I was excited to present at the Medicaid Medical Directors’ Learning Network, invited by Amanda Brodt, MPP, from AcademyHealth, in St. Paul, MN. The Network is coordinated by Academy Health and Sponsored by the Agency for Healthcare Research and Quality.

I had not heard about the network before Amanda told me about it, so it was great to sit in on the round robin as these medical leaders shared their perspectives on serving Medicaid recipients across the United States. Their jobs are challenging to be sure, at the same time they bring a lot of energy and interest into serving well, which includes supporting the medical communities they work and practice in.

The topic of the session I attended was the Patient Centered Medical Home (PCMH) and how concepts are already being deployed in Medicaid populations. I was invited to give a private sector perspective and in that vain, gave a presentation entitled, “4 1/2 reasons why patients and families should be involved in their care, and 2 1/2 things you can do to help,” covering my experience implementing health information technology and visiting practices across the US over the past 7 months.

I expected to find an innovative group of physicians with a perspective on improving health care from a societal perspective, and I was not disappointed. Many of the States are grappling with the implementation of electronic health records locally and across large geographies - HIT is no longer the domain of a single health care organization. This means patient access is also a possibility across organizational and provider boundaries, which is really good news. Oregon, I believe, is now reimbursing for online visits within its program.

There was a comment made about the fact the Group Health has not experienced the same penetration of its online services in its contracted network, as demonstrated in this paper. I think this should be seen as a great opportunity, rather than an unchangeable reality, because the data indicates that patients at all levels of income and education are online and want to be involved in their care. The challenge is to outfit smaller practices with EHRs, and this is happening in places like New York and California, in what I think is a replicable model. At the same time, it was pointed out that the most vulnerable patients probably have the lowest level of access relative to their less vulnerable peers. It’s an excellent point to be made that populations with 40 % Internet penetration may benefit most from greater involvement.

Several of the Medical Directors expressed a belief that I share, which is that the leadership role is about enabling the best care, and awakening the desire on the part of all health professionals to be the best for their patients. I think this group and the programs they represent have the potential to support patient centered care for every patient in every system, and I like being in rooms where that’s the case, of course!

One thing I couldn’t find online is a web site (or blog :)) describing this group’s activities. I know that they are all extremely busy - I think their communities, though, should be impressed with the work these physicians do on their behalf.

Thanks again to Amanda, AcademyHealth, AHRQ, and my sponsors, California Healthcare Foundation and Center for Information Therapy, for the conversation.

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