In the last post, I described my day at two different care organizations; Partners, and East Boston Neighborhood Health Center.
Continuing, a summary of….
Brigham and Women’s Hospital, Dr. David Bates: I shadowed David for several patients who are on his panel and well known to him. David uses the Longitudinal Medical Record produced by Partners Health Care, integrated with Patient Gateway. Jonathan Wald, MD, the Physician Lead, was next door working with a colleague to talk about Patient Gateway in practice. I think there were a ha’s for all of us about how to use a resource like this, including how to bridge the world of regular electronic mail and the PHR. David visibly practiced Information Therapy in front of me, when he printed out a document to describe a condition for a patient he was treating. The LMR as I understand it, does not automatically produce an after visit summary. I didn’t see David use Patient Gateway features during our visit, but we did have some time to talk about PHRs and the interest in supporting good research for the production of good outcomes knowledge about how to use them in practice. Jonathan is working on the issue of patient adoption, which he may comment about separately
East Boston Neighborhood Medical Center, Dr. Stephen Simon: EBNHC uses EpicCare, and has used it since 1998. Physicians have been documenting and ordering using the system for about 4 years. Their urgent care is also on the system. In shadowing, I was able to observe the first visit in this experience in Spanish, which was important for me to see. In the exam rooms at EBNHC, screens are pointed toward the exam table, where physicians can review data with their patients together, and I saw this happen in the visit(s). Stephen was very facile with EpicCare and has taken the time to customize it for best use. EBNHC does not yet have a PHR active for its patients.
One thing that was really important for me to see was a difference in focus. During my time at EBNHC, the staff was applied to recent health care reform policies that have gone into effect in Massachusetts, which affect everything from co-pays to drug formularies. It was impressive to note how much this was on the minds of the staff here, to support a transition that is successful for their patients. This issue did not come up in conversation at the other medical centers – different populations, different needs. I honestly know very little about this initiative as I don’t live in this community, but it’s clear that it should be understood as a modulator of capabilities. At the same time, EBNHC is also pioneering electronic prescription transmission from its EpicCare system.
Partners, as I mentioned earlier is positioned for adoption, and are making plans to integrate the Patient Gateway into practices more. The system has good functionality and can provide staff experience in using technology to reach patients wherever and whenever they need to.
EBNHC, in contrast, does not yet have a PHR online. The considerations here are the impact of system upgrades, which must be done accurately, and continued optimization of portions of their system. Much like the Institute for Family Medicine in New York, they maintain a very robust EHR with a smaller staff pool. It’s actually very impressive. In fact, during my time there. Dr. Kuebler was updating parts of the system based on requests for her peers, like in near real time. That’s nimble! This can also make readiness for the jump to PHR more challenging at the same time. One key issue for this population is the need for a multi-lingual PHR. Coming to East Boston really brings home the fact that the time now upon us to address disparities in the way systems are designed so that they are accessible by the same population that accesses the health system. It felt very real when I was there.
Of course, Josh and I would like to follow both organizations as they continue on their journey to support their communities in the distinct ways that they do. I think both will contribute to the conversation significantly.
With thanks again to Drs. Wald, Bates, Kuebler, and Simon, and the staff and patients at Brigham and Women’s Hospital and East Boston Neighborhood Health Center for the gift of their time.