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

August 23, 2007

Problems with sharing clinical data across organizations are spreading

Filed under: e-health news,Information continuity — admin @ 5:37 am

Organizations working to exchange clinical data across health care institutions are running into more problems. The latest casualty is a system in our neighbor State of Oregon:

http://portlandtribune.com/news/story.php?story_id=118670243207447600

Reading the article gives a hint to the challenges faced by very dedicated people who want to do the best for patients. The unfortunate reality in many of these situations is the overall market/financial environment doesn’t really incentivize this activity.

What is Group Health doing?

We (Group Health) are building several new medical centers:

http://www.ghc.org/locations/eastside.jhtml

The largest is next to a hospital that we do not own or operate (Overlake Medical Center) and does not have the same EMR as we do, but we are building electronic clinical data exchange at the same time we are building the brick and mortar. The work is not easy every day, but it’s what our patients expect : their care team regardless of facility to have needed information when they arrive, and at times, before they arrive. Same goes for themselves and family on the Web, as well as accompanying information (Information Therapy).

We call our approach Information Continuity ( http://en.wikipedia.org/wiki/Information_continuity ).

It’s going well so far, with great engagement from everyone involved, and I think we’ll be able to show value by doing it in an ideal care system, one that happens to be member governed.

One day, through the work of CCHIT (which I am serving on currently) and related bodies, it will be terrific to create these connections to health information exchanges for both PHRs and EHRs.

Our Bellevue Medical Center opens May, 2008. Data is already beginning to flow with 10 months left to go. It makes perfect clinical and business sense for this to happen, and I think we’ll be very successful.

August 22, 2007

New After Visit Summary – Description and walkthrough with “thought bubbles”

Filed under: After Visit Summary — admin @ 9:35 am
Avssummaryfinal

PDF document including executive summary and walkthrough of the new After Visit Summary

Colby Voorhees, the Manager of the After Visit Summary team, prepared a nice summary and walk through of the new AVS to help all of us know what’s new on the AVS and where it came from. In previous posts, we’ve included information about laboratory orders and medication reconciliation.

As always, comments are welcome.

Thanks to the entire After Visit Summary team, including developers, Quality Assurance Engineers, physicians, and staff (and members!) for helping Group Health with this.

August 20, 2007

John Kaschko, MD, Leadership Eastside Class of 2010

Filed under: Informatics Team — admin @ 4:20 am
Leadership Eastside - 3

Leadership Eastside, Class of 2010

I had the privilege of attending the welcoming reception for the Leadership Eastside Class of 2010 with John Kaschko, MD, and his wife Cathy Kaschko.

John is the only physician in this group of distinguished individuals and community leaders to be, sponsored by Group Health Permanente as an individual, and as a program by Group Health Cooperative. John is joined by another health care professional from Group Health, Alice Chao, who is the project director for our Bellevue Specialty Center and Redmond Primary Care projects.

Leadership Eastside is a 3 year program that brings together emerging leaders to create connections to other community leaders and organizations in the interest of supporting the health and welfare of the Eastside Community. Also in attendance were Vic Collymore, MD, who is a Board Member, and Jill Ostrem, VP of Consultative Specialty Services, and alumnus Helga Ding, DDS, Director of Operations for Center for Health Studies. In the program, John will work on community projects with leaders in companies like Microsoft, Boeing, Seattle Times, Evergreen, Wal Mart Stores, among others. He’s bringing together his experience as a physician, and successful leadership of three major projects in Informatics: EpicCare Emergency Department Module, EpicCare Consulting Nurse Module, and Voice Recognition. John is beginning an even bigger role as Physician Champion for the Epic Billing and Scheduling Module implementation. He started this journey as the very first Group Health physician to send a secure e-mail in 2000, from his Internal Medicine practice at Eastside Primary Care.

We are really excited for John, and for our team. Group Health Informatics distinguishes itself from Informatics in other institutions is that we are focused on having excellent Permanente physicians first (excellent clinicians, leaders, partners) and systems experts second. Being a part of the communities we practice in is a commitment to this excellence and fits in well with our goal as Informatics – to help our members and their communities achieve their life goals through optimal health.

August 17, 2007

Introducing….the new AVS

Filed under: After Visit Summary — admin @ 12:54 pm
081707 Avs Adult Final

The new After Visit Summary, coming soon

As you have been following on this blog, we almost completed a major improvement effort of the After Visit Summary. You also saw that we found some additional things we needed to improve, namely laboratory orders, and health maintenance reminders. We took the AVS back into the lab for another 3 day push, and now it’s done.

In addition to the medication reconciliation features I mentioned (see this link), we’ve now added lab order reconciliation.

This means that the AVS will include all lab orders that are awaiting a patient that visit from all providers involved in their care as well as lab orders that are set to be due, again, from all providers involved in their care.

This allows patients and providers to tell at a glance if there are conflicts or if something that is supposed to be ordered is not ordered. If there are duplicates, they can be spotted quickly and reconciled before the patient goes to the lab.

UPDATE: We are working on finalizing the date that we will turn this on. It must go on all at once, across our system. We’ll be calling Medical Center Administrators and Medical Center Chiefs to discuss. One thing we want to check is that the extra information doesn’t slow our system down.

Take a look at the attached document. I welcome your comments.

Another idea to support AVS workflow, practice of Dr. Clarice Sackett and Dr. Art Aron, Redmond Primary Care

Filed under: Workflow — admin @ 5:02 am

Clarice Sackett, MD, and her flow staff, Art Aron (who himself has a medical degree and experience as a practicing ENT surgeon from Russia), showed me an approach they are trying out at Redmond Primary Care. I went to visit with them about a week ago, and they and their patients graciously allowed me to shadow them receiving and providing care.

The layout of printers in their workstation is not as ideal as it is in Team 2b at Family Health. This makes for a challenge. On the other hand, the exam rooms are in a direct line of sight, where they are not at Team 2b. Every team has its unique attributes!

In any event, on thinking more about the Team 2b workflow, Clarice showed me what she and Art are experimenting with. It’s the use of a color coded number as a visual system to notify Art when a patient’s visit is complete and checkout may begin. The visual can be seen from the exam rooms where the printer as currently configured cannot be. Clarice told me that she’s trying it out and it helps. She said she is learning to share AVS duties with Art in the interest of the other patients who are ready to be seen – it takes discipline, she said, because the tendency that we all have is to watch the process through all the way to discharge.

I was really really impressed by the thinking that Clarice and Art put into this and in taking time to try something new, that made a difference. When I say that this actually made my week, it will probably cause some of you to think that I need to get out more. But it did, because one of the most enjoyable things about health care for me is watching people solve problems. (What’s the most enjoyable thing about health care for you? Feel free to comment….)

Thanks to both for grabbing me and showing me what you’ve done!

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