“You have the information and I look out for you” – ONC Visits Kaiser Permanente West End Medical Center, Washington, DC

Eytan-Onc-2007Presentation: Office of the National Coordinator Shop Floor Tour, Ted Eytan, MD

These were the words of Mark Snyder, MD, Associate Medical Director, Information Technology, Mid-Atlantic Permanente Medical Group, as he demonstrated a new paradigm of information sharing using a simulated medical record, taking the record (represented by a notepad) out of his hands, and placing it in a member’s hands. This happened during a “process walk” that we set up to show the workflow of secure e-mail in a medical practice, at Kaiser Permanente’s West End Medical Center, in the heart of Washington, DC.

The visit came about because I was asked to provide information to the Office of the National Coordinator (ONC) about Group Health Cooperative’s work in adopting secure e-mail as part of care across the State of Washington. Since I am a believer of Genchi Genbutsu through the work I have been doing in LEAN, I invited the group to “come and see for yourself,” and they did.

With assistance from the staff at Kaiser Permanente’s West End Medical Center, including Medical Center Chief Doug VanZoeren, MD, I presented the Group Health Health Profile, an electronic health risk appraisal linked to an electronic health record, along with data about adoption of our patient portal, MyGroupHealth. Mark Snyder followed with information about Kaiser Permanente’s HealthConnect project and associated personal health record, kp.org. He indicated that 100,000 of Kaiser Permanente Mid-Atlantic’s members have signed on to the system, giving it a steeper adoption curve than even Group Health as Mark pointed out, since it is has been on the scene for less time. It is now fully operational, though, and forging ahead with features like direct booking of primary care appointments.

The process walk part of the visit involves physically going to where the work happens, in this case, the handling of a patient secure e-mail, which was the goal for today. For the purposes of the walk, Mark logged in as a test patient and began the workflow by sending a message to himself through kp.org. The group then traveled to the Infectious Disease unit within the Medical Center, where the message was handled by a member of Mark’s (and the member’s) care team. The group then followed Mark into an exam room where he demonstrated the integration of message handling with the electronic health record, which he and fellow providers use to support all aspects of care. It was at this point that Mark did a demonstration of how this technology is changing the paradigm – from “I (the care provider) have the information” to “you (the member) have the information.”

We were asked great questions, including whether members can see who has looked at their record through the Web (not currently, but they may request this information), how the systems handle lab results (in several Kaiser Permanente regions and Group Health, many lab results are delivered to patients and physicians at the same time), and how messages in different languages are handled (because the medical record is shared, information given in languages other than English should be summarized in English so members of the care team have access to it).

Some of these questions have been asked of me in the past, some of them have not, which is why I welcome an experience like this. The Office of the National Coordinator, in its work to provide counsel to the Secretary of HHS and Departmental leadership, is exposed to a broad range of stakeholders and ideas about how to promote adoption of health information technology, including personal health records. I think it’s a good idea for even the most leading edge organizations to know about these ideas so that what they do can be a model for others who would like to do the same. Because Kaiser Permanente’s Mid-Atlantic Region Medical Centers are fully live with the kp.org PHR, it is now possible to look at the impact of this technology across our population in our nation’s capital.

Thanks again to staff from the ONC for their interest in knowing as much as possible about the experience of health care enabled with an EHR and a PHR, and to the staff at Kaiser Permanente West End Medical Center for their time in showing what they do for members. I also have to send a thank you to the MyGroupHealth team in Seattle, Washington, for their openness in sharing what they do so that every patient in every care system has a great care experience.

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Ted Eytan, MD