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.

In the home stretch now.  Don Kemper, the guru of this information therapy, self-care stuff is up now.  His goal is that every medical encounter ends with an information prescription, which would then drive better compliance and better health outcomes — and by the way save a whole lot of money.

Don wants to pay for IX  by finding all the big disease categories and incorporate IX into disease management.  He things that we need more members for this "billion dollar club".

And to move this along, the Center for Information Therapy is going to become a new, independent center with no direct connection to HealthWise.

And it’s a new dawn for Information Therapy….at least he thinks and we ought to hope.

More from Park City….

Shorter Mark Bard (Manhattan Research)– two thirds of docs are suggesting that younger female patients go to the web, but there’s no financial mechanism for it, and no real business case for physicians to do better websites, eVisits, or anything much else so far.

Shorter Susan Denzter (PBS NewsHour Corespondent) (via phone as she’s on the way to cover Rita) — Consumers don’t understand numbers, they don’t understand simple instructions, and simple numeracy and literacy is a big challenge especially among the elderly and less educated, which is a lot of people. Plus no-one understands (and this includes journalists and drug detail people) the difference between relative and absolute risk. And people make irrational choices even when presented with the correct information. She calls it not Information Therapy, but Information Fughedaboutit. So she asks her sources to talk to her on air as if she’s an intelligent 12 year old. So there are lots of reasons why information is good but no way is it enough to explain behavior.

I’m reminded of the time that at IFTF we put the California HEDIS measurements up on one chart and asked the audience to pick their health plan by looking at it. It was a rainbow of conflicting color-coded circles. No one could figure out until about a year after we’d been showing it one bright guy said "look you should join Cigna Southern California as they do the best on the most measures".  And he was right.  Then we told him that Cigna Southern California was the staff-model Medicaid HMO with clinics in Compton and South-Central LA.  Somehow we felt that that information, even though it was irrelevant to objective care measures, may well have swayed his choice of plan.

David Sobel runs Kaiser Permanente Northern California’s attempts to provide patient information therapy — to him there are professional providers and lay providers of health care!

The opportunity is in self-care management.  Ought to be easy for Kaiser–as the incentives are in the right place– but there are "information implementation disorders".

• Noise overload disorder
• Professional dominance disorder (medical Hemianopsia — google it)
• Not invented here
• Disease specific syndrome
• Office visit tunnel syndrome (tyranny of doctor visits as a metric)
• Mindless body syndrome
• Technophobia

How to get around this? Need to go to the expensive places (chronic disease). Need to get cost-effectiveness data and compare it to other stuff that doesn’t demand data (no business case asked for office visits). Need to tell stories, such as the Healthwise handbook story about a guy who’s wife made him go in to get an arterial blockage taken care of instead of blowing off the pain. Saved an amputation and tens of thousands of dollars.

Need to rename, retrain, integrate Information therapy into everything the doctors do, and into physician continuing education. So KP doctors are asked when they are doing CME, What questions are available to KP members for information about disease XYZ?  But more than that they had to redesign the program about how to make physicians feel better by communicating better with their patients, and 4,000 docs have gone through the program on their own time because it works. Got to re-frame the language.

And of course relationships, champions, values, persistence and proving yourself matter — In other words don’t try to sell to Kaiser! (Oasis, Oceania, anyone else?)

Rushika Fernandopulle runs Renaissance Health, the attempt to set up a model small practice in Boston.

He thinks that despite he’s in a small practice, we need to think big, and we need to change what we’re doing.  We can’t manage the patients condition, because they do it mostly themselves. They’ve kludged together various IT systems. They ask their patients to pay $20-40 a month to keep their panel size down and their extra work (non-reimbursed) up. The most important thing they’ve done is to change the culture so that widget production is not the goal of the practice. They pay patients if they make them wait more than 15 minutes. And their practice works. He loves working there–his patients love coming.

But with that number of patients per docs we’d need 375,000 primary care docs in the US, and they we’d have to take $250 per patient per year away from somewhere else in the system to pay for it.  Worth thinking about though.

Still in Utah, still at the Information Therapy conference — A session on how to guide consumers to high quality content, that’s integrated with their care, electronically

Shorter Tom Lee (Calif HC Foundation): Standards for consumer data don’t really exist, but integration of all the technologies providers need without that consumer stuff is a bitch…and anyway the standards are being designed for providers. So this is tough.

Shorter Josh Seidman (Center for Information Therapy): PHRs are disconnected from EHR systems, and give data not information. Integrating a real EMR with a PHR with a content system is even more of a bitch. So getting the right info to the consumer when they need it is difficult.

Shorter Leslie Kelly Hall (St. Alphonsus Regional Medical Center, ID): Can we make looking at our info simpler without going to the level of granularity that providers or plans want? So lets not go to the level of complexity that’s more than we need. But there’s political leadership to do it now, which wasn’t there before.

Tom and Leslie agree with me that we need to change the business models to get there, and by the way CareEncentive may be doing that. (That was an interesting presentation, about how to get docs in Oklahoma to follow guidelines by paying them extra to answer questionnaires, and seeing cost reductions to boot). But Tom thinks that to save the day we need clinician organizations to step up and get the organizational, clincal process transformation done.