Menu-labeling laws are changing food purchases in New York City, study finds | California Consumer | Los Angeles Times – I wrote previously about the impact that transparency can have on health care. This study finds proof that it’s working.
Posts Tagged ‘New York’
Menu-labeling laws are changing food purchases in New York City, study finds | California Consumer | Los Angeles Times
October 26th, 2009 | Popularity: 2% 2 commentsWhen physicians are ready to promote patient empowerment / engagement, what do we want them to do?
October 8th, 2008 | Popularity: 61% 40 commentsThis question was posed to me by Ann Barber, MD, who I just spoke with. Ann reached out to me because she has been following the work of the group at e-patients.net, and specifically their call to recruit physicians to support the patient empowerment movement. Ann is an internist who specializes in hospital medicine, and has recently relocated to New York.
Ann asked me the question in the title of this post, and in talking with her, I decided to ask it here as well, because I’m unsure of the answer.
I wondered if this is because I/we have assumed that the majority of physicians are not interested in empowering patients, and therefore we don’t know how to support those that are?
I did a mini-check in with myself on this, and although I have alluded to some physician groups still feeling challenged by the idea of patient empowerment on this blog, the majority of my writing here points to the idea that physicians are very interested in empowering patients, because they want to perform well for them. The overwhelming majority of my posts here point to that idea, and here’s just one example.
Back to the question – where should a physician start when they have the energy and drive to make a difference in this area? When they interview for positions, what vocabulary should they use to describe what they are looking to do? How do they find the institutions in their communities that are already forging ahead in this area? If there are no institutions identified, how do they find the ones that are open to new ideas/thinking in this area?
My suggestion was to walk the hallways of any potential medical center employer and observe and ask questions – how are patients and families involved in their care? Do nurses and doctors round at the bedside (like they do at Medical College of Georgia, and hospitals in the Kaiser Permanente system [article in Harvard Business Review describes this] )? Are there visiting hours? How does the institution keep families and informed throughout a hospital stay?
I recommended a few resources, including the Wachter’s World Blog, written by hospitalist expert Bob Wachter, MD, the Institute for Family Centered Care, to find institutions in a community that are practicing patient and family centered care in New York, and of course, HelloHealth in Wlliamsburg.
I think the inpatient setting is the next frontier of patient and family involvement in their care, enabled by technology, and welcome the creativity of Ann and other hospital medicine specialists who want to make a difference for patients and famlies everywhere, which is why I wanted to think about this more.
Are there other ideas for Ann and the physicians in our profession who are among the “already recruited?”, in New York (and beyond)? Post them in the comments, please!
And thanks to e-patients and all the patients who have made it easy to remember who I am accountable to.
Patient Online Access in the Safety Net: Adam Szerencsy, MD and Neil Calman, MD’s slides
August 30th, 2008 | Popularity: 40% 0 comments | Leave a replyThese 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.
“In a couple weeks, you’ll be able to see this, too” – Ending where I began, at Institute for Family Health
March 25th, 2008 | Popularity: 43% 0 comments | Leave a replyIt’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.
Live! from Staten Island – Innovation in patient-centered care
March 23rd, 2008 | Popularity: 25% 0 comments | Leave a replyWhen I found out that Sal Volpe, MD, Mat Kendall, and the PCIP team were going to be talking about their work in the community where Sal practices, I knew I wanted to come and experience it.
We started with Sal allowing me to experience the trip from Manhattan to Staten Island, which can take up to 2 hours by car as it did this day. This says something about Sal’s commitment to this work. He makes this commute regularly to support New York in rolling out this program, at the same time he supports his family and Internal Medicine/Pediatrics/Geriatrics practice on Staten Island. On the way over, he told me how the electronic health record has changed things for him. Prior to having an EHR, he used to take his sons for a walk to his office, where he would catch up on charts for a bit, and then walk with them home. Since that time, they don’t have to stop at the office anymore – they just walk longer together. This is not to say that the EHR has reduced the workload, it has allowed Sal to integrate it better with his family.
We arrived at Richmond University Medical Center and began with an overview of the PCIP program by Mat Kendall, the Director of Operations. It really is impressive to think that here is a Department of Health actively engaged and interested in community providers having better tools to take care of patients first.
Sal then came on and presented his experience, and I think his experience is important, given that he manages his own practice and accepts the risk of the business decisions he makes. With the data showing that EHR’s are more prevalent in group practices, Sal’s story is important in the conversation. He included his experience with the patient portal that comes with the system he uses, which is manufactured by eClinicalWorks. He then spoke about the fact that since he turned on the system, he has given every patient a copy of his physician’s progress note. When asked about this, he said, “What’s wrong with giving them a copy?” I thought that was a great question to ask of all physicians everywhere.
I was given a ride back by Mat Kendall and the rest of the PCIP team. Spending time with Mat reassures me that optimism is infectious – usually I am the most optimistic person in the room but when I am around Mat, this is not the case. It’s always nice for me to have optimism radiated in my direction. We had a nice conversation about the future of the program and of the patient portal in it. Mat has 4 years’ worth of experience managing a Federally Qualified Health Center, so he has a good idea about how to be successful with patient access, and I believe him. Despite the challenges of a visit-based reimbursement model, there’s the idea that patient access will improve access to good health care and promote better use of the system among patients who do not know their risks. Mat also points out that the data to date about visit reduction comes from commercial health plan settings. The PCIP team is well aware of data about Internet use in the population it serves and the potential benefit from giving them access to data contained in EHR systems. Right on.
I left the conversation and the evening as optimistic as I ever have about patient access to health information technology. Before I started this journey, I didn’t forsee that one of the most innovative practices I would discover would be in Staten Island, NY, or that a Department of Health could steward health information technology adoption for a whole community. I did and they are.
Congratulations, Institute for Family Health!
March 20th, 2008 | Popularity: 25% 0 comments | Leave a replyThe 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.
Health 2.0: Jay Parkinson, MD, OnCall Medical Group, Enoch Choi, MD
March 4th, 2008 | Popularity: 32% 0 comments | Leave a replyA few more interesting ideas in Health 2.0: Jay Parkinson, MD, in a video about his practice, invoked the work of Toyota Motor Company (smiley face) as a company that works to remove errors from processes.
The On Call Medical Group, like Jay, go to where the patients are – home or work, their true Gemba. I liked the comment about the fact that going patients’ homes allows physicians to assess patients’ capabilities and work with them collaboratively.
The patient filmed was judged not to have a high likelihood of strep infection, yet a culture was still drawn and antibiotics prescribed.
Panel moderated by David Kibbe, MD, from the American Academy of Family Physicians. Overall, it is great to see physicians interested in the art of medicine and able to equip themselves to do something different.
“Our patients, not my patients” – UNITE HERE Health Center, New York City
February 29th, 2008 | Popularity: 47% 0 comments | Leave a replyThe quote is from Abigail Chen, MD, who I shadowed yesterday as I was shown UNITE HERE’s implementation of the Ambulatory ICU (you can read more about the A-ICU concept here). Before I get to that though, I arrived in the morning with my usual level of interest in both seeing how patients benefit from health information technology and integrating into the flow of the medical center as unobtrusively as possible.
A few pictures (click on any to see full size). I have to admit I got caught up in learning about the team care concept and didn’t get as many photos as I wanted to. Next time!
Fortunately, Andrew Tzellas, MD, quickly slowed down my CPU and invited me into his team’s huddle for the morning. I was invited to have a seat next to Palmeras and Nancy, team experts on chronic disease management and coverage, and then joined by Jenny, the clinic coordinator, Andrew, and his medical assistant. As they started the huddle, Nancy printed off the day’s schedule and gave them to me so I knew what general issues the team was working on. Each patient in this ambulatory clinic was reviewed by the team across the spectrum – health status, disease management, social and coverage issues. A green tracking slip was pre-filled by Palmeras for each patient and added information about due health maintenance. Andrew and Jenny, each viewing the electronic health record, worked with the team to create the day’s plan. While this was happening, walkie talkies would announce patients’ arrival (I wasn’t paying attention to this, but Jenny pointed out that the whole team was). At one point, as Andrew was talking about the guidance for a particular patient, he said, “I can inform them about my, I mean, our feeling about this issue.” The transition from individual planning to group planning of care was apparent.
I sat in on the next huddle as well, this time for Abigail Chen, MD. Same flow. It reminded me a bit of being a third year medical student on my first rotation in medical school, when I walked into a functioning team (my first rotation was trauma surgery – that requires functioning!) and I was impressed with the cadence and “beat” of the group (or as they say in Japanese, takt). I could tell the teams had spent quite a bit of time forming the approach here.
UNITE HERE serves a very special population. From their web site:
UNITE (formerly the Union of Needletrades, Industrial and Textile Employees) and HERE (Hotel Employees and Restaurant Employees International Union) merged on July 8, 2004 forming UNITE HERE. The union represents more than 450,000 active members and more than 400,000 retirees throughout North America.
UNITE HERE boasts a diverse membership, comprised largely of immigrants and including high percentages of African-American, Latino, and Asian-American workers. The majority of UNITE HERE members are women.
The Health Center itself is gorgeous, but it wasn’t so very recently. As I talked to staff, I learned about the transformation that has happened in the last 7 years, from a health center that sometimes served 100 patients on a Saturday with wait times several hours long, to a health center where customer service training is the norm, innovative approaches to chronic disease care are standard, and patients are treated with respect. I was told that staff were even trained using callers who role-played actual patients to ensure that each patient was treated with courtesy. That’s an impressive commitment.
I was able to shadow a patient of Abigail’s, where she of course used the Health Center’s state of the art electronic health record, (Centricity, manufactured by General Electric). In the course of the visit, Abigail ordered some screening lab tests for the patient and took the time to explain the purpose of each, in Spanish, the patient’s native language. The patient was immediately referred at the end of the visit for teaching about pre-diabetes, which was performed by medical assistants, all specially trained in a variety of health topics. Great care was placed in involving the entire team in the care, as the quote at the top of the post states, and from my observation, this busy medical center had a more relaxed feel, or at least a feel that everyone was accountable to each patient together. This coordination did not come overnight – it came with support from leaders who encouraged innovation, and in my view of outcomes in the waiting room (where are were publicly posted), it’s working.
In the background of all of this, where does patient centered health information technology fit in? UNITE HERE has a state of the art electronic health record. They are preparing to launch a patient portal which will include staff messaging and other features that are being developed now. Unlike Urban Health Plan, there is not a big pediatric population, and there is a clear emphasis on chronic disease management, team care, and a further emphasis on diabetes. The Health Center is already innovating to provide patient-centered care, which is a prerequisite for success in implementing patient-centered health information technology. One of the tenets is “from the board room to the bedside.” In this health center, the board room is just around the corner, so it’s easy to cycle through improvements rapidly. This is the advantage of the small practice over the integrated delivery system – the risk of ideas not counting (or worse, being wasted) is less.
I have not previously seen a patient portal launched off of a Centricity system, so this experience should be valuable both in the population being served and the technology being used. For a health system working to attract Union members across industries and across the geography of New York City, this will add another great reason to choose this team.
This brings the number of patient accessible EHRs coming on line in New York City to three – Institute for Family Health, Urban Health Plan (Part of the Primary Care Information Project), and now UNITE HERE. All will add significant information to the conversation about patient access in a diversity of populations. This is the real thing, and they are all going to do an excellent job, and we’ll be helping along the way. Congratulations to all of the patients in these three leading health systems.
Thank you again to Karen Nelson, MD, MPH, the patients, staff, and physicians at UNITE HERE for the gift of their time and (some of) their knowledge. There is a lot to learn here.
Addition 2/29/08: One thing I forgot to mention that’s really important is the fact that I only shadowed one patient. The reason why is because the team appropriately asked for explicit consent from other patients who stated their preference to not have an observed visit. This is a marker of respect for the patient, because the consent is asked as a question, and the answer is listened to. I don’t think it’s a coincidence that at every site we have visited, at least one patient declines having an observer. What that says to me is that we are at a place where the patient is at the center of care.
PCHIT Personas: Vulnerable Population
February 27th, 2008 | Popularity: 43% 0 comments | Leave a replyIn many, if not all, of the sites we visited, the question of disparate access to PCHIT was raised. The same question has been raised with regard to EHR’s as well. In its report, the Expert Consensus Panel (see Electronic Health Records Still Not Routine Part of Medial Practice, Robert Wood Johnson Foundation, 3:27):
(The Expert Consensus Panel) has identified racial and ethnic minority patients and low-income or publicly insured patients as the two highest priority patient populations
The PCHIT Initiative broadens this view of vulnerable populations to include those with documented disparities including but not limited to individuals who are lesbian, gay, bisexual, and transgender. An additional vulnerable population of interest are returning soldiers (see: Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War).
Available data about Internet access contradicts conventional wisdom
Charts: Click on any to see full size (Sources: Benchmarking Digital Inclusion, ITIF, and Estabrook L, Witt E, Rainie L. Information Searches that solve problems. Washington, DC: Pew Internet & American Life Project; 2007)
In a review of the literature related to Internet use among vulnerable populations, we discovered that commonly held beliefs about use and access are not true. Even at the lowest educational and income levels, Internet use approaches 60 %, where it was only 10-30 % in 2001.
The following studies shed additional light on this issue:
- Estabrook L, Witt E, Rainie L. Information Searches that solve problems. Washington, DC: Pew Internet & American Life Project; 2007. A random sample survey performed between June and September, 2007 shows gains in Internet access and explores type of access – “High” for broadband at home or work, “Low” for no access or Dial-up only
- McNeill HL, Puleo E, Bennett GG, Emmons MK. Exploring Social Contextual Correlates of Computer Ownership and Frequency of Use Among Urban, Low-Income, Public Housing Adult Residents. J Med Internet Res 2007;9:e35. – In Boston public housing, 51 % of adults own and 42 % of adults regularly use computers, and those reporting feeling “safe” in their neighborhoods have a greater likelihood (76 % higher association) of using a computer regularly.
- Beckjord BE, Finney Rutten JL, Squiers L, et al. Use of the Internet to Communicate with Health Care Providers in the United States: Estimates from the 2003 and 2005 Health Information National Trends Surveys (HINTS). J Med Internet Res 2007;9:e20 – “In 2003, Internet users with high levels of education were more likely to have communicated online with an health care provider, consistent with previous studies. That education was nonsignificant in 2005 may suggest that health care consumers’ level of education is less of a barrier to communicating online with health care providers as the prevalence of online patient-provider communication increases.” and “We did not observe associations between online communication with health care providers and characteristics such as race/ethnicity or annual income that have been documented in other studies as evidence of a “digital divide””
- Carroll AE, Zimmerman FJ, Rivara FP, Ebel BE, Christakis DA. Perceptions about computers and the internet in a pediatric clinic population. Ambul Pediatr 2005;5:122-6. – “Most families like using computers and feel comfortable using the Internet regardless of socioeconomic status. Fears about the digital divide’s impact on the attitudes of parents toward computers or their comfort using the Internet should not be seen as a barrier to developing Internet-based health interventions for a pediatric clinic population.”
A more sensitive indicator of patient access to electronic health records is likely to be online banking (see this post on that topic), because online banking requires confidence and convenience as well as access to be successful.
Online banking use and income level, from Online Shopping, Pew Internet & American Life Project, 2008
East Boston Community
Patient-centered HIT applications do not necessarily require use of a computer on the consumer’s end. For example, a mobile phone may be the most effective vehicle for certain populations, whether the information coming to them is in the form of an automated phone call (which can be delivered in multiple languages), a text message (such as for medication reminders), or a more sophisticated combination of audio, graphics and video. A variety of strategies are profiled in a recent report published by the Georgetown Health Policy Institute’s Center for Children and Families (see Health Information Technology: Innovative Applications for Medicaid).
Outside of patient access to computers or the Internet, there are opportunities
Some analysts shortchange vulnerable populations by suggesting that language barriers, the digital divide, or health literacy pose insurmountable obstacles to effective PHR adoption. Perhaps no population faces a greater panoply of barriers–including Spanish as primary language, health literacy, access to computers and the Internet, geographic challenges, and a lack of care continuity–than migrant farm workers. The tool, MiVia, has demonstrated that PHRs can be effective tools when appropriate accommodations are made, such as using community health workers to help facilitate PHR adoption.
As we consider patient-centered health information technology, the definition should be broadened beyond personal health records, to any technology that provides the benefits and impacts of patient access. These impacts accrue whenever the health system is accountable to those it serves, by providing them the information they generate about them, whether in paper, computer or smart card form.
Unresolved issues
- It is unclear how pervasive the conventional wisdom of the “digital divide” is, and if there are related factors that would bias toward inaction even if the data were better understood for populations studied (ethnicity, income, education)
- For populations that are less well studied (e.g. lesbian, gay, bisexual, transgender, returning soldiers), the impact of provision of access to PCHIT in safety net environments is also unknown. With limited funding available to study sexual minority populations, for example, disparities may only be exacerbated in an environment of HIT without PCHIT.
Countermeasures
In 2008, we are emphasizing safety net providers and vulnerable populations in PCHIT work. We are providing the technical assistance of a knowledgeable medical informaticist and patient empowerment advocate to demonstrate the impact of PCHIT in a vulnerable population. We would also like to spend some effort in packaging this data and presenting it in leadership forums. Ted Eytan did this recently for the District of Columbia Primary Care Association, where it was well received (see Presentation to DCPCA, December 18, 2007), as well as on a recent event at Urban Health Plan, in Bronx, New York (see: “We did it! Thanks Affinity Health Plan and Urban Health Plan!“)
Ways to Engage
In addition to working with health care and IT leadership on promoting PCHIT as part of HIT, it would be valuable to engage with patients themselves. In 2008, we are hoping to shadow a patient who is part of a vulnerable population as they manage chronic disease. This will most likely happen on our trip to Sonoma, California, in March, 2008.
A Different Kind of Patient Access to HIT at Queens Health Network
February 26th, 2008 | Popularity: 34% 0 comments | Leave a replyAs I mentioned in my previous post, I was beckoned to the borough Queens, NY, shortly after my presentation at the United Hospital Fund. Despite the snow, the trip wasn’t that difficult (in fact, Rachel’s advice to stop and get shoe covers made all the difference in the world).
It was, of course, well worth the trip. I came to Elmhurst Hospital Center, part of Queens Health Network, where they have been using smart card technology to enable better patient care.
First, pictures (click on any to see full size):
As the images show, patient ID cards for the network have embedded smart chips in them that store 64K worth of information, in read-only format. A new version is being rolled out that will store 128K worth of information and be read-write. Given that 22 different languages are spoken by the borough’s 3 million residents, it is easy to see that having a portable version of a medically-understandable health record could be useful. The Network has outfitted local emergency rooms with card readers.
In an innovative program with the Queens Library, patients will be able to access card readers there to see what is on their smart card. What I was shown was a concise clinical summary of health care activity, that included medications, recent tests, and ongoing medical conditions. I could imagine how this could reduce the stress of relaying a person’s medical history to a new doctor or a doctor in an emergency situation. Within the hospital, the patients’ records are available on a state of the art electronic health record; the card is just for portability. Outside of the emergency room environment, a PIN code is used to access the data.
The commitment is there to make this work. Clinics have machines that generate the special ID cards. Card readers are attached at key points in the clinical workflow to ensure updating of the latest information from the EHR. Challenges remain, including making sure that updating of the card occurs at every visit. We did not discuss in detail the impact of a read/write card, and how that would bring data back to the Health and Hospitals’ Corporation electronic health record.
During my visit I was also shown Queens Health Network’s work to improve chronic disease care using registry systems linked to their electronic health record, by Rand David, MD. They have made significant gains in the last 5 years in both process and outcome measures for diabetes, which is what I was shown. Alfred Marino, Glenn Martin, MD, and Amelia Shapiro, are the team working on the smart card piece, in addition to several operations leaders who are integrating this into the workflow. Besides the interest in the technology, they have an interest in the distinct attributes of the population they are working to serve, which came across very clearly to me.
What strikes me as very interesting about this idea is that it supports a simple and “interoperable” health record that is under patients’ physical control. In my own work, I had not considered the value of a smart card linked to our electronic health record, but why not? If it improves the comfort with which a patient is able to seek care, especially in a multicultural community, I think this could fill an important niche.
There are definitely challenges regarding workflow and community support of this program, which are both being actively worked on. The work of Queens Health is a very nice demonstration that patient access to their own health information is not just about having Web or Internet access, and it can make a difference in supporting good health care.
New York Business Group on Health at United Hospital Fund
February 26th, 2008 | Popularity: 34% 1 comment
United Hospital Fund, Empire State Building, New York City
On our last day in New York City, Rachel and the United Hospital Fund arranged for a presentation on patient-centered health information technology to the New York Business Group on Health, at UHF-NYC headquarters in the Empire State Building.
As I do with most presentations, I started with a thought provoking question, and this day’s was “When was the last time you looked at your medical record?” The responses, as expected, were extremely varied. Most had never seen their medical record, or seen it in disconnected parts. There were some answers that went like this: “I have seen my claims data in a PHR, but not my medical record.” I thought it was interesting that people were able to differentiate between claims data and a medical record.
At the same time I said, “I wouldn’t be here talking about this if I didn’t think you could do it,” and I meant it. As I posted previously, New York is having great success implementing EHR’s through their PCIP project, and are about to add patient access to these systems. A strong purchaser community can bring the next level of integration – that of a wellness ecosystem.
Several audience members pointed out, accurately, that there are things that can be done in an integrated health system that cannot be done in a dis-integrated one. At the same time, there was sharing of some innovative projects that are happening in the health plan community as well as the purchaser community. I left as impressed with the possibilities as I was when I came.
When I looked out the window at the brewing snowstorm at the end of my talk, Rachel reminded me, “You’re still going to Queens.” Of course I was, and I’m glad I did. More on that in the next post.
New York’s Primary Care Information Project – Moving Ahead
February 25th, 2008 | Popularity: 24% 0 comments | Leave a replyAs 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
We did it! Thanks Affinity Health Plan and Urban Health Plan!
February 23rd, 2008 | Popularity: 28% 1 commentThe expression of happiness in the title is a reflection of the milestone that this was in this journey. It was the first time that we went to the Gemba (“the factory floor”) with health plan leaders and delivery system leaders together, to talk about patient centered health information technology.
We were guided by Urban Health Plan’s inspiring CEO and Chief Medical Officer Paloma Hernandez and Samuel De Leon, MD, who allowed us to observe the process of care at their Bronx, NY-based care system. Invited guests included Susan Beane, MD, the Chief Medical Officer, and Linda Erlanger, the Director of E-Commerce, from Affinity Health Plan, which, “..for 18 years, has been operating managed care programs designed to address the needs of low-income populations. We are a mission-driven organization, striving to achieve positive change in the lives of the families and communities they serve.”
The goal was to do something we had not done before, bring stakeholders together to see the the actual place where the facts of health care impact the patient (for a nice description of the philosophy behind this, based on work done at Toyota Motor, see this post).
First, some photographs. Click on any to see full size.
Asthma, an Epidemic in this Community
I shadowed Mayra Nadal, MD, who is a pediatrician, and like all of the other physicians at Urban Health Plan, are using a fully functional electronic health record, manufactured by eClinicalWorks.
After a few visits, I noticed that several of her patients had severe asthma, and were being treated very intensively. One patient, a young boy, was on multiple ambulatory medications yet he was still not able to breathe normally.
I learned from Mayra that this is a sad reality for this community – this population is at exceptionally high risk for being affected by asthma. This is well known in the community. What I saw in the exam room were the best attempts of this care system to blunt the impact of this disease (and Urban Health Plan has distinguished itself nationally as a leader in managing chronic illness). Mayra showed me that they had taken extra care in the build of the EHR to include standard asthma histories and tracking of asthma plans because of the prevalence. The tools looked very complete; at the same time, they are the tools an informaticist wish they didn’t have to build. It doesn’t seem right that children in the Bronx community should grow up without an expectation to breathe normally.
Mayra was very facile with the EHR, and like me, prefers the use of an EHR because she can type faster than she writes. When I asked about online access to health information to patients, she was receptive to the idea that patients’ families would have access to ordered tests, if they had Internet access. This might be useful for things like newborn screens and other screening exams.
Overall, the impression I got from observing physicians here was one of competence using a state of the art EHR in practice. It is also worth noting that Samuel De Leon, MD also provided a very visible optimistic brand of leadership throughout this part of our experience.
On creating a prepared, proactive care system
» Read more: We did it! Thanks Affinity Health Plan and Urban Health Plan!
Burger King Internet Kiosks, New York City
February 22nd, 2008 | Popularity: 6% 1 commentJosh spotted these and asked me to snap a photo or two. We noticed these at multiple Burger King restaurants in New York City.
Yet another place for patients to gain access to their health care information – if it is made available to them. And that’s beginning to happen here.
It was a great several days re-visiting several innovative organizations in this city. Watch for upcoming blog posts…
“Take this with you and show it to your significant other” – A Conversation with Sal Volpe, MD
February 22nd, 2008 | Popularity: 18% 0 comments | Leave a replyA little bit behind on blogging this week, and a little out of order because we’re back in New York City, working with some of the stars we began our journey with.
The quote comes from a conversation I had with one of those individuals, Sal Volpe, MD, who now as part of his process of care, regularly prints his full progress notes and gives them to every single patient. Sal’s board certified in Internal Medicine, Pediatrics, and Geriatrics, and is running the eClinicalWorks EHR in tandem with its patient portal. And this is how we got connected.
When I knew we were coming up, I learned from fellow blogger (on here) Melinda Jenkins, that there was a physician who had the eCW portal up and running. I of course asked if I could visit, meet, or talk to them, and Sal is him. His practice is located in Staten Island, New York.
Sal has about 50 patients up on the patient portal, out of a panel of about 1,700, so he’s just starting out. But he’s not worried about it – he would be happy with 1,000 patients online. He’s currently running a half-time practice, and prior to his work on the eClinicalWorks project, he’s had experience across a breadth of health plan administration and other physician leadership roles. He’s got a blog (of course), which is at http://ehrphrpatientportal.blogspot.com/.
So I asked him about the case for an EHR, and the case for a patient portal. He talks to a lot of medical groups about this. Given his health plan experience, he has a good understanding of how the benefits accrue in terms of quality, billing, and service, and he’s got optimism for the future.
The quote above says something about small practices’ ability to innovate. Sal told me that he can use the tool of the transparent progress note to communicate about needed prevention or testing not just to the patient but to their families. He knows I’m going to blog about this because I think it is a big deal.
We continue to find a lot of good things happening in New York around health information technology and patient access. More posts on the way…..
San Franciso’s Medical Home, Steelcase’ Nurture, NYC recommendations for EHRs
November 27th, 2007 | Popularity: 20% 0 comments | Leave a replyPCHIT 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 –
The Bronx, IFH, and Urban Health Plan
October 5th, 2007 | Popularity: 20% 0 comments | Leave a replyOn 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.
Primary Care Information Project
October 4th, 2007 | Popularity: 14% 0 comments | Leave a reply
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.
