Please post a total of four of your favorite quotes from a variety of sessions from Boston. This section, which includes the quotes, the presenter, and why it is of importance to you should be posted as a comment to this post no later than 3/31.
Posted by IS/HIM 385 - Spring 2008 - Sue Feldman
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This was such an amazing experience and the breadth of knowledge that I received was beyond expectation. There were so many great messages conveyed. My four favorite quotes are as follows:
1. "Personal accountability will start with "Kelly" will know." This quote was delivered by keynote speaker Dr. Paul Tang, Friday morning session entitled "Connected Health and the Medical Home of the Future".
- What I enjoyed about this quote was the reality connected with it. Often times a patient will lie about their symptoms or how closely they are following their orders because they are afraid that the doctor will yell at them or may be afraid to hear the truth. What I found absolutely interesting about this presentation was the focus group results and how patients prefer the custom tailored information. I believe that this method of conveying information that showed the patient their own data, information about their problem and probability of outcomes if they continue to neglect their care was absolutely amazing and I think patients would take the prognosis that much more serious because it is directly affecting them and not making them feel as though it is just a statistic...it is something real and could potentially happen to them if care is not altered.
2. "If patients are a new set of eyes added to this (viewing test results), this would likely reduce the frequency of poor outcomes." This quote was received by the panel presentation held on Saturday morning by Larry Garber, MD, Robert Hanscom, JD, Luke Sato, MD and Micky Tripathi entitled "Opportunities and Risks in Clinical Data Sharing within the Modern Clinical Practice".
-What I related to with this quote was truth. In my own recent experience I received a medical diagnosis that left me stressed, frustrated and not very secure with the system that was in place at my doctors office. I did not trust that my doctor or her staff were going to cross every t and dot every i. I really felt as though I needed to become very proactive in my diagnosis, this meant constantly calling the dr.'s office to make sure that my request for my referrals had been placed for various test to be completed. Countless hours of research to make sure that I fully understood with what was happening to me and ruling out similar diagnosis that had not yet been addressed. Given my medical history, I was not embarrassed to tell my doctor about some of my findings and could these potentially harm me in the long run. After my exhaustive research and what seemed to be like endless test, I finally came to a complacent state and received peace of mind. Had I not been so involved, I truly believe that I could have just been brushed to the side with the real answer or understanding of what was happening to me.
3. "Doctor's have to get involved in help building a better tool. If not, you will forever be waiting for a better tool." This quote was obtained from key note speaker David Ross, ScD entitled "Transforming Public Health Information Capabilities in the eHealth Era."
-What I enjoyed about this quote was that you will often find a quick finger pointed at the person who has implemented a system or tool to assist with streamlining processes. Rarely will the person who has requested such a system to be implemented take blame because they do not understand how to utilize the program to their fullest capabilities or they did not do enough research to find out if that system was the best fit for their organization and what it was they were trying to achieve. If the right person/s do not become involved with the implementation process or gain full understanding of the program, they will never find satisfaction in the potential thus leaving a perfectly capable program unused with wasted cost associated.
4. "People are not made of sugar...go put on some waterproof clothes and get outside to take a walk". This quote came from the panel session entitled "Telehealth Options for Disease Management and Remote Monitoring" conducted by Timothy Bickmore, PhD, Denise Goldsmith, RN, MS, MPH and Joseph Kvedar, MD.
-This quote I just simply enjoyed due to the humor involved and the creativity around their studies in using an avatar to have the patient become more involved with their diet and exercise.
The conference speakers in the discussed several issues with regard to implementing and adopting Electronic Health Records (EHR) and thereby Personal Health Records (PHR). These included challenges, architecture, components, including Health Information Technology (HIT) Health Information Exchange (HIE) and health players. The health system’s players include health providers, consumers, laboratories, pharmacies, health plans, payers, and physicians. It is important to mention that the implementation of any PHR system faces many critical challenges which many form barriers to the adoption process. Among these challenges are 1) engaging patient in the process, 2) increasing awareness to encourage the public to use PHRs, 3) health network complexity, 4) standardization, 5) the PHR business model, 6) privacy, security, and confidentiality, and 7) issues of politics and social context. The following sections spot out some important quotes from the speakers and describe their impact on the eHealth and PHR implementation in particular as well as on changing the behaviors of the involved parties in the health system.
The quote “EMR’s are great, however, without interfaces to the other parts of the healthcare system, EMR’s will fall short of their goal to improve the quality and safety of healthcare while reducing costs.” - Larry Garber, MD.
There is no doubt that the healthcare network in the U.S. is complicated. This is due to three main factors: the broken competition between involved parties as described by Porter and Teisberg, the lack of standardization as providers maintain different norms in formatting and controlling patients’ data, and the independency in the existing health systems as parties use different platforms, technologies, and applications for maintaining their EHRs. The eventual goal of PHR is to enable fragmented EHRs to interact with each other to provide consumers with confidential and secure access; this is achievable only by developing interfaces by which these systems can interoperate. Interfacing these systems is one of the major issues in PHR implementation. For instance, GoogleHealth and HealthVault, offered by Google and Microsoft respectively, are examples of interfacing between several healthcare systems. In such a case, effective interfacing is must for simplifying data access, enabling integrity, improving quality, increasing efficiency, and ultimately reducing costs. Basically, interface has the impact of providing connectivity between players in the health system.
The quote “Involving the patient in the management of their care will also make them responsible to some extent for follow-up.” - Luke Sato and Robert Hanscom.
As I stated in the above introduction, patient engagement in PHR adoption is one of the critical challenges. This engagement is crucial not only for introducing PHR to patients but to encourage them to accept the system as part of their daily activities. The whole notion of PHR is to provide patients with a system that enables them to maintain their health records with minimal effort, better value, easier access, and lower cost. To achieve this, patients must: first, be willing to use the system; second, understand the importance of maintaining their health records; and third, feed the system with data as changes in their health occur. PHR targets patients, who are the system’s most important stakeholders. If patients will not use the system because they do not see it as beneficial, then PHR can not be successfully implemented.
The quote “We have a structure of public health that really does not match the way information infrastructure is supported . . . so, we have to leverage our communality and we have to define common work . . . we have to define, in fact, our work in a very common terms and that’s mean defining business process . . . in public health we are still garbling with the term ‘business’“ - David Ross.
Ross discussed what he called the ‘common ground’ that aims to provide interoperability and consistency to health systems. He believes that defining the business model for public health on the federal level is critical (i.e. to re-think what needed and describe what IT systems must do to redesign the business process). Frameworking the correlations between components and entities is another challenge in adopting PHR. Moreover, it is important to exploit IT and base it on the needs that emerge around the working process. Defining a business model means conducting a business process analysis to 1) identify business requirements, 2) understand the existing work cycle, 3) precisely define goals and objectives, and 4) model the context to the work. Public health business process analysis will help define the work in ways that information and information systems must support that work. This will enable redesign of processes, and provide interoperability between public health entities and consistency in the interoperable data. This is in addition to its impact on quality and performance improvements.
The quote “ . . . all of these is about patients; when we think about these circles, the patient dimension, the provider dimension, and the public health dimension . . . these three dimensions really missing the key ingredient . . . the key ingredient is the patient . . “ – by Blackford Middleton, MD; and the quote “it is very important to bring the patient on board on the pilot position to help share and control information . . . “ - by Paul Tang.
These two quotes assure the invaluable involvement of the patient in developing healthcare system. The impact of patients and/or public on the development of eHealth components can not be ignored. The patient is the key stakeholder who should be encouraged and satisfied with the outcomes of eHealth systems. However, the impact becomes much higher when implementing PHR system. Unlike other components (e.g. EHR, HIE, EMR, etc), PHR is in the patient’s control. He/she owns the data, authorizes access to physicians and others, and stewards the data. Considering the requirements for successful implementation of information systems, consumer satisfaction – in this case patient – is a key factor that must be taken into account and given high priority. In addition, the complexity of eHealth’s architecture in the U.S. makes the role of the patient even more critical due to the sophistication of the existing health network. Although it is not simple and may affect the progress of the implementation of PHRs, I see that patient engagement and encouragement in the efforts of developing PHRs is the right and proper beginning for adopting a patient-centric healthcare system."We are lagging on structured data exchange and it will be years before we have an optimal system."
-Micky Tripathi reagrding EHR's of WellLogic and eClinicalWorks
"People fear PHRs because they fear they can lose their jobs or even their insurance"
-Paul Tang explaining his Markle Online Survey slide
"On a legal and malpractice point of viewpertnering with patients is a good thing"
-Robert Hanscom explaining his (legal) take on medical malpractice
"Google Health offers APIs to anyone who wants to join in to help their customers"
-Dave Hotchkiss from Google voicing perhaps the only IT piece of information during the conference.
Quote 1: “How to engage healthy persons in using PHR is a major issue”
Presenter: Eric Pan
Session: Costs and benefits of implementing HER and PHR Solutions into Practice Settings
What are the incentives for healthy persons to use PHR? I always wonder about this issue since it is true that many users become concerned about PHR only when they get sick. They start to seek related knowledge and search for helpful tools including websites. At this time, PHR becomes a major concern for patients as they realize its benefits and importance. A healthy person, on the other hand, might find it time wasting to use PHR. It is very important to search for reasons and methods that can be employed in order to engage healthy people in using the PHR. I think that spreading awareness about the potential benefits of the PHR is a key factor in motivating healthy people to use the PHR.
Quote 2: “No evaluation for the system is a bad thing, you have to evaluate, if the system is not used, practically it is worthless regardless of the money spent on it”
Presenter: Ramesh Farzanfer
Session: Advances in Behavioral Telehealth
From an MIS perspective, I realize how important it is to continuously evaluate the system during the entire life cycle. Meeting the end-user’s needs is the objective of designing any system. Through planned and continuous evaluation, functionality of the system can be improved. The evaluation is conducted through several ways. The most important method is the involvement of the end- user in the development phase. In the case of PHR systems, patients are the major player in regard to success or failure of the system. Their feedback is very important. They should be interviewed and surveyed in order to come up with successful final product that meets their needs.
Quote 3: “You need to invest in training, I am used to the system but my colleagues are not”
Presenter: Elizabeth Mort
Session: Using an Electronic Health Record for Population Health Management
Money spent on well planned training is worthy. It is not an extra expense as it might be seen. In order to attain high functionality at work, employees should be trained on how to use the system. This will result in high productivity, less disruption to the work flow and efficient time management. As a result, the return on investment will be high. With the continuous advancement in technology and its great influence on healthcare provider’s job, planned and continuous training is essential.
Quote 4: “Privacy has to be negotiated”
Presenter: Stephen C. Porter
Session: Personal Health records: The Basics
This statement partially answers a question I have about privacy. I realize that consumers have different perspectives of privacy. In other words, what might be considered as private by a user might not be private for another user. So, tailoring the privacy to suite the consumer’s perspectives is needed. However, it adds more complexity to EHR and PHR. In addition, privacy perspectives can change with time. Culture plays a major role in regard to privacy concernsWith every action, there is a reaction: everybody knows this cliché phrase. The demand for PHRs is a reaction to the little action Health Care is taking in improving workflow. The lack of a good system for workflow has resulted in many errors that increase costs in Health Care. It also results in the increase in workflow, which also increases costs: For example, patients take the same tests multiple times since lab work is not exchanged between different physicians. Patients should not have to re-take lab tests or carry around their own medical records with them to every doctor they see. They should also be able to rely on their physician to take every action possible to decreases errors. A small error by a physician can cause a lifetime of damage to a patient’s life. More than anyone in the Health filed, the patients pay the biggest prices for errors. Patients simply want better care that is more coordinated so they can focus on recovering rather than being worried about errors. It seems as though PHRs are the best solution to the array of problems patients have to pay high prices for and currently the best way to increase coordination between physicians.
I found David Ross’ use of “context diagramming” to map out what health professions do and how they do it to analyze the flow of interaction to be very interesting. The map allowed him to visually see how to better “engage people.” I pulled three key quotes out of his keynote presentation because I found them all to link well with my first quote by John D. Halamka. Little consistency in Public Health is the reason why there is poor workflow. David Ross points out a good reason as to why there could be little consistency: “the belief that they were all different.” Although some health care systems are different, most are alike and ALL need to interact to increase quality of health care and decrease errors and redundancy. After attending the conference, it was fascinating to me to hear what doctors had to say about PHRs. To me, many of them sounded hesitant and reluctant to the concept. As a result, Ross’ quote to advise physicians to get involved in developing better tools was very much needed and I felt may have let down some guards about PHRs.
Being one who hates reading irrelevant material that I get little to no use out of really made this quote stick out to me. Searching through a pool of words when only a portion of it is beneficial to your needs is tedious and time consuming. I found Victor Strecher’s concept of tailoring information towards patients needs to be very innovative although it is such a simply and easy concept. Sometimes, simplicity is the best way to go in order to convey knowledge. As an English major in undergrad, I always enjoyed short stories and poetry for this very reason. Every word used is a important part of the story or message trying to be conveyed. No space is wasted in unnecessary words. By using the same concept to tailor information for patients specifically to their needs will ease their healing process.
Two minds are better than one: When I heard this quote by Robert Hanscom, I realized how much this concept applies to a patient/doctor relationship. By allowing patients to view their medical records, you are enhancing the relationship between the doctor and the patient with both parties having the same goal. The patient wants to feel better and the doctor wants to find the cause for the patient’s illness. It seems as though many physicians at the conference were concerned that allowing patients to view their own medical records would take control out of their hands. In reality, allowing a patient more access to their records facilitates the process of curing the patient and in the long run, makes the doctor’s job easier by forcing the patient to take more responsibility for their health.
#1)
David K. Ahern, PhD
National Program Director
Health e-Technologies Initiative
Day 2 Daily Synthesis
“We need to be e-health pragmatists, we have to be judicious, we need to monitor our work, in that way we may be able to avoid mega privacy blow ups”
This quote by David Ahern touches on several important issues relative to e-Health. Overall, it was great to hear that the issue of privacy is a major concern to such a great leader in the field of e-health. Acknowledging the significance of privacy is definitely a good first step towards examining and resolving such problems. What is needed next, is for the various healthcare organizational stakeholders to be extremely pro-active in resolving such problems before they happen.
#2)
Blackford Middleton, MD, MPH, MSc.
Chairman, Center for IT Leadership
Day 2 Daily Synthesis
“It all has to be connected for the full clinical benefit from the public health perspective… I am convinced that once a government official or a celebrity is saved through an EHR, we will be able to reach the public and their perspectives will start to change”
In the above quote, Dr. Middleton is addressing two critical matters relative to the value and benefits of the nation’s e-Health infrastructure. The added value of implementing such technologies for the national public health sector will start to be realized only if tight integration is present between the numerous healthcare information systems on a national level. Moreover, what I believe he was implying is that in order to achieve this vision/goal, strong high-level support from the government is needed. However, according to him this is hard to gain, and requires strong dedication on behalf of the nations e-health leaders in conveying this message to the respective government officials. Even though what he said about the government’s support sounds sad, it is definitely true. In line with that it would be great to find and suitable and dedicated celebrity to be an e-health ambassador on the national level to help promote the domain of e-Health.
In relation to this, Dr. Middleton in his keynote presentation (EHRs, PHRs, and HIE: Impact on Patient Safety, Healthcare Quality, and Costs) relative to the topic of value and ROI said:
“As soon as you get into the million dollar range, those people in Congress start listening and responding”
#3)
Steve Ross, MD
University of Colorado Health Sciences Center
Panel Presentation: Patient Preferences and Evidence-based Decision Support
“A computer engagement without personal intervention is not in line with patient preferences”
This quote by Steve Ross is very important to realize. Being an IS professional, I tend to feel that this is a matter that IS/IT people are not too knowledgeable about. If it were up them, they would like to automate everything, including the physicians themselves. What is needed is more of a balanced approached. Understanding patients and healthcare providers behaviors and what they like and don’t is a very important requirement that should be examined when implementing technologies that relate to them one-way or the other. Based on my professional experience, this is one key element that both senior management and the IT management within healthcare organizations tend to oversee most of the time. From the perspective of change management, this whole cycle or computer engagement should be implemented in more gradual phased approach to gain buy-in and adoption on behalf of the system users (Patients, and Healthcare Providers)
#4)
Daniel Z. Sands, MD, MPH
Senior Medical Informatics Director
Cisco Internet Business Solutions Group
Assistant Clinical Professor of Medicine,
Harvard Medical School
Panel Presentation: Avoiding Pitfalls to Implementation of eHealth Solutions: Do As I Say, Not As I’ve Done
“Let people do the structure when you know you need it, but don’t always enforce it on everything…this is a cumbersome task!”
A very important point made by Daniel Sands. The majority of implementing organizations tend to always listen to the vendors when it comes the subject of structuring. From my experience, the vendors tend to always push their technologies as is, trying their best to avoid any customization to be done for the specific facility they are implementing at. What is needed here is for the healthcare organizations to be very firm in negotiations with the vendors from day 1. They need to make it very clear to the vendors that they will not accept to be dictated by them. Consultation, advice, and recommendations are acceptable as long as they are in line with the overall benefit of the organization. However, the final say must come from within the organization based on their overall acceptance. Such acceptance cannot happen without details requirements analysis in the pre-RFP stage. Data elements that are to be structured or not, should be clearly analyzed and documented within the RFPs addressed to the vendors.
#5)
Jonathon Wald, MD, MPH
Product Manager, Patient Gateway
Partners Healthcare
Wokshop#3: Engaging Patients in Using PHRs Effectively
In relation to the Partners Patient Gateway PHR implementation and training, he said:
“We’ve done no marketing, awareness, and/or training campaigns at all”
Wow, I was very surprised to hear the above statement, especially from an organization that is as large as Partners. So they have basically invested millions of dollars in implementing such high-end sophisticated applications, but never considered and allocated portions of their funds for the activities of marketing, awareness, and most importantly training. These are all key elements affecting the success of any project, specifically when you are talking about changing the overall workflows and business processes. Change Management is a must, and must include a plan for such activities. In return, doing so will aide in increasing the adoption rate and decreasing the overall resistance rate relative to the technologies being implemented. Engaging your end-users from the early stages of such projects should be an essential ingredient of any e-Health project implementation.
In line with this, Elizabeth Mort, MD, MPH acknowledged the need for training in Workshop#2 (Using and Electronic Health Record for Population Health Management), by stating:
“You need to invest in training as well as analyzing your workflows throughout the implementation process.”
According to Dr. Middleton, “we just begin our journey “when it comes to transform our healthcare systems to become more quality, efficiency, less error and less cost. 2 trillions has been spent on our health care system and the cost of healthcare services will continue to grow with the rapid speed, becomes a heavy burden to our economy, and can cause us bankruptcy. He also addresses the following key points:
“Modern US healthcare practice may be characterized by frequent challenges in information and knowledge management resulting in failure to abide by best practice guidelines.”Indeed, a lot of information related to patient health record is in handwritten format without any recorded data. Most of the information is not shareable and no decision support connects to it and cannot integrate with any medical information systems. Medical error cause 98,000 deaths, 40% of outpatient prescription is unnecessary, and patient receives only 54.9% of recommended care. Our health care system is fracture because medical beneficiaries sees 1.3-13.8 unique providers per year and patient‘s multiple records do not interoperate. Moreover, “18% of medical error is due to inadequate availability of patient information.” The delay translation of new knowledge to clinical practice is another issue. It takes more than 17 years for new medical knowledge to be applied in clinical practice.
In order to make it better, we need to “integrate” all the important elements together based on the most current technology. We are living in the digital age with Ipod, Face book, search engine, AI, culture, human, vision. Some are material and some are not. The human factor is very important. No matter how good the system is, nobody will use it unless people want to use, attach, and “engage” to it. For this reason, our healthcare should be personalize and allow patient connecting to their PHR. According to Dr. Paul Tang from Palo Alto Medical foundation, he states in his presentation:
“Patients should have uttered access to their own medical information and to clinical knowledge”It is very important to get patient involve in the reform of the healthcare industry in the beginning because they are the one will use it, benefit form it and help it to become better. Here is a formula from Dr. Tang :
Wants – Fears + Loves = CSF for PHRsAlso, Another question that he mentions in his presentation:
“Which of the following technologies would you like to have access to when seeking care from a doctor or hospital?”Based on some Harris Interactive Poll surveys, 75% of patients want to make appointment online and 74% of patients want to email directly to the doctors. In addition, 64% of patient wants to access their electronic medical record (EMR). So the desire of using online service for healthcare services to monitor their health status, test results, doctor’s advice and more and more….. The healthcare systems should help patients “partner with physicians to better manage chronic diseases” like diabetes and TB. In summary, he said:
“Personalizing healthcare is key to transform healthcare delivery”Of course, we will have concern, issues and we need to come up with a good standard from the very high level of government, institution, healthcare provider, doctors, patient in creating “a lifetime Medical Record”. According to Dr. John D. Halamka, he states:
“My medical record should be Human Readable and Computable”The medical record of a person should be readable and is easier to understand if it was typed and post it in the text format. It‘s also link with doctor’s comments and can be transfer between different systems if the patient has to move from one state to another state and country to country. Patients will be able to access their record everywhere, anytime by Google, Microsoft. Revolution Health.
In brief, we just start the journey but I think we will be there from the beginning until the end.
Elizabeth Mort, MD, MPH
Workshop address: Using an Electronic Health Record for Population Health Management.
The reason I like this quote is because it is really true that training for effectively using a system is a must; so, we get the most of it. This is simply because it is useless to build a system (or LMR in this case) while health providers and physicians are not able to effectively use it. Such ability is only obtained by training. In case of untrained users, having the system or not will be equally the same. Meanwhile, thinking about a system’s workflow and how to get tasks processed more efficiently is a privilege. This is simply because this will lead to the best quality if the system in use. Moreover, analyzing the workflow leads to the right training programs. Therefore, workflow and training are necessary processes to achieve a valuable system.
“More active policy when moving from paper to electronic is to allow doctors and nurses to update the medical records when patients come in”David Z. Sands MD, MPH
Panel Presentation address: Avoiding Pitfalls to Implementation of eHealth Solutions: Do as I say, Not as I’ve Done
The value of any system lies in the value of its information. Therefore, I believe it is really important that physicians who are more involved with patients should participate in updating their patients’ data because they know their patients much better than anyone else who may be far from those patients and with limited medical background. Moreover, hiring people, to update patient’s data, who are not familiar with patients, may lead to data missing, misuse of data, and poor quality data. This will eventually weaken quality of the whole system.
"Cultural waves are similar to tsunami waves and legislative is reacting to a cultural push in health care."David J. Brailer, MD, PhD.
Keynote Address: 2nd Annual Warner Slack Keynote Lecture-Digital Medicine in the Era of Health Reform.
I thought this quote reflects a fact which can’t be denied. This fact is the cultural difference and how it may impact the success of any system, especially when we are talking about a system of a global use. However, even locally, there are still some differences between regions within the same country which may lead to several impacts due to cultural differences. Talking about US and its health care system, legislations are different from one state to another and this makes it more complicated adapting to too many various legislations in order to get an integrated health care system. Also, culture plays a role in shaping the community’s interests which might be reflected in its interests in PHR adoption.
“email messaging is more quicker and efficient more than phone calls, but I discourage people to send long emails”Charles H. Weiss, MD
Panel Presentation address: Patients’ Perspectives on eHealth
I think it is very important for patients to understand that email is just a tool that can be used to arrange for doctors visits, and to request helps in emergency cases. Physicians have concerns about long emails, and they have right. This is because patients may think that they can send whatever information they want, but at the end it maybe irrelevant. So, this will take more time for physicians to read all emails from many patients. Moreover, email is an unsecured tool to communicate with physicians about confidential data. Therefore, patients should keep it short and into the main point to help physicians to give high quality services.
1) Paul Tang, MD: “Must put patients in the pilot seat…especially important for the influx of baby boomers as they age.” Being an aging baby boomer and a health professional – it is important for me to know as much as possible to make aging less problematic for me and my family. I have enough of a background in basic medicine to be able to understand and to make knowledgeable decisions if given the opportunity to have my physician discuss and share access to my medical information (which he already does). However, gaining access to my lab results directly from the lab has been worse than “pulling teeth”. Dr. Tang describe the PHR as allowing patients access to their health related information, to manage that information, to glean materials relevant to their situation, and to give patients the ability to share their medical information in a safe, confidential manner. He stressed how creating a medical home would foster a continuous healing relationship which personalizes health care. This personalization was the key to transforming healthcare delivery. However, the widespread use of the PHR is entirely dependant on Doctor-patient relations. I will figure out the PHR next and talk to my doctor about going completely electronic.
2) Victor Strecher PHD, MPH: “Must tailor to each patient so it is not everything for everybody… as one size doesn’t fit all!” He felt that tailoring was the most effective means for achieving positive behavioral changes to impact a person’s health. This has always been my approach and goal with each of my patients. Even though the same technique may be used – that technique is used for different reasons which are dependant on each individual’s needs related to their “chief complaint” and/or what they want to see different about their smile. Our motto is that we customize our patient’s treatment to give them the best possible result. However, I have not seen many physicians take this approach until recently when my daughter had surgery to remove cysts on her ovaries. The type of cysts were unknown, however, the surgeon gave several differentials. The usual approach for this type of surgery is to utilize an abdominal incision. However, since the surgeon is my daughter’s good friend and knows how active my daughter is physically – she described using a minimally invasive technique to allow my daughter to be back to gyrotonic instruction within a week. This surgeon did an excellent job at tailoring the surgery to fit my daughter’s profession and lifestyle.
3) David Hotkiss and Donald Wald: ‘People with serious illnesses go to the MD first…those with minor illnesses go online first”. This statement literally hit “home” as last month my husband came home one night complaining of a stomach ache. He had previously talked about how several of his employees had either gone home early or called in sick with the stomach flu earlier in the week – he thought that he was coming down with the same flu. He did a web search for symptoms, virulence and for what he could expect if he had the flu. Of course, I had to give him my opinion of several differential diagnoses for his stomach pain – which he took with a grain of salt. However, when he woke up in the morning he complained that the pain was much worse. Again, I suggested that it might be appendicitis as the pain was now centered around his navel and asked if I could do the classic appendix test. He wasn’t having pain on his right side and had read that appendicitis was uncommon in men his age – so he declined my offer and my suggestions (I’m only a dentist!). By noon – he was moaning so loud due to the pain that I insisted that I take him to the hospital. He wanted to talk to his doctor first. I called her, told her the symptoms and she told him to get to the hospital STAT. Guess what – he had a ruptured appendix! The surgeon asked me how I could let him wait so long, especially with my background! When my husband thought it was the stomach flu he looked up info online. When he thought it might be more than the flu he wanted to talk with his doctor.
BTW: We just opened the bill up tonight - $53,197.00!!! for less than 24 hours in
the hospital!
4) Eric Pan, MD, MSC and David Kaelber, MD, PhD: “The system (to bring the latest guidelines to influence care and quality) can anticipate actions, but is predicated on the clinical decision support system (CDSS), i.e. if have an EMR without CPOE (eRx) won’t have the necessary info needed”. This was another statement that reminded me of my daughter’s surgery in January. While she was in the first recovery area she was given and effective analgesic. When she was brought to the second recovery area (where we could join her) she complained of pain and was given a different and uneffective analgesic. (BTW: My daughter is a doctor and her surgeon is one of her patients and good friend. Before the surgeon left for another surgery she said she completed the EMR and informed the nurse to take great care of her friend.) However, the nursing staff changed and the new nurse was only aware of the analgesic ordered for the second recovery room and refused to give another medication. The EMR could not be accessed in the recovery room – go figure! There was a paper record that they would fill in the blanks with when they could get a copy of the EMR from surgical services. I did suggest to the nurse that she call the surgeon assuring her that the surgeon would agree to give my daughter the first medication – the nurse had to hold the phone an arm length from her ear when she reached the doctor for the scolding she received about not having the orders sooner. (I won’t tell you what that bill cost!) This was a classic example of how the system must improve to benefit the nursing staff as well as the patients.
This was a terrific course – very well organized, with superb presenters who are leaders in their field. The students were a joy to be around. Thanks to Mrs. Feldman for organizing the exhaustive details of the trip and accommodations and for being a shepherd for the students, as well as to Dr. Horan for his vision and for his support of enlightening his students with this powerful course offering.
" Technology in Human genome will be available and affordable to everyone in the near further.” John D. Halamka. I am excited to see Human genome of an organism is its whole hereditary information and is encoded in the DNA.
“ We should put patient in the picture” Paul Tang. He explains this to emphasis looking into patient needs in PHR.
" Cultural waves are similar to tsunami waves and legislative is reacting to a cultural push in health care." David J. Brailer. It is an uphill task to deliver EHR and PHR in a health care system.
“ Electronic record technologies could help to transform practice of healthcare using information and knowledge management” Blackford Middleton. We are seeing that as a evolution of the health care industry.
John D. Halamka: National Policy Standards, Review and Update
" The science associating genomes and disease therapy is evolving repaidly. Personlized medicine is here."
This quote summarized many of the points that Dr. Halamka made. In particular, his talk provided some great insight on what current sequencing technology can potentially bring to the healthcare industry. His discussed that the incorporation of this information can lead to more personalized (and preventative) care. He also emphasized the importance of standards in the heatlh care industry, both in terms of medical records and in the representation of genomic data.
Patricia Flatley Brennan: Personal Health Record Systems of the Future: A Bold Vision
"Provide a window on the day-to-day happenings in a person's life"
Dr. Brennan presented a very interesting outlook on PHRs primarily from a research perspective. She discussed a lot of the aspects that make a PHR successful. In particular, the importance of engaging the patient in the process including getting an accurate assessment of the patient's lifestyle and preferences. This information according to her, in addition to excellent data and robust data exchange can really enhance the value of a PHR.
Blackford Middleton: EHRs and PHRs: Impact on Patient Safety, Healthcare Quality, and Costs
"Lots of information in handwritten notes...but no data gathered"
Dr. Middleton's quote seems to be an excellent summary of exactly why electronic health records are so important. The generation of information in the written form has not necessarily led to actual data collection or improved care for the patient. In his talk, he takes time to define exactly what EMRs, EHRs, and PHRs are. In addition, he explains their unique role and importance in closing the gap in knowledge between, not only between the clinician and the patient.
Paul Tang: Personlizing Health Care: Getting Patients Together Online
"Patients do seek information about diagnosis and treatment plan (including alternatives)."
Dr. Tang opened the conference with some interesting insight on patient's perspectives. The above quote which may seem obvious tries to point out that patients want additional information and will seek outside opntions. In particular, he discussed the enhanced connection to the information and decision-making process experienced by the patient when they have access to this information readily (in electronic form).
1) Paul Tang: Connected Health and the Medical Home of the Future
In talking about why patients seek medical information online, Dr. Tang stated, "62% of patients trust their doctor - 49% go online simply because the information is there."
The broader context of the discussion at this point in the presentation was that some physicians are adverse to patients educating themselves on line. Dr. Tang's point was that this information can be a resource to enable people to become more active in understanding their health. Further, patient use of online resources is not a sign of mistrust. It is merely to way to supplement what they learn in the few minutes they have with their doctor.
2) Paul Tang: Connected Health and the Medical Home of the Future
While talking about the impact PHRs could have on disease management, Dr. Tang stated, "Doctors do not get paid for disease management, however, this would be more effective in controlling costs associated with patient care."
This was a critical point made by Dr. Tang. If health care delivery is going to improve, physicians need to be compensated for the work they do. As Dr. Porter points out in his book "Redefining Health Care" it is more expensive to treat patients in urgent situations (like the ER). If physicians were compensated for keeping chronic diseases under control, overall costs would decrease.
3) Denise Goldsmith: Telehealth Options of Disease Management and Remote Monitoring
When Ms. Goldsmith was describing how "remote monitoring" impacting tracking the effectiveness of home care, she stated, "Parents are willing to use Internet-based systems to track medication administration, side-effects and general observations about their child. Furthermore, such systems showed that continuity of care in divorced families was enhanced when an online collaboration tool was available."
For children whose parents are divorced, it is clearly beneficial to have a system where medication administration can be externally tracked without the parents having to directly communicate on the issue. I think the use of PHRs for children could be key factor in the generational adoption of PHRs.
4) Joseph Kveder: Telehealth Options of Disease Management and Remote Monitoring
While Dr. Kveder was describing how EMC employees were using the Internet for blood pressure self-management, he stated, "Patients seem to respond well to clinician oversight."
This underscores the point that the patient to physician relationship is a key factor in the willingness to use a PHR.