eValue8 Health Plan Innovation Awards: 2009 – Group Health Cooperative and UnitedHealthcare Recognized by NBCH for Programs that Improve Health and Health Care 2009 – Based in Seattle, Group Health Cooperative is a consumer-governed, nonprofit health care system that coordinates care and coverage that was selected for creating a comprehensive health risk assessment, called the Health Profile, which is integrated into care delivery.
Posts Tagged ‘Group Health Cooperative’
Myths and Realities of Meaningful Care Plans
September 24th, 2009 | Popularity: 3% 0 comments | Leave a replyMyths and Realities of Meaningful Care Plans – Speaking of trust and transparency – I love that Group Health Cooperative physicians and leaders are “blogging as they go” with regard to their reinvention of primary care. They tell us, they don’t know exactly the best way to do some things on day one, but they are trying, and talking about it openly. Really, what is not to like about that.
“So that’s my new routine. Our current approach to “Care Planning” may change over time. EPIC may develop a slick new module with its own tabs and toolbars. I don’t know. What I do know is that by following a few simple conventions and “rules” as I have outlined above we can have a consistent, meaningful, and helpful way for our patients, their families, and our colleagues to know where to find their latest care plans. What’s not to like about that. To me it is a huge step towards providing patient-centered care that really works for everyone.”
Featured Seattle-area Video On Demand | Seattle News, Local News, Breaking News, Weather | KING5.com
September 11th, 2009 | Popularity: 2% 0 comments | Leave a reply- Featured Seattle-area Video On Demand | Seattle News, Local News, Breaking News, Weather | KING5.com – Feature story on King 5 news about the Group Health Medical Home.
Crowdsource request: What should we present during the PHR panel discussion at the AHRQ Annual Conference, September 14, 2009?
August 19th, 2009 | Popularity: 8% 5 commentsNote, this request is also cross-posted on the Chilmark Research Blog.
I have the distinct honor of being moderated by John Moore of Chilmark Research, as part of participation on a panel discussion entitled, “Personal Health Records: What Are They Good For?” which will take place at the Agency for Healthcare Research and Quality’s Annual 2009 Conference, September 14, 2009, 1:00 pm – 2:00 pm.
Prior to the era of social media, the moderator and participants for a panel like this would get together on a phone call and figure out what they were going to speak about, and then provide the information during the discussion that they wanted to.
Actually, even in the era of social media they still do that.
To think a little differently, I asked John if he wouldn’t mind suggesting some questions on his mind as an expert in the field, and then if we could crowdsource these with a broader audience (John said yes to this request!).
That’s what this blog post is for.
So first, brief description of what the session is intended to cover:
In recent years, health care providers, insurers, purchasers, and technology companies have launched personal health record (PHR) initiatives. This interactive panel discussion will provide insight on the PHR marketplace, adoption levels, and the goals and impacts of their use.
Next, these are the very thoughtful questions that John came up with. In the comments below, feel free to
- Let me/us know which ones are of greatest interest to you,
- Suggest others that we haven’t thought of,
- Provide any answers you have from your own work in the field (we want to share leadership in all parts of our care system)
- Provide any general comments
Thank you for your help with this – The goal is to share information that’s as close to what the audience is looking for (audience-centered care). After all, we are doing what we do so that every patient in every care system benefits.
(questions from John Moore below)
Following are questions that have been swirling abut in my head re: adoption
What is the breakdown of populations/demographics that actually use the KP PHR?
Is it just the worried well, or Mothers?
Are their any conclusions that can be drawn?
To what extent due specific sub-groups use, or not use the PHR, e.g. are there any racial or socio/economic disparities?
What is KP doing today to minimize disparities and insure broader participation?
What about Chronic Disease grps?
Has KP found that certain chronic disease lend themselves to greater PHR use?
If yes, what are they?
Reflect on the role of the physician in encouraging adoption and use of a PHR?
Does consumer use require a a lot of guidance and encouragement?
What tricks as KP learned along the way to encourage broader adoption and use?
How has KP embedded the use of PHRs into physician workflow and driven adoption and use by the physician (that is assuming that KP allows the pt to add comments/notes to their PHR)?
The transition from acute to outpatient care is fraught with challenges and data drops. How has KP used the PHR to minimize such?
And on a related note, how does the KP PHR accept clinical data from systems outside of the KP network (not sure it even does that today).
Since the title of this session is PHRs, What Are They Good For, will need you and James to circle back to some of the broader attributes of PHRs to practice, behavioral change & improved outcomes. No need to mention such things as 25% fewer offices visits as this will kill of most practices.)
Trust that is enough to get you started and I may think of a few more …..
A trip to the Reinvention of Primary Care at Group Health Cooperative (Pictures and Quicktime VR)
August 4th, 2009 | Popularity: 14% 3 comments“C’mon Ted, let me show you the visual system for Primary Care.”
I am still in Seattle, and visiting colleagues from Group Health Cooperative, where I learned about LEAN, in large part from Lee’s efforts (Group Health Permanente, Group Health’s medical group, is part of The Permanente Federation, so we are still in the family).
It’s never enough to just have lunch with Lee Fried, one of the LEAN senseis at Group Health Cooperative, and co-founder of the Daily Kaizen blog with me. He has to fill your head full of innovative ideas – just what I needed after spending two days discussing innovation last week in Oakland. Fortunately, I always have more room for ideas… So we walked over to the Group Health campus and headed to one of the conference rooms on the top floor.
What Lee showed me was a whole room of visual displays used to track the progress of the reinvention of primary care. This includes everything from leadership/manager standard work, call management, use of virtual medicine, preparation for visits, as well as the vision, strategic plans, outcomes, and staffing.
All are available visually, across all the primary care medical centers of Group Health, by entering this room. I asked Lee how this room is updated, given that medical centers span the State of Washington. He told me that leaders come here, in person, to update status, point out problems, and propose countermeasures.
What Lee probably doesn’t know about this particular room is that it is the room where I had most the academic sessions (didactics, faculty meetings, etc.) during my residency.
Back then, we were discovering the wonder of the World Wide Web, and how all of the data anyone would ever need would be reachable from a computer desktop. I never would have guessed that white boards and paper would be used to visually assess the health of a primary care system several years later. However, I would have predicted that Group Health would always use the most rational, effective techniques available to support its members, which they are doing.
Feel free to track their progress on their blog, Reinventing Primary Care. Didn’t think we’d be blogging back then, either!
Images: Click on any to enlarge
Quicktime Virtual Reality: For the technologically adventurous. Allows you to move around the room using your mouse. Quicktime Plugin (PC & Mac) is required.
Photo Friday: Sunday coffee to talk about primary care
August 2nd, 2009 | Popularity: 10% 0 comments | Leave a reply
This week’s photograph was taken in Seattle, Washington, where I am back for a visit, and could not (and will probably never) turn down an offer from colleague David Kauff, MD, Associate Medical Director for Informatics for Group Health Cooperative, to meet him at our local coffee establishment, Fuel.
David and I used to meet here periodically before work to get organized about issues affecting the implementation, maintenance, and development of health information technology. This time, we were talking about primary care. David is an internal medicine specialist who’s also a great informaticist, and has a great passion for education.
I now work with David in a different role working for The Permanente Federation, which sponsored the Medicine and Management course for Permanente leaders that he just graduated from, and I’m still as excited as ever to sneak behind the counter with him to see what more we can learn…..
Group Health Cooperative: Reinventing Primary Care by Connecting Patients with a Medical Home
June 30th, 2009 | Popularity: 5% 0 comments | Leave a reply- Group Health Cooperative: Reinventing Primary Care by Connecting Patients with a Medical Home – Report from Commonwealth Fund on Group Health Medical Home
Now Reading: Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care. Health Affairs. 2009 Mar 1
March 13th, 2009 | Popularity: 50% 15 comments
Note: the article no longer requires a subscription for access (3/14/09)
The much anticipated health information technology issue of Health Affairs, and in it is an article written by Carleen Hawn about Social Media in Health Care. The links above to to the Health Affairs site, but it appears a subscription will be required to view it, so hopefully readers have access to an institutional or other subscription to read it.
The genesis of this article was a discussion that was started in July, 2008, at the American Board of Internal Medicine’s forum on Patient Centered Care, where i presented about some of these concepts. This was followed up with discussions with myself and other leaders in the field, such as Jay Parkinson, MD, from HelloHealth, Bob Coffield, a well known legal expert in the area of social media, as well as real patients.
I actually attended the briefing announcing the release of this issue in Washington, DC, and was pleasantly surprised to see that the article is billed on the front cover of a very full catalog of scholarly works. Who would have thought 4 years ago that an article about social networking/media would be front cover material for the Health Affairs issue on Health Information Technology. This says a lot about the impact that social media, or perceived impact, in this area of health care! At the same time, I think Matthew Holt correctly points out that there’s a part two (and three and four) to be written covering what’s below the tip of the iceberg.
In addition to the information mentioned in the article, Carleen Hawn also consulted with some of my favorite innovators in health care, including Scott Shreeve, MD, and the team at the Kaiser Permanente Sidney Garfield Center for Health Care Innovation.
In addition to these contributions, I would also mention the contribution of the California Healthcare Foundation, whose leaders, including Veenu Aulakh, MPH, Sophia Chang, MD, MPH and Sam Karp, stimulated the development of the crowdsourced definition of Health2.0 mentioned the article with a simple question to me: “Ted, what is Health2.0?” (my answer was, “I don’t know, let’s ask the crowd.”)
And, I would also like to mention that innovation like this comes from health care organizations and systems that are able to say,”Not everything has been tried before,” and in my case this is/was Group Health Cooperative, who have learned from our early blogging experience and now bring their physicians and staff online for the world to learn about what they are doing to reinvent primary care. I’ve been engaged in maybe a few conversations over the past few years about why health care organizations should be transparent and it’s helpful for everyone to have an example of why this works well for everyone.
Thanks again to Carleen Hawn, The Health Affairs Team, and The American Board of Internal Medicine Foundation for taking the time to explore this topic for America’s patients (that’s all of us).
Medical Home: A New Model of Caregiving – AARP Bulletin Today
February 13th, 2009 | Popularity: 25% 5 comments- Medical Home: A New Model of Caregiving – AARP Bulletin Today – More coverage of Group Health Cooperative's patient-centered medical home:
"“Why don’t you come in?” says Shriver, a family physician who is chief of staff at Group Health Cooperative’s Factoria clinic in Bellevue, Wash. He schedules an appointment for 2 p.m. that day.
Few Americans can get their doctor on the phone immediately and schedule a same-day appointment. But Shriver’s clinic lets patients phone and e-mail their doctors directly to discuss medical concerns and book visits on short notice.
That’s part of Group Health’s successful two-year experiment with one of the hottest concepts in health care delivery: a patient-centered practice often called a “medical home.”
Group Health Medical Home
February 6th, 2009 | Popularity: 20% 2 comments- Group Health Medical Home – Seattle's Group Health launches an external blog to talk about its medical home work – reinventing primary care. Great work, Group Health! Thank you for innovating in primary care.
Now Reading: Adolescent Access to Online Health Services: Perils and Promise
February 3rd, 2009 | Popularity: 29% 1 comment
One of the authors of the article and former colleague from Group Health Cooperative, David Grossman, MD, tipped me off to its publication, and I’m glad he did.
This piece adds to a growing volume of work that doesn’t ask “why?” patients should have online access, but work that asks “why not?” for patient online access. Unfortunately, the peer reviewed literature lags significantly behind what is known in the world about patient online services – it points to some of the deficiencies of peer review in a Web 2.0 world that I an others have written about previously.
One disclosure is that I am an acknolwedgee and was one of the individuals interviewed by the author, although I was not involved in any significant way in the content or conclusions reached by the author.
The article covers online patient access for a vulnerable population, teens, and the author makes an astute observation about their vulnerability in today’s health system, which parallels their vulnerability in online health systems:
Adolescents, as a group, do not typically advocate on behalf of their own health care needs, and generally are not the primary subscribers on health insurance plans. As a result, teen needs may not be among a health care organization’s highest priorities.
From my experience, many of the online programs that exist for adolescents are there because of the support of a handful of dedicated pediatricians and family physicians as well as their nursing and allied health colleagues who care for this group. That’s changing, though, as parents who enjoy this access for themselves are asking how their entire family can participate.
There’s a very nice table in the article about what, specifically, leading edge organizations are doing to provide teen access. This table alone should serve as a guide to understand what conventional limitations are. However, I would stress the word “conventional,” because as the authors point out, much more should be possible in the care of adolescents, so organizations out there looking to implement teen access hopefully would use this information to provide even more service – this is the foundation of innovation after all!
In addition to the useful summaries of potential beneficial uses of teen access, the article includes a fairly good review of the benefits of personal health records in general.
The other thing I liked (and like in any article like this) falls into the category of what I call “myth explosion,” which is where a critical eye is applied to assumptions made about how things might work if some thing new is tried. (In my LEAN work, I used to say, “not everything has been tried before.”) This includes concerns about parents coercing teens to provide passwords to their online health information, which is successfully challenged as a concern, in my opinion. Beyond thoughtful analyses like this, I think patients and their families are the best at myth explosion and do it quite readily. With that in mind, a great follow-on to this article might be one written about the experiences of teens and parents involved in the adolescent access programs now underway.
The one other idea that comes to mind is the fact that the recent HIPAA guidance put out by the Department of Health and Human Services has no information in it regarding adolescent access. I think it might be useful for the next chapter of that guidance to include this group, to make something that seems difficult to so many not seem so.
Thanks to Megan Moreno, MD, for her work to change the question from “should we?” to “how and when?” Hopefully, soon. If there are any teens or parents out there using this access or want to use it, please feel free to comment on your experience as it is or as you would like it to be.
Doctors get the time they crave with patients
December 29th, 2008 | Popularity: 22% 0 comments | Leave a reply- Doctors get the time they crave with patients – Article in the Seattle Post-Intelligencer – innovations in organizations with fully deployed health information technology include spending more, rather than less, time with patients. Good job, Group Health Cooperative!
Now Reading: Practice-Linked Online Personal Health Records for Type 2 Diabetes Mellitus: A Randomized Controlled Trial
October 27th, 2008 | Popularity: 23% 0 comments | Leave a reply
A news article that quoted my response to this article was titled “Mixed Results for Personal Health Record System” which is true for the PHR being discussed here, but just for this one. For right now. The team putting together this PHR is a great team that will get great results with greater patient adoption.
Why do I say that? Well, despite the statement early in the article that “To date, there have been no large-scale studies of interventions that integrate PHRs directly with the electronic medical records (EMRs) used by patients’ own primary care physicians,” there actually have been.
There was a really good one in fact, performed at Group Health Cooperative in Seattle, WA (my review of that one is here), with great results.
The other issue that worked against the study team is patient adoption of their PHR system. This is not an artifact of PHRs in general, because other organizations, notably Kaiser Permanente and Group Health Cooperative have been seeing “hockey stick” slopes of adoption for their PHRs (see a picture of this here). Because there weren’t enough patients signed up for the Partners PHR (only 244 patients in the study, out of 6553 possible), they could not detect meaningful differences, so we don’t know if there were any real changes following the intervention or whether there is just random variation. I was informed last week, that Group Health Cooperative just passed the 50 % mark for adoption of its personal health record by the adults served in its Western Washington service area. In Eastern Washington, they are not far behind, with 42 % adoption. That’s transformational in terms of care processes.
So the next question is “why is Partners’ PHR adoption low?” It’s a great system supported by a great team, and the patients that enjoy using Group Health and Kaiser Permanente’s PHRs are really not that different in terms of the conditions they manage. The key may be in looking at the environment that most of health care still operates in. This photograph that I took recently illustrates that.
Don’t count the personal health record out just yet. There are a lot of really dedicated physicians and other experts creating great systems who will do great things when our health care system supports the therapeutic potential of their work as much as it does that of the imaging suite. Fortunately in 2008, we now have evidence that we can get great results by involving patients in the use of health information technology to improve their health.
“We’ve brought these 3 boutique health care organizations together…”: Top Leadership Teams Event, Chicago, Ill
October 17th, 2008 | Popularity: 26% 0 comments | Leave a reply
Darrel Kirch, MD, talks about physician supply in Chicago
This was the phrase that Jim Molpus, Editor-in-Chief of HealthLeaders Media used in jest to introduce a panel I was on along with Jay Srini, Chief Innovation Officer of UPMC Insurance Services, and Jeffrey Balser, MD, Ph.D., who was just named Dean of the Vanderbilt University School of Medicine. The “boutique” I was representing was a combination of my previous employer, Group Health Permanente, and my current employer, The Permanente Federation.
I suppose beyond the common interests we have in technology, the three of us are also settling in to new positions. From my perspective, it is a whole different level of scope to be in a room and thought of as “Kaiser Permanente” with all of the innovation and work that happens across this system. I have a lot more learning to do. At the same time, I was impressed that not everyone knows (yet) how much access patients have to their own health information via organizations like ours (Vanderbilt and UPMC have patient portals as well). I am always happy to deliver the message of how useful this access is to patients in a group like this.
Speaking of innovation, I enjoyed the time with both panelists. Vanderbilt has been doing impressive work in creating an anonymous DNA databank and specifically, the way they are doing it, involving patients and the community is part of the impressiveness. Jeff showed a video of how this might work with patients, and the video presented vignettes of patients having access to the data and managing it with their personal physician, rather than labs and test tubes. Great job.
I recognized Jay right when I walked in the room, from her energy level and enthusiasm, and her background is really interesting – spanning industries including banking, manufacturing, and health care. I always like meeting people who apply lessons from one industry to another, and UPMC has always been known (in my mind) as a star in the innovation and patient-centered world.
I am happy to say that the thing that all of the best organizations had in common this day was participation – involving patients and their communities in their care. . The other thing that the organizations represented had in common was their concern for, and passion around supporting primary care.
We were treated to a talk about the future of physician supply by Darrel Kirch, MD, President and CEO of the American Association of Medical Colleges. I was glad to see Darrel touch on this and relay the understanding that the AAMC is aware of this situation and are working on it. I hope the organization can help.
“Everyone feels that their work is important” – learning about leading primary care at Kaiser Permanente and affiliates
October 7th, 2008 | Popularity: 30% 0 comments | Leave a reply
Leveraging advanced member tools to support primary care at Kaiser Permanente
The quote in the title of this post is from Harry Shriver, MD, who is the Medical Center Chief of the Group Health Cooperative Factoria Medical Center, where a pilot has been under way to improve primary care through a Medical Home model of care. In this model, a medical center has been given additional physician and staff person-power, to attend to the needs of patient in the way they feel is best, with a full complement of technology and process tools.
In addition to Group Health’s primary care leadership, leadership from 8 Kaiser Permanente regions’ primary care organizations are also here, in Englewood, Colorado, for the first ever gathering of this group of physician and operations leaders.
I am still very much in learning mode about this organization, so it is a great opportunity for me to see how primary care is being prioritized in the Kaiser Permanente regions, as well as what the challenges are. In the area of challenges, it seems that these are common across the Kaiser Permanente system and the nation. It is truly becoming difficult to fill positions for primary care physicians – the primary care shortage is not in the distance. The demands of information flow within a highly advanced technological infrastructure are significant, and the need to adapt both the workflow and the technology together are here today, relative to other organizations who are just beginning to envision a electronic health record-enabled care experience.
At the same time, there is an immense amount of innovation possible here, and an interest in sharing what is discovered for the benefit of all of health care, of course. Scott Smith, MD, is the Associate Medical Director of Primary Care for the Colorado Permanente Medical Group, who are our hosts for the discussion.
Today was a review of the state of primary care in the regions and a look at some innovative practices in them using the technology platform of Kaiser Permanente. Tomorrow will be a big picture look at where primary care can go within Kaiser Permanente and what Permanente physicians can do do support primary care in the nation. As Scott said, “We have the building blocks to make primary care work.”
What Healthcare Could Learn from Amazon – ClickZ
August 13th, 2008 | Popularity: 22% 0 comments | Leave a reply- What Healthcare Could Learn from Amazon – ClickZ – Article I was interviewed for. Sadly the experience described by the patient in the article is not uncommon. And more sadly, they probably didn't know how common it was until it happened to them. Nice commentary from my former boss, Matt Handley, MD, at Group Health Cooperative, nice to know they are still setting an example.
In the AHRQ Innovations Exchange
August 6th, 2008 | Popularity: 41% 0 comments | Leave a replyMaurena Moran, Group Health Cooperative’s Executive Director of Web Services and Enterprise Information Management, sent me a note that our work together is now published in the AHRQ Innovations Exchange:
Here’s the description of the Exchange from AHRQ:
The Agency for Healthcare Research and Quality’s Health Care Innovations Exchange is a Web-based resource designed to support health care professionals in sharing and adopting innovations that improve health care quality.
The message forwarded from AHRQ encourages linking to the Exchange and having other people comment there. I have to say that this is a great resource for the times when people have asked, “tell us what it is you did again on your project?”
Prior to the existence of the Exchange, I had a PDF document on my hard drive of an application we wrote for a national HIT award that described our work in launching a personal health record and electronic health record simultaneously across the State of Washington. We didn’t win the award that we applied for, but the effort put into the application paid off well considering the number of times I sent the document out to other people/organizations. Now there’s a real place to send people to learn more.
I think the Exchange fills a niche for large organizations who want to provide open access to the work they are doing but don’t have the right place to organize this information on service-oriented Web portals. Thanks, AHRQ, and thanks to Maureena, her team, and everyone at Group Health for changing the way we think about interacting with patients where they live, work and play. It’s a great story…
Now Reading: “Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial
June 24th, 2008 | Popularity: 24% 0 comments | Leave a reply
Green, Beverly B., Andrea J. Cook, James D. Ralston, Paul A. Fishman, Sheryl L. Catz, James Carlson, et al. “Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial.” JAMA 299, no. 24 (June 25, 2008): 2857-2867.
Our findings demonstrate the effectiveness of using home blood pressure monitoring combined with pharmacy care over the Web to improve BP control for patients with essential hypertension
This is a significant study in the world of health care and e-health – the first randomized controlled trial to test the use of care management over the Web. It was performed at Group Health Cooperative, using the Web services that I helped implement as part of our electronic health record system.
Looking at the data, it appears that patients with uncontrolled hypertension without access to supportive pharmacists over the Web were much less likely to have their blood pressure controlled compared to patients that did. In other words, patients were not able to achieve as sufficient control through doctor visits alone.
This study further supports the idea that we have a great opportunity to support non-visit-based, participatory health care as a modality to manage chronic illness.
For a health system already paying for physician visits that have less than a 1 out of 2 chance at recording a controlled blood pressure in them, maybe there’s an opportunity to change the way high blood pressure is managed, for example, in California.
PCHIT Personas: Integrated Delivery System
February 18th, 2008 | Popularity: 27% 1 comment
Sites Visited
Benchmarks in incentive alignment and scale
Kaiser Permanente, and organizations like it, are in many ways a benchmark for patient centered health information technology. They have the highest EHR and PHR penetration in health care. Kaiser Permanente currently has 1.7 million of its members using its PHR, and relaunched in November, 2007 as “My Health Manager.” Group Health Cooperative of Washington State is currently at 46 % of enrolled adults with verified access to the MyGroupHealth web site.
MyGroupHealth (ghc.org) adoption curve, 2002-present
The alignment of incentives is reflected in the slope of adoption by patients. The adoption curve for Group Health patients is significantly steeper than comparable organizations (see: Halamka JD, Mandl KD, Tang PC. Early Experiences with Personal Health Records. J Am Med Inform Assoc 2008;15:1-7.)
The work of these organizations is critical in demonstrating that patient centered health information technology can be a reality for all of health care. As we observed, they are post-implementation and involved in relaunch and refinements of their PHRs to support both patient workflow, and the workflow of staff who serve patients in medical centers.
If there are challenges in these organizations, it is that their work requires scalability beyond the typical physician practice, so there is always a risk that innovative ideas may be harder to implement. They are able to work around some of these limitations by supporting regions with higher levels of innovation (for example, the Colorado Region of Kaiser Permanente is a pioneer in teen-physician electronic messaging, see iHealthBeat: Kaiser Colorado Lets Teenagers E-Mail Doctors, Check EHRs).
In my visits to these organizations as a Permanente physician myself, followed by visits to other organizations described here, I noted an gap in knowledge about the potential of PHRs – an understanding of the benefits of PHRs of involving patients and their families in their care has been built up through experience among Permanente physicians that does not yet exist in other parts of health care. In addition, there is no official policy for knowledge transfer that I noticed. Group Health Cooperative generally shares knowledge in the interest of promoting patient empowerment. Kaiser Permanente is embarking on a significant initiative to share its experiences as well. In a session hosted at the California Healthcare Foundation, Holly Potter, Director of National Communications for Kaiser Permanente HealthConnect indicated to the group that, “We don’t have that option anymore” (see: Presentation: Blogs in Health Care) when it comes to delaying or restricting communication about its efforts to the community.
Unresolved issues
- Person to person knowledge transfer (attitudes, technical, workflow) to non-integrated care systems
- Risk of reduced innovation due to high expectations for consistent service across large populations
Countermeasures
Doug VanZoeren, MD, Mark Snyder, MD, and Ted Eytan, MD, bring leaders from the Office of the National Coordinator to Kaiser Permanente West End Medical Center, Washington, DC
This initiative represents a portion of the effort that Kaiser Permanente and Group Health Cooperative are making to provide knowledge to the entire industry. Other efforts include participation in national standards bodies, commissioning high quality research studies, and providing access to its operations (see: Office of the National Coordinator Visits Kaiser Permanente West End Medical Center). One of the most important efforts I have been engaging in throughout is to bring technical and execution expertise to organizations who are implementing PHRs. This will continue throughout the initiative.
It might be useful in the future for these organizations to put together a publicly available “toolkit” for PHR implementation, which would include everything from tested organizational policies, communication collateral, and staff and patient adoption techniques. Currently, this information is being transferred one to one by individuals within the organization. Perhaps a repository of experiential knowledge of basic items such authentication procedures could be made available for other organizations.
Group Health Cooperative has previously released its “Clinical Information System Rollout Toolkit” to the health care community for unrestricted use. We did not create a companion “PHR Toolkit,” however as a part of this work, I recently put together a basic PHR Toolkit that was forwarded to the Institute for Family Health, to assist in their implementation efforts.
Ways to Engage
Victor Silvestre, MD, Kaiser Permanente Oakland Medical Center
Kaiser Permanente is engaged at many levels to promote PHRs, including in the establishment of standards and sharing information, including on this blog.
Several staff members in these organizations are active in public conversations, such as on standards bodies, and are an excellent way to support involvement and knowledge transfer. In addition, given current initiatives to demonstrate the value of their care models, both organizations’ Communications departments will be useful in arranging for access to practices and Permanente physicians who can demonstrate the value of PHR-enabled practices.
The Upsides of Virtual Medicine
February 9th, 2008 | Popularity: 17% 3 commentsThe recent story in the Los Angeles Times has sparked some helpful commentary about a transformed medical system, which is great. I thought it useful to write about one commentary I read recently on the Health Beat blog. I would characterize the tone on the cautious, maybe negative side about “virtual medicine.”
Health Beat: The Downsides of Virtual Medicine
While the focus of the commentary was on commercial providers of messaging services, there’s a whole other practice of patient-centered care supplemented by technology that is going on in integrated and progressive non-integrated care systems. This was the feature of the Los Angeles Times article, which highlighted a colleague of mine, Christine Calderone, MD, from Kaiser Permanente’s Whittier Medical Office.
On the topic of low-income populations, it’s interesting that the 58 percent figure that is cited for having computers in these households is called low, was actually a very high figure in 2000, when organizations like Group Health Cooperative and Palo Alto Medical Foundation began offering these services. From my perspective, 58 percent is very compelling. I’d disagree with the statement that “those most likely to benefit from the web-doc movement are the young, affluent folks who are already plugged in.” Our experience has shown that there are many non-affluent, non-young folks are plugged in, and receiving great benefit. We shouldn’t assume or build a system around the idea that they will not, and our experience going to practices demonstrates that we don’t have to.
Another issue worth pointing out is the question about whether online visits drive up volume. The excellent study at Kaiser Permanente Northwest answers this question well. They do not. In fact, they are associated with both a drop in face to face visit volume and a reduction in trend for phone calls, meaning that the demand for care that is currently unreimbursed in both fee for service and integrated systems is less.
I applaud the careful critique of the trend to involve patients more in their care. At the same time, I keep coming back to the idea that there aren’t very compelling arguments for limiting patients’ access to their care providers or their medical information. I’ve practiced medicine in both worlds, and now around 2 million patients and counting (if you look at Kaiser Permanente and Group Health Cooperative) have received care in both. For me, I can finally be the kind of physician I hoped I could be, and I don’t plan to go back. Does anyone else?
