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.

May 6th through May 7th:

• The Happy Hospitalist: This Deserves The Middle Finger - I guess it is controversial (the RUC report on Medical Home Reimbursement)
• AMA (RBRVS) RUC Medicare Medical Home Demonstration project recommendations - RUC and Medical Home. Might this be controversial?
• reportonbusiness.com: Asking ‘why’ again and again is harder than you think, but it works - Good description of the 5 Why's Exercise
• What is Hypertension? - WrongDiagnosis.com - Factoids about Hypertension, useful in planning a community intervension
• Cigna clients seek answers after expiration -
• Cigna ends pact with hospitals, leaves thousands in the lurch - This local story has not made the national news. I wonder why?

April 1st through April 2nd:

• Pattern Recognition » Blog Archive » I really hate Zotero - Like the concept, wants to improve the implementation
• Medical Home | Solution to Chronic Care Management? | Health Care | Disruptive Innovation for a New Primary Care Model | Center for Health Solutions - Deloitte LLP - Very nice overview of Medical Home, particularly with the rundown of stakeholders in the back, plus the medical home cost model.
• WordPress ? Support » Tags Import As Numbers, Not Words - Importing issues Wordpress
• Web 2.0 Expo San Francisco 2008 ? Co-produced by TechWeb & O’Reilly Conferences, April 22 - 25, 2008, San Francisco, CA -
• Compare Accounts | YouSendIt - Store and forward service for the times when e-mail isn’t so efficient. I use XDrive.
• Convert Your Paper to iPaper | Scribd - An ambitious project to convert paper , no extra charge
• John Furrier Says Google?s CIO is Leaving for EMI - Interesting change of employer, could the same thing happen if a Google employee was recruited to run a health care organization?
• Twitter - A Teaching and Learning Tool | ICT in my Classroom - Nice discussion of the uses of Twitter in education
• VoiceThread - Group conversations around images, docs and videos - An interesting image, video, voice annotating service. What are the applicaitons in medical group training and patient involvement

PCHIT links for January 30th through January 31st:

• Group Offers Doctors Bonuses for Better Care - WSJ.com - “Far Reaching” seems an accurate description. This could really drive PHR adoption.
• Personal Health Records Online? Just Say No! - Commentary from the Patient Empowerment Blog at About.com. I’ve added my own comment at the bottom.
• Project Health Design Blog: Minimal federal government impact on PHRs in 2008? - Discussion of the federal role in PHR development from the excellent HealthDesign blog. If not useful in designing PHRs, what about in incentivizing them, such as part of current HRSA grant programs?

PCHIT links for January 14th through January 29th:

• FreeMD? Your Virtual Doctor - A guided diagnostic tool for patients. There is limited record keeping that comes with this.
• California Could Be Health IT Model, Medicare Official Says - iHealthBeat - PHRs, they haven’t arrived.
• New York Insurers Launch Pilot To Test Medical Home Model - iHealthBeat - PHRs, have they arrived?

PCHIT links for November 29th through December 4th:

• How to talk to a doctor - USATODAY.com - I wonder how much if the burden being placed on patients is necessary in the era of PCHIT?
• Delivering a new kind of care | IndyStar.com - Patient centered HIT starts with patient-centered care, from Indiana
• Benefits of Electronic Health Records Seen as Outweighing Privacy Risks - WSJ.com - Poll by WSJ/Harris: Consumers want interaction with their care providers online. Less agreement on reimbursement.

PCHIT links for November 15th through November 21st:

• Healthy San Francisco: - San Francisco starts a Medical Home program
• Nurture by Steelcase > Home - Work by Steelcase for a supportive health care environment
• EHRs Lack Features To Boost Patient Care, New York City Official Says -

PCHIT links for November 9th through November 13th:

• JAMA: Soliciting the Patient’s Agenda: Have We Improved?, January 20, 1999, Marvel et al. 281 (3): 283 - Data often cited and here’s the source: patients redirected an average of 23 seconds while providing their history.
• The Center For Health Design Research - Pebble Project - Center for Health Design supports evidence based design of health environments. Have they done work in PHR/EHR enabled institutions?
• Life as a Healthcare CIO: Personal Health Records - John Halamka, MD, supports the idea that PHR adoption is not a technology issue. Consistent with my findings on our recent trip to Boston.
• A Model for Health Care That Pays for Quality - New York Times - NYT Reports on Patient Centered Primary Care Model promoted by ACP, IBM, and others
• E.H.R. Home - HL7 announces balloting for PHR standards

PCHIT links for November 2nd through November 4th:

• Patient-Centered Care: What Does It Take? - New report from Commonwealth fund
• UI Design Newsletter, October - This year, world usability day is focused on health care
• Putting Patients First: Developing and Maintaining Patient-Centered Medical Practices - Brookings Institution - Just released report discussing patient experience in Washington, DC practices

PCHIT Advisory Group - Slides

This post is first in a series will summarize our status and input from our Advisory Group (Blogs are about a little information at a time). Both the Group and this audience are welcome to comment. Our goal is to make any adjustments necessary, now, and continually improve our process as we do this.

The summary comes in the form of an “A3″ document and a short set of slides. The slides are published here.

A reminder that an A3 document really just outlines a story. It’s probably best for this medium for me to discuss the work of each Advisory Group member (with the exception of Patricia Flatley Brennan, who could not be with us this first time) and the impact on adjusting our work.

To also keep this manageable, I’ll do it over the course of the week, one each day.

Michael Barr, MD, MBA, FACP: Michael, as Vice President of Practice Advisory and Improvement for the American College of Physicians, is leading the Medical Home work of the College. This includes establishing the “systemness” of the Medical Home, as well as understanding the economics of the Medical Home. He is working with payers to establish the benefit to patients and ability of Medical Home to address self-management goals. As currently devised, this model is most effective in practices where there are longitudinal relationships, such as primary care, but also in specialty care in certain circumstances. Several demonstration projects are set to begin in 2008. The College’s Center for Practice Innovation has been working with small practices to transform them, in line with Medical Home principles. The ACP is heavily involved in technology issues, at the level of some delivery systems. Finally, we are alerted to the publication of a white paper in the Annals of Internal Medicine on payment methodologies.

Adjustment: The impact of Medical Home discussions locally and nationally is very clear, and observations in PCHIT should be connected to Medical Home principles. Ted Eytan is presenting at the CPI conference in Washington, DC, on November 17 and will be spending time with CPI staff and practices as part of this involvement. The ACP white paper will be reviewed by us as well for implications for PCHIT.