“When I walk in the room, it’s like going to medical school.” : PCHIT in Boston

Thad Schilling, MD, and Caroline

Thad Schilling, MD, and Caroline, Harvard Vanguard Medical Associates

These were the words of Caroline, who’s Thad Schilling, MD’s, Medical Assistant at Harvard Vanguard Medical Associates‘ Medford Medical Office. She was commenting on the fact that Thad uses a whiteboard when he teaches patients about their health. This has the impact of involving his team in understanding the patient’s condition as they support the care.

Yesterday, Joshua Seidman and myself shadowed practices at the Medford office (Dr. Schilling) and at the Kenmore office (Dr. Kate Koplan). We went to see what was happening at Harvard Vanguard because they have an established PHR, MyHealth Online, that’s produced by a very respected EHR manufacturer. I was interested in MyHealth Online because it’s a system very similar to the one that Group Health produced for its members in Seattle. However, patient adoption of this system has not been at the levels of Group Health. I wanted to get some insights on the issues at the exam room level.

This was also Josh’s first time shadowing in a medical center, as part of this project at least, so it will be good to read about his perspectives doing this along side me. Consent was obtained from each patient of course, and it actually worked out well to have us alternate shadowing experience. Thad had a relatively busy schedule and he has experience with people learning from his practice, so Caroline and his stewardship worked out really well.

First some pictures, and then the rest of the story:

The practices: Kate and Thad are from a generation of physicians who are very comfortable with electronic health records. Kate trained using one. In both practices, I did not detect any discomfort, therefore, using the EHR and the focus was on the visit itself. A little caveat in that I am from the same generation (relatively speaking), so may not detect differences as well.

Kate practices in a facility that a broad diversity of patients, with different capabilities. In general, Kate is a promoter of the PHR service and tailors the invitation to each patient, but she does invite them to join her online personally. There is a challenge around verifying patients’ identity online to get them signed up. She told me, “Because you’re here, I would probably ask this patient about online access, but I otherwise would not.” In particular, Kate is very good at alerting the patient to her use of the exam room machine and setting expectations accordingly. She indicated to me that she is in a medical office where she’s lead adopter of these services.

Thad practices in a facility also with a diversity of patients, with my understanding that the age range may be a little older. He too is a promoter of MyHealth online, and also, from my sense, the lead adopter in this medical office. Caroline is very engaged in the caring of the patients they support and is really interested in working alongside Thad for a good care experience. She was kind enough to allow myself and Josh to shadow her caring for patients. As I have learned in my previous work, the contribution of support staff to patient centered care is significant, and I always recommend that physicians shadow all of the members of their team. In this case, there seemed to be a very nice rapport from patient to patient between Caroline and Thad – they were in sync. They work to maintain this. The comment at the top of this post describes a continuous learning that happens within the team, which is really great. I love the whiteboard idea.

I think in both practices there isn’t a consistent model of appealing to patients to use MyHealth online, it is tailored to the person and the setting. I did not get a good sense of whether practices were aware of what percentage of their patients were signed up except in general terms. Their system does inform providers whether the patients is verified for use on MyHealth online.

The organization: We ended the day with a very helpful discussion with key physician and business leaders, led by Joe Kimura, MD, and attended by both Thad and Kate. It was great – the group was very open and clearly has a strong interest in patient centered care. What struck me during the conversation about the use of the HVMA PHR was that most of the issues identified in terms of adoption were internally focused. In other words, this group wasn’t looking to external forces (eg reimbursement, health care environment, etc) as the reason for use/non-use of the PHR, even though these can be very real issues. One question that I did ask was who the physician lead was for the MyHealth Online work, and in this case, I am not sure there is one. Read on, though.

I was thinking about this later and my take is that this group knows the value of the PHR for their patients because they use it already. It has robust functionality and each physician has direct experience in how it has helped them support their patients. The issue is more of an organizational strategy one, around priorities. It turns out that they are doing significant work innovating around patient-centered care, and the PHR is a strong component of that. So it’s a tool to support bigger outcome goals, which makes sense. The PCHIT role is not to realign strategy for an organization, just to understand where they are at in the journey. In this case, the PHR is not a strategy in an of itself, but part of a bigger picture, because there is more going on. If there is/are physician leads for overall patient centered care innovation, they should include the PHR in their toolkit.

It will definitely be worth following the experience of these talented clinicians and the patients they serve. With much appreciation for their time and commitment.

1 Comment

Hi Ted –

Thanks for coming to visit us here in Boston. I must say that we learned a ton from you experiences at GHC as well as your observations of other practices working with PHRs.



Ted Eytan, MD