from a conversation I had with one of those individuals, Sal Volpe, MD, who now as part of his process of care, regularly prints his full progress notes and gives them to every single patient. Sal’s board certified in Internal Medicine, Pediatrics, and Geriatrics, and is running the eClinicalWorks EHR in tandem with its patient portal. And this is how we got connected.

When I knew we were coming up, I learned from fellow blogger (on here) Melinda Jenkins, that there was a physician who had the eCW portal up and running. I of course asked if I could visit, meet, or talk to them, and Sal is him. His practice is located in Staten Island, New York.

Sal has about 50 patients up on the patient portal, out of a panel of about 1,700, so he’s just starting out. But he’s not worried about it - he would be happy with 1,000 patients online. He’s currently running a half-time practice, and prior to his work on the eClinicalWorks project, he’s had experience across a breadth of health plan administration and other physician leadership roles. He’s got a blog (of course), which is at http://ehrphrpatientportal.blogspot.com/.

So I asked him about the case for an EHR, and the case for a patient portal. He talks to a lot of medical groups about this. Given his health plan experience, he has a good understanding of how the benefits accrue in terms of quality, billing, and service, and he’s got optimism for the future.

The quote above says something about small practices’ ability to innovate. Sal told me that he can use the tool of the transparent progress note to communicate about needed prevention or testing not just to the patient but to their families. He knows I’m going to blog about this because I think it is a big deal.

We continue to find a lot of good things happening in New York around health information technology and patient access. More posts on the way…..

PCHIT links for December 19th through December 21st:

• RCHC Redwood Community Health Coalition chooses eClinicalWorks - A California Safety-Net system that is implementing an electronic health record.
• Racial Profiling: The Unintended Consequences of Coronary Artery Bypass Graft Report Cards — Werner et al. 111 (10): 1257 — Circulation - I am starting to dig a little into disparities research. The authors point out that the benefit of CABG is the same for diverse populations, yet the performance is not the same. Should we think of HIT in a similar way? I am worried about profiling in the
• How Do Physicians Use the Internet for Work-Related Activities? - iHealthBeat - 39 % say they e-mail online with patients, 20% in 2005, with NCI estimate at 10%.

PCHIT links for December 13th:

• New E-primer ? The Need to Know: Addressing Concerns about Privacy and Personal Health Records - Quote:”Project HealthDesign teams have found that while confidentiality is important to end users, they are often willing to share personal information in exchange for specific benefits and functions? “
• eCWusers.com :: An Independent Users Group for eClinicalWorks - A user forum that is publicly hosted by users of the eClinicalWorks EHR
• Create a personal MedActionPlan? for every patient - Interesting approach to guiding patients on medication regimens
• EMR - Electronic Medical Records and Practice Management for Clinical Practices by eClinicalWorks - eClinicalWorks Patient Portal information
• HIMSS - National Capital Area - Forum on focusing on the consumer in health care, January 17, 2008