Next up was Paul Tang, the CIO of the Palo Alto Medical Foundation. He wanted to talk about patients, and about transparency. PAMF went to open access to physician visits (i.e. you call up, and you get a same day appointment) a while back, but found that half the people would rather treat themselves than come in. Worse, even in those visits patients missed the problem that the doctor talked about 54% of the time. So access to the patient’s information by the physician (even if the physician is immediately available and the information is immediately available to the physician) is not enough becuase the patients aren’t getting the information from the doctors. In the US 71% of patients not given any information after an office visit. PAMF now gives out a post-visit summary which is a simple print out for their EHR and patients love it.
Paul contrasted the health care information system with the air traffic control back up system, and the pilots’ interface in their cockpit with the health care interface in the ICU (guess which one is non-standard). We have not set up the interfaces (e.g ICU’s are all different and non-intuitive) or the standards that work, and have no computer back-up. American health care sucks (his words).
He suggested 3 solutions —
1) give a warning that the patient has to sign a consent that the physicians is not using and EMR and nothing can be expected to go right. (Somewhat unlikely even if true!)
2) Patients already keep a medical record at home (which some are already doing) or
3) provide patients with the information that they need when they need it — this is what PAMF does using the Epic patient look-into the EMR. Their information therapy shows the patient what to do, and allows them to message the doc/nurse — and all of this is captured in the EHR. It shows the personalized content for the patient connected to their actual personal information (e.g. a dabetic diagnosis changes the content offered to stuff about diabetes management).
The most popular feature is lab test results with the physicians annotation and next step instructions. Their systems now has good enrollments and 96% patient satisfaction. Patients are respectful when they communicate electronically with their physicians and docs are 90% happy too. One patient quote "It’s not just a website it’s a good deed", 20% of patients changed their behavior just from seeing their results, such as graphing test results against time helps patients stick to diet.
Somehow Paul gave this whole talk without mentioning the words "Information Therapy". I assume Don Kemper is taking note somewhere.