It’s Not About The Box Improving Care at Group Health with People, Process and Technology

July 31, 2006

HL7 Votes to Approve Group Health’s Addition to Lab Standard

Filed under: e-health news,Lab,MyGroupHealth — admin @ 5:41 am

Group Health’s proposal to amend data transmission standards to support patient centered care. They said yes!

The HL7 consortium, the group that defines standards for delivery of medical data between computer systems, has given a thumbs up to Group Health’s patient-centered addition to the standard around lab results transmission.

Group Health has done a tremendous amount of work to change the game around lab test results. We’ve applied clinical rationale to the types of tests that should be shared with patients immediately, which ones should be held in queue for a short period of time, and which ones always require a discussion.

We didn’t want other organizations to have to go through this – many simply wouldn’t do it because they don’t have the time and energy to. If there was a standard for every lab test, that said something like, “In general, this test is always okay to give to a patient without delay,” it would be more likely that patients would be getting these results automatically. In this new world, lab systems would have this information in their databases by default. Every physician would not have to decide what to do with each test when they set up their patient internet portals.

The original proposal is attached. It is labeled the “Group Health Nomenclature” and recognizes that our work on behalf of patients doesn’t just follow standards, it sets them. May every health care organization in the world receive the same benefits our members have from MyGroupHealth.

Here’s the meat of the vote – they key part is the very last line. This is how standards are made. Many thanks to Dav Eide and the Group Health Laboratory Team for being engaged on the national level on behalf of Group Health. They participate in this national discussion as our technical experts.


• Adjusted the codes (0-5) to acronyms.

• Moved to accept.

• Adjusted length from 1 to 10.

• Not limited to Lab. If there is no Abnormal Flag value/concept (OBX.8) in play, STBD, SIMM, and SWTH are still valid to be used. At some future may get into Procedure (OBR) level.

• We agreed to keep STBD somewhat ambiguous for now to enable case-by-case or organizational policies to not decide immediately whether to release or not.

• Against: 0; Abstain: 1; In Favor: 5

July 28, 2006

New Screensavers in Exam Rooms

Filed under: MyGroupHealth — admin @ 5:34 am

An image from the new exam room screensaver

You may have noticed the brand new screensavers that are in place in our exam room computers and beyond. They are a product of our leading-edge MyGroupHealth team, who designed them in house. They include our brand new logo and “lifestyle” images. We have learned from extensive research that patients much prefer images of people in activities that they would themselves do, rather than images of health care activities. We also know that short, brief messages are best, and that MyGroupHealth is still an important differentiator for Group Health.

The screensavers support a welcoming environment in the exam room while highlighting one of the most recognized features of Group Health’s 21st century delivery system. Several organizations that have come to visit Group Health have remarked on the screensavers as a nice touch in supporting exam room computing. We have heard that other organizations have put messages like, “Do not touch this computer” on their exam room devices. I think our approach is one of those details that reminds me of the advantages of a system like MyGroupHealth that is designed by patients for patients.

July 27, 2006

Request for medical staff input from Group Health Pharmacy

Filed under: Medications — admin @ 10:03 am

The following issues were relayed to me by Katherine Brown, from the Group Health Pharmacy. If you could take a look and comment on any of your experiences with these, both of us would be grateful. Just go ahead and write comments on the post and we’ll follow that way, so everyone else can see your experience as well. Many thanks.

(1) First, if a provider puts in a drug (generic or trade name) and it is not on his/her preference list–it won’t come up (need to hit F5 and then the whole database comes up to select from…). So, if a provider tells us that s/he can’t find a drug—we should look at the preference list. It’s been awhile since we reviewed pref lists so that is something we could do. If we knew what drugs providers were having difficulty finding, we could make sure it was on the appropriate preference list. (2) Second is the naming issue. Currently, drugs are not listed with both the generic and brand name. This causes problems for flow staff as well as providers. We all agree that this needs to be addressed but the current functionality does not make this possible. However, I do believe that with one of the next upgrades, we will be able to take a look at the naming conventions. If we knew what the biggest problems were, we could start with those–I just don’t have an ETA as to when we would be able to take that on (depends when the technical capability is there).

July 26, 2006

Real-Time Specialty Appointing and EpicCare

Filed under: Informatics Team — admin @ 7:07 am
Rtam Proposal Qi

Real time appointing for GI: One way to do this

Ruth Krauss, MD, and I have been working on the Real-Time Specialty Appointing project, which will allow patients to leave primary care medical offices with a specialty care appointment in hand, when a referral is placed. This has been a desired service for some time and welcomed by many.

One of the purposes of a communication vehicle like this (a blog) is to talk about when things go well, and also when they don’t go so well. The not going so well part is that we haven’t met expectations regarding the way EpicCare supports this process. The business office pieces of real time appointing are in place. The EpicCare clinical pieces are not.

The pilot of Real Time Appointing involved the addition of actual questions to referral orders for certain specialties (Ortho, Otolaryngology). in consultation with the Epic team, we realized that this approach would not be the best moving forward for all of the service lines doing real time appointing, from an interface perspective. In addition, some of the service lines have quite a few questions, which would significantly impact the work of placing a referral using the referral order process. This doesn’t mean this approach is ruled out altogether.

We are looking at the use of smartphrases or smarttexts that provide decision support within, to guide the primary care practitioner to the best pre-workup or referral appointment for the patient. I have only worked in detail with GI so far, and put together a sample (see attached). Ruth and I don’t know for sure that this is content that should go in the After Visit Summary for patients, or whether it should go in the referral order (which does not end up in the chart note), or in the progress note (not visible by patients).

From the primary care perspective, an ideal experience would have the primary care practitioner visibly confident in referring to the best practitioner and with the most appropriate workup. For the patient, the experience would be, “My personal physician/provider is helped by her/his specialty colleagues in taking care of me, even when that specialist is not in the room with us.”

This is the goal. The fact remains that we have not fully worked out the best way to do this, and are now working with primary care and specialty providers to try a few approaches and find the best one. We don’t know the best one right now. We will figure it out soon. However, this is causing angst.

Feel free to look at the GI example above and add any comments below. Also feel free to comment on your experiences so far with real time appointing. How do you see it working for your patients and what’s the best experience?

July 25, 2006

EpicCare earns CCHIT Certification

Filed under: Informatics Team — admin @ 5:38 am

Earlier this month, the first group of electronic medical record products were given the “stamp of approval” by the Certification Commission for Healthcare Information Technology (CCHIT). CCHIT is a private sector body created to support the work of the U.S. Government’s role in improving healthcare through information technology.

The certification is intended to (From the CCHIT Website):

  1. Reduce the risk of HIT investment by physicians and other providers
  2. Ensure interoperability (compatibility) of HIT products
  3. Assure payers and purchasers providing incentives for EHR adoption that the ROI will be improved quality
  4. Protect the privacy of patients’ personal health information

“Reducing risk” means having a system that is moving toward the future, and works with other systems. Group Health has expected from the beginning that EpicCare would move forward with us into the future.

From our knowledge of Epic Systems’ work in the electronic medical record arena, this finding is not surprising. EpicCare has been achieving significant penetration in the market and we have good knowledge that the company is complying with and in many cases setting standards for electronic medical records systems. Beyond the product itself, Group Health is now a part of a community of over 100 of the best health care organizations in the nation who also use EpicCare. Many of them are like us and share information freely on how to provide the best care of patients using this system.  This aspect of our involvement with EpicCare alone has been very beneficial.

EpicCare’s certification is available here on the CCHIT Website.

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