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

October 24, 2009

Reading now…

Filed under: Uncategorized — Gwen O'Keefe MD @ 6:31 am

I just finished The Healing of America – A Global Quest for Better, Cheaper and Fairer Health Care, by T.R. Reid. He’s a NPR commentator and Washington Post correspondent who went on a worldwide trip with his painful shoulder to compare healthcare systems – and found many of our assumptions about other countries’ systems are incomplete and incorrect.

Many Asian countries have fairly recently put in health systems – studying the West for best examples. None of them chose our (the US) system. And they all base their systems on a basic moral principle – every person has a fundamental right to health care. Even when respecting this right, they often have quite a capitalistic bent, but still keep their costs way lower than ours.

He also calls out the countries that have single unified electronic medical records (like France, with carte vitale )that maintains all the patient’s medical and billing information in one format on a single card. Their administrative fees are only a couple of percent of total costs, and all medical information is always available.

Also fascinating to me (but likely to be controversial here) – no other country has a medical home style model. All of the primary care systems are based on many visits per day.
Anyway – great read and fun stories, thought provoking. I highly recommend it.

October 14, 2009

Resource Stewardship

Filed under: Radiology — Tags: , , , — admin @ 5:37 pm

I am sitting at our Medical Staff meeting on Central Campus – my second of these fall meetings, first one down in Olympia. A great turnout tonight. Even in these difficult financial times, I am very hopeful. We are having direct discussions about resource stewardship, really for the first time in our history (well, except for prescribing). And when our group decides to tackle a difficult issue, we have a great track record.

Uwe Reinhart, the health economist from Princeton, posed a great question – “How can the best medical care in the world cost twice as much as the best medical care in the world?”. He was referring to data from top medical centers in the country, which showed that care at Cedars-Sinai cost twice as much as care at Mayo, with the same outcomes. In our group, we are now confronted by data about our use of high end imaging, which demonstrates three fold variation in imaging rates by clinic, and up to five fold variation within clinics/service lines. Time for us to have conversations to make sure that we are consistently providing the most cost effective care for our patients, learning from each other. We will be tracking our rates in the months ahead, and i expect that we will start to see significant improvements.

October 8, 2009

OpenNotes Project

Filed under: Uncategorized — Matt Handley @ 1:05 pm

At Group Health, patients have access to more of their electronic medical record than anywhere – right? MyGroupHealth provides:  real time access to normal labs – check;  near real time abnormal labs – check;  pathology and radiology reports that can be released for viewing (we can and will do better on this ) – check; medications – check; a visit summary for the patient – check; immunizations and allergies – check.

Looks now like we won’t be out front for long – a Robert Woods Johnson grant is supporting a research project called the Open Notes Project, which will strive to understand the impact of allowing patients access to the progress notes of clinicians.    The idea of “nothing about me, without me” taken to a logical end, after actually asking patients what they want.  Not surprisingly, they want it all, including the progress note including our summary of the history and exam and our reflections on diagnosis and care planning.

I am not sure that I have talked with docs about an area they feel more threatened by than this one.  I think that while there is a reasonable concern that there will be a language barrier (e.g., what does dysdiadokinesis mean?), reading clinician notes suggests other causes for concern, mostly around how we describe patients’ stories, exams and clinical situations.    While we are incrementally improving the way we document care, we have a ways to go.

I am hopeful that empiric evidence will help us break down this last bastion of secrecy.

October 6, 2009

Microsoft’s Rx for health care

Filed under: Improvement News — David Kauff @ 12:55 pm

Nothing earth shattering here but good to know about anyway.  A few years back when we talked with Microsoft last, there were only a handful of people in the Healthcare Division, now there are more than 600.   Microsoft is currently going at the problems in delivering care from the information side of things,  not the patient care.  It currently has 2 products out, Amalga and Health Vault that manage data and a simple PHR.  There is no EHR on the horizon yet.  Here is the article from yestedays paper that give a bit of the details:
Microsoft Health Care

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