Rittenhouse DR, Casalino LP, Gillies RR, Shortell SM, Lau B. Measuring The Medical Home Infrastructure In Large Medical Groups [Internet]. Health Aff. 2008 Sep 1;27(5):1246-1258.[cited 2008 Oct 14 ]

Only 10 percent reported that most of their physicians would strongly agree with statement that the group regularly incorporates feedback from patients in improving care and developing new services.

This is among the largest medical groups, the ones with the greatest infrastructure.

This figure comes from the attached article, published in Health Affairs , which is a survey of a sample of the largest medical groups in the United States (those with 20 or more physicians), with the exclusion of Independent Practice Associations (due to theoretically less infrastructure present), and via self-report of the CEO’s/Presidents/Medical Director. In other words, this is best case.

With regard to online access:

Thirty percent of medical groups use group visits for patients with chronic illnesses at a majority of their practice sites (data not shown). A similar proportion reported that most of their physicians communicate with patients via e-mail “occasionally,” although only 1 percent reported that physicians use e-mail with patients daily. Nine percent said that a majority of their patients could access some part of the group’s EMR online.

Unfortunately, the performance of the medical groups surveyed lessens as the size of the group does. I thought it might be possible that smaller practices in this group might employ greater efforts to incorporate patient feedback. That could still be the case, since groups with less than 20 physicians are not included here (and those are the overwhelming majority of places where Americans receive their ambulatory medical care).

What about measuring “Medical Home-ness”?

Although some argue that “ medical-homeness” is better evaluated from the patient’s perspective than from the physician’s, others balk at all attempts to measure aspects of the PCMH as overly reductionist. Regardless, the demand for clinical practice “ transparency” remains a reality of the current policy environment, and success of the model will depend in part on continued multistakeholder involvement in the development of standardized, comprehensive assessment tools.

How, in a Health 2.0 world, could we combine the significant expertise of NCQA and lighter weight solutions to support patient involvement in the measurement of medical home-ness? Would this approach also guide medical groups to select the right infrastructure improvement projects for themselves and implement them quickly? This fits in nicely with the LEAN concept of “seeing the impact of what you do,” by getting smaller bits of feedback soon, combined with more comprehensive feedback over time.

Maybe a parallel iPhone Medical Home measurement application will surface …. see what you think.

AHRQ WebM&M: October, 2008, Case & Commentary: Recurrent Hypoglycemia: A Care Transition Failure? Commentary by Ted Eytan, MD, MS, MPH

I wrote this month’s spotlight case in AHRQ’s Web M&M.

At first glance, this article looks like a traditional M&M (”Morbidity & Mortality”) review of an internal medicine case, replete with lab values, diagnostic discussions, and the like. However, the cases on this site stretch beyond diagnostics, as I found.

Bob Wachter, MD and his team invited me to write a commentary on a case about recurrent hypoglycemia that was about system supports rather than diagnostic and clinical errors. This included putting together all the thoughts on having an accessible EHR, patient and family involvement in care, and in the design of the system. The whole thing is in there, wrapped in a package for clinicians and those who support them to review and ponder.

It’s the spotlight case this month, and as I review it, I remember all of the people along the way who added this idea or that idea (and there’s many more to add). You’ll probably recognize yourselves in there….

With thanks to Bob and team for envisioning that a difficult medical case could be the foundation for a discussion about what Health 2.0 will do for our nation. See what you think.

Kolodner RM, Cohn SP, Friedman CP. Health Information Technology: Strategic Initiatives, Real Progress [Internet]. Health Aff. 2008 Aug 19;hlthaff.27.5.w391.

Kibbe DC, McLaughlin CP. The Alternative Route: Hanging Out The Unmentionables For Better Decision Making In Health Information Technology [Internet]. Health Aff. 2008 Aug 19;hlthaff.27.5.w396

Diamond CC, Shirky C. Health Information Technology: A Few Years Of Magical Thinking? [Internet]. Health Aff. 2008 Aug 19;hlthaff.27.5.w383

When I read these I thought about what my opinion was about them, and what I might write in a blog post about them. I didn’t really want to critique their opinion or lay mine on top, because I think the pieces stand up well on their own, and I am no more connected to the facts than these authors are.

So I thought I’d just end up writing a post that said that I read these articles (I know, uncharacteristic of me).

Then, I stepped on the Washington, DC Metro, and this advertisement, for a local hospital stared me in the face:

I looked at it several different ways - on the one hand, the implication is that if your child has a serious spine problem, they will take care of it. However, if you do not have a child with a serious spine problem, should you go elsewhere for primary care, or are they good at that, too?

Is 3-D imaging today’s marker for quality health care? That’s what brought me back to the point of these three pieces.

In my travels, I don’t often see advertising for health care organizations that say, “Come to us for your primary care, your child is more likely to be immunized by us.” Or, “Come to us for all of your care - we’ve been rated the best listeners in DC.”

Here’s another example from my Twitterfeed. How did health care come to this?

What these pieces do for me is support the work to move to a system where the customer is the patient. The care experience should be as good as any a person can get from any other industry, online or offline, and one that is accountable to it for the things patients care about. It’s not how many personal health records there are, but how often patients and families make meaningful decisions to stay healthy because of them.

For me, this is where the energy comes from around patient access, patient and family involvement in care, and in the design and improvement of the health system.

Finally, I just re-acquainted myself with this quote yesterday, from my reading of A Fortunate Man, by John Berger about a country doctor in 1967. Here’s what the author said about computers in medicine back then.

It may be that computers will soon diagnose better than doctors. But the facts fed to computers will still have to be the result of intimate, individual recognition of the patient.

Was he right? (rhetorical question)

We recently facilitated an exercise involving a patient, a clinical expert, and interested stakeholders at the California Healthcare Foundation, to look at the way a chronic condition (in this case, high blood pressure) is managed.

Over the next several days on this blog, I will step through our patient’s real story, along with clinical and public health commentary.

I created this cartoon from the exercise, suitable for downloading and discussion (
PDF version can be downloaded using this link or click on the image directly to see a larger version):

The cartoon is based on this output of our exercise which began with our patient’s story, clinical commentary, and the creative use of paper:

Feel free to answer the question in the title of the post at any point.

I will explain the meaning of the symbols and the meaning as we go along.

By the way, the exercise resulted in this future state, which I’ll go over on the last day:

Tomorrow: Step 1 - Initial Discovery

I am experimenting with storyboarding using cartoons to help people visualize how to connect Californians to better management of a chronic condition. The goal is for potential partners and patients to see the value of a program like this, and add their input based on technical and clinical knowledge. Full storyline coming…working on getting patient involvement. On that note, is there anyone out there managing high blood pressure that would like to be a patient advisor?