Hello Health Launch Party 7.31.08 - a set on Flickr

Thanks to Jen McCabe Gorman for sharing. The party looks like a lot of fun, and let us hope it helps patients and their families and communities become more involved and engaged in their health. Congrats to Jay & Myca.

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.

I was fortunate to speak recently with Paul Grundy, MD, MPH, the director of healthcare technology and strategic initiatives at IBM, about the work he is driving as the chair of the Patient Centered Primary Care Collaborative. Through the magic of Web2.0, I first picked up word of Paul’s work via this post on the IBM HealthNext blog, and since then have participated (in one meeting last summer) and watched as the movement has gained traction.

I chose Patient centered health information technology as manageable scope for a sabbatical; the ultimate goal for a career is patient centered care that respects patients, their communities, and those who serve them.

Paul sent along his thoughts on patient-centered primary care, and I am reposting them here, for others to read. As I have listened to Paul and his colleagues and compared it to my own experience studying Informatics and process improvement methodology, I have become acutely aware of not just the value stream within health care. I am aware of the value stream for a person in society, which is to achieve their life goals through optimal health.

When I wrote about my visits to work sites, like Genie Industries in Washington (see: “Overwhelmed with Possibility,” DailyKaizen Blog, July, 2006) and the NUMMI Plant in California (see: “NUMMI, Fremont California,” DailyKaizen Blog, August, 2007 ), it has become clear that our role is as the support system for these individuals, who are providing for themselves and their families, and finding fulfillment in their lives, through optimal health. The medical center is just a stop on the journey, not the destination. Employers add this perspective to our work and can assist in having our health system reflect this ideal design.

Paul’s words are below. As usual, your comments are welcome.

Read the rest of this entry »

A Fortunate Man: The Story of a Country Doctor

I’m a bit of a suggestible reader these days. I learned of this book from one of the comments on the PCHIT blog that I maintain. If you look at the comment and my interests (patient-physician communication, primary care, reducing disparities), it probably makes sense why this work would be of interest to me.

The book was written in 1967 as an essay about a general practice physician in the English countryside. It starts with a few vignettes about Dr. John Sassal’s interaction with patients, continues on into a description of his practice, and into the physician’s life and thoughts on the doctor’s role in society.

He decided to be a doctor when he was 15, when his image of a doctor was “a man who was all knowing but looked haggard,” who could come to your home in the middle of the night, with his pajama trousers hanging out, and still be calm and composed. Into his 20’s and then into his 30’s, his approach changed, to become less about the excitement of the emergency and more about the patient as a “total personality,” who he would work with for life.

The origin of the doctor role is discussed, as starting when medicine men were relived from food procurement duties, in exchange for the awareness of illness in the tribe. A special relationship was created with the physician role - a person (a stranger) who one would submit their body to in the hope that their malady or complaint would not seem so unique. The doctor’s role is to make the patient comparable to himself.

How does he do this?

..he is acknowledged as a good doctor because he meets the deep but unformulated expectation of the sick for a sense of fraternity…It is as though when he talks or listens to a patient, he is also touching them with his hands so as to be less likely to misunderstand; and it as though, when he is physically examining a patient, they were also conversing.

He does more than treat them when they are ill; he is the objective witness of their lives. They seldom refer to him as a witness…that is why I chose the rather humble word clerk: the clerk of their records.

Being a physician takes a greater emotional toll than is shown outwardly.

He is a man of extreme self-control. Nevertheless, when he was unaware of my presence, I saw him weep, walking across a field away from a house where a young patient was dying.

The minor complication that is not recognized by the patient as significant in their disease course is significant to the physician in their role. It causes depression in the professional whose attitude to their work becomes “obsessional.”

In all of this, there is a discussion of the value of this work. Unlike a scientific discovery, how do we measure the “easing” or even saving of thousands of lives by the country doctor? We are reluctant to do so because it would mean measuring the value of human life itself, and this is something that society is incapable of doing.

The book is interspersed with photographs of Dr. Sassal at work in “the surgery (his office)” and of the community members at work and at play. I think every physician today experiences many of the same feelings of a Dr. Sassal, as well as the same accountabilities to the communities they serve. It is useful to remember this as we engage in discussions of how we measure productivity and give people credit for being “good.”

As the comment in the PCHIT blog stated, many of us are only in the business of creating tools. We are not creating the heart of the relationship that the tools support. I think some of these concepts are ones that are personal and as such difficult for physicians to articulate in these discussions, so a work like this is useful.

And what about computers? That’s covered, too:

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.

This was a question that was asked of me by a generalist physician colleague at the Robert Wood Johnson Foundation-sponsored workshop that I am attending in Princeton, NJ.

The question is part of a theme of work being undertaken by leaders here, and also in my travels in the last several months now. What about primary care and how should it be supported?

So I thought about this overnight. I am a family practitioner. I went to medical school hoping to be a family practitioner. I left medical school hoping to be a family practitioner. My interest in being a family practitioner is to provide patient and family-centered care, and promote it in my profession and in all of health care, in order to reduce disparities. This is really what’s at the heart of all of my work in health information technology.

I would therefore pursue a different question, which is, “How do I feel about any medical school that doesn’t teach patient and family-centered care?” My answer would be similar to the question, “How do I feel about a health system that doesn’t involve patients and families in their care?”

A family practice department and a transparent health system go hand in hand with a patient centered approach. We should continue to support the thinking about patient-centered approach in every educational institution. A sign on a door doesn’t make that happen. It’s the icing on the cake.

It has been a delight to spend time with fellow alumni of Robert Wood Johnson Foundation fellowship programs this week. We are sharing a diversity of health issues and interests with each other. The thing that our interests have in common, in my opinion, is the desire to support a health system that respects patients, their families, and their communities. The experience has been very affirming of the Foundation’s commitment to health and health care.