As the initiative’s lead, Harvard surgeon and noted mainstream author Atul Gawande said, the idea is to borrow from the processes adopted by the much safer airline industry. Checklists went a long way in reducing flight errors so long ago that they are now fully ingrained in the process.

The Surgical Safety Checklist is brilliant in its simplicity and in the way it directly addresses many problems that arise with surgery, but I also think there’s a big missed opportunity on WHO’s “first edition” of the checklist. The third column–the “Sign Out” process–doesn’t specify any patient engagement. The closest it comes is, “Surgeon, anaesthesia professional and nurse review the key concerns for recovery and management of this patient.”

My understanding from people involved in the process was that the first stage of the campaign specifically decided to focus on the “intra-operative” aspects of safe surgery to the exclusion of patient participation and education. No doubt there are plenty of errors that can be solved by getting the surgical team all on the same page, but failure to engage patients is a major lost opportunity.

As WHO prepares for its “second edition,” I hope that at the very least, they add an additional box to check on the “Sign Out” column of the checklist that would read, “Patient’family provided an information prescription regarding instructions for post-operative management and what signs should trigger contact with providers or other actions.”

With Consumers Advancing Patient Safety President Susan Sheridan advising WHO, I know that they are getting excellent and passionate guidance about consumers’ information needs. I just hope that they listen to it as they go forward to maximize the potential impact of the Safe Surgery Saves Lives campaign.

ShareThis

This is where I jump in and tell him that when I was his age, I had to wait for 2 to 3 hours in the waiting room to see my doctor (you know, the “When I was a kid, I had to walk uphill in the snow to school…both ways!” story).  I only went to the doctor when I was sick.  The doctor would promptly produce a small white piece of paper (an Rx), and that was the end of my visit.  I hated going to the doctor and had never heard of prevention and would never expect the doctor to explain what he/she thought was wrong with me.  I would have never thought he/she would discuss my treatment options with me or ask me, “Would I like to try medication for it?” or “Would I like to try some preventive approaches to avoid this happening again in the future?”.

Fast forward 25 years and I have a kid who does not appreciate how far the health care system has come.  I really can’t blame him, though.  Information Therapy is kind of like, “Duh!”  It’s a no-brainer.  It’s an “invention” that is so overdue that when it finally appears you ask yourself, “How have I lived without this for all these years?”.

“Mom, I wrote the blog.  Can I go play on the Internet now?”

ShareThis

Answer: An information therapy (Ix) crusader… That breeding produced a baby version of Joshua Seidman, who grows up to be considerably less cute but slightly more articulate.

Although my parents are mostly retired, my dad still teaches M programming to IT professionals at the VA (and other places).

More to the point of Ix, however… Not surprisingly, when you go to my mom’s personal Web page, you will find that her interests include:

• Improving communication between information providers and information users
• Integrating traditional with electronic library services
• Fostering core information competencies for students, faculty, researchers
• Developing cooperative activities among different types of libraries
• Family and work issues
• International exchange of information

My mother spent several decades running special libraries–at the Environmental Protection Agency, Hanscom Air Force Base Geophysics Lab, and ultimately the MIT Sciences & Engineering Libraries. The mission of the organizations she ran was basically to figure out how to most effectively deliver the right information to the right person at the right time.

Much like I wrote in my blog post yesterday, the librarian doesn’t necessarily need to prescribe the information to the consumer (whether that be a patient, a research scientist or a library user–which, BTW, are all examples of consumers of Ix that various special librarians encounter). In fact, my mother was a pioneer in both using electronic search techniques decades ago and in trying to figure out how to make such tools more accessible to the library consumer.

The key for the librarian, the clinician, or any other “information therapist” is to provide multiple vehicles to allow the consumer to access the information in the way that works best for him or her at the particular moment in care. Because sometimes I want a precise information prescription and other times I want to go to the stacks myself to rummage around…and other times I want to make a trip to the virtual library with a peer that I trust.

ShareThis

Hoch notes that the information overload across industries has given rise to the Information Overload Research Group, which is dedicated to “reducing information pollution.” I agree with Hoch that the Internet’s information democratization has been an important driving force behind what he terms the “e-patients movement.” No doubt that is a critically important contribution.

I would never suggest that consumers should be prevented from unfiltered information. But availability of all information on a topic does not equate with real access to meaningful, usable information for everybody. For some people, OD’ing on information may not be possible but many people would like to get guidance from other sources–that could be their personal physician, another health care professional, a community health worker, or another person who shares the condition.

As stated on this blog earlier in the week, Susannah Fox noted that Pew Internet Project data demonstrate that 80% of Internet health information seekers turned to a professional in a time of crisis, and that this figure is much higher than any other information that Pew studies.

Those of us who advocate for information therapy (Ix) never suggest that information should be available “by prescription only.” Information prescriptions are simply another tool, designed to help people navigate the vast information that exists in cyberspace and elsewhere.

ShareThis

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.

ShareThis

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?

ShareThis

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.

ShareThis

He noted that he came of age as a physician during what he termed “Health 0.0.” Although much of health care is now being practiced in a “Health 1.0″ mindset as information flows more freely, there is still a long way to go until we’ve reached the Health 2.0 goals of on-demand, 24/7 access to information that can be democratically created.

Paul pointed out that we need to figure out how to hold onto the close in-person relationships from 0.0, and build the information flow from 1.0 as we create the social networks and real-time information access of 2.0. The goal they all have in common is building trust–one of the most important elements in an ideal health care delivery system.

Ideally, the new tools of Health 2.0 will actually help us do a better job of meeting the demands of 0.0 by creating more efficient ways to allow for personalized health care. How can new technologies enhance our ability to take care of people one patient at a time?

ShareThis

ShareThis

ShareThis