Now Viewing: Patient-Centered Care

Dr. Bruce McCarthy of Columbia St. Mary’s on Adopting OpenNotes

Nov 4, 2013, 8:00 AM, Posted by Pioneer Blog Team

bruce mccarthy Dr. Bruce McCarthy, Columbia St. Mary’s Health System President, Physician Division

On Nov. 1, Columbia St. Mary’s Health System in Milwaukee became the first hospital in Wisconsin to implement OpenNotes. Beginning this month, some 1,100 multi-specialty doctors, nurse practitioners, and others who write visit notes will be sharing them with more than 300,000 patients via a secure online portal. Columbia St. Mary’s is part of Ascension Health, the largest nonprofit Catholic health system in the country. This month, it also becomes the first hospital system to share hospital discharge summaries with patients. Bruce McCarthy, MD, President, Physician Division, an internist who oversees the system’s medical group, spearheaded the rollout of OpenNotes here. An innovator who "puts patients first," Dr. McCarthy talked to Pioneer about why it’s time to make the idea of sharing medical notes a routine practice.

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Introducing the Pitch Day Finalists: MD 360

Oct 4, 2013, 9:00 AM, Posted by Pioneer Blog Team

Tara Bishop Tara Bishop, MD, MPH

Tara Bishop, MD, MPH, wants to offer 360-degree reviews of doctors and other healthcare providers that incorporate objective measures of quality as well as peer and patient ratings. She was one of eight finalists we invited to pitch us their ideas live and in person at the first-ever Pioneer Pitch Day. Read Dr. Bishop's 1,000-character proposal below, and join the discussion on Twitter at #pioneerpitch.

Dr. Bishop is a practicing physician as well as the director of quality improvement operations for the Department of Medicine at Weill Cornell Medical College. You can connect with her on Twitter at @tarabishopmd.

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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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User-Centric Innovation

Jul 10, 2013, 8:00 AM, Posted by Christine Nieves

Christine Nieves / RWJF Program Associate Christine Nieves

Determined to increase my productivity and keep my desk free from clutter, I recently read an excellent book that several friends recommended to me called Getting Things Done: The Art of Stress-Free Productivity by David Allen. We at Pioneer talk quite a bit about what it takes to change behavior – what kinds of innovations can we support that will help more people embrace healthy habits? Implementing this book’s recommendations reminded me just how stressful change can be – even change that’s designed to reduce stress! And it got me thinking about how important it is to base any innovation on a real understanding of the people it effects.

I recently spent the day at the MedStar Institute for Innovation -– at Pioneer, we’re always interested in learning more about other units within large organizations that are focused on innovation (and we love to play host, too). Anyway, the folks at MedStar spoke quite a bit about human factors engineering. If you aren’t familiar (I wasn’t), human factors engineering is about accepting the fact that humans will inevitably make mistakes, and designing environments and tools that take that inevitability into account, so that the impact of mistakes is significantly decreased. Human factors engineering often goes hand-in-hand with extensive usability testing.

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