The Bronx, IFH, and Urban Health Plan

On this day, I visited the Institute’s Walton Family Health Center in Bronx, New York. Due to a time constraint on my part, I did not get to shadow providers caring for patients, but I did attend a CME in the morning and then walked around the facility with it’s Medical Director. Pictures are below, click on any to see it in gallery format.

The facility is about 10 years old, and to my eyes, it seems very well designed, as well designed as any outpatient medical center I have seen. This is a medical center that has transitioned to the EHR that the rest of the Institute uses, so they have experienced the return of space back to the practice now that paper charts are gone. You can see a scanning station in one of the images – this is where the medical records room used to be.

This medical center is interesting in that it also houses a dental practice, which coexists well according to the Medical Director. It was pointed out to me that the dental exam rooms have no doors, to promote team efficiency. The dental practice also uses a dental-specific EHR, that in this case does not communicate with the medical EHR. I have long been fascinated with dental practices, because I believe that they have done a lot of work to maximize workflow in the era of electronic records that allopathic medicine could learn from. I have seen that dentists do a great job of involving care team members in the use of the EHR and in producing documentation, and this was the case here, when I asked how documentation was supported.

You’ll note the picture of the flourescent viewbox – physicians are forgetting how to use this in the area of digital radiology, and that’s the case here. There are challenges in this medical center in not having on site radiology, though. Radiology services can be challenging to arrange, and retrieval of exam data that goes with it can be equally challenging. This has implications for a personal health record and patients’ desire to have complete results available to them.

I was also able to talk with Paloma Hernandez, CEO of Urban Health Plan of Bronx, NY, and her Medical Director, Samuel De Leon, MD, about visiting this organization as one of our future sites. I got the sense of their innovation by the fact that they are now piloting iris scanners for patient identification, linked to their EHR system. It looks like they are doing outstanding work, as is the Institute.

Microsoft Introduces No-Cost, Online Personal Health Record – iHealthBeat

As has been rumored for some time, Microsoft Corporation has jumped into the PHR arena, with HealthVault, which seeks to consolodate needed health information for patients. It looks to have a facebook-like integration quality, with developers able to add applications that users can subscribe to.

Microsoft Introduces No-Cost, Online Personal Health Record – iHealthBeat

More diversity in the field is welcome. The PCHIT project is really about understanding things at the health system level, to allow projects like this to flourish – whatever it takes to empower patients in their care.

I *heart* New York (and their pedometers especially)

NYC Health PedometerToday marked a bit of a milestone for me in that my company issued pedometer died. I’ve been walking with it non-stop since 2004 – it was my permanent company brand. The thing about pedometers is that you can’t really buy them easily, but you can get them because so many organizations give them away. So today, courtesy of the Clinical Systems Improvement Group in the New York Department of Health and Mental Hygeine, I got rebranded. I’m still trying to evangelize the walking meeting here, but I admit it’s a little hard if the humidity is at a level that makes you want to duck into the nearest air conditioned space.

I spent the morning in the South Bronx, visiting one of the Institute’s facilities and meeting with leaders of Urban Health Plan, and then in the afternoon with folks from Clinical Systems Improvement. I will detail that information on the PCHIT blog when it’s up.

One thing I notice about New York is that people walk as fast as I do here (well, some of them do). It’s good that I can count my steps again.

Generation Y; A new breed of e-physicians

Bookmarks that cover the reading I have been doing on generational differences, and new blogs springing up by physicians who are practicing differently.

October 2nd through October 3rd:

Primary Care Information Project

The Year We Get Things Done
Yesterday, Neil Calman brought me to meet with the Primary Care Information Project Group to follow-up on work his team has been doing to leverage the Institute’s EHR to support public health. I was only briefly introduced to the work they are doing, but I will of course want to learn more. A Personal Health Record system is part of their plans. I was given a nifty Electronic Health Records Action Kit by the group, which puts together the rationale for going electronic very nicely.

There is not yet a personal health records action kit that I can see, but judging from the quality of the EHR kit, I think they’ll do a good job with this one when it’s produced. The team was very welcoming of new ideas and I was also impressed at their interest in understanding the EHR and how to leverage it to maximize the community’s health. It seems like a very nice partnership.

First Day

I spent my first real day yesterday, as a guest of the Institute for Family Health, as a guest of President Neal Calman, MD, and IFH’s patients and staff, who practice family medicine at the Sidney Hilman Family Practice Center.

The Institute is an organization that I have not yet encountered in the past – a highly functioning community practice, a network of Federally Qualified Health Centers, an active teaching program, a user of a state of the art electronic health record system. Dr. Calman is a founder as well as the President, and explained to me that he wanted to create a health system that blended the best parts of private practice and community-based primary care.

Part of my work is to bring up a new blog describing my experiences with these impressive health systems. That will light up at pchit.org in the near future. In the meantime, it’s noteworthy to say that I really enjoyed observing this practice, and it reminded me, in true LEAN (Toyota Management) fashion, that I can learn 10 things in 10 minutes, and the best way to take a history is to allow the patient to speak.

Institute for Family Health, New York

First site! Institute for Family Health, based in New York City.

I spent my first day at Sidney Hilman Family Practice Center, shadowing 3 clinicians and flow staff. Pictures are below, click on any to see as a photo album.

Institute for Family Health

I started the day shadowing flow staff (medical assistants) to see how patients are roomed and brought into the practice. They do something I have not seen in my practice, which is assess patient’s learning ability for every new patient, prior to the provider entering the room. They do this via a template that they fill out with the patient. Something I heard a medical assistant tell a patient that I really liked: “Have a nice visit…” – this seemed to be nice stage setting for a good interaction.
Continue reading “Institute for Family Health, New York”

Healthplans and Libraries; HIT Adoption Low

Bookmarks, September 23rd through October 1st:

State of the Union: AHRQ HIT Conference

As part of my arrival, I attended the annual Agency for Healthcare Research and Quality’s annual Health Information Technology Conference. As of this writing, the materials from the conference are being posted, so more should be available soon.

I read a review of this conference that characterized it as “interesting, yet confusing.” What I saw was continued nascency of this field. There are unfortunately many incentives that do not support the ideals that we have for health care information technology; much of the work done in that light shows progress.

Of course, I immediately drifted to one of the sessions discussing the use of LEAN (Toyota Management System) in healthcare. This was headlined by very well known organizations in the field, including Intermountain Healthcare, University of Pittsburgh, and Denver Health. I was interested in both the presentations and the people giving them as well as the audience. When I sit in a room like this, I always ask, “Is Art Byrne in here?” because he/she may very well be, given the right fuel and environmen. This is why I appreciate that AHRQ is funding work across a diverse group of health systems. One thing I noticed, though, was that there were people who knew six sigma really well, there were people who knew LEAN really well, there were people who knew the Chronic Care Model really well, but I was unsure that anyone knew all three together. There is so much passion for quality improvement – is there a standard method to do it?