These are Adam Szerencsy, MD and Neil Calman’s slides from the recent discussion in Oakland, “Patient Online Access in the Safety Net,” hosted by the California Healthcare Foundation.

Adam and Neil are from the Institute for Family Health, and as you can tell, have learned a lot in providing online access to their patients in New York City.

This presentation had special meaning for me for several reasons. The first is that Neil’s organization was the first to host me outside of my integrated health system environment, to learn about applying PHRs to the care of all patients. The second is that I got to watch Adam lead the rollout of IFH’s patient portal from the initial thinking through to watching him prepare his patients for its eventual rollout, when I got to watch him practice in Bronx, New York. You can read the story (and see the pictures at this link) about what that day was like. I still remember it as strong affirmation that there are really exceptional physician leaders among us, who with the right tools can be freed to do great things for their patients and their communities.

It’s interesting that it worked out the way it did, but the last organization I am visiting on my PCHIT journey is the organization I started at, Institute for Family Health. I didn’t plan it this way, it just happened. This time, though, things are different. IFH now has a physician champion for its online patient access to the medical record, Adam Szerencsy, DO, who is also the Medical Director of the Urban Horizons Medical Center in Bronx, NY.

Pictures, click on any to see full size

I give the leadership of IFH credit - when I first met Neil Calman, MD, literally on the first day of my sabbatical, he said that they would be launching patient online access in Spring, 2008, and here it is, happening. Spring, 2008 seemed like a long time for patients to wait at the time.

In the interim period, I have worked with Neil and Adam and their superstar developer Jonah some, but they have done all of the work. My visit was a bit of a graduation day for me, and it was terrific. At the end of every patient visit, Adam excitedly told every patient that they, too, would be able to share in the access to their own medical records. I really loved the way he inquired, too. He would start with, “Do you have a computer at home?” Some patients said, “No,” but he did not stop there. He then asked, “Do you have access to the Internet?” And guess what, I think every answer to that question was a “Yes.” The best part for me was to watch Adam talk to patients about how he would be there for them in this new way.

As with every other innovative organization I have visited, I learned of a new application of the patient access system - in a community where primary care / specialty care communication is at a premium, Adam will use this system to support doc to doc communication, by keeping patients informed and involved in their care. They will have access to a secure web site with their medical information (using a system manufactured by Epic Systems, Inc.), and will be able to print or show this information to referral physicians. In a sense, they will become human information exchanges. It’s important to know that they are already serving in this role - this will add accuracy to it and empower patients with their own medical information.

One other little thing that I hadn’t considered that Adam pointed out to me was the work of documenting in English on the electronic health record at the same time he was having a spanish conversation with the patient. He has mastered this now, but it’s another consideration for our field (Informatics) to have as we support culturally competent care. The record is in English, the conversations are not. What’s best for our patients?

After shadowing Adam in his clinical morning, we had lunch at a local eatery in the Bronx, and talked about the future. Adam has done a lot of work to support his physician colleagues in adopting this technology and as an adopter himself, and the Medical Director of his medical center, I think he’s put together the winning recipe - enthusiasm, energy, accountability, leadership, for the patient and for the community. When Institute for Family Medicine is successful, they will have a wonderful story to tell health care about how every patient in every health care system deserves the best health care available anywhere.

After talking about our digital futures, I asked for the check, and it came as a reminder of the past - a written piece of paper. I took a picture of it for this blog and captioned it with Adam’s word when it was handed to us. He said, “Authentic.”

Moving to a new blog

This is the last post of my journey here with PCHIT. I’ll be continuing at http://www.tedeytan.com, as this blog moves over to the Center for Information Therapy. I’ll post more on that soon.

New York Times Company : Press : Press Release : The New York Times Company Announces Ten Semifinalists for the Second Annual Nonprofit Excellence Awards

The Institute for Family Health - dedicated to the development of innovative ways to provide primary health care services to underserved urban populations based on the family practice model of care.

I was treated to the news that Dr. Neil Calman, President of CEO of the Institute for Family Health has launched his own blog, at http://neilcalman.blogspot.com/. Of course I’m excited by this as I got to meet Neil and his care system very recently and will look forward to being updated about things as they happen with Neil and IFH. When I see Neil, instead of asking, “what’s happening, Neil?” maybe I’ll be asking, “how’s that thing happening, Neil?”

I have noticed in some of my own professional interactions that the conversations start more deeply, more quickly, when I am having them with someone who has been following a blog of mine. I have to remember what I write so I don’t tell the same story. My antidote for this is to appeal to others to have their own blogs, so they can experience the same embarrassment.

I think this is a great way to stay connected to other leaders, and hopefully we’ll have Neil write a few guest posts about the work IFH is doing to support patient centered health information technology.

I spent my last day in New York shadowing in one of Institute for Family Health’s smallest practices - two physicians and a nurse practitioner. Like the other practices in the system, this one is busy, taking scheduled patients and walk-ins. And like the others, it is fully enabled using an electronic health record. Pictures are below. Click on any to see full size.

I saw the art of family medicine here, which is that regardless of the time pressures always faced in medicine, physicians are able to focus and be there for their patients. The physician I saw practice on this day had a really nice rapport with her patients and I noticed was able to connect with them on topics important to them outside of health care - trips they might be taking, or significant family issues. This is always great to see in the context of an electronically enabled practice - doctors can still be doctors. The other significant thing for me was the kindness of the patients in their willingness to let me learn about their relationship with their doctor by watching the interaction. The several that I observed were welcoming after an informed consent was obtained by their physician.

Also, a new best practice for me (I think) - sitting while shadowing. I have traditionally stood in a corner to be as unobtrusive as possible, but it was brought to my attention that my height may be a little imposing in the exam room. I liked it - more at the level of the patient, and more blended in. With great thanks to the 13th street practice.

What about the PHR? I was informed that this practice is diligent about sending patients results and other important health information, which made me think about the value of a personal health record here. What if patients could retrieve their own information, accompanied by information about each test automatically (Information Therapy)? It was important for me to come visit and see that reality for this practice. I think there could be win here in physicians empowering patients to become informed about their own care on their own time. One issue this system will face is in their use of external ancillaries, such as lab and radiology. The PHR may force the issue of establishing a solid interface to both, and this is a good thing - the patients will expect their data to be available to them and to their provider. Everyone wins.

Later in the day, I met with Karen Nelson, MD, MPH, the CEO of Unite HERE Health Center. The facility is beautiful and modern (see pictures below), and also fully electronic, using the General Electric Centricity Product.

We talked about the history of UNITE HERE! and the patients seen here. They are doing a lot of work in Ambulatory ICU and serve a distinct group of special patients in the city. I would very much like to come visit on my return, and had the idea that I would not only like to shadow a provider, but shadow a patient living with chronic disease, if this is possible.

On this day, I visited the Institute’s Walton Family Health Center in Bronx, New York. Due to a time constraint on my part, I did not get to shadow providers caring for patients, but I did attend a CME in the morning and then walked around the facility with it’s Medical Director. Pictures are below, click on any to see it in gallery format.

The facility is about 10 years old, and to my eyes, it seems very well designed, as well designed as any outpatient medical center I have seen. This is a medical center that has transitioned to the EHR that the rest of the Institute uses, so they have experienced the return of space back to the practice now that paper charts are gone. You can see a scanning station in one of the images - this is where the medical records room used to be.

This medical center is interesting in that it also houses a dental practice, which coexists well according to the Medical Director. It was pointed out to me that the dental exam rooms have no doors, to promote team efficiency. The dental practice also uses a dental-specific EHR, that in this case does not communicate with the medical EHR. I have long been fascinated with dental practices, because I believe that they have done a lot of work to maximize workflow in the era of electronic records that allopathic medicine could learn from. I have seen that dentists do a great job of involving care team members in the use of the EHR and in producing documentation, and this was the case here, when I asked how documentation was supported.

You’ll note the picture of the flourescent viewbox - physicians are forgetting how to use this in the area of digital radiology, and that’s the case here. There are challenges in this medical center in not having on site radiology, though. Radiology services can be challenging to arrange, and retrieval of exam data that goes with it can be equally challenging. This has implications for a personal health record and patients’ desire to have complete results available to them.

I was also able to talk with Paloma Hernandez, CEO of Urban Health Plan of Bronx, NY, and her Medical Director, Samuel De Leon, MD, about visiting this organization as one of our future sites. I got the sense of their innovation by the fact that they are now piloting iris scanners for patient identification, linked to their EHR system. It looks like they are doing outstanding work, as is the Institute.

Yesterday, Neil Calman brought me to meet with the Primary Care Information Project Group to follow-up on work his team has been doing to leverage the Institute’s EHR to support public health. I was only briefly introduced to the work they are doing, but I will of course want to learn more. A Personal Health Record system is part of their plans. I was given a nifty Electronic Health Records Action Kit by the group, which puts together the rationale for going electronic very nicely.

There is not yet a personal health records action kit that I can see, but judging from the quality of the EHR kit, I think they’ll do a good job with this one when it’s produced. The team was very welcoming of new ideas and I was also impressed at their interest in understanding the EHR and how to leverage it to maximize the community’s health. It seems like a very nice partnership.

First site! Institute for Family Health, based in New York City.

I spent my first day at Sidney Hilman Family Practice Center, shadowing 3 clinicians and flow staff. Pictures are below, click on any to see as a photo album.

I started the day shadowing flow staff (medical assistants) to see how patients are roomed and brought into the practice. They do something I have not seen in my practice, which is assess patient’s learning ability for every new patient, prior to the provider entering the room. They do this via a template that they fill out with the patient. Something I heard a medical assistant tell a patient that I really liked: “Have a nice visit…” - this seemed to be nice stage setting for a good interaction.
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