Maurena Moran, Group Health Cooperative’s Executive Director of Web Services and Enterprise Information Management, sent me a note that our work together is now published in the AHRQ Innovations Exchange:

AHRQ - Innovations Exchange: Online Tools and Services Activate Plan Enrollees and Engage Them in Their Care, Enhance Efficiency, and Improve Satisfaction and Retention

Here’s the description of the Exchange from AHRQ:

The Agency for Healthcare Research and Quality’s Health Care Innovations Exchange is a Web-based resource designed to support health care professionals in sharing and adopting innovations that improve health care quality.

The message forwarded from AHRQ encourages linking to the Exchange and having other people comment there. I have to say that this is a great resource for the times when people have asked, “tell us what it is you did again on your project?”

Prior to the existence of the Exchange, I had a PDF document on my hard drive of an application we wrote for a national HIT award that described our work in launching a personal health record and electronic health record simultaneously across the State of Washington. We didn’t win the award that we applied for, but the effort put into the application paid off well considering the number of times I sent the document out to other people/organizations. Now there’s a real place to send people to learn more.

I think the Exchange fills a niche for large organizations who want to provide open access to the work they are doing but don’t have the right place to organize this information on service-oriented Web portals. Thanks, AHRQ, and thanks to Maureena, her team, and everyone at Group Health for changing the way we think about interacting with patients where they live, work and play. It’s a great story…

• EPJ-Observatorium - From Denmark - the EHR Observatory - which follows dissemination of EHRs in that country. Why not a PHR Observatory in the United States?

Colleague in patient empowerment Susannah Fox e-mailed me this question and so we thought we’d start one.

Jay Parkinson, MD, linked to a discussion happening on Digg in his blog. E-patients is also hosting an informed discussion on their blog.

Is it cliche to say that this is evolutionary, not revolutionary? I think it’s of benefit to patients and our profession that a dialogue has started around moving health care data in a standardized way to a place where people can aggregate and do things with it to improve their health. A year or two ago, it was hard to think about a standardized extract of a medical record that you could send from an EHR system except in very specialized situations. Now you can do with several partners, Google being the most recently announced option.

I didn’t even think about writing a special post about it, even though I thought, “Cool, this work will support the ideas I am exploring with the California Healthcare Foundation, that patients can be involved and active in their care, across health environments (health system, work, play).” So rather than writing about it, I just incorporated the possibility into the work we’re already doing, which is great.

I think of privacy as a state of being that allows a person to feel comfortable seeking health care regardless of the issue. This is a good place to be, and when that state of being doesn’t exist, people will seek it out, even if it means not seeking needed care, which could be devastating both to patient and health system. At the same time they seek comfort, they also want to build confidence in their ability to manage their health by having as much information their care as possible. In systems where patients have good access and trust, the care is better, and it feels great (and is great) to provide and receive care in that setting. Both things are important, we should not sacrifice one for the other; every patient deserves to achieve their life goals through optimal health.

May 15th through May 18th:

• CCR Product Compatibility List — AAFP Center for Health Information Technology - Adoption list of CCR - not up to date, but gives a glimpse of who has been involved.
• Montana Healthshare - Montana organization to use CCR to improve population health
• Solventus CEND/PHR - A reference implementation of a PHR using CCD, developed by Stephen Waldren, MD and David Kibbe, MD
• PDF Healthcare - A technology platform for enclosing historical documents - can contain a CCR
• SourceForge.net: CCR Acceleration Resources Project - The XSLT transofrm from XML -> HTML for CCR
• www.ccrstandard.com - Continuity of Care Record (CCR)Standard — Resource Site _uacct = “UA-2242673-1″; urchinTracker(); - Home base for CCR
• “I hope that some day you get your wish” - "Medicine has a 100% failure rate" - a discussion of physicians in information technology.
• The WETA Guide to Fine Dining | WETA TV 26 - A nice series on DC treasures
• The Health Care Blog: PODCAST/CONSUMERS/TECH: Interview with Joseph Kvedar, Partners’ Connected Health guru - Information about ConnectedHealth and the EMC pilot they are doing

I have been intrigued by EMC’s work in managing an employee personal health record - it seems above and beyond (in a good way) how an human resources function and grow and support talent. Also, time to upgrade Office for Mac. It went OK. I’ll update “my own CIO” tools list in the near future.

• Employers Find Benefits with PHRs - More info about EMC and its employee PHR
• News - - Gainesville.com: Dean admits student without backing - It’s interesting that this is posted in the entertainment section. That aside, this looks concerning. I don’t understand how a student is admitted to medical school on a personal recommendation, and without taking the MCAT. How will we have a diverse medi
• Event Calendar - A way to put upcoming events on a wordpress blog
• TimeDriver - Coming Soon! A revolutionary online personal appointment scheduler - A very high potential meeting scheduling package. Given that Timebridge only allows 5 slots to be determined, this looks very interesting.
• GE Healthcare-Press Release-NCHL and GE’s Institute for Transformational Leadership - I didn’t know about GE’s work in this area. It looks like they are doing work in LEAN as well as Six-Sigma, which they are known for.
• Report cites UA med school crisis | www.azstarnet.com ® - Sad news from my alma mater, related to the difficulties medical schools are having balancing revenue and their mission.
• D.C. Not-for-Profit Offers Model for IT Adoption - iHealthBeat - More progress in DCPCA’s EHR adoption efforts
• Burlington Free Press.com | Fletcher Allen’s new EHR - Fletcher Allen in Vermont gets approval to go ahead. I believe this is an Epic Systems install, bringing with it the possibility for excellent patient engagement with their health system as a result.
• Database Problem with Office 2008 for Mac - Office 2008 Install problems, just in case

I recently pulled several articles to help leaders understand Web2.0 better. That’s what’s in the links below.

The image is one that I snapped while taking a flight recently. It reflects the accommodations an already troubled industry is having to make to support our health (or lack thereof).

• CDC trends in obesity 1985 2001 - CDC trends in obesity 1985 2001. Disturbing.
• A List Apart: Articles: Take Control of Your Maps - Useful article about integrating mapping visualization
• A List Apart: Articles: Accessible Data Visualization with Web Standards - Really nice article on simple data visualization using CSS
• VM — Being There, Mar 01 … Virtual Mentor - The use of telemedicine technology, while convenient, can at times be inadequate, as shown in the portrait painting entitled The Doctor, where the physician stays at the bedside of a gravely ill child and offers his presence as comfort to the family. Virt
• Notional Health Server | Economist.com - A flagship service adrift - problems with online booking at the National Health Service
• Health 2.0 | Economist.com - Technology and society: Is the outbreak of cancer videos, bulimia blogs and other forms of â??user generatedâ?? medical information a healthy trend?
• Social networking | Joined-up thinking | Economist.com - Social-networking sites are not just for teenagers. They have business uses too
• Sources and acknowledgements | Economist.com - Helpful links for Web2.0 research from the Economist
• What sort of revolution? | Economist.com - Both good and badâ??but it’s too early to say in what proportions
• The wiki principle | Economist.com - Are many minds better than a few?
• Compose yourself | Economist.com - Journalism too is becoming interactive, and maybe better
• It’s the links, stupid | Economist.com - Blogging is just another word for having conversations
• Among the audience | Economist.com - The era of mass media is giving way to one of personal and participatory media, says Andreas Kluth. That will profoundly change both the media industry and society as a whole

April 5th through April 8th:

• Headzoo » WP Anti-Wares - Now it looks like we have to worry about insecure wordpress themes, too.
• Electronic Prevention - washingtonpost.com - Nice writeup of the New York PCIP program. What the writer doesn’t realize, is that a patient portal is coming, so a visit isn’t always going to be required….
• Jack and Suzy Welch: Leader vs. Manager - ‘We’d wager it only comes into play when you don’t want to offend an employee who crosses t’s and dots i’s but couldn’t excite a busload of kids bound for Disney World. In such a case, what do you say? You got it. “You’re a good manager.”‘
• Generation Y’s Bad Rap - It’s not really that bad, according to Jack Welch. I agree.
• The National Physicians Alliance encourages all doctors to join our Unbranded Doctor Campaign — a national network of physicians committed to reducing the influence of pharmaceutical marketing on our profession. - NPA appears to be a grown up version of AMSA. They include consumers in their governance
• Macworld | Mac OS X Hints | Add more power to 10.5’s screen sharing - Economical screen sharing alternatives using Leopard
• Total Value, Total Return: Invest in Health Management Programs -
• Office 2004 for Mac Solution Center - Office 2004 downloads for Mac. Time to upgrade

Yesterday, I wrote a post about my visit to Sonoma, California, and the health care that MiVia is enabling. Heidi Stovall then gave me a tour of the application, and allowed me to take screen shots of it to post here. All of the information in the screen shots are not from real patients, so there is no personal health information being displayed.

Let’s take these one by one. And here are the images that go with the tour. Click on any to see full size.

1. This is the patient login, and includes their identification screen. Notice the LAC. That’s a “Limited Access Code” and allows a selected person access to the information, for example a care provider in an emergency.
2. A chart note. This allows a provider to document right into the patient’s personal health record. An interesting paradigm - the customer of this system is the patient, not the provider (sort of how I think these systems should be designed). Important to remember that these patients typically do not have medical records in other EHRs.
3. The printable ID card. I mentioned yesterday that this is not an actual ID, but to the users, it signifies “belonging” to something. At the same time, it can be given to a provider to signify that “there is a place you can go to learn about my medical and dental history.” It’s worth noting that my health plan offers this, but via a telephone service, not through the Web (I can access my own information, but I do not have an access code I can give to someone to do it for me).
4. A medical summary report. A easy place to find out about a person’s medical and dental conditions.
5. Sharing preferences. The patient can automatically add their record to the roster of a participating provider. If they do not add this, the provider can also add the patient by getting access code information. Again, the heritage of a patient-centered application is apparent. I think this looks very simple and understandable.
6. Pain and symptom diary. What’s significant here is that the patient-centered nature of this record means that patients can document in it as much as providers can. It’s a basic interface to be sure, but physicians know that a cornerstone of pain management is for patients to document what they are feeling.
7. Dental Records. Again, a basic interface, but it’s a bit of a breakthrough in my experience to combine oral health and general health in one place. From the patient perspective this makes total sense. From the physician perspective, we are used to segregating “medical” and “dental.” Why? Tradition? Because we went to different professional schools? I think the patient’s way is the best way.
8. CCR Export. I think this is one of the most promising features. It’s clear that this is a group of patients that are unlikely to be served by a health system with a tethered PHR, and one of our findings is that a tethered PHR is not the only way to serve patients. What if this subset of the community could upload their record to a tethered system, for example, if they receive care in a tertiary care hospital, or if they obtain a specialty consult in a system that has an EHR? In this case, they will still use MiVia as their portal. The idea is that the specialty care provider could either document here (copy their note), or send a CCR export to MiVia.

Here are some thoughts:
Read the rest of this entry »

PCHIT links for February 26th through February 27th:

• Life as a Healthcare CIO: Dispatch from HIMSS - Related to what I saw at Queens Health Network, a portable personal health record managed by a patient can make interoperability go faster.
• Are Consumers Interested in Having Online Access to Their Medical Records and Test Results? - iHealthBeat - Patient access to EHR’s IS compelling. Low adoption rates mean something else is going on.

As 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.