Author Archives: Steve Downs

Moving Forward with OpenNotes

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

Doctor talking with a patient.

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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The Body-Data Craze, the Hype Cycle and Why It Matters

Jul 3, 2013, 11:15 AM, Posted by Steve Downs

On my way out to visit the Calit2 team that is running the Health Data Exploration project (sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio), I read Alissa Quart's excellent piece in Newsweek about the Quantified Self (QS) movement and health. The article covers many of the possible benefits as well as the downsides of self-tracking.

As Quart acknowledges, she also focuses quite a bit on the edge cases, the extreme QSers, painting a picture that can seem a little ridiculous. It’s inevitable; whenever a new technology emerges, a subset of early adopters takes it to the extreme, making the technology and its applications easy for us to mock (see "glasshole").

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Video: Larry Smarr on the Health Data Exploration Project

Jun 10, 2013, 8:00 AM, Posted by Lori Melichar, Steve Downs

As we set forth on the Health Data Exploration project, we're being guided by a wonderful set of advisors. Here's a quick video post from one of them, Larry Smarr, the director of Calit2.  Larry's a pioneer who's exploring the frontiers of quantified self, as you can see from the extraordinary talk he gave at TEDMED earlier this year.

This commentary originally appeared on the RWJF Pioneering Ideas blog.

Health Data: Let's Go Exploring

May 29, 2013, 8:00 AM, Posted by Lori Melichar, Steve Downs

A man typing on a smart phone.

Think about it for a moment. When you consider what you "know" about health, where does that knowledge come from? While we all have our sources—doctors, friends, news articles—our knowledge at its core is derived from research. And that research is built on a foundation of data.

Data about health typically come from several types of sources: clinical data, gleaned from electronic health records or chart pulls, and billing and claims data, which are byproducts of the health care process; and public health surveillance data, which are specialized collections about particular topics or populations. All of these sources can then be supplemented, at a considerable cost, by original data collection efforts specific to a particular study.

These different types of data are like pieces of a jigsaw puzzle; when assembled, they create a more complete picture of health.

But a piece of the puzzle is missing.  Or it has been up till now.

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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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When Moneyball Meets Medicaid

May 16, 2013, 8:00 AM, Posted by Steve Downs

New York State Commissioner of Health Nirav Shah is the Billy Beane of health care.

Let me explain. 

Billy Beane—the general manager and minority owner of the Oakland Athletics—and made famous in the book Moneyball: The Art of Winning an Unfair Game by Michael Lewis, was made even more famous when Brad Pitt portrayed him in the movie adaptation. (Generally speaking, having Brad Pitt portray you is a good way to get famous.)

For those who aren’t familiar, Moneyball is about how, under Beane’s unconventional leadership, “the Oakland Athletics achieved an amazing winning streak while having the smallest player payroll in Major League Baseball. (Short answer: creative use of data.)” (Thank you, New York Times.)

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OpenNotes: The Results Are In

Oct 3, 2012, 6:00 PM, Posted by Steve Downs

Steve Downs Steve Downs

Originally posted on The Health Care Blog.

A few years ago, Tom Delbanco and Jan Walker pitched us with a simple idea: Patients should routinely be able to see the notes that physicians write about them.  Now it’s true that we all have the legal right to see these notes, but obtaining them is anything but routine. The process involves phone calls, faxes (sic), duplicating fees and all sorts of other demoralizing steps. The net result is that reviewing your doctor’s notes about you is a rare experience.

Tom and Jan said that the physicians with whom they had spoken about this idea were split. Some were interested, some were resigned: They recognized that transparency was an increasingly powerful wave and that the world seemed to be heading this way, and the others thought they were crazy—notes were for documentation and communication among doctors and were never intended for patients.  The arguments were of a religious quality—they were about belief and values.  The obvious solution was to test the idea and let data help sort it out.  Today, with the publication of the study results in the Annals of Internal Medicine, that debate is now illuminated.

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