Let me know what you think!

Ending Secrecy: Physician Makes Case for Full Disclosure of Health Records - iHealthBeat

Health care disruptor Jay Parkinson, MD, just posted a nice demo of the Myca platform for patients and providers, that wowed so many at the Health2.0 conference in March.

The things I liked are the fact that they are demo-ing the platform in the first place - some vendors are reticent to show their user interface publicly. I liked that Jay starts out with the patient experience and flows to the provider experience, not the other way around. I like that the provider experience piece is equally capable of storing a video or IM interaction as much as the in person physician documentation.

The provider user interface looks very slick. I can’t say either way how I might practice with it. I would ask how the practice is able to keep prevention issues a part of every interaction (Jay started the demo by looking at the problem list). I would also be more interested in how flexible the product is over time to support a patient centered practice, as opposed to whether it is there today.

I was really impressed with what I see as the entre of basic tagging - providers being able to tag treatments for each patient. I’m not sure whether they can tag significant test results, too, but this would be very handy (e.g. which chest x-rays are the ones to remember moving forward).

All in all, more innovation is better, and let’s see what the patients think of the care, and let them guide us on what works best - it looks like HelloHealth is set up to do that, which is the most important thing in my mind.

See what you think of the demo yourself.

The Myca Platform

In Augusta, Georgia, a national epicenter for Patient and Family Centered Care, as featured on “The Remaking of American Medicine.” It’s a really impressive place. I’ll be blogging more about it soon. Nothing provides more energy than patient empowerment.

The quote in the title is from Mark Snyder, MD, Associate Medical Director, Information Technology, Mid-Atlantic Permanente Medical Group, who once again, volunteered to demonstrate how Kaiser Permanente improves medical care for patients using the latest technology. This happened at Kaiser Permanente North Capitol Medical Center, which takes great care of a community that includes the United States Capitol.

Mark was demonstrating the After Visit Summary, in this case, to a group of leaders from the District of Columbia Primary Care Association, which is currently undertaking an impressive program to implement health information technology in safety net medical centers in Washington. Senior Project Specialist Lauren Mardirosian was in attendance, along with Tracy Knight, NW Social Services Director from Bread for the City, and Deborah Parris, Health Information Manager from Family and Medical Counseling Services.

I set up the visit, with Kaiser Permanente’s help, because I am excited by the fact that our members’ experience can help patients in every care system, locally and nationally. It’s a virtuous circle - sharing our experience brings other experience back that we can use to do even better, and the cycle continues. I have really learned the reinforcing power of sharing in this journey. It’s even more enjoyable when I get to work with colleagues like Mark and Medical Center Chief Doug VanZoeren, MD, who willingly give their time alongside me.

What about the After Visit Summary? Mark showed that by involving the patient in its development, he makes the creation as important as the delivery in achieving its goals - involving patients and families in their care. In an era where we talk about Web2.0, Health2.0, and focus on user generated content, I think this is a great example - we create the record of what happened today, together.

DCPCA is implementing a modern electronic health record system, manufactured by eClinicalWorks, that has this capability. A care system that I visited in Sonoma, California, is already generating these for patients. Sometimes a piece of paper (albeit one that is also available on the Web in real time, on Kaiser Permanente’s personal health record, kp.org) can be as revolutionary as the people who put it together.

Thanks again to DCPCA, Mark, Doug, and Kaiser Permanente North Capitol Medical Center members and staff for their interest in helping patients everywhere.

Pictures: Click on any to see larger. Note: The patient displayed is a test patient. No actual patient information was demonstrated during the visit.

Patient Safety and the “Just Culture”:
A Primer for Health Care Executives, Prepared by David Marx, JD, for Columbia University under a grant provided by the National Heart, Lung, and Blood Institute

A lot.

There’s an interesting discussion underway at e-paients.net, about a recent case in Minnesota, which I was asked to (and did) comment on.

(e-patient) Dave brought up an important point, which concerns holding people accountable. Is it for the error, or knowing that the potential for error exists, or both?

I remembered this excellent paper from my files about this, and fortunately it is public domain, since it has been funded by our tax dollars. It’s useful to review the principles contained in it, which include supporting accountability and learning at the same time. Interesting that a lot of smart people have already done the thinking. Now we need to operationalize it.

With regard to the discussion on e-patients, I also remembered something about me. Whenever I walk into one of my organization’s medical centers, I assume that I am 100 % accountable for everything that is happening there. As I walk by the pharmacy, the lab, and head up to primary care, I imagine that my role is to protect every patient receiving care in all of those areas, whether or not I am directly involved in providing that care.

Now, imagine that every physician, staff member, patient, patient’s family, community member, carried themselves that way in every hospital and medical center. What would health care be like?

This cannot happen unless we support the idea that everyone on the care team, patient included, deserves access to all of the information about their care.

This video was posted on the Mayo Clinic Health Policy Center Blog and includes the voices of people and their views on health care. There’s one in the middle that I found powerful. See if you agree.

I think more of the discussion should come from those receiving care in general, and I like that YouTube and Web2.0 in general is making that a reality.

There’s an associated slide presentation with data about patient access, and I liked the wording of the question, which was “Patients should be able to obtain accurate and complete information on their own health conditions so they can actively participate in making treatment decisions.” 79 percent said this was Very/Extremely important.

These were the words I heard overhead while I was having dinner with a friend recently. Within minutes I was ushered into a back room and encountered a true medical emergency, with confused and concerned bystanders. They ultimately showed excellent judgement by activating the emergency medical system and reaching out for help locally in the interim.

I have answered several public calls for a physician in the past few years, and each situation makes my heart sink out of compassion for both the unwilling patient and the people around them, who want to do whatever they can to help.

As it so happens, my friend found me as I was pondering the situation. He asked, “Ted, how would a patient having their medical records accessible to them on the Internet make a difference here?”

I didn’t have well formed answer then, but I do now. It could have made a big difference, and not because we would bring up a web browser and start surfing.

A physician who practices with the knowledge that their patient is a partner and will see everything they do is more likely to produce records that are (a) accurate (b) involve the patient in treatment planning (c) at the patient’s health literacy level (d) involve family members in assisting in ongoing care needs. Patients can carry accurate diagnosis and medical lists and learn more about how treatment impacts their daily living.

So it’s not about the web site, it’s about the way we respect patients when we involve them and their families in care. When I think about the types of very powerful compounds we prescribe patients and the amount of information we give them (in one study, only 62% of prescriptions were fully explained to patients, 26% of the time even the name of the drug was not told to patients), it is possible to think about how many of our friends or family could be in a situation like this against their will. Prepared, knowledgeable, patients may be less likely to have emergencies in the first place. I know for certain that this was the cause of one of the emergencies I responded to about a year ago. No one leaves their home in the morning hoping to ride in an ambulance later in the day.

As my friend and I parted for the night, it seemed that the story had a happy ending as the patient received the help they needed and life went on in the environment we were in. But just like the physician in “A Fortunate Man,” even if everything turned out just fine, I would still be sad.

Each time this happens I can’t help asking the question, “Why did this happen? And why didn’t the health system prevent it?” When I think about the answers, I become just a little bit more restless to change things.