Into the Future at John Muir Health

John Muir Physician Network (20071205)

Josh and I spent our day yesterday at two leading edge health organizations in the Bay Area, Kaiser Permanente, and John Muir Health. This post is about our time at John Muir Health. Like Kaiser Permanente, John Muir Health is a big place – out attention was focused on the John Muir Physician Network, which provides multispecialty care within owned and operated practices as well as within an Individual Practice Association.

And…it was very valuable. My background is as a family physician within an owned and operated multispecialty group, so even though I understand the implementation of both an EHR and PHR at an enterprise level, I am not acquainted with the environment of physician-owned practices. To this end, Michael Schierman, MD, hosted Josh and I at his practice at Blackhawk Medical Center, in Danville, California.

Michael is a family physician, originally from Calgary, Alberta, who shares his full time practice with two physicians who are general internists. His practice is leading the way for a transformation to electronic health records using the NextGen platform. In my work, I have also never seen the NextGen product, which is a fully CCHIT certified electronic health record, in action. Michael’s practice has only recently gone live, and he’s pretty facile with the system in practice, from my view. They are now doing the hard work of converting paper charts to the electronic work, and a great metaphor for this was Michael’s office. Before we visited, he apologized for any messiness in his office, which comes as a result of the paper charts he is diligently reviewing as part of the transition. Again, the value of being there is made apparent, because I could see that the transition to an electronic health record means everything from changing your workflow to uprooting your physical practice environment.

In the patient rooms themselves, the story was a very pleasing one. Michael was able to tell his patients that laboratory studies could be obtained without needing a paper lab slip, and prescriptions would be sent electronically from his laptop during the visit. His patient population, which is a busy and professional one, seemed impressed. In reference to my presence, he asked several of his patients what they would think about e-mailing their doctor. The comments that came back were very interesting, and tracked what we’ve heard at Group Health. There was a measured concern and respect for their doctor’s time that came with each response – “I would want to keep things to the point.” At the same time, Michael showed me his work list that was nicely displayed on his laptop. The question would be how this other avenue of communication would fit into this portion of his practice life.

Pictures: Click on any to see full size

There is more to look at here, I think, with regard to the financing of care provided, and differences between owned and operated practices and solo and small-practices. It’s impressive to note that in this case, the IPA has taken the initiative to select a system, manage its own transformation, and make it work for their patients. From that perspective, a physician group like this would be well suited to figure out how to deploy patient centered health information technology into practice in a way that works. As with other practices I have visited, there is not a sense that physicians don’t want to reach out in ways that help their patients. It is just important to see what they are working on now and how they can make this fit in. And I think they can. As an example, I watched as Michael printed out a patient’s lab report and sat down with them to explain what every test was, and what every lab value meant. I typically do this in practice with patients when there is a lab done on the spot, but I have not done this for labs that have been ordered prior to the day’s visit. I thought this was a nice touch, which reinforces the relationship, and demonstrates the value to the patient of the proactive practice – when they take the time to order needed tests before the visit, the interaction is pleasing for everyone. Because a practice like this knows how to do this on paper, I think they could devise a way to do it online, too.

At every place we visit, I also get to add to my list of “shadowing best practices,” and Michael introduced a new one to me. He personally thanked every patient before they left for providing their time and input to my observations. I usually do this myself, but I thought the additional thanks from their own doctor was really great.

Outside of the IPA, the John Muir Physician Group is going to be implementing RelayHealth for patient communication, and will tie it to systems that use McKesson and Cerner products. As with the other organizations we have visited, the environment here is rich in helping to understand adoption of PCHIT.

Thank you again to John Muir Health, the John Muir Physician Group, and Michael Schierman, MD, his patients, and staff for the education. Errors: is not accessible or supported filetype. is not accessible or supported filetype. is not accessible or supported filetype.

1 Comment

In addition to my thanks to Mike and his staff as well, I wanted to add one additional observation from the patients that I shadowed.

After a new diagnosis of hypertension for a middle-aged woman, she requested him to prescribe some information therapy (Ix). Or, more specifically, after Dr. Schierman wrote her an Rx for an ACE-inhibitor, she asked, "Is there anything you can give me that I can do in terms of lifestyle to help me reduce my blood pressure?"

Dr. Schierman first provided some brief oral instruction about diet and exercise but quickly realized that him reeling off lots of detail in conversation was going to have limited utility (and this was also toward the end of a fairly lengthy visit and his patients had begun to stack up behind this encounter). So, he paused, turned to his laptop and explained that he was printing out just such guidance for her at that moment.

He stepped out of the room, returned within 5 seconds, and handed her the Ix she requested (I'm not sure of the content source). Not only did this patient have a smile on her face and thank her doctor, but she also said, "Hey, cool! It even has my name on it."

Clearly, this "personalized" information prescription conveyed to her that Dr. Schierman listened to her question, responded to her, and provided her withs some important guidance to help her better manage her own health–which research shows is critical for the management of any chronic condition.


Ted Eytan, MD