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

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.

December 1, 2008

More on High End Imaging

Filed under: Radiology — Tags: , — Matt Handley @ 7:26 am

A few people have expressed interest in the high end imaging work – basically building simple decision support into Epic (the American College of Radiology appropriateness criteria) to better manage the value and safety of imaging that clinicians in GHP order.

That work is based on work done in Minnesota, where 5 different medical groups (including Health Partners and Mayo) who all use Epic worked together to implement the same strategy – which we are now adopting here.   Their use of imaging (in commercial groups, in outpt care) is just over half what our is.

A few select slides from their presentation are below, and another post about this topic can be accessed here

health partners imaging build in epic

health partners imaging outcomes

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.

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