Just Read: In a health system where patient-physician email is actually used, how it impacts care

In an American health system, where, for the most part, patients *still* do not have access to their online medical records or access to their physicians (see: Patel V, Barker W, Siminerio E. Individuals’ access and use of their online medical record nationwide. Office of National Coordinator for Health Information Technology and Majority of Americans don’t use digital technology to access doctors | CAPP), this is a study conducted by the research team at Kaiser Permanente (@KPDOR) where patients mostly *do* have this access.

Of interest, they looked at how patients who had higher co-pays thought of using email as their first contact with providers, and how it may have shifted their use of services. This article on the @KPShare web site summarizes things nicely so I won’t repeat here: Patient-Initiated E-mails to Providers: Associations With Out-of-Pocket Visit Costs, and Impact on Care-Seeking and Health

I do want to clarify that the study is not asking about cost-sharing for email interactions. It asked what people would do if they didn’t have email at all. Totally different question. And no less interesting at this stage of adoption.

Speaking of adoption, the national numbers are 30% of people are offered their online medical record, and 46% viewed it at least once. That’s super low.

At Kaiser Permanente, 100% of people are offered their online medical record, 69% of the eligible population (as of 2Q2015) have signed up to use it, and 68% have viewed it at least once in the last quarter. 40% accessed it 5 or more times in the last quarter. By definition this is patient directed activity because there aren’t any organizational barriers to this access. These numbers are much better 🙂 .

Read the study to find out more what they do with it once they have it, which is a much more interesting question than, “when are they going to get it.”

Just Read: Patient & Family Health Care Leadership: A Resource Compendium from the National Academy of Medicine

So you would like to learn about patient and family health care leadership, where it’s happening and what the results are (and why wouldn’t you, I always want to).

This compendium has just been published as a body of work of the participants in the Patient & Family Health Care Leadership Network convened by the National Academy of Medicine, part of the National Academies of Sciences (@NASciences). So while not a report of the NAS, sometimes, like this time, compiling what is known is a great thing. And this compendium has both the leading institutions and the leading people represented – I was fortunate to join a meeting of the Network, and it was fantastic.

Thanks to Deidtra Henderson (@dee_henderson) at the NAS for being a part of this, sharing it with all of us, and posting it so others may enjoy.

This Compendium was created to assist and to inform volunteer patient & family council leaders and such leaders have contributed valuable feedback from its inception to its completion. It presents summary information on available evidence and information about the impact of patient and family engagement on health care outcomes and care improvement. It is intended to be a continuously updated living resource, and suggestions for inclusion are encouraged.

The compendium also has links to short video testimonials like this one, from one of the nation’s leaders in respecting patient and family involvement, Georgia Regents’ University, who I’ve spent time with previously, and where I was fortunate to be exposed to the leadership of Pat Sodomka, F.A.C.H.E., who I will always remember as the person who involved patients and families not because she had to, because it was the thing to do as a leader (see: Remembering Pat Sodomka, F.A.C.H.E.).

When people are ready to promote patient empowerment/engagement, what can they do?

The title of this post is a variant of the title of another post (“When physicians are ready to promote patient empowerment/engagement, do we want them to do?“). That post came about from a conversation with another physician. This one is coming about with a conversation with a person, not a physician, Erica Brand, who works in silicon valley and is interested in the same idea.

We got in touch because Erica has been following the work of myself and the e-patients.net group, and on reflection of her own experience with health care is interested in making a difference.

We talked about different opportunities for someone with talent in an industry that is not health care could help health care succeed, and there are lots of them. For example, depending on who a person’s employer is, they may belong to a coalition of employers focused on health issues. In California, this might be The Pacific Business Group on Health, or in silicon valley, the Silicon Valley Employers Forum is an affiliate of PBGH, which is also a place to get involved in transforming health care.

As I look back at the original post, though, the advice/recommendations are generally the same, which says to me that we all have as much if not more in common as fellow patients than we do being in health care / not being in health care. I still think health care can learn a lot from other industries and we should welcome all of the help we can get, and I think talent is talent regardless of the industry that it comes from. In the era of Health 2.0, the improvement of health is truly democratic.

It is nice to discover in these conversations that there are many people who want to bring their professional and personal experiences forward to help us improve. Come join us!

Now Reading: 25 Percent of Large Medical Groups Use Data from Patients to Improve Care

Only 10 percent reported that most of their physicians would strongly agree with statement that the group regularly incorporates feedback from patients in improving care and developing new services.

This is among the largest medical groups, the ones with the greatest infrastructure.

This figure comes from the attached article, published in Health Affairs , which is a survey of a sample of the largest medical groups in the United States (those with 20 or more physicians), with the exclusion of Independent Practice Associations (due to theoretically less infrastructure present), and via self-report of the CEO’s/Presidents/Medical Director. In other words, this is best case.

With regard to online access:

Thirty percent of medical groups use group visits for patients with chronic illnesses at a majority of their practice sites (data not shown). A similar proportion reported that most of their physicians communicate with patients via e-mail “occasionally,” although only 1 percent reported that physicians use e-mail with patients daily. Nine percent said that a majority of their patients could access some part of the group’s EMR online.

Unfortunately, the performance of the medical groups surveyed lessens as the size of the group does. I thought it might be possible that smaller practices in this group might employ greater efforts to incorporate patient feedback. That could still be the case, since groups with less than 20 physicians are not included here (and those are the overwhelming majority of places where Americans receive their ambulatory medical care).

What about measuring “Medical Home-ness”?

Although some argue that “ medical-homeness” is better evaluated from the patient’s perspective than from the physician’s, others balk at all attempts to measure aspects of the PCMH as overly reductionist. Regardless, the demand for clinical practice “ transparency” remains a reality of the current policy environment, and success of the model will depend in part on continued multistakeholder involvement in the development of standardized, comprehensive assessment tools.

How, in a Health 2.0 world, could we combine the significant expertise of NCQA and lighter weight solutions to support patient involvement in the measurement of medical home-ness? Would this approach also guide medical groups to select the right infrastructure improvement projects for themselves and implement them quickly? This fits in nicely with the LEAN concept of “seeing the impact of what you do,” by getting smaller bits of feedback soon, combined with more comprehensive feedback over time.

Maybe a parallel iPhone Medical Home measurement application will surface …. see what you think.

My AHRQ M&M Case & Commentary – The Promise of Patient and Family Involvement

AHRQ WebM&M: October, 2008, Case & Commentary: Recurrent Hypoglycemia: A Care Transition Failure? Commentary by Ted Eytan, MD, MS, MPH

I wrote this month’s spotlight case in AHRQ’s Web M&M.

At first glance, this article looks like a traditional M&M (“Morbidity & Mortality”) review of an internal medicine case, replete with lab values, diagnostic discussions, and the like. However, the cases on this site stretch beyond diagnostics, as I found.

Bob Wachter, MD and his team invited me to write a commentary on a case about recurrent hypoglycemia that was about system supports rather than diagnostic and clinical errors. This included putting together all the thoughts on having an accessible EHR, patient and family involvement in care, and in the design of the system. The whole thing is in there, wrapped in a package for clinicians and those who support them to review and ponder.

It’s the spotlight case this month, and as I review it, I remember all of the people along the way who added this idea or that idea (and there’s many more to add). You’ll probably recognize yourselves in there….

With thanks to Bob and team for envisioning that a difficult medical case could be the foundation for a discussion about what Health 2.0 will do for our nation. See what you think.