Today was spent at two practices at within Massachusetts General primary care, part of Partners Health Care. Another new addition to the process was the fact that Jonathan Wald, MD, the Physician Lead for Partners’ Patient Gateway, also shadowed with us. I thought shadowing with both Josh and Jonathan was great. Both should be posting their experience here, so I will let them do that.
We actually started the day at the Stoeckle Center for Primary Care Innovation, hosted by Susan Edgman-Levitan, PA, its Executive Director. Susan is a hero for patient-centered care in my (and many individuals’) eyes and kindly introduced us to some of the innovation in primary care that’s happening here. And it’s great to hear about innovation in primary care. I honestly had to do a soft reboot during our discussion because there’s more happening here than I could glean prior to our visit. So, we’re coming back for more, and this is why it’s good to come in the first place.
First, the pictures, and then a description of the practices. Click on any to see them full size:
The Practices: Our shadowing began and Bulfinch Medical Group, where I was paired with Charles Weiss, MD. Charlie says that he’s “pluralistic” in his use of documentation and information review tools, with a combination of the longitudinal medical record (LMR) developed by Partners, some paper and dictation, and of course the services provided by Patient Gateway. This practice has a high penetration rate and is responsible for almost 1/3 of all patients signed up for Patient Gateway across the Partners System. Charlie appeared pretty comfortable with the Patient Gateway features. I did learn in the course of the experience that this portal is not Macintosh compatible – yet. This keeps some patients from accessing the system currently. This will be fixed soon. BMG has someone on site that assists with obtaining access, which makes a difference. Without in person assistance, a patient would need to print out a form and await a PIN code for access. Patient Gateway is developed and maintained by Partners Health Care. Across the system, penetration is in the single to low double digit percentages. Jonathan is working on this and has some plans that he may be able to announce on this blog once they are finalized.
We got to meet Marcy Bergeron, RN, MS, ANP, who is the Diabetes Program Manager and also does a lot of work in practice innovation. She’s a heavy promoter of the system and uses it to monitor many of her patients, especially diabetics, remotely. We did a test drive of the system and saw its features, which are the basics that a patient would typically want. There is some transition happening, as the team works on sharing lab results, proxy access, and other tools, like patient data entry.
Our shadowing continued at Beacon Hill Primary Care, where I shadowed John Muse, MD, an internist there. I was impressed that John enjoys the clinical practice of medicine, which I always get a lot out of. John’s using voice recognition and also some advanced tools to do his clinical documentation. What we learned at this practice is that there isn’t a built in way in the LMR to produce after visit summaries, like we have seen in other EMR systems. I loved the pictured sign about the physicians at this practice moving to sharing lab results on line. It’s an example of a local innovation to promote PHR use in a practice that also has high penetration. The Administrative Manager, Richard Perrotti, Jr., immediately demonstrated how he’s changing the practice of primary care in the way this clinic is staffed and managed, to be team outcome focused by sharing tasks and ensuring flow across the practicing physician pool. A lot of the things he’s doing are things I have seen implemented in leading edge medical groups studying LEAN. This is of course a huge asset to a team developing a PHR – having a clinic pioneering new ways of patient centered care will guide useful improvements of the tool.
The PHR: Patient Gateway is developed and maintained by the care system that uses it. From that perspective, it should be responsive to the system it supports. What I appreciate, as I did with Harvard Vanguard, is that they know what a PHR can do for patients and the issues that they grapple with are only partially about the technology, which they understand well. This system is working to enhance adoption and have some ideas on how to that, and again, here the issues seem to be about internal capabilities not related to technology. These are good organizations to follow as the “what if you had a robust PHR, how would you use it.” I hope Jonathan will continue to blog with us as he continues his work to empower patients in this health system.