This year, for the second time in my life, I had the opportunity to choose between several health insurance providers.  I opted for a provider that has a good reputation for embracing the latest information technology and also being patient-centered.  I chose my doctor online, scheduled an appointment online, and received communication - prior to my initial appointment - online.

Several days before my appointment, as instructed, I went to my assigned one-stop shopping center (a.k.a. medical center) to have my blood drawn.  Later that day, I received my cholesterol levels online (cool!).  The day before the appointment, I received the results of the remaining blood tests.  I don’t know much about white cells and red cells and what is supposed to be high or low, but my results were reported alongside desirable ranges.  At my appointment, my doctor walked me through the blood test results, reviewed my medical history, and asked about my medical concerns. 

The grand finale of my visit was receiving my first “after-visit summary.”  In addition to my vital signs (I could have lived without the inclusion of my alleged weight!), the summary included follow-up instructions for various issues we discussed.  For example, since I am a new patient, the summary tells me where to go in the one-stop shopping center to request the transfer of my previous medical records.

I feel like a kid again, like a child who has just learned a new and exciting skill.  I feel a sense of ownership over this experience because I was able to do things like choose a health plan and view my test results online…all without the “supervision” of an adult!  Obviously, I was happy to have an in-person interaction with a real doctor to explain my test results and address my medical concerns.  I feel like a big kid, though, because I feel I am being treated like a capable and welcome participant in my own health care.  Maybe it’s not really me “growing up,” but the health care system.  Either way, it’s a good thing.

(Continuing to follow up with commentaries on insights from the 7th Annual Ix Conference…and the slides are not only available now, but they also are right-side-up!)

The day before the Ix conference, the California HealthCare Foundation released the report (“Helping Patients Plug In: Lessons in the Adoption of Online Consumer Tools”) that Ted Eytan and I authored summarizing the Patient-Centered HIT Initiative (funded by CHCF, the United Hospital Fund, Kaiser Permanente, and the Group Health Community Foundation). At the conference, Rachel Block–formerly with UHF and now the Executive Director of the New York eHealth Collaborative–provided an excellent overview of the project with a particular emphasis on our experiences with safety-net populations.

Susannah Fox–Associate Director of the Pew Internet Project and also a member of the PCHIT Advisory Group–responded with a presentation highlighting the digital thermometers she has created with Pew data. They provide a great snapshot of consumer use of Internet/email, cell phones and broadband, broken down by a wide range of demographic characteristics. Susannah has explained that access to electronic technologies is not a matter of a “digital divide” because access is not an “on-off switch” but more of a “dimmer switch.”

A few of her comments beyond the thermometers are worthy of considerable thought as we figure out how to maximize the potential of Ix and patient-centered HIT.

• Susannah notes that 80% of Internet health information seekers turned to a professional in a time of crisis–far greater than any other industry that Pew studies.
• It’s clear that low access does not equate with low interest–a finding that matches exactly what the PCHIT Initiative found.
• To better understand the Internet’s potential for health care, it’s critically important that we talk to those people who are not online as well.
• The world is changing rapidly, so it’s important to (as Susannah paraphrased Diana Forsythe) “design for what could be.”

What do all these findings from Pew and the PCHIT Initiative report mean for next-generation patient-centered care?

(Continuing to post on some of the session from our 7th Annual Ix Conference from June 12-13. Note that the PowerPoint presentations are now available. We had a minor glitch in our transfer to PDFs, so you need to rotate them sideways. We’ll get that fixed tomorrow.)

One of the most innovative Ix leaders in the safety-net provider community is Neil Calman, MD, the CEO of the Institute for Family Health (IFH), a network of federally qualified community health centers in New York. He presented in our Ix & Health Disparities Track in a session on “Engaging Safety-Net Providers in HIT” with Kyu Rhee, MD, MPP, Director of Innovation & Program Coordination, NIH Center for Minority Health & Health Disparities. IFH was one of the sites we visited during our Patient-Centered HIT Initiative.

Neil has a direct way of putting things and his presentation probably set a PowerPoint font size record. He started off by telling the audience that, “For the past 6 years we have done everything we could to help bring information to our patients to help them improve their health.”

He then frames this in terms of what it means for the clinicians at IFH: “We have worked really hard to be a model for how electronic health records could be used to help us become…Information Therapists!!”

Neil explained what they learned from their patients when they studied what the health care experience was like for people with chronic conditions in the southwest Bronx. What they found out was that–for many of them–going to the doctor’s office was often “traumatic.” They found two really important things. First, there was great distrust of, and disrespect by, health care providers serving racial an d ethnic minorities. Second, there was bad communication resulting in major misunderstandings.

So when IFH decided to invest $2 million in its EHR deployment, they did it with these two lessons from their patients in mind. Neil said, “We deployed our EHR in a way that would build trust wit our patients. And give them the tools to help them find their way through the health care system.”

That’s why they designed their exam rooms so there were flat-panel monitors that clinicians and patients could look at together and put printers in there so clinicians could print out Ix for their patients and hand it right to them.

It’s amazing what clinicians can do for their patients in EHR implementation if they start by asking them what they need and then bake that into their implementation plans. It’s too bad that’s not a requirement for every EHR deployment in the country.

Over the next several days, I’ll share insights generated from our 7th Annual Information Therapy (Ix) Conference, “WIxRED: Next-Generation Patient-Centered Care.” You can also check back on our site later in the week to see all the PowerPoint presentations. In the interim, you might want to check out what others are saying about it.

Susannah Fox from the Pew Internet & American Life Project put together a nice summary of her favorite moments at e-patients.net. Matthew Holt and Jen McCabe Gorman had a number of reports on June 12 and 13 at The Health Care Blog.

At the conference on June 12, Rachel Block, Executive Director of the New York eHealth Collaborative, provided an overview of findings from the Patient-Centered HIT Initiative. The day before, the California HealthCare Foundation, released their report on PCHIT that I authored with Ted Eytan titled, “Helping Patients Plug In: Lessons in the Adoption of Online Consumer Tools.”

I will be doing a considerable amount of my blogging about information therapy (Ix) at the now-live Patient Centered Health Information Technology (PCHIT) blog. The Center for Information Therapy’s (IxCenter’s) new PCHIT Initiative will have an active learning community of clinicians hosted by me and Ted Eytan, MD, the IxCenter’s Senior Visiting Fellow, who is currently on sabbatical from Group Health Cooperative in Seattle, where he serves as Medical Director for Health Informatics & Web Services.

–Josh

A colleague out in Seattle posted a great story, Information Therapy on the Go, about his experience in despensing information therapy (Ix) in taxis. The end of his post raised some questions: What is an information therapist? Who can be an information therapist? How can we train people to be information therapists in order to meet the great need that’s out there for them?

I, too, get asked to prescribe Ix to family, friends and randome people with considerable frequency (and I’m more than happy to help if I can). Even though I’m not a physician like Ted, as my at-the-time, 3-year-old Ben said, I am a “question doctor,” perhaps a colloquial version of information therapist.

The colleague I mention above is Ted Eytan, MD (Medical Director, Health Informatics & Web Services, Group Health Cooperative), who is on his way to Washington next week for a sabbatical. He’ll be spending quite a bit of his time serving as a Visiting Senior Fellow here at the Center for Information Therapy (IxCenter), and we’re thrilled to have him working with us more closely. Since he’s been one of the greatest Ix champions in the country, we’ve been working with him ad hoc since the birth of the IxCenter six years ago, but having a greater mindshare is going to be a fantastic opportunity for the IxCenter.

Stay tuned for much more on this in the near future…

–Josh