The quote in the post comes from Roslyn Marshall, RN, Nurse Manager of the 3West Inpatient (Neurology and Neurosurgery) unit at Medical College of Georgia, in Augusta.

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Just as with several other organizations I have visited, I did not imagine that I would be heading to Augusta, Georgia to learn about how to involve patients and families in their care, but I’m glad I did. This is a place where so many things that are seen as abnormal in the rest of health care, are normal (see this paper for a description of patient centered care, with a focus on MCG). In an environment like this, it’s okay to ask “why?” when it comes to issues of involving patients and families in their care.

The occasion of my visit is related to a grant that Medical College of Georgia has received to study the use of a personal health record to improve hypertension care. With respect to the idea that being as close to the patient as possible is important, Ms. Pat Sodomka, Senior Vice President of Patient and Family Centered Care, hosted my visit on behalf of the organization.

Part of my study included watching the excellent program, The Remaking of American Medicine, which featured Medical College of Georgia in its last hour, and it was amazing to see how much has been accomplished both in involving patients and their families, and in transforming the organization.

Today, I’ll post about what I saw clinically. Tomorrow, I will post about what I saw systematically in this leading edge care system.

I began in Family Medicine and Internal Medicine, where practitioners and patients are both busy, and integrating one or two electronic health records in the care that they use. This is what I observed when shadowing family medicine specialist Bill Phillips, MD.

Besides data from their own organization, they need to integrate the needs of patients working to stay healthy in a system with an affordability crisis. In my own practice, I had not had to think about which big box retailer offers which drugs for $4 , or even free, as a loss leader. However, this is a big issue for patients. I reviewed the formulary for Wal-Mart’s $4 program - it’s extensive.

I was able to shadow the Director of the Osteopathic Medicine Program, Julie Dahl-Smith, DO, who is also board certified in Family Medicine, as she performed a manipulation visit and acupuncture visit for a family. This made me think about the value of patient involvement through a personal health record. The treatments that Dr. Dahl-Smith provides are distinct from the allopathic treatments that I have been trained to do. There’s an opportunity for patients to become more knowledgeable about the treatments that work best for them through patient access.

I spent time with Shilpa Brown, MD, who manages her own faculty practice as well as a residency practice and extensive student teaching. Patients in each have distinct needs. I also observed some key differences in workflow between private practice and academic practice. Faculty are ultimately accountable for 1, 2, 3 or more residents’ care, whether that care is provided in person or virtually. There is much that MCG will contribute in this area as an innovative academic medical center.

In between, I visited with the Neurosciences Interdisciplinary Rounding Team, which includes nurses, pharmacists, students, residents and attendings, led by Dr. David Hess. This is a unit, 3W (which I will talk more about tomorrow) that serves patients and families not just locally but regionally. What would it be like if a family member who is based far away from Augusta could connect with their family’s care team electronically? The team was open to this idea.

This organization is unique in my travels because it is a full academic medical center with many top notch training programs, which include a family medicine residency and an osteopathic residency. It is also special in the way it involves patients and families in the care, through its advisor program. The program reaches all the way into undergraduate medical education, and every new program seeks involvement. Patient advisors are free to visit MCG facilities and talk to patients and families about their care.

As I was being guided to the Internal Medicine clinic by Bernard Roberson, Director of Family Services Development, we passed by one of the “commons” (a different way of thinking about a waiting room that’s more patient centered) and a patient waiting to be seen said to us, “Tell me more about patient and family centered care.” It turned out it was one of MCG’s Patient Advisors, and I think we both saw it as a welcome sight. That’s how things are different here.

Tomorrow, a post about the system-ness of Patient and Family Centered Care at Medical College of Georgia.

In Augusta, Georgia, a national epicenter for Patient and Family Centered Care, as featured on “The Remaking of American Medicine.” It’s a really impressive place. I’ll be blogging more about it soon. Nothing provides more energy than patient empowerment.

Kate Christensen, MD, Medical Director, kp.org, with Paulanne Balch, MD, Physician Lead for HealthConnect Online, Colorado Region

Greetings from Oakland, where I have been graciously invited to attend a get together of Kaiser Permanente’s clinical and business leadership for HealthConnect Online, which serves the personal health record connected to the electronic health record, HealthConnect, and accessible through kp.org.

I will say that even in the absence of the PCHIT work, I would want to be here. Why? Because I have always thought that the most innovative staff within Kaiser Permanente support the HealthConnect project, and the most innovative of that group support HealthConnect Online.

This was the first such meeting with every Kaiser Permanente region now fully live with the PHR, with Ohio up now for 30 days. And from my perspective, the news is good. As each region of the system discussed their current and future plans for the PHR, commentary focused on value of each feature for the members. I really liked what Gail Sands, Director of Innovative Projects for the Ohio region said: “This is the patient’s chart. They should know what’s inside.”

Strides in Transparency

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This is a link to Kaiser Permanente’s press release about the relaunch of the site with My Health Manager. As the release states, the personal health record is continuing to be a large focus of Kaiser Permanente’s work in health information technology. All of Kaiser Permanente’s regions are now operating a personal health record as of this year now that Ohio is online.

Of interest, they are also going through and replacing “your” references to “my” references around the site. For the PCHIT initiative, we are following the progress of Kaiser Permanente as a benchmark organization, and they are a sponsoring partner.

One of my to-do’s is to schedule an in depth tour of kp.org. I am a user (and builder!) of Group Health’s PHR, which is based on similar technology. I know from my own physician and patient experience that more interaction like this is the right step forward for the people we serve.

Kaiser Permanente Puts Personal Health Record Front and Center

Speaking of “what am I observing for,” Holly Potter from Kaiser Permanente let me know about this excellent report from the Commonwealth Fund. It’s a nice review of the history and components of Patient-Centered Care, accompanied with data from interviews of key experts in the field.

For this project, it helps add a little structure to our observations, because there are discrete things we can look for. The report takes the reader through two example organizations that have these attributes. The checklist it cites is:

1. Leadership
2. A strategic vision, clearly communicated (”from the boardroom to the bedside”, or I might say, “from the boardroom to the exam room”)
3. Involvement of patients and families at multiple levels
4. Care for the caregivers through a supportive work environment
5. Systematic measurement and feedback
6. Quality of the physical environment
7. Supportive technology

These concepts, especially #7, are right up PCHIT’s alley, as are others that were emphasized by our Advisory Group last week. We have to be careful that this initiative is mostly about #7, at the same time, #7 is a tool to serve the other 6 items.

In contrast to the way data was acquired about organizations, in interviews, I am going to the exam room myself (”Genchi Genbutsu“) to understand each organization’s experience. I think by definition, an organization that is interested in the answer to these questions probably has answered them well already.

Part of the support for PCHIT comes from Kaiser Permanente, which operates the kp.org portal for its patients. Part of what we’ll do is to demonstrate the work that organizations are doing alongside kp.org, which has 1,558,651 signed up for secure features, as of second quarter, 2007. I think that makes this one of the largest, if not the largest in the world.

Kaiser Permanente has posted a flash video of the new kp.org for external audiences which will include “My Health Manager.” Take a look - what do you think?

I hope to be shadowing in a Kaiser Permanente facility soon to observe how physicians and staff leverage kp.org in practice. The mid-Atlantic Region is pioneering online booking of medical appointments right now.