Josh and I spent our day yesterday at two leading edge health organizations in the Bay Area, Kaiser Permanente, and John Muir Health. This post is about our time at John Muir Health. Like Kaiser Permanente, John Muir Health is a big place - out attention was focused on the John Muir Physician Network, which provides multispecialty care within owned and operated practices as well as within an Individual Practice Association.

And…it was very valuable. My background is as a family physician within an owned and operated multispecialty group, so even though I understand the implementation of both an EHR and PHR at an enterprise level, I am not acquainted with the environment of physician-owned practices. To this end, Michael Schierman, MD, hosted Josh and I at his practice at Blackhawk Medical Center, in Danville, California.

Michael is a family physician, originally from Calgary, Alberta, who shares his full time practice with two physicians who are general internists. His practice is leading the way for a transformation to electronic health records using the NextGen platform. In my work, I have also never seen the NextGen product, which is a fully CCHIT certified electronic health record, in action. Michael’s practice has only recently gone live, and he’s pretty facile with the system in practice, from my view. They are now doing the hard work of converting paper charts to the electronic work, and a great metaphor for this was Michael’s office. Before we visited, he apologized for any messiness in his office, which comes as a result of the paper charts he is diligently reviewing as part of the transition. Again, the value of being there is made apparent, because I could see that the transition to an electronic health record means everything from changing your workflow to uprooting your physical practice environment.

In the patient rooms themselves, the story was a very pleasing one. Michael was able to tell his patients that laboratory studies could be obtained without needing a paper lab slip, and prescriptions would be sent electronically from his laptop during the visit. His patient population, which is a busy and professional one, seemed impressed. In reference to my presence, he asked several of his patients what they would think about e-mailing their doctor. The comments that came back were very interesting, and tracked what we’ve heard at Group Health. There was a measured concern and respect for their doctor’s time that came with each response - “I would want to keep things to the point.” At the same time, Michael showed me his work list that was nicely displayed on his laptop. The question would be how this other avenue of communication would fit into this portion of his practice life.

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