Posts Tagged ‘Patient and Family Centered Care’

When people are ready to promote patient empowerment/engagement, what can they do?

December 9th, 2008 | Popularity: 17%
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The title of this post is a variant of the title of another post (“When physicians are ready to promote patient empowerment/engagement, do we want them to do?“). That post came about from a conversation with another physician. This one is coming about with a conversation with a person, not a physician, Erica Brand, who works in silicon valley and is interested in the same idea.

We got in touch because Erica has been following the work of myself and the e-patients.net group, and on reflection of her own experience with health care is interested in making a difference.

We talked about different opportunities for someone with talent in an industry that is not health care could help health care succeed, and there are lots of them. For example, depending on who a person’s employer is, they may belong to a coalition of employers focused on health issues. In California, this might be The Pacific Business Group on Health, or in silicon valley, the Silicon Valley Employers Forum is an affiliate of PBGH, which is also a place to get involved in transforming health care.

As I look back at the original post, though, the advice/recommendations are generally the same, which says to me that we all have as much if not more in common as fellow patients than we do being in health care / not being in health care. I still think health care can learn a lot from other industries and we should welcome all of the help we can get, and I think talent is talent regardless of the industry that it comes from. In the era of Health 2.0, the improvement of health is truly democratic.

It is nice to discover in these conversations that there are many people who want to bring their professional and personal experiences forward to help us improve. Come join us!

Disruptive Women in Health Care » Blog Archive » Communicating with Health Care Professionals

November 22nd, 2008 | Popularity: 10%
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Now Reading: 25 Percent of Large Medical Groups Use Data from Patients to Improve Care

October 14th, 2008 | Popularity: 34%
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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.

My AHRQ M&M Case & Commentary – The Promise of Patient and Family Involvement

October 13th, 2008 | Popularity: 25%
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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.

When physicians are ready to promote patient empowerment / engagement, what do we want them to do?

October 8th, 2008 | Popularity: 61%
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This 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.

Now Reading: “Why Work Sucks and How to Fix It: No Schedules, No Meetings, No Joke–the Simple Change That Can Make Your Job Terrific” (Cali Ressler, Jody Thompson)

August 25th, 2008 | Popularity: 49%
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As a leader in an organization, imagine reading this description of an employee’s workday:

A typical day for me includes waking up when my room is too bright from the sun and I can no longer sleep. I check my e-mail to make sure there are no pressing issues and respond to anyone who needs my input. I will typically watch an episode of South Park on the Internet, then walk to my local grocery store and buy some breakfast, even though it’s closer to lunch at this point. After eating I will work in front of my television with ESPN on in the background. At this point I will choose to go into the office or continue to work from home, or maybe not even work at all and go for a bike ride or jog. If there is still work to do later that night, I’ll do it then and it’s no big deal.

I’ll admit it – it kind of made me gulp when I read it.

At the same time, though, I have been in a lot of conversations with a lot of personal and professional colleagues over the past 3-4 years or so, where the question we’re asking ourselves is, “Is this how work life is supposed to be?” Spoken or unspoken, the answer is “we don’t think so.” Various companies’ data also show a trend toward less vacancy in their physical locations.

In the middle of that self-discovery, I read about BestBuy, Inc., (see “Smashing the Clock“). This is the book about their journey.

It’s time to let go and see what our employees can really do – BestBuy Manager

A Results Only Work Environment (ROWE) is as it says – one where results are measured, not time spent. There are no timeclocks, no discussion of time, and no “Sludge” as the authors refer to it. “Sludge” are the comments people make to each other about time, whether it’s about being late to a meeting, or working late at night. Simply put, the authors state, an employer is trading work for money. Why not give them what they pay for?

Reading beyond the BusinessWeek article was very useful – this is not flextime, it’s not “working from home,” it’s a different philosophy altogether. That includes the vignette above. Totally allowed, if you have the results to show for it. The concept can appear challenging; however, it makes sense, in the context of strong leadership committed to respecting employees and customers. That’s where I found similarities to the work I have done.

About respect

When I first read about this work, I asked about how this was similar or different from the LEAN transformation I participated in, in the area of health information technology. Some of the things were consistent, some seemed less so, like having technology teams physically present alongside doctors and nurses, guiding care and feeding of an electronic health record system.

My reconciliation of all of this rests with not comparing individual tools/approaches between ROWE and LEAN. What they both have in common is respect for the customer and staff, and strong leaders. It’s impressive that at the heart of the ROWE movement was (at the time) a 24 year old employee of BestBuy (Cali Ressler), who was dissatisfied with the status quo. The authors also explicitly reject war analogies in business as I have. In my own situation, there was not just a desire to change the way we worked, it was clear that not changing would be unsafe. Healthcare organizations across the country are now learning this, thankfully, but it’s a slow transformation, and the transformations that are happening are nowhere near as radical as ROWE, which is why I am interested in the movement (not because I want to be radical, but because the threats to our patients and their families’ health are so significant).

Just because you can no longer be late doesn’t mean you can be lame

Preliminary data from the University of Minnesota’s Flexible Work and Well-Being Center are showing that voluntary terminations are down, involuntary terminations are up.

Mea culpa and, as usual, I see analogies to health care

I liked the concepts in the book a lot, and have done a self-inventory of my own sludge and the sludge that’s been directed my way. The kind of sludge I get nowadays is really from people who want to understand better how technology can be used to help patients stay healthy. I welcome it as an opportunity to teach and learn. As the authors discussed, people can learn to live sludge-free, and they really want to live sludge-free. It starts with us.

I could see myself promoting ROWE in health care settings, and I think physicians, primary care ones especially, would benefit. The work I do to change health care is completely connected to the idea that health is a means, not an end, and people who go into health care want to support our patients where support is needed, mostly where they live, work, and play. I don’t believe people in health care are any more attached to time than Cali and Jody’s (former?) colleagues at BestBuy are. When I read the stories of BestBuy employees before and after, I reflected on some of the conversations I have had with health professionals (at all levels) who have really been challenged to juggle their passion for helping people and their ability to provide for themselves and their families, physically and emotionally. What would it be like for a family medicine or internal medicine specialist to provide their cognitive services to patients and families using a combination of virtual tools and office (or even home presence) when the situation called for it? Look at what HelloHealth is doing. It’s possible.

A Results Only Patient Experience (ROPE)?

A came upon this table in the book, and curiously, I found it extensible to our health care system. I hope I won’t get in trouble for using it to think about what our health care system were like if our patients experienced it the way a BestBuy employee experienced their work life. The edits are mine.

ROPE.jpg


Moving Closer to Patient Centered Care in Yountville, California

July 30th, 2008 | Popularity: 46%
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Yountville

I think word has gotten out that I am something of an urban dweller; Susan Edgman-Levitan was nice enough to ask me, “Ted, are you hanging in there?” as we spent several days in Yountville, California at the American Board of Internal Medicine Foundation forum on Achieving Patient-Centered care.

I ended up doing just fine – it’s about the content, not the place, and a scenic jog through the vineyards of Yountville can’t be argued with.

And the content was right up my alley, with thanks to the ABIM Foundation for hosting this discussion. The discussions at the Forum are being compiled by the ABIM Foundation, so I will let them report on that rather than me, but I can share my perceptions of the event here.

First of all, patients and families were involved throughout, as faculty and equal participants. This continues an important precedent in helping health care leaders achieve comfort with this idea.

One of the most powerful moments was Margaret Murphy sharing the story of her son Kevin’s death (You can read more about it here) within the Irish health system. I really appreciated Mrs. Murphy’s use of images in her storytelling – in the future, a presentation without at least 50 % images and a video or two is going to be minimum bar to go in front of an audience. There was discussion about Kevin’s death being the result of diagnostic error. I think that’s true, and I also think that if the family had access to all of his medical information from the beginning, it might have changed the diagnostic approach or caught the fatal series of errors before they happened.

For my part, I presented the following slides in the 10 minutes I had alotted, around the topic of the use of health information technology to put patients, families, and communities in the center of care.

Enjoy (I hope) and thanks to the ABIM Foundation for hosting this discussion and follow-up.

Click on any image to see them larger

Running a hospital: The message you hope never to send

July 22nd, 2008 | Popularity: 22%
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Running a hospital: The message you hope never to send

As with many stimulating blog postings, the comments are as interesting as the post itself. Kudos to Paul Levy for doing his best to handle this differently than is the norm in health care – that’s an important role for a CEO who wants to change health care for the better.

I’m particularly drawn to the comment(s) by Ray Poses, MD about doing a “5 Why’s” type exercise to see what is happening upstream (why are teams being pulled in so many different directions regularly) that causes protocols to be slipped.

I also think there’s an opportunity for BIDMC to bring in patients and families to own the solution together. What would care be like if there was a family member in the operating room during surgical prep (Medical College of Georgia does this)? Or if the family had access to the patient’s electronic medical record in real time while in the hospital? Preventing this for another patient may be less about “what” to do in the operating room, but “how” teams (that include patients and families) are involved in the design of the system.

Given the work BIDMC has been doing to be transparent and involve more, rather than less, people in designing and improving their care system, it seems that they’ll do their best for their patients this time, too.

Now Reading: A Few Peer-Reviewed Articles About Patient Willingness to Self-Monitor

July 20th, 2008 | Popularity: 52%
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Patients' experiences and opinions of home blood pressure measurement

Rickerby, J, and J Woodward. “Patients’ experiences and opinions of home blood pressure measurement.” J Hum Hypertens 17, no. 7 (0): 495-503.

Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base

Pare, Guy, Mirou Jaana, and Claude Sicotte. “Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base.” J Am Med Inform Assoc 14, no. 3 (May 1, 2007): 269-277

Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care

Little, Paul, Jane Barnett, Lucy Barnsley, Jean Marjoram, Alex Fitzgerald-Barron, and David Mant. “Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care.” BMJ 325, no. 7358 (August 3, 2002): 258-259.

Not pictured: Port, Kristjan, Kairit Palm, and Margus Viigimaa. “Daily usage and efficiency of remote home monitoring in hypertensive patients over a one-year period.” J Telemed Telecare 11, no. suppl_1 (July 1, 2005): 34-36.

There’s a potentially serious gap in the Connectivity for Californians initiative that we are addressing. Here’s a quote that illustrates it:

It is very clear from the interview data that patients have their own ideas, and spend a lot more time thinking about their BP than is apparent in the average 10-min consultation in general practice.

The gap is patient involvement in the design and planning of this initiative, or any healthcare initiative for that matter. Patients have many more ideas about what the problems are to be solved than can be gleaned even from articles like this – the articles simply show that the ideas are out there. Fortunately, we are committing ourselves to have a patient representative involved from the beginning, and that is coming together before any work is started.

The quote above is from the first paper by Rickerby, et. al (click on the images to the right to review any of the papers yourself), which described a qualitative study to look at a small number of patients’ attitudes toward monitoring their own blood pressure, in a practice that routinely recommends this.

The question (#1)

The reason I have reviewed these particular papers is because of the commonly posed question to me over the past several months, in the form of, “Ted, will/are patients really motivated to check their own blood pressure?” with the implication that they are not and they won’t. It’s a fair question that deserves an informed response. Several of the readers on this blog have given me some information from their own lives. These papers add to that knowledge.

The answer (#1)

They are and they will.

The question (#2)

This came up during reading of the papers. Does patient engagement come from having knowledge? Or does knowledge come from being engaged? This came up because patients in the first study who did not have knowledge about why they should monitor their blood pressure or how to do it seemed less engaged.

The answer (#2)

Unclear, with the implication being about whether to work to engage patients with more knowledge or use knowledge as a means test for engagement. I think regardless of the answer, there’s no reason not to provide information to patients. That answer is good enough in this case.

Read on for more conclusions….

» Read more: Now Reading: A Few Peer-Reviewed Articles About Patient Willingness to Self-Monitor

Thoughts on Patient and Family Centered Care

June 2nd, 2008 | Popularity: 25%
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PFCC 08

As I posted previously, I was honored to present at the Institute for Family Centered Care’s intensive training seminar, on the leveraging of health information technology to promote patient and family centered care. Bev Johnson, the Institute’s CEO continues to impress me with her boundless energy – I include her in the class of individuals that probably has more energy than I do.

I enjoyed great interaction with the rest of the attendees, many who came in teams, with either a record of change in their institutions, or about to create one. What I haven’t really appreciated to date is the fact that this type of care is still not the norm in most medical institutions. I should say that I appreciate it, but maybe I don’t have the best understanding of the challenges of transforming to a system that involves patients and families in all aspects of care. This includes family presence in all rounds (physician and nursing), 24 hour access to their loved ones in the hospital, ability to access all information generated as part of the care experience. A lot of the seeds of this transformation come from the pediatrics arena; it is slowly making its way into adult health care. There is a significant leadership presence in the nursing community. Imagine a family being present during nursing rounds where a nurse discovers that a scheduled dose of antibiotics has not been given. This seems challenging on its face, but turning it around to create an opportunity for Poka-yoke is far less challenging than allowing an event like this to happen again. I noticed that a lot of nurses and physicians understood this, and it is terrific.

In my own environment, I also reflect on the fact that I’ve been supported in promoting patient-centered health information technology. Yet at the same time, if even a greater percent of the organization’s activities was devoted to promoting this method of care, there are things I might not have to “nemawashi” about that I do now. Regardless, I am happy to do this; if IT is going to be the nidus of patient and family centered care in some organizations, so be it (for now). In the end, though, I’m going to continue to work for IT be the support for patient and family-centered care philosophy, rather than the lever.
Thanks to Bev and the IFCC team for continuing to move into ambulatory care, and to understand the changing landscape of HIT and the opportunities to use it for its true customer, the patient.

“If You’re Sitting at This Table, You’re in the Wrong Place” – Moving Forward With Patient and Family Centered Care

May 29th, 2008 | Popularity: 23%
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Team MCG

I am in Besthesda, MD, attending the Institute’s intensive training seminar. The quote above is from Roslyn Marshall, RN, Nurse Manager for the Neurosciences Unit at Medical College of Georgia, who placed a sign with the words in the title near the place where nurses used to do their shift changes. They now do shift changes at the patient bedside. The other quote I liked was from Terry Griffin, who said:

No one more than parents wants to make sure their baby’s care is error free

In reference to including parents in hospital rounds and nursing rounds. I also learned to not call “Carts on Wheels” “COWs” – “WOWs” (“Workstation on Wheels”) is better.

“Why Don’t We Make This a Record for the Patient” – Learning about CCR at TEPR

May 18th, 2008 | Popularity: 25%
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The quote in the title of the post is from David Kibbe, MD, MBA, who co-taught a workshop on the ASTM Continuity of Care Record Standard with Steven Waldren, MD, MS, in conjunction with the TEPR Conference in Fort Lauderdale, Florida.

I took the workshop on behalf of my work with the Calfornia Healthcare Foundation to look at creating a connectivity ecosystem for patients, families, and health stakeholders in a community, which I’ve started to blog about here.

It was a good workshop, with a nice step-through of the CCR standard, which for me was fairly straightforward to follow. Here’s a screenshot of the XML schema of a sample (test) CCR XML file. If you’re medically inclined, you’ll see that it’s an XML representation of a prednisone taper. I didn’t put this XML file together, but I consider this a sort of “hello, world” – to show that a clinical summary can be represented with a human and machine-readable file.

CCR is figuring into many well publicized Health 2.0 applications and I am of course a fan of anything that has its genesis in engaging patients in their care.

Now Reading: “Tell Back- Collaborative Inquiry” to Assess Understanding of Medical Information

May 5th, 2008 | Popularity: 31%
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One of my patient centered health-care mentors, David Sobel, MD, from Kaiser Permanente passed this study on to me in the context of work we are exploring in the area of self management. Since I haven’t mentioned David on this blog before, I’ll point out that his impact in my career and many other health care professionals has been significant. David is the physician that taught me that the primary care giver is the patient (and their family, community). Because of this, when I think of “medical home,” I don’t think of the primary care provider’s office. I think of the true medical home, the place where the patient lives, works, and plays (with their family and community).

I digress, but back to the article, it puts together the call to action to involve patients and families in their care, before they leave the exam room.

First, the paper starts with a very helpful literature review of the “elephant in the exam room,” as I call it, the fact that patients don’t remember most of what doctors tell them during visits. When they are tested afterward, they typically don’t remember things correctly (correct treatment was relayed back by patients to researchers in only 49% of cases after immediately leaving the emergency room). I use this data to support the idea of a written summary of every visit that patients can use by themselves, and with their families and communities. As colleagues of mine have pointed out, the written summary is not the product, the process of preparing it is.

The study itself examines three different ways of inquiring about patient understanding, in a specific and potentially scary situation, a deep blood clot in the leg. The approaches are “Yes-No” (Which most physicians will relate to as the “hand on the door knob to leave the exam room), “Tell back-collaborative,” and “Tell back-directive.”

Here’s the content of the “Tell back-collaborative” approach:

I imagine you’re really worried about this clot. I’ve given you a lot of information. It would be helpful to me to hear your understanding about your clot and its treatment.

In testing the three approaches using standardized video clips, this approach was significantly more preferable by patients, and there’s a nice discussion of what this means.

The study brings up a lot of compelling issues for me at the same time:

  1. This collaborative approach could easily be worked into the after visit summary process: “I’ve given you a lot of information. Let’s compose the summary of what we talked about, together, so that your treatment is successful.”
  2. In the era of secure e-mail between patients and providers, what a wonderful tool to support an approach like this and provide continuity of care. Imagine saying (in addition to the above): “I would like you to e-mail me your understanding of the condition tomorrow in the event any questions have come up, and also let me know how you’re doing.” The days of depending on the visit to ensure understanding are hopefully over.
  3. As a practitioner of LEAN (Toyota Management System), this approach also speaks to the value of “getting inside” the clinical encounter, to standardize things that should be standardized (but not things that shouldn’t be standardized, like personal preferences). In health care systems, we have been anxious about scripting parts of the physician visit. I think we should move past that and use approaches that work, for every patient, every time. If every patient in a care system could expect the same approach to confirming understanding, it could change interaction during the visit, to something like, “I know she/he is going to ask me my understanding of things, so I should ask questions now, or note which areas need more explaining.”

The study does not measure whether patients were able to understand the treatment regimen from the various approaches, just which they preferred. It’s possible that their preference for an approach at the very least would have an impact on their satisfaction on the visit, and in turn on the satisfaction of the provider in helping patients understand (the “happy providers come from happy patients, not the other way around” hypothesis). At the most, a return visit, or a devastating complication could be prevented.

Our profession has incredible and incredibly complex therapies at our disposal – this is about making sure they actually help the people that we ask to use them to achieve their life goals through optimal health.

To the patients out there (all of us) – what approaches have you seen used at the end of the visit? To the providers out there – what are you willing to try during your next patient visit?

Ending Secrecy: Physician Makes Case for Full Disclosure of Health Records – My First “Perspectives” Column in iHealthBeat

April 16th, 2008 | Popularity: 48%
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Let me know what you think!

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

Learning More About the Medical Home and Finding Innovation Where It Lives

April 16th, 2008 | Popularity: 55%
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If you are interested in innovation, I think this is a good podcast worth listening to – and the actual audio is more useful than the printed version.

I listened to it the day before I attended the latest Patient Centered Primary Care Collaborative, in Washington, DC. At the meeting, I was fortunate to run into one of my role models, Susan Edgman-Levitan, PA, and we talked about the idea that the Medical Home is about improving the care of patients where they spend most of their time – where they live, work, and play. We can help patient-centered care flourish by including ideas from everyone involved in the care, including nurses, doctors, allied health practitioners, eye care, oral health care, behavioral health care, just to name a few.

I liked what Jack said in the podcast, that in a company, there has to be

a sense that in every soul of the company, the idea that everybody innovates.

Toward the end of the podcast, Jack gets quite fired up about the idea that innovation can’t be regulated to the chosen few. My experience reinforces this. In the area of health information technology, this is critical. When most people think about implementing HIT, they think about the implementation period. The most powerful part of HIT is what happens after implementation, and using a management system like the one developed by Toyota Motor Company (as we are) can allow an organization to turn HIT into an organization wide innovation engine – if they capture all of the ideas of everyone involved in providing care and put them to use. To not do so is to waste one of the most valuable raw materials for growth – ideas and time (and most importantly our patients’ time).

One other conversation that has come up in the last several days is about generational changes in approach. Many of the Generation X and Generation Y colleagues I have been talking with were raised in a professional environment where we were not going to have all the answers, and we are uncomfortable being accountable for them. We want to share the power of coming up with the answers with our provider colleagues and our patients. This is not to say that our baby boomer colleagues don’t have this desire, too. I think we are stimulating each other to do what they’ve always wanted to do, and involving patients, their families, and all practitioners, all specialties and roles, is really going to make a person’s medical home special.

Feel free to take a listen and let me know what you think:

Finding Innovation Where It Lives

“There’s Always Something to Do Better” – Medical College of Georgia, home of patient and family centered care

March 26th, 2008 | Popularity: 46%
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The quote in the post comes from Roslyn Marshall, RN, Nurse Manager of the 3West Inpatient (Neurology and Neurosurgery) unit at Medical College of Georgia, in Augusta.

Images: Click on any to see larger

Just as with several other organizations I have visited, I did not imagine that I would be heading to Augusta, Georgia to learn about how to involve patients and families in their care, but I’m glad I did. This is a place where so many things that are seen as abnormal in the rest of health care, are normal (see this paper for a description of patient centered care, with a focus on MCG). In an environment like this, it’s okay to ask “why?” when it comes to issues of involving patients and families in their care.

The occasion of my visit is related to a grant that Medical College of Georgia has received to study the use of a personal health record to improve hypertension care. With respect to the idea that being as close to the patient as possible is important, Ms. Pat Sodomka, Senior Vice President of Patient and Family Centered Care, hosted my visit on behalf of the organization.

Part of my study included watching the excellent program, The Remaking of American Medicine, which featured Medical College of Georgia in its last hour, and it was amazing to see how much has been accomplished both in involving patients and their families, and in transforming the organization.

Today, I’ll post about what I saw clinically. Tomorrow, I will post about what I saw systematically in this leading edge care system.

I began in Family Medicine and Internal Medicine, where practitioners and patients are both busy, and integrating one or two electronic health records in the care that they use. This is what I observed when shadowing family medicine specialist Bill Phillips, MD.

Besides data from their own organization, they need to integrate the needs of patients working to stay healthy in a system with an affordability crisis. In my own practice, I had not had to think about which big box retailer offers which drugs for $4 , or even free, as a loss leader. However, this is a big issue for patients. I reviewed the formulary for Wal-Mart’s $4 program – it’s extensive.

I was able to shadow the Director of the Osteopathic Medicine Program, Julie Dahl-Smith, DO, who is also board certified in Family Medicine, as she performed a manipulation visit and acupuncture visit for a family. This made me think about the value of patient involvement through a personal health record. The treatments that Dr. Dahl-Smith provides are distinct from the allopathic treatments that I have been trained to do. There’s an opportunity for patients to become more knowledgeable about the treatments that work best for them through patient access.

I spent time with Shilpa Brown, MD, who manages her own faculty practice as well as a residency practice and extensive student teaching. Patients in each have distinct needs. I also observed some key differences in workflow between private practice and academic practice. Faculty are ultimately accountable for 1, 2, 3 or more residents’ care, whether that care is provided in person or virtually. There is much that MCG will contribute in this area as an innovative academic medical center.

In between, I visited with the Neurosciences Interdisciplinary Rounding Team, which includes nurses, pharmacists, students, residents and attendings, led by Dr. David Hess. This is a unit, 3W (which I will talk more about tomorrow) that serves patients and families not just locally but regionally. What would it be like if a family member who is based far away from Augusta could connect with their family’s care team electronically? The team was open to this idea.

This organization is unique in my travels because it is a full academic medical center with many top notch training programs, which include a family medicine residency and an osteopathic residency. It is also special in the way it involves patients and families in the care, through its advisor program. The program reaches all the way into undergraduate medical education, and every new program seeks involvement. Patient advisors are free to visit MCG facilities and talk to patients and families about their care.

As I was being guided to the Internal Medicine clinic by Bernard Roberson, Director of Family Services Development, we passed by one of the “commons” (a different way of thinking about a waiting room that’s more patient centered) and a patient waiting to be seen said to us, “Tell me more about patient and family centered care.” It turned out it was one of MCG’s Patient Advisors, and I think we both saw it as a welcome sight. That’s how things are different here.

Tomorrow, a post about the system-ness of Patient and Family Centered Care at Medical College of Georgia.