That’s colleague and fellow Washington, DC resident Divya Shroff, MD, on the cover of the Department of Veterans Affairs website, announcing the sharing of information between the two organizations to care for our nation’s veterans. Sharing looks great on everyone, and it’s much better than hoarding information.
I was delighted today to spend time learning about the possibilities of telehealth and application at leading edge care systems at the Broadband Breakfast, in Washington, DC, including Department of Veteran’s Affairs, and The Army.
The room we were in was not really conducive to showing audiovisuals (however, I was able to play one of Kaiser Permanente’s new radio spots about the Internet…), so I am posting the slides I would have shown here for the audience, and any other interested parties.
A few a ha’s from this very accomplished panel included Ron Poropatich, MD’s experience that the people he serves often have full e-mail boxes these days. They tell him, “text me.” Jay Sanders, MD from the Global Telemedicine Group continues to inspire with his optimism that telehealth is achievable, and not just for the sick, but the well, also.
If you’ve seen my recent presentations, these slides will look familiar; however, I have added a few pieces on Kaiser Permanente’s commitment to eliminating health disparities, and to reducing the carbon footprint of health care. The image of the award is one that Kaiser Permanente owns,given to it by the Environmental Protection Agency in April, 2009.
Finally, I have to say that it’s still impressive, in 2009, that you can ask a room of professionals supporting next generation technology if they have broadband at home (all of them raise their hand), and then you ask if they can e-mail their doctor, all of the hands go down.
Actually, all the hands went down except for the two people in this room who are Kaiser Permanente members … and I am one of them.
See what you think, and enjoy.
On the heels of a recent study demonstrating problems with patients receiving notification of abnormal lab test results, this study offers more insight in the area of diagnostic imaging results. And…the problems are just as concerning. Tip of the blog post, by the way, to Anita Samarth, who tweeted these findings initially to me.
When talking about “imaging results,” we’re referring to things like chest x-rays, CT scans, and MRI scans. These are often ordered to check for the possibility of cancer.
In fact, 11 times, results that were not relayed to patients after 4 weeks were of an abnormality that turned out to be cancer.
The interesting difference between this study and the study referenced previously is that it was done in a setting with a robust electronic health record (EHR) – The Department of Veterans Affairs.
What was studied was whether the (well) functioning EHR resulted in patients learning of abnormal imaging studies, not whether there was a working process to have these results brought to the attention of doctor in the first place.
The results are similar to those seen previously – Of 123,638 outpatient studies, 1,196 results were flagged “critical. 92 of these 1,196 critical notifications, or 7.7 %, did not result in timely notification, defined as 4 weeks. I’d say many patients and their families would not even classify “timely” as 4 weeks.
So the news is not very good with our ability to involve patients and families in their imaging results, either.
One other tidbit that caught my eye related to all of this is that if two doctors were involved in the notification instead of one, there was a greater likelihood of an alert not being acknowledged. That difference disappeared, though, when it came to looking for follow-up in the chart.
The issue of accountability leads me to what impressed me about this paper, and sort of not in a good way. There is no discussion of the potential for patients to assist in timely notification by having access to their imaging results online. This is especially surprising considering that the Department of Veterans Affairs manages a very good patient online access portal, MyHealthEVet.
Was this an oversight (not considering patient access as a solution), was this approach considered but not discussed in the article, or was this approach not considered a good solution at all?
As mentioned in a post on the Disruptive Women in Healthcare blog, it is the patient who will “care more about it or own it” the most when it comes to medical information. This is especially true, I think, when multiple clinicians are involved.
I have discussed the value of providing imaging test results to patients here previously – Several organizations already do this, including Beth Israel Deaconness Medical Center, and Palo Alto Medical Foundation.
Why not have this a standard (patient access), if we now know that in even the most technologically advanced systems, failure of notification can happen, and can potentially be devastating?
Veterans Affairs Medical Center, Washington
Veterans Affairs Medical Center, Washington
I was fortunate to spend time with Hank Rappaport, MD, the principle PM for the Microsoft Azyxxi Team, to fill a few big gaps in my EHR knowledge recently. Hank is a critical care specialist and has extensive experience building and maintaining electronic health records within the Department of Veterans Affairs, and now will do the same as a leader at Microsoft.
I sought Hank out originally because I wanted to learn more about what the Department of Veteran’s Affairs is doing with patient access to their highly regarded electronic health record. The Washington, DC, VA Hospital was a pilot site for the MyHealthEVet program, which allows those served in this system access to their medical records online. What’s special about the pilot sites is that they allow patients access to the entire record, without any filtering. This includes progress notes. More on that later.
Hank simulated access to both systems for me to get a sense of each systems’ strengths. Azyxxi was actually born at Washington Hospital Center, where Hank showed it to me, and is an excellent aggregator of clinical and other data, in a very accessible way. It seems to fill a niche that some electronic health records lack, which is a population view of data. The heritage of Azyxxi was the emergency room; at the same time, the utility is very relevant to primary care. With Microsoft supporting its future development, it should continue to add to innovation in health information technology. Of course, wearing my patient-centered hat, I thought there could be very interesting applications of this tool for patient access.
Following the tour in Washington Hospital Center, we walked across the way to the VA Washington to look at a simulated view of CPRS. The system is of course very capable (it lives up to its stellar reputation), specifically in the areas of order entry and decision support. It’s able to capture structured and unstructured text data, for example in progress notes. Like Azyxxi, I think there are rich areas for expansion for the system. The capabilities of this development team are different, though, and there are some changes being made in the way that the VA manages its health information technology.
There is currently not much interaction between the physician / staff view of the medical record and the patient view. However, it’s remarkable that patients have full access to their entire medical record, and has Hank indicated to me, this has not been a problem. I understand that the production (non-pilot) versions of MyHealthEVet do not have full patient access in them. In the meantime, I think the experience here in Washington deserves further attention in terms of its innovation.
I appreciate the value of the experience of seeing these two very competent systems a little closer.
Now, on to California and Heatlh2.0 to see some other cool stuff up close!
February 20th through February 22nd:
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