This is a link to Kaiser Permanente’s press release about the relaunch of the site with My Health Manager. As the release states, the personal health record is continuing to be a large focus of Kaiser Permanente’s work in health information technology. All of Kaiser Permanente’s regions are now operating a personal health record as of this year now that Ohio is online.
Of interest, they are also going through and replacing “your” references to “my” references around the site. For the PCHIT initiative, we are following the progress of Kaiser Permanente as a benchmark organization, and they are a sponsoring partner.
One of my to-do’s is to schedule an in depth tour of kp.org. I am a user (and builder!) of Group Health’s PHR, which is based on similar technology. I know from my own physician and patient experience that more interaction like this is the right step forward for the people we serve.
Today was spent at two practices at within Massachusetts General primary care, part of Partners Health Care. Another new addition to the process was the fact that Jonathan Wald, MD, the Physician Lead for Partners’ Patient Gateway, also shadowed with us. I thought shadowing with both Josh and Jonathan was great. Both should be posting their experience here, so I will let them do that.
We actually started the day at the Stoeckle Center for Primary Care Innovation, hosted by Susan Edgman-Levitan, PA, its Executive Director. Susan is a hero for patient-centered care in my (and many individuals’) eyes and kindly introduced us to some of the innovation in primary care that’s happening here. And it’s great to hear about innovation in primary care. I honestly had to do a soft reboot during our discussion because there’s more happening here than I could glean prior to our visit. So, we’re coming back for more, and this is why it’s good to come in the first place.
First, the pictures, and then a description of the practices. Click on any to see them full size:
Thad Schilling, MD, and Caroline, Harvard Vanguard Medical Associates
These were the words of Caroline, who’s Thad Schilling, MD’s, Medical Assistant at Harvard Vanguard Medical Associates‘ Medford Medical Office. She was commenting on the fact that Thad uses a whiteboard when he teaches patients about their health. This has the impact of involving his team in understanding the patient’s condition as they support the care.
Yesterday, Joshua Seidman and myself shadowed practices at the Medford office (Dr. Schilling) and at the Kenmore office (Dr. Kate Koplan). We went to see what was happening at Harvard Vanguard because they have an established PHR, MyHealth Online, that’s produced by a very respected EHR manufacturer. I was interested in MyHealth Online because it’s a system very similar to the one that Group Health produced for its members in Seattle. However, patient adoption of this system has not been at the levels of Group Health. I wanted to get some insights on the issues at the exam room level.
This was also Josh’s first time shadowing in a medical center, as part of this project at least, so it will be good to read about his perspectives doing this along side me. Consent was obtained from each patient of course, and it actually worked out well to have us alternate shadowing experience. Thad had a relatively busy schedule and he has experience with people learning from his practice, so Caroline and his stewardship worked out really well.
First some pictures, and then the rest of the story:
Of late there has been discussion in the role of blogs in communication, both for relaying information, and stimulating action. Much of the discussion in my environment about this is generated by the fact that I am blogging most of what I am doing, and intentionally so (such is the life of a change agent/leader type).
On the micro level, it has been interesting and great to explain to the organizations and people that I meet that I am blogging what I see/do (with the exception of any personally identifiable information of patients). The reactions are varied, as one might expect and there isn’t really a lot of time to explain everything there is to about Web 2.0 because people are busy just doing what they do.
On a macro level, I have a prepared talk that I have given about blogs and their role in change management / communication. I think they have a huge one now and into the future, especially in a learning organization.
At the same time, I think about the value of peer review in describing what I’m doing. What is it?
When I look at the communication revolution that is happening with Web 2.0, I’m unsure that MEDLINE citations are the most important standard for creating portable knowledge in health care, especially in the areas I am working with, Informatics and process management and improvement (LEAN and Toyota Management System).
Speaking of “what am I observing for,” Holly Potter from Kaiser Permanente let me know about this excellent report from the Commonwealth Fund. It’s a nice review of the history and components of Patient-Centered Care, accompanied with data from interviews of key experts in the field.
For this project, it helps add a little structure to our observations, because there are discrete things we can look for. The report takes the reader through two example organizations that have these attributes. The checklist it cites is:
A strategic vision, clearly communicated (“from the boardroom to the bedside”, or I might say, “from the boardroom to the exam room”)
Involvement of patients and families at multiple levels
Care for the caregivers through a supportive work environment
Systematic measurement and feedback
Quality of the physical environment
These concepts, especially #7, are right up PCHIT’s alley, as are others that were emphasized by our Advisory Group last week. We have to be careful that this initiative is mostly about #7, at the same time, #7 is a tool to serve the other 6 items.
In contrast to the way data was acquired about organizations, in interviews, I am going to the exam room myself (“Genchi Genbutsu“) to understand each organization’s experience. I think by definition, an organization that is interested in the answer to these questions probably has answered them well already.
This post is first in a series will summarize our status and input from our Advisory Group (Blogs are about a little information at a time). Both the Group and this audience are welcome to comment. Our goal is to make any adjustments necessary, now, and continually improve our process as we do this.
The summary comes in the form of an “A3” document and a short set of slides. The slides are published here.
A reminder that an A3 document really just outlines a story. It’s probably best for this medium for me to discuss the work of each Advisory Group member (with the exception of Patricia Flatley Brennan, who could not be with us this first time) and the impact on adjusting our work.
To also keep this manageable, I’ll do it over the course of the week, one each day.
Michael Barr, MD, MBA, FACP: Michael, as Vice President of Practice Advisory and Improvement for the American College of Physicians, is leading the Medical Home work of the College. This includes establishing the “systemness” of the Medical Home, as well as understanding the economics of the Medical Home. He is working with payers to establish the benefit to patients and ability of Medical Home to address self-management goals. As currently devised, this model is most effective in practices where there are longitudinal relationships, such as primary care, but also in specialty care in certain circumstances. Several demonstration projects are set to begin in 2008. The College’s Center for Practice Innovation has been working with small practices to transform them, in line with Medical Home principles. The ACP is heavily involved in technology issues, at the level of some delivery systems. Finally, we are alerted to the publication of a white paper in the Annals of Internal Medicine on payment methodologies.
Adjustment: The impact of Medical Home discussions locally and nationally is very clear, and observations in PCHIT should be connected to Medical Home principles. Ted Eytan is presenting at the CPI conference in Washington, DC, on November 17 and will be spending time with CPI staff and practices as part of this involvement. The ACP white paper will be reviewed by us as well for implications for PCHIT.
These were the words of our server this morning over a breakfast with Neil Calman, MD, who is in Washington, DC, to talk to our national legislators and researchers about health information technology.
How did this come up in conversation? Well, as our order was being taken, I noticed a brochure for her health insurance plan in her uniform. That visual alone said so much about how much health care means to us.
So I asked what she thought of her health care.
She told us that she was a breast cancer survivor for several years now, and that she had excellent cancer care. (She told us, “your patients have probably told you this – a part of you dies when you learn that you have cancer.”) After her treatment was completed, she was referred to her primary medical center to continue care. She said that whenever she goes to get care, though, her primary doctor is not available. She hasn’t seen her in awhile, and she told us it’s not the same. “Your mother knows everything about you.”
I asked if she had Internet access and if she used this to communicate with her care system. Yes, she said, but her primary doctor did not respond to her messages in a timely manner. “I know she’s very busy just like me.” She told us that she’s given this feedback directly to her plan. At the same time, she told us with some pride where she got her cancer care, and where she now gets her primary care. She also told us about several of her work colleagues who have been diagnosed with cancer. They are all aware of each others’ conditions. Continue reading ““Your Primary [doctor] is like your mother. You don’t change your mother””
The last few days has brought work that is PCHIT-the Initiative centric, which is good. I always say that if there’s something I can do better, I want to know about it. Our Advisory Group meeting happened on schedule yesterday. The process of the preparation and hosting of the discussion will be very useful moving forward. Josh and I will summarize things here in the next few days. In the meantime, here’s a photo of this very accomplished group, at the Center for Information Therapy.
From left to right: Joshua Seidman, Ph.D., Deven McGraw, Susannah Fox, Veenu Aulakh, Ted Eytan, MD, Rachel Block, Charles Milligan, Jr., and Michael Barr, MD, MBA, FACP. Not pictured: Patricia Flatley Brennan, RN, PhD
You can read biographies of Advisory Group members by clicking on this link.
A lot of reflection and housekeeping happened this week, in prep for another journey next week to visit with another great community, Boston, Massachusetts. I was honored to attend The Health Affairs Silver Anniversary Gala as a representative of Group Health Cooperative and Kaiser Permanente, which was a presenting sponsor.
One more photo this week, of Barracks Row, in the Capitol Hill neighborhood. I was introduced to this neighborhood officially by Lygeia Ricciardi who runs the Project HealthDesign Blog, in addition to a portfolio of work promoting consumer empowerment. There is a large community of talented professionals here who are both working to support a patient/person-centered health system, and willing to introduce diverse parts of this community to new arrivals. I highly recommend both the neighborhood, and the blog.