Now Reading: Proof that it IS Meaningful if Patients can Use it

How appropriate that the very first peer-reviewed journal article I read from start to finish on the iPad is this one.

In Patient Experience Should be Part of Meaningful-Use Criteria , published today in the annual Health Information Technology issue of HealthAffairs, Group Health Cooperative presents a new snapshot of their experience with an electronic health record that is patient-centered, because its goal is to deliver information to them.

I’m a little biased since Matt Handley, MD is my former boss and Group Health is where I learned that patients are the ones who decide what health information technology means for them. So before I continue, I have concluded that this is one of the best peer-reviewed articles about health information technology ever written :).

A well-implemented patient portal to a comprehensive electronic health record is unstoppable

The trend noted in the article is clear. In a world where many providers of personal health records wonder why there is no traction, the experience here shows exactly the opposite – continuing, almost accelerating use. Why?

..most patient engagement with the electronic health record is not focused on viewing an archive of past care, but rather on actively using a constellation of services that support day-to-day care needs and patient-provider relationships.

An electronic health record and/or personal health record that doesn’t do this will have its expectations met accordingly. People want access to their health information in the context of their relationship with trusted people (e.g. their doctor, their family, their community), it’s the “people just like me” of the electronic health record.

Meaningful in the eye of the patient

You can tell from reading the article that this organization conceptualizes an electronic health record differently – it grades itself on how useful services are for patients, including whether they (the patients) are satisfied with them, and whether they contribute to retention in the health system.

This is striking in comparison to other work I have seen/read that focuses on physician satisfaction and maximum revenue generation of electronic health record systems as the primary outcome measure. Are these outcomes the greatest hopes of people seeking a better health care system in the 21st century?

This is not to say that physician satisfaction is unimportant – as the article describes, comprehensive efforts to integrate addition to interacting with patients into the office visit and beyond have been undertaken. The Group Health patient centered-medical home was begun in 2006 and is now being expanded across the Group Health system. It’s got its own blog (as any innovative effort should), and creates the environment that supports physicians in performing well for their patients. The key is that physician satisfaction is not the primary outcome measure. Results from this approach are back, and are encouraging of this approach – design of the system around the patient with electronic tools supporting it. It’s all connected….

I have done some literature reviews on this topic, I believe that it’s true that a happy patient = a happy physician, but not necessarily the other way around, because physicians want to perform well for patients.

The “beyond” is what patients want.

As the paper mentions, much work was done to use this tool to support physicians and the health system in being there for patients when they are in the office, or not. Patients like that, and more importantly they want that. If that’s what they want (and I say, “because patients want it” is as good a reason as any to do something innovative in health care), the paper argues that this is what should be measured and reimbursed for. Its noted that meaningful use criteria, as currently designed, do not require patient-physician messaging.

Hopefully, what this work does is demonstrate that this (involving patients and their families in their care using HIT) is easy to do, not hard to do. The most important thing is to want to do it, and I actually think most physicians want to do it. The next step is to create the environment where doing anything else doesn’t make sense.

Did we mention that it’s not meaningful if patient’s can’t use it yet?

I first posted about this issue in May, 2009, when I met Regina Holliday. , and as I have also mentioned previously, meaningful use as defined in the ARRA law did not include patient and family engagement – the HIT Policy Committee added it, which says great things about our accumulated experience with health information technology to date.

Luckily there is a Group Health Cooperative that makes this a reality for 350,000 patients, and works to communicate to the world not how hard this is, it communicates how much better it is.

And, before readers of this article address it with the “We can’t do it because we’re not….”, please print out this tweet , a quote from Jack Cochran, MD, and carry it with you for those moments.


A few weeks ago I testified before Aneesh Chopra's panel on Innovation in EHR implementations and used the Group Health model as the case study.

Both Ted and Matt were my mentors when I worked at Group Health on our amazing patient centered health care information system and is the reason I am not only so passionate but so convinced that this is the way to transform our healthcare system.

Secure email, lab results, online appts, RX refills, are all key satisfiers for patients. The latest metrics are impressive – As of March 1, 2010 over 198,000 GHC members are using the EHR system (41.8% of adult enrollees) and in one week alone 62,929 labs were looked up, 13,592 after visit summaries were produced,

Ted Eytan, MD