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

November 28, 2008

Virtual Visits

Filed under: Medical Home,Secure Messaging — Marc Lowe @ 9:58 am

Technology is a gift of God. After the gift of life it is perhaps the greatest of God’s gifts. It is the mother of civilizations, of arts and of sciences.
Freeman Dyson

These are exciting times to be in healthcare. Indeed, we are just seeing the tip of the iceberg with how we leverage the available technology in this industry. Our organization is on a continuing journey to use technology in creative and nontraditional ways. The Medical Home Model is one part of this endeavor. Within the context of The Medical Home Model, the use of virtual visits has become an important and necessary change for providers. Last week I participated in an RPIW (LEAN term that stands for rapid process improvement workshop) in Factoria on virtual visits (the use of electronic mail, telemedicine, and the telephone to facilitate delivery of healthcare). The use of virtual visits may seem intuitive to those of us who have already embraced technology, but after participating in the RPIW, and having several years of leadership experience, I can attest to the fact that many providers still cringe at the possibility of having to adapt to this new world. The RPIW was an intense week of daily work, with a cross functional team of primary care providers, RNs, PTMs, LPNs, business office representatives, and others. The week felt like being placed into a foxhole with several different people with differing personalities and temperaments. With the help of daily goals, good facilitators, and some sharp participants, we were able to brainstorm problems, and come up with tools and guidelines for our teams to carry back to their respective clinics and hopefully implement.

Although the RPIW was a primary care workshop, I feel I learned a huge amount and will try to implement and carry this message back to our specialty group. Remember that virtual visits don’t as much take away our ability to see patients–as they enhance the visits that are really necessary.  By the way, it was also very nice to see colleagues that I’ve only met through electronic forms of communication in the past—a reminder that we still are human and need live in-person contact once in awhile.

November 24, 2008

Radiology results on MyGroupHealth

Filed under: MyGroupHealth,Radiology — Tags: , — Matt Handley @ 2:23 pm

Our group has led the way nationally on many different eHealth initiatives – the remarkable penetration of MyGroupHealth sign up, secure messaging as a system property, auto-release of abnormal lab results to name a few.  Now it is time for us to follow some others and take a next step.

We have historically been timid about releasing radiology results to patients, worried about several things:

  • The complexity of the language – “they will call about every test and ask things like “what is a retroperitoneum?”
  • Radiologist sometimes use language that generates more rather than less uncertainty (e.g., normal CXR, but cannot rule out cancer”
  • That the patient learn they have a serious medical condition from the web rather than from a conversation with their doctor

All of these are legitimate issues, of course, and they are very reminiscent of our concerns prior to auto-releasing lab tests online.

So what are others doing?  At KP Northern California they mail results of imaging results to patients, and at Beth Israel and Palo Alto Medical Foundation they auto-release them to patients through the web.  None of these groups report that this has caused difficulties, and all believe that it is an important patient safety improvement, allowing patients to catch missed results.

I will be advancing this work with the help of Bob Karl, head of radiology and GHP board member, who believes strongly that we should work to increase the transparency of wour work in support of our patients.

One of my favorite quotes about transparency is the patient motto “Nothing about me, without me”.  We hope to be able to get closer to that aspiration in the new year.

November 21, 2008

‘Care Everywhere’

Filed under: Information continuity — David Kauff @ 11:13 am

Imagine, you are in an exam room and your patient tells you that the results of a pulmonary consultation and chest CT were done at a hospital in Portland, Oregon two weeks ago.  This is information that is vital to you and the patient as you plan next steps.  With a new Epic application called ‘Care Everywhere’, it will be possible for you to get permission and real time access to this information in the exam room. It is now possible to access the remote chart as if it was right there in the exam room

Yesterday,  Informatics leaders from various institutions from around Puget Sound and Oregon met a Qualis Healthcare to talk about using this software to share patient health records.  Representatives from the UW, Swedish, PacMed, VM, Multicare and the Everett Clinic and others, saw a demonstration of this technology. It will be possible for us to share protected health information between institutions using the same navigation tools that we use in Epic today with the same user interface and access to data. It was very slick to see progress notes, procedures and radiology/lab reports from other institutions easily woven into our own patient’s charts.

Currently only three Epic users have installed this application, and 20 more are soon to sign on.  The technology will also allow non-Epic EMR is to be shared in our Epic system.  As more groups embrace EHR technology the need and immediacy for sharing information across organizations can only grow.  It seems that this is the right direction for us to go to more efficiently and rapidly meet patient’s needs. Group Health and our Informatics group in particular, will help spearhead the rapid adoption of this with the collaboration of our health care neighbors both locally and nationally.

My first impression was that this is a right next step in the evolution of the EHR.  ‘Care Everywhere’, stay tuned.

November 19, 2008

The Triple Aim – IHI’s biggest initiative

Filed under: Population management,Quality / Affordability — Tags: , , — Matt Handley @ 9:36 am

I  am at a meeting of the “Triple Aim” collaborative in Chicago right now – The Institute for Healthcare Improvement (IHI) is sponsoring this effort to help like minded organizations collaborate in their efforts to simultaneously solve for quality/health, the care experience and affordability.  I had dinner last night with participants from KP Colorado and KP MidAtlantic, Breakfast with participants from Great Britain.  All kinds of different perspectives on population health.

My goal at this meeting is to find some other organizations to help us accelerate the content of care work – benchmarking in consultative specialty areas and share best practices.  While hopeful, there are only a few groups with high performing specialty groups like ours.

One of the challenges all organizations face is helping us all get out of our silos in thinking about satisfaction, cost and quality.  Our Primary Care leadership has done a great job in doing this with the Medical Home work.  The team from Bolton, a Primary Care Trust in England has a great diagram to help keep it simple – you can see it here:  Bolton Triple Aim diagram

November 13, 2008

What is the best way to share Smartphrases?

Filed under: Smartphrases — Tags: — Matt Handley @ 4:29 pm

At recent medical staff meetings and some other forums there has been a lot of interest in having the ability to share Smartphrases.  The Epic tool that supports individual innovation is the Smartphrase.  When people share best practices, one of the coins of the realm is the smartphrase.  So when one of my colleagues has a great way to explain a new clinical topic to their patients – I want to take advantage of their expertice in my own practice.  One of the great things about being in a large and innovative medical group is that we all don’t have to do it from scratch.

Unfortunately, Epic doesn’t have an easy way to do this.  The informatics team is working on the technology side (do we have a searchable database? a wiki? a blog?), but we have some other ideas to consider.

Do we want to just have a mosh pit?  Do we just throw everyone’s favorites into a searchable bin, or should we consider some vetting (some might be a bit more eivdence based vs clinical hunch, some written in plain language and some in medical jargon)?

We would love to hear from you about what you want in sharing Smartphrases.  We are considering the technical options (and have queries to other Epic customers to see what others are doing).  What we need from all of you is some discussion about what you want to get from a tool.

Thanks in advance for joining the conversation – just leave a comment on the blog.

Older Posts »

Powered by WordPress