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…

Sites Visited

• Kaiser Permanente (Oakland Medical Center, Oakland, CA, West End Medical Center, Washington, DC)

Benchmarks in incentive alignment and scale

Kaiser Permanente, and organizations like it, are in many ways a benchmark for patient centered health information technology. They have the highest EHR and PHR penetration in health care. Kaiser Permanente currently has 1.7 million of its members using its PHR, and relaunched in November, 2007 as “My Health Manager.” Group Health Cooperative of Washington State is currently at 46 % of enrolled adults with verified access to the MyGroupHealth web site.

MyGroupHealth (ghc.org) adoption curve, 2002-present

The alignment of incentives is reflected in the slope of adoption by patients. The adoption curve for Group Health patients is significantly steeper than comparable organizations (see: Halamka JD, Mandl KD, Tang PC. Early Experiences with Personal Health Records. J Am Med Inform Assoc 2008;15:1-7.)

The work of these organizations is critical in demonstrating that patient centered health information technology can be a reality for all of health care. As we observed, they are post-implementation and involved in relaunch and refinements of their PHRs to support both patient workflow, and the workflow of staff who serve patients in medical centers.

If there are challenges in these organizations, it is that their work requires scalability beyond the typical physician practice, so there is always a risk that innovative ideas may be harder to implement. They are able to work around some of these limitations by supporting regions with higher levels of innovation (for example, the Colorado Region of Kaiser Permanente is a pioneer in teen-physician electronic messaging, see iHealthBeat: Kaiser Colorado Lets Teenagers E-Mail Doctors, Check EHRs).

In my visits to these organizations as a Permanente physician myself, followed by visits to other organizations described here, I noted an gap in knowledge about the potential of PHRs - an understanding of the benefits of PHRs of involving patients and their families in their care has been built up through experience among Permanente physicians that does not yet exist in other parts of health care. In addition, there is no official policy for knowledge transfer that I noticed. Group Health Cooperative generally shares knowledge in the interest of promoting patient empowerment. Kaiser Permanente is embarking on a significant initiative to share its experiences as well. In a session hosted at the California Healthcare Foundation, Holly Potter, Director of National Communications for Kaiser Permanente HealthConnect indicated to the group that, “We don’t have that option anymore” (see: Presentation: Blogs in Health Care) when it comes to delaying or restricting communication about its efforts to the community.

Unresolved issues

• Person to person knowledge transfer (attitudes, technical, workflow) to non-integrated care systems
• Risk of reduced innovation due to high expectations for consistent service across large populations

Countermeasures

Doug VanZoeren, MD, Mark Snyder, MD, and Ted Eytan, MD, bring leaders from the Office of the National Coordinator to Kaiser Permanente West End Medical Center, Washington, DC

This initiative represents a portion of the effort that Kaiser Permanente and Group Health Cooperative are making to provide knowledge to the entire industry. Other efforts include participation in national standards bodies, commissioning high quality research studies, and providing access to its operations (see: Office of the National Coordinator Visits Kaiser Permanente West End Medical Center). One of the most important efforts I have been engaging in throughout is to bring technical and execution expertise to organizations who are implementing PHRs. This will continue throughout the initiative.

It might be useful in the future for these organizations to put together a publicly available “toolkit” for PHR implementation, which would include everything from tested organizational policies, communication collateral, and staff and patient adoption techniques. Currently, this information is being transferred one to one by individuals within the organization. Perhaps a repository of experiential knowledge of basic items such authentication procedures could be made available for other organizations.

Group Health Cooperative has previously released its “Clinical Information System Rollout Toolkit” to the health care community for unrestricted use. We did not create a companion “PHR Toolkit,” however as a part of this work, I recently put together a basic PHR Toolkit that was forwarded to the Institute for Family Health, to assist in their implementation efforts.

Ways to Engage

Victor Silvestre, MD, Kaiser Permanente Oakland Medical Center

Kaiser Permanente is engaged at many levels to promote PHRs, including in the establishment of standards and sharing information, including on this blog.

Several staff members in these organizations are active in public conversations, such as on standards bodies, and are an excellent way to support involvement and knowledge transfer. In addition, given current initiatives to demonstrate the value of their care models, both organizations’ Communications departments will be useful in arranging for access to practices and Permanente physicians who can demonstrate the value of PHR-enabled practices.

• Health IT Pioneer Calls for Changes in Federal Health IT Strategy - iHealthBeat - More changes requested in federal involvement around Health IT
• JAY PARKINSON + MD + MPH on Carol - Jay says it isn’t going to work. I’m not sure it will either as I think about what Apple had to do to create the iPhone. I found the CEO’s ideas compelling. We should start with what’s best for those we serve and figure out a way to make it work.
• ChangeThis Newsletter: 42.05 Ideaicide: How To Avoid It And Get What You Want by Alan Parr and Karen Ansbaugh - I would call this a nice primer on “Nemawashi” - or conversations around the office to get ideas off the ground.
• A Food Fight Over Calorie Counts - Interested more in the approach to sharing information than the issue of calorie counts (per se) - that “consumer confusion” is used as the reason to not provide information.
• Chapter 70.02 RCW: Medical records ? health care information access and disclosure - Background information; Transparency Law in Washington State
• Forrester?s Top Health-IT Predictions for 2008 ? Digital Healthcare and Productivity - Clinical analytics, EHRs gain a greater toehold, RHIOs will take a little longer. My experience in the field seems to resonate.
• The Health 2.0 Blog: Carol aims to disrupt the health care market by Matthew Holt - There’s that “d” word again, in reference to Carol.com. Can they do it? If we think about creating patient-centered HIT systems, why wouldn’t we include cost information as part of the Information part of HIT?

• IHE.net IHE North America Connectathon 2008 Conference - Happening today - vendors getting together to demonstrate connectivity - ahead of standards
• Report: One in Five D.C. Residents Is Without Regular Health Care - washingtonpost.com - Sobering data about the health of DC residents
• Details Sparse, But Federal EHR Program Draws Praise, Optimism - iHealthBeat - Information about Blue Cross of Hawaii’s efforts to spur EHR adoption, with $20,000 per physician.
• Local News | Hospitals to tear up bills for medical mistakes | Seattle Times Newspaper - Washington State Health Care Organizations agree not to bill for “never” events
• Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries — American College of Physicians 148 (1): 55 — Annals of Internal Medicine -