The True Collaborative Health Record

I’ve been going about this all wrong.

It’s not my dumping of the payment system so I can focus on care over codes, my use of technology to connect better with patients, or my vision of the “collaborative record” that is wrong. It’s the fact that I am doing this without my most important resource: my patients.

I realized this while driving in to work this past week. My first patient was a tech-savvy guy I’ve known for a long time. Not only does he know me, and knows more than me about technology, he also is a regular reader of my blog (bless his heart)…and he still chose to switch to my practice! So I was looking forward to running some of my ideas by him to see if my thoughts have strayed to the land of silliness (which they often do) or if I am actually onto something. This line of thought led me to think about collaborating with him to work on my IT vision, since he does work for an IT company. My line of thought then careened into the brick wall of the obvious: why just him? I’ve been getting suggestions and offers for help from many of my patients, who are clearly intrigued by my direction and desirous to lend their expertise on the project. So why not involve any of my patients who want to be part of this project?

So this morning I sent out an invitation to all of my current patients:

Many of you know that my biggest frustration at the moment (besides congress) is the total lack of software that supports a practice like mine. I have a vision for what I need, but right now that is only possible using multiple tools in different places. In other words, it’s confusing and chaotic — something the old way of doing health care was good at, but something I am trying to avoid. As I’ve worked to figure out what to do with this project, I’ve been getting lots of offers for help and suggestions on what to do from some of my patients. It occurred to me recently (not sure why it didn’t sooner) that I need to involve you, my patients, in the building of this system. First off, you are real smart (as witnessed by your choice of doctors, of course), and could give me significant insight and help in this area. Second, these are your records, and I believe this whole thing won’t work unless I build something that works for you. Here’s what I need:

  • A “brain trust” of patients who can help me get to the best solutions in this area. I need a group of folks who know software/databases/IT (or who are good at faking it, like me) to discuss, brainstorm, and possibly build the tools that will work for both me and my patients.
  • A group of folks willing to test various tools (Twistle is an example of one of those tools), and give me their opinions on what is good/bad/ugly about them.

We can meet in person, but since this is a geeky thing, I suspect most of our meetings will be held in the far reaches of cyberspace. If in the end we come up with an ingenious piece of software, I have no hesitation but to share the piles of cash that fall out of the sky on us. I don’t really care about that side of things, actually. I really just want a system that will let me take care of all of you most effectively.

If you are interested, please let me know.

I am not sure why I hadn’t thought of this earlier (except that my mind is still affected by the “doctor is the center of the universe” reality-distortion-field that our wonderful system perpetuates. The truth is, my patients have as much if not more at stake in this project. They want me to succeed because that success will mean better care for them (and that I can stay in business and not move to New Zealand to wait for my Medicare Opt-Out period to end). Many of them have joined me because they share my vision for care that is better for patients, better for doctors, and saves money. Besides all that, anything I build won’t fly at all unless it works for them.

So I’ve started on this new project: the true collaborative health record. It’s important to me because it enables me to run the system as well as possible. I believe my model of care can only succeed if supported by an infrastructure to support it, but that with that infrastructure, it can become a viable alternative to the spend-care, sick care system both patients and doctors hate.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind),where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.

13 replies »

  1. Rob,

    I’ve run a cash practice for almost 22 years. In the first 6 months I was sure I was going to go broke. One day it started to change and I’ve been busy ever since. I came back into practice after leaving my first one due to insurance burnout. In those days I saw up to 70 people per day and had to, to make ends meet. BTW it was because I needed to pay the bills, not drag in an income. It’s a heck of a lot more expensive to run a solo practice than most people think.

    I came back into practice back then because I wanted to be providing care they way I wanted to be treated if I was my patient. It’s been the third best decision of my life (#1 was marrying my wife, #2 was becoming a doc) and has provided me with riches in my soul that money can’t buy. My patients become friends – contrary to what others who still have an old world distance from their patients espouse. I believe that I can look after people who I relate to better than someone I don’t connect with. When I’m with them I am present…the world exists just for them. I try to help each one each time and every time try to get them thinking about how they want to be when they are old. I truly believe that by this approach I have healthier patients than those chasing the buck. For sure there is a cost to the patient but the return for them is great – shorter wait times, more time to answer all their concerns etc.

    You sound like you are on track to enjoy a rewarding future, don’t listen to those who are threatened by your decision. There have to be 1,000 people who would love to have you as part of the family. They will find you. They will tell others. You will get busy. Just remember when you are busy, why you wanted to be busy. Don’t ever lose sight of the principles that started you on the path.

    I can tell you from my experience that you are going to have more time, help more, feel better about your profession, enjoy relationships which will elevate your life, and have way more fun because you stepped out of the ever compressing box that we somehow got jammed into!

  2. I think having the patient collabrorate with you is a great idea. How about collabrorating with their care giver (I.e. parent, child, family member) too?

  3. Very interesting discussion glad that I came across such informative post. Keep up the good work friend. Glad to be part of your net community.

  4. Have already opted out. The point is that I can’t go back and work for “the man” until 2015. Not that I would want to work for him again…it just limits my options if this practice doesn’t fly.

  5. I am not limiting this to just Geeks. But since this project is, at its core, an IT project, I want to first work with the IT folks to tell me what’s possible and what of my ideas are nonsense. We also need to look at stuff that’s out there and build on it, rather than dream up something new (that’s not really new). I sent this email out to all patients, though, and have gotten a mix of interested folks signing up. I do think that in the end this must be a project that works for everyone, not just the geeks. I am very much aware that the end product must not be for the geeks, but for the least tech-savvy of my patients.

  6. The main reason to start with this is because they have the most at stake. I simply care more about my own patients’ opinions than I do of folks on the outside, as they have skin in this game (literally). I don’t want something so big that it distracts me from the people I am serving. They know me and I know them.

    I do like the ideas you put out there, though, and would not simply limit this should it warrant growth. I am truly wanting to be open-source on this project, but am just beginning. This is the first step. Once people shower us with money (hah), I’ll have the resources to do something bigger. My main goal is not software development, it is making a viable practice model with an IT structure that supports it, not resists it.

  7. @Mighty Casey “Rob, we’d shift this battleship like a Zodiac on a calm lake.” Amen.

    Rob – I know nothing about IT, what it takes to be a primary care provider or how to run a medical office, but I have lots of experience as a patient. Too much, quite frankly.

    Why limit input to patients who know about IT?

    Starting in 2014, as you know, all docs must be computerized or perish. Will this new system you propose dovetail with the Fed’s requirements and systems?

    There are lots of new crowdsourced research projects out there. And one patient who crowdsourced his cancer. http://scopeblog.stanford.edu/2012/09/10/ted-fellow-uses-crowdsource-approach-to-treat-his-brain-cancer/

    Check it out, lots of leads there I’m sure. Good luck and God bless.
    Damn, we need more docs like you.

  8. LET.PATIENTS.HELP. If only *all* of healthcare was as smart as you are, Rob, we’d shift this battleship like a Zodiac on a calm lake.

    Hospital boards should include members IDed as patients. Implementing a new system? Ask some patients for insight. Got an idea for a new treatment? Talk to some patients. Want to make a difference to an entire industry? Just ask a savvy patient.

    We – practiced, participatory patients – can also help educate your not-so-savvy-or-participatory panel on how to be more actively engaged in their health/care.

    We’re here. Just ask us. That goes for big health systems, too …

  9. Rob,

    Good idea here – patients have the answer. I am building a wiki-technology for doctors and patients to mine all of the expertise – check out healthloop; were in early beta but 87% of patients are digging it.

  10. “(and that I can stay in business and not move to New Zealand to wait for my Medicare Opt-Out period to end)”

    “It is simple to opt out of Medicare – far simpler than staying in the Medicare program.”

    “Your patients are the answer. Inviting them in is the key.”

    And they’ll work for free!!

  11. Dr. Rob:

    I love the egalitarian thinking behind this. I think you’re right. Your patients are the answer. Inviting them in is the key. This would in fact be “engagement.”

    But I don’t get one thing. Why limit yourself to patients who are enrolled in your practice and those who live in your area? (I may be misreading you here and if I am, forgive me.) Why not open this up to everyone? This seems much more in keeping with the spirit of your venture.

    Why not create an collaborative web-based project – a bit like Mozilla and the open source Firefox project that built the Firefox web browser or the Wikipedia project – call it the Open Patient Project?

    You’d get an organization that you can tap into as you reinvent your practice and one that other like minded physicians can work with as well. One where patients .

    Coincidentally: you match the theme of Leslie’s post below and also the med student debt piece as well .. Huh. Maybe you can look at ways your patients could invest in your practice as well?