Small Practice, big ideas

I spent my last day in New York shadowing in one of Institute for Family Health’s smallest practices – two physicians and a nurse practitioner. Like the other practices in the system, this one is busy, taking scheduled patients and walk-ins. And like the others, it is fully enabled using an electronic health record. Pictures are below. Click on any to see full size.

I saw the art of family medicine here, which is that regardless of the time pressures always faced in medicine, physicians are able to focus and be there for their patients. The physician I saw practice on this day had a really nice rapport with her patients and I noticed was able to connect with them on topics important to them outside of health care – trips they might be taking, or significant family issues. This is always great to see in the context of an electronically enabled practice – doctors can still be doctors. The other significant thing for me was the kindness of the patients in their willingness to let me learn about their relationship with their doctor by watching the interaction. The several that I observed were welcoming after an informed consent was obtained by their physician.

Also, a new best practice for me (I think) – sitting while shadowing. I have traditionally stood in a corner to be as unobtrusive as possible, but it was brought to my attention that my height may be a little imposing in the exam room. I liked it – more at the level of the patient, and more blended in. With great thanks to the 13th street practice.

What about the PHR? I was informed that this practice is diligent about sending patients results and other important health information, which made me think about the value of a personal health record here. What if patients could retrieve their own information, accompanied by information about each test automatically (Information Therapy)? It was important for me to come visit and see that reality for this practice. I think there could be win here in physicians empowering patients to become informed about their own care on their own time. One issue this system will face is in their use of external ancillaries, such as lab and radiology. The PHR may force the issue of establishing a solid interface to both, and this is a good thing – the patients will expect their data to be available to them and to their provider. Everyone wins.

Later in the day, I met with Karen Nelson, MD, MPH, the CEO of Unite HERE Health Center. The facility is beautiful and modern (see pictures below), and also fully electronic, using the General Electric Centricity Product.

We talked about the history of UNITE HERE! and the patients seen here. They are doing a lot of work in Ambulatory ICU and serve a distinct group of special patients in the city. I would very much like to come visit on my return, and had the idea that I would not only like to shadow a provider, but shadow a patient living with chronic disease, if this is possible.


You make the good point that working with the computer in exam room didn't get in the way of the doctor being a doctor. I think this is something that a lot of clinicians worry about (and more than a few patients too).
Can you talk more about how this doctor used the computer (physically as well as functionally)? And how does that compare with the strategies you use?

I think in the era of the electronic health record that the goal isn't so much that the computer "not get in the way" as much as it is that the computer be integrated by not intrusive. An article published in the Kaiser Permanente journal offers some insights into this: Computers: Friend or Foe. The goal is to add the computer as a useful tool.

Ted Eytan, MD