Now Viewing: Patient-centered care

Moving Forward with OpenNotes

Aug 14, 2013, 8:00 AM, Posted by Steve Downs

Open Notes_20120530_00476

As Beth Israel Deaconess Medical Center (BIDMC) begins its institutional rollout of OpenNotes, it's becoming clear that we've moved into a new phase of the diffusion of this innovation. I've been in discussions with OpenNotes co-directors Tom Delbanco, MD and Jan Walker, RN, MBA about the idea of opening up physician notes to patients since 2008, when it was a bold, controversial idea that needed to be tested. The landmark study that Tom, Jan and their colleagues conducted over 2011-2012 and published last fall made it quite clear that the idea had merit: overwhelming percentages of patients found it helped them better understand their conditions, feel in more control of their health and even take their medicines more regularly. 99 percent of patients in the study wanted to continue with the practice. As for physicians, their fears went largely unrealized. It simply wasn't a big deal.

Recently we've seen more leading institutions climb on board with the practice of sharing medical notes: the VA is adopting OpenNotes, as is Group Health Cooperative; Geisinger, one of the original study sites, is expanding the practice throughout much of its system; the Cleveland Clinic announced its intention to share visit notes; and you can now read your doctor's notes at the Mayo Clinic. More will undoubtedly follow in the months and years ahead. As we move into the implementation phase at these and other institutions, the questions will shift from whether the idea is good to more practical inquiries around how well it fits certain specialties (like psychiatry) or departments; whether there are patterns in the types of patients (or physicians) that flourish under this approach; and how to manage the cultural changes that OpenNotes implies.

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What’s Next Health: Flipping the Visit

Jul 18, 2013, 3:00 PM, Posted by Pioneer Blog Team

Rishi Desai Rishi Desai, medical fellow at the Khan Academy

Each month, What’s Next Health talks with leading thinkers about the future of health and health care. Recently, we talked with Sal Khan, founder of the Khan Academy, who shared his vision for “reimagining education” and what that means for health and health care. Khan Academy medical fellow and Pioneer grantee, Rishi Desai, MD, MPH, shares thoughts on how Khan Academy's approach to learning can help transform the patient experience.

By Rishi Desai

In my pediatric clinic, I generally get 20 minutes with each patient, which is long by many standards. I spend most of that time asking questions and sharing a treatment plan, leaving only two or three minutes to really talk with people about my assessment and address their thoughts and concerns. As a result, patients (in my case, a child and their accompanying adult) too often go away unconvinced or confused about what to do next.

But what if we flipped the visit? What if I could spend time quietly listening to a patient who comes to me already informed and prepared to talk about her child's health and any issues she might be facing? What if the doctor/patient visit allowed us to build better trust—to work as partners instead of me “giving a lecture”?

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Listen Up: Why Innovators Need to Listen to Consumers

May 23, 2013, 8:00 AM, Posted by Beth Toner

Beth Toner Beth Toner, communications officer

I recently spent the day at the MIT AgeLab, and it was an important reminder of why successful innovators in any field need to listen to the consumer.

I was there to participate in a roundtable discussion on engaging the “older” consumer online (much to my chagrin, I realized that I am in fact part of this demographic). Folks from a variety of for-profit organizations were at the table, along with MIT AgeLab staff conducting and supporting research in this area. I was the only person there from a philanthropic organization.

The presenter line-up was eclectic. To my delight, Sally Okun from Pioneer grantee PatientsLikeMe was there to share her perspective on how PatientsLikeMe helps patients make complex decisions about their health. Courtney Ratkowiak from Proctor & Gamble highlighted that company’s innovative efforts to reach women ages 55 and older who buy beauty products. (I was surprised to learn that most women 55+ don’t own a smart phone.) Mark Duffey, CEO of Everest Funeral Planning, showed how his company makes difficult decision-making easier by going out of his way to make prices clear. (Apparently, the three things women dread purchasing the most are financial services, cars and health care.)

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Bringing OpenNotes to Geisinger

May 20, 2013, 12:59 PM, Posted by Steve Downs

Doctor listening to man's breathing

In a post this week on the Kevin MD blog, Jon Darer, chief innovation officer for the Division of Clinical Innovation at Geisinger Health System, discussed Geisinger's decision to roll out OpenNotes to most of its physicians and patients.

Geisinger's approach highlights the choices that will be facing many health systems: The results of the OpenNotes study, published last fall, provide compelling evidence to go forward in general, but there is a need to be careful and thoughtful about how to do so. Different specialties and different patient populations have special circumstances that need careful consideration. And each institution has its own culture to be navigated. As more early adopters like Geisinger move forward, we'll learn more about how best to implement this practice and through that learning, make it more widely available. — Steve Downs

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500+ Geisinger Doctors Adopt OpenNotes

May 8, 2013, 8:00 AM, Posted by Steve Downs

OpenNotes: Health care leaders speak out

“Today, Geisinger Health System, one of the nation’s premier health systems, is taking an important step to expand OpenNotes. We hope other systems follow Geisinger’s lead to share doctors’ notes with patients, giving them information they can use to participate more meaningfully in their care." – Steve Downs

This excerpted post by Geisinger CEO Glenn Steele, MD, first appeared in October 2012, when results from the OpenNotes pilot were released. Geisinger was one of three health systems that participated in the study.

…As a health system CEO who also is a doctor, I believe it is an ethical imperative that our patients at Geisinger know everything that we know about them. And, I think it’s a logical imperative that if we can open up our medical visit notes to our patients, we’ll find out what they understand and what they don’t, so we can answer questions and work as partners to chart a path to better health.

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