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

March 30, 2009

Second Life in Medical Education

Filed under: Education — Tags: , — Gwen O'Keefe MD @ 11:14 am

Although I am not in medical education anymore, I am still very interested in how we train future doctors and how we continue our own lifelong learning. I thought this piece was cool – the Imperial Medical College in London is experimenting with using Second Life (where you have an alter ego called an avatar) and interact with others in a virtual world. Maybe we can use this in Group Health CME someday?

Link to CNN piece on Second Life in medicine

March 26, 2009

Who Owns the Patient Data? JAMA Commentary

Filed under: Uncategorized — Tags: — Gwen O'Keefe MD @ 2:41 pm

We (the Informatics group) have been struggling with a few patient issues lately regarding incorrect entry of an HIV diagnosis into patients charts.  These errors have been made both by staff in the past and at least once by the patient.   Our gut instinct is that this needs to really be  removed, not just deleted from view, so it can’t accidentally be released in paper form in the future.    HIPAA does give patients the right to inspect and ask for corrections, but the law seems to get a bit murkier after that. It is not clear on what our responsibility is and how far we can go when we (health care providers) make a mistake. Even more interesting is what to do when the patient makes a mistake?

Much of the discussion had been occuring with our colleagues in HIM, Legal and the Privacy office and I think we have all been surprised by the lack of clarity surrounding the law on who ultimately owns the information, what does “removing” something from the record really mean and how do we assure it never affects the patient in the future.

The JAMA commentary published today addresses this and how the lack of clarity and onerous nature of some of the laws needs to be addressed in order for us to attain the full benefit of the stimulus package push to increase EMR use. We have to get it all right in order for patients to attain the full benefit and I hope we are going to be leaders in figuring this out!

JAMA commentary
Posted by Gwen O’Keefe

March 25, 2009

The Shared Health Record – Better than Personal Health Records (PHR)

Filed under: Epic,Medical Home,MyGroupHealth — Tags: , , — Matt Handley @ 6:15 pm

Today’s NEJM has a great piece that makes clear the distinction between a personal health record (PHR) and what we have at Group Health – both patients and clinicians sharing access to a single electronic health record.  I believe that there are considerable advantages to what we have –  it sets us up as the integrator of information on behalf of the patient, rather than require the patient to integrate their information, and it strengthens the relationshoip between the patient and the clinical team.  It does require an accountable integrated care delivery system – but that is always the best approach for value in health care.  This is just another demonstration of that value.

Shared Health Record vs Personal Health Records-nejm

Creating Better, Safer Health Systems

Filed under: Safety — Matt Handley @ 7:51 am

I am spending the day with leaders of different health care systems from across the state – a very different kind of meeting than the one I attended yesterday ( Its Good to be Us ), which had a lot of self promotion.  Today is all about safety and the culture changes that will be required for us to advance this work, and about working together to bring that about.  How do we create a community that advances the interests of patients?

It is a “target rich” environment – the tools that have been used to date have not been as effective as hoped, and don’t “scale” (how many things can you set up pay for performance measures for?) Regulatory frameworks and pay for performance will not solve the challenges we have before us.

Dr David Flum from UW believes that a New Professionalism, setting boundaries from within, holds more promise.  Moving away from the model of the autonomous clinician towards a member of a team – responsible for the performance of the clinical team, and of departments and delivery systems.   He has led the establishment of a state wide collaboration to improve surgical care, SCOAP.  SCOAP (Surgical Care and Outcomes Assessment Program) is now a great example of how a clinician led collaboration has led to a reduction in variability and improvement in outcomes across the state for a few (but growing number) of procedures.  It is now three years old, and going strong.  Checklists, tools, measurement and feedback enable a cultural change that promotes continuous improvement.

So the first perspective today – an example of how appealing to the common aspiration of doing a better job on behalf of our patients in a collegial professional model.  More to come later.

March 24, 2009

Its Good to be Us

Filed under: Quality / Affordability — Tags: — Matt Handley @ 7:29 am

I am sitting in the Spanish Ballroom of the Olympic Fairmont hotel in downtown Seattle.    Virgina Mason is hosting an event titled “A Shared Commitment to Change” – all about improving quality in our community.  And about marketing VM and their work in Lean.  They are working to get closer to what we are able to do all the time – find ways to deliver value to customers, our patients.  They face a lot of challenges that we are insulated from — the incentives and challenges of the payment system in the US.  They are working with payors to lower their rates of inappropriate care, and trying to find innovative ways to retain revenue lost by eliminating unnecessary tests.

Mom and apple pie, and right up our alley.  We are lucky enough to be able to organize care for all of our patients based on their needs rather than our revenue.  Other organizations are working bravely to find a few clinical situations where they can, with a lot of work, reduce wasteful utilization to the betterment of our patients.  And in some ways they are ahead of us – their attention is (in some areas) more focused.

I did love their focus on the patient/customer’s perspective.  Lets challenge ourselves to live this every day.


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