In yesterday’s post, I started by describing what is meant by “population care.” To be even more clear, this is isn’t a statistical analysis / measurement program. It’s a saving lives program, not using surgery or antibiotics, using passion and compassion. As I say, “Your patients will tell you what this means.” Here’s Mary Gonzales, in a minute and a half:
She says, “I am one of the lucky ones,” and the innovation she describes is learning about her breast cancer screening needs at the Allergist’s office, and not just learning about them, acting on them. Before population care systems, this wouldn’t have happened. After them, saving a life doesn’t have to be about luck.
Yesterday we spent time at Orchards Medical Office in Vancouver, Washington, with Terry Williams, MD, a family physician in the Northwest Permanente Medical Group. As I have said on here before, I’m not that smart and my ideas aren’t that original, and in this case, Atul Gawande, MD, had already been here, in September, 2009, to learn about the “Kaiser methods” that piqued him.
We learned too, about what family medicine in all of health care could now become. Terry showed me how a physician can have a thoughful, I’ll say almost magical, relationship with a patient that includes attention to all of the science we have about what will keep them healthy, and the art of listening to what’s needed today. A patient might say, “But I just came here for my hand pain,” and Terry will say back, “You know I’m going to talk about everything else, too,” and they do.
Terry told us, “I’m on their care and they know it” and in that statement he means that he has all the data I need to take care of everything in the fastest and easiest way, AND a program surrounding this data that includes regular feedback at the patient, physician, practice, and regional level.
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The Personal Health Record is a tool for populations
I am never hesitant to promote the power of a personal health record in all of health care, and I am still amazed at how much the PHR (Kaiser Peramanente’s My Health Manager at http://www.kp.org ) is now being leveraged for population care.
Terry has 1500 of his 1900 of his patients signed up for the personal health record (!!) . When he finds a patient that is noted on the electronic health record not to have signed up, he not only asks if the patient will join him, he does a 3 minute demo of how to get an account. I have seen this change before in smaller doses, from physicians being frustrated/anxious about the personal health record, to today, being frustrated/anxious that not enough patients are using the personal health record. Based on the experience I feel I get to say this now – anyone who says physicians are not interested in using personal health records are just wrong. Come on down and see for yourself.
As if the individual physician experience wasn’t reinforcing of the value of the personal health record, we saw even more in the Prevention Services department (more on that below). The Personal Health Record is actually being used as a primary channel to communicate with members who are behind on preventive health services. What is happening is that when a group of patients is identified as needing something, the first thing that happens is that their status on the personal health record is cross matched and they are being reached out to via that mechanism. The patients that are remaining are then contacted via more analog means. This surpasses even my wildest dreams.
Chasing 100 (Percent)
We then went to the Prevention Services Department at Kaiser Permanente Northwest. It doesn’t exist in a typical medical office building, but it functions like one. It has a physician, Mike Kositch, MD, and medical assistants, who conduct outreach in partnership with the nurses and physicians who care for patients in actual medical offices. This takes the form of some algorithms and automation AND medical judgement and knowledge in reviewing the health care record, finding out the best way to work with a patient, and delivering the preventive health service. It’s kind of an individualized approach to health care of lots of people at once, and it can’t all be done by computers, and I don’t think that patients would expect that it would be. All of the data I have seen says that patients and their families want information from their doctor/health professional first, and this is what the data + the program deliver.
Within that paradigm, as I mentioned to yesterday, the goal is moving away from “best in health care” (which is often 70-80% success) and even from “best anywhere” (which is often 90% of higher) to just, “100%”. No best anything, all patients receive their preventive care and lives are saved. This place, the one that’s about how to close every “hole in the prevention net” has less science about what works. Michael and I talked about what it was like to be a physician 10-15 years ago, to go home at the end of the day believing that you had done good prevention work, but not knowing for sure. Then, the focus was on how to identify the opportunities and the people, so you didn’t miss anything. Now science may be needed to understand how the medical profession and health care can support people who are not engaged/not receiving their preventive care, for reasons beyond “we didn’t know who they were.”
In this new era of knowing, the challenge is also less that people can be found, it is more that they may be found more than once, and so there is much coordination that happens in this part of the organization with the rest.
Today we are scheduled to meet with some of the leaders of the program, to find out how they think they are doing and where they want to go next. With great thanks to the care team at Orchards Medical Office in Vancouver, Washington, and Prevention Services, Kaiser Permanente Northwest.