Patient-Centered Computing and eHealth

In early May, I had the opportunity to attend the Harvard Medical School CME course, Patient Centered Computing and eHealth: Transforming Healthcare Quality. The 2 1/2 day course is directed by  Blackford Middleton,MD, MPH, MSc Corporate Director Clinical Informatics Research and Development Partners HealthCare and co-directed by Patricia C.Dykes, DNSc, MA, RN Senior Nurse Scientist Nursing Research Program Director Center for Nursing Excellence Brigham and Women’s Hospital.  The outstanding faculty of experts included Brent James, Paul Tang, Patti Brennan, John Halamka, Fabienne Bourgeois, Josh Seidman, Victor Strecher, Judy Murphy, and many others.  The full list of the faculty and their affiliations is included on the site linked to above.   I served as the “official tweeter” for the course and want to share with my readers some of the highlights of this practical course designed for the physicians who are responsible for adopting EHRs and applying health IT in “meaningful” ways to improve healthcare quality.

The full transcript can be found at: http://hashtags.foxepractice.com/healthcare-hashtag-transcript.php?hashtag=PCeHealth11.  For smaller doses, you can read the daily summaries here:

Day 1 Summary

Day 2 Summary

Day 3 Summary

The course included workshops, panel discussions and plenary presentations. To give a taste of the topics covered and insights shared, I’m posting a few outtakes from the Twitter stream for #PCeHealth11 below:

dahern1

Brent James opening keynote sobering view of healthcare crisis but making case of HIT as one key factor for positive change Clinicians are poor at “rate estimation” and need technology tools to support decision making - James

bfm

Brent James — more important to standardize care than anything else to control costs and improve quality. Great opening talk!

Sobko: 25% of Medicare recipients had a complication during care transition within 30 days post-discharge

janicemccallum

Sobko on care transition: setting goals helps engage patients with care plans; also teach them when there is a red-flag.

bfm

Vic #Strecher #UMich to achieve behavior change don’t always need Health Coach, often eHeatlh tools sufficient, or combo

janicemccallum

Common theme for engaging #patients : establish a mission or goal to drive behavior change. Tools alone aren’t sufficient.

#MU incentives have to be aligned so that efficiency gains aren’t viewed as income reduction by some: @jhalamka.

#NHIN isn’t a “thing”; it’s a set of data usage agreements and standards: @jhalamka #HIE

Micky Tripathi: think of #HIE as a verb, the act of exchanging information.

Common theme here: secure provider-patient communication saves time b/c it replaces phone calls that typically take more time.

Recap from @bfm for day 1: healthcare system is in crisis (Brent James) & has severely negative effect on US financial health.

Need to train physicians to be effective knowledge managers; simply too much to know everything. @bfm #KM #CDS #pcehealth11

bgaustin

Paul Tang keynote: cannot change issues like obesity one person at a time. Change must be community-driven.

janicemccallum

Jon Wald—biggest driver of usage of patient journals in study: marketing of the patient portal by the practice. #PHR

bgaustin

“Any doctor who can be replaced by a computer deserves to be replaced.” -Dr Warner Slack

janicemccallum

Who sponsors #PHRs? 50% health insurers; 25% providers. J. Wald, RTI.org

Not much focus on #patient-reported data yet in #EHRs; Wald calls it “patient-entered data” or P-E-D. #PHR

BI-like dashboards w/ trend data in #EHRs help provide early warning signs to physicians. #analytics

Too many facts to remember & the right information is often not available at point of need. #CDS #EBM #POC @bfm

Referral is weak link in continuum of care: Zuccotti’s team developed clinical referral management system. Patient role was key.

Jonathan Teich def of #CDS: makes the right thing to do the easy thing to do. #EBM

Teich refers to #AHRQ’s eRecommendations project: http://bit.ly/jMMS3G #CDS

Cool: @jjseidman describing new program #pophealth: http://projectpophealth.org/ Open-sourced qual measures prog. #CDS #MU

AF4Q works with #ONC #REC (regional ext. centers) to help them w/ #quality measures; also trying to harmonize the many meaures.

janicemccallum

Alt. future: If providers don’t respond to challenges they will be disrupted & insurers & payers will become coaches @bfm

#ARRA #HITECH: the $27B tail wagging the $2.5T dog (Paul Tang). #HCR

#EHR and #CDS adoption isn’t so much a function of fear of techology; rather physicians need to be convinced of added value. @bfm

#ACOs will shine light on importance of handoffs btwn providers & reduce missed communication. Luke Sato

bgaustin

Powerful keynote by Brent James: “Today’s problems are nearly always yesterday’s solutions.” #EBM