TECH/CONSUMERS: Tang on the unstated information therapy

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

(his favorite)

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.

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2 replies »

  1. I want google to do it, but my email to senior management must have got lost in the shuffle or I’m sure there would already be a beta program.

  2. // Patients already keep a medical record at home//
    I can almost hear ringing Republican endorsements of Personal Responsibility now.
    First, I believe medical records should be in the patient’s custody. One of the biggest reasons is that the exchange for letting a big organization keep them for you is letting them abstract your information to make profitability decision. And it may turn out your abstract group of people isn’t profitable, so you get booted, lol.
    BUT, the problem is, what happens when your house burns down? Sure people can get storage boxes at the bank, but they cost money, and it’s an extra trip to the bank to go there. Also, what if you’re a homeless person with no continuous storage space (medical records are extra weight in your backpack)? Therefore, I don’t think people should be made “personally responsible” for keeping their aggregated medical record at home.
    What I’d like to see is a way of banking electronic medical records, free for people with little or no income. The idea is that the medical records are “deposited” in the patient’s own account. The information doesn’t become part of the health care provider’s business assets and it can’t be used for population management used to make business decisions. If the Federal govt. is going to use taxpayer dollars to fund parts of the EMR, then surely some of it can go to protecting the patient/consumer rather than just giving Health Care providers windfall funding in the name of technological progress.
    Hey, wait, I think I can make technical progress at my house. Anyone want to throw me $5 billion dollars to aid my noble efforts? I’m sure I can partlay my technical investment into $50 billion dollars of personal profit in no time, lol. 🙂

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