Tag Archives: engagement

Change doctors’ minds on OpenNotes in about an hour

My prediction for 2014 is that it’ll be a blockbuster year for OpenNotes – sharing clinical notes with patients online.

For providers who want that level of transparency, yet find physician attitudes can be a roadblock – take heart. We can move the needle and change minds. I observed this during Medicine Grand Rounds at Oregon Health & Science University (OHSU).

Tom Yackel, MD, MPH, OHSU’s Chief Medical Information Officer invited me to join him to give a talk on OpenNotes. It was a easy ask; I’m a huge champion of the Veterans Health Administration’s Blue Button offering OpenNotes, now one year and counting. Sharing notes is also an area of my research, particularly from the perspective of patients and caregivers.

Grand Rounds was just before the holidays, so I worried about attendance. Turns out it was well attended. Maybe the topic raised curiosity. We gave out audience response gadgets to poll attendees at the beginning and end of the talk. Early on, we asked people their agreement with the question, “I think sharing progress notes with patients in MyChart is a good idea”. Purposely not displaying results the first time, we asked again after the presentation & discussion. The proportion who agreed sharing notes was a good idea increased from 54% to 80%.

It’s hard to know if the patient experience stories hit home, or maybe people were leaning to support OpenNotes in the first place. Perhaps a crucial moment happened when the discussion focused on provider workload and a physician leader said:

“We’ve been doing this for 10 years at the VA, and I’ve never had any problems from a patient being able to read their notes. We need to get over this and move on.”

Here’s our results — Before and After Grand Rounds:
DMICE Grand rounds 2013

When it comes to OpenNotes, engagement with Patients starts by Engaging with Providers. Yes! We Can!

Link to Grand Rounds video is here.

Here are the slides we presented:

Patient portals, Blue Button & OpenNotes are the next generation of quality.

It’s been awhile since my last blog post. Summer does that. Particularly if there’s a winning combination of sun, beach, family, fresh corn (I heart Cape Cod). You get my drift. The right factors combine, giving you a great experience.

The same thing goes for digital tools. We intuitively know what’s needed. Easy login. Nice interface. Valuable functionality. Bringing the right information at your fingertips when you need it.

Making an application easy to use and beneficial doesn’t sound so hard, right? Yet why does it take so long for health care to figure this out?

I was asked to give a webinar on the topic of Patient Portals for Maine’s HealthInfoNet last week. I focused on the combination of features that bring the most value – in other words, what people need (based on what they use) and how positive change can happen – based on evidence and experience. We have a rapidly expanding literature about this information, and this data needs bright lights shining on it, firing it up.

I did a back of the envelope summary of some evidence. Not a systematic or exhaustive synthesis, but my cumulative view of a continuously expanding bibliography of relevant papers and presentations.

Co-presenters included Steve Bien, a physician at Wilson Stream Family Practice, the first independent practice to use Maine’s health information exchange. As an early adopter, Steve touted the use of secure email, remarking that online communication not only meets patient needs but reduces workload and offers efficiency. Nice to hear that from a small practice.

Adding the patient voice to the panel was Ann Sullivan, advocate and HealthInfoNet Board member. She provided insightful, day-to-day experience of how eHealth tools add value by fitting into the patient workflow (life!) through convenience, access and helping with self-care.

Thanks to Gemma Cannon, Service Coordinator for Maine’s Regional Extension Center, for convening the group to focus on patient meaningful use!

Slides from the @hinfonet webinar are available from HealthInfoNet and on slideshare.

Northern California transforms HIMSS with a patient centered conference. Engage!

Jan Oldenburg, Regina Holliday and Kate Christensen

Jan Oldenburg, Regina Holliday and Kate Christensen

My dear friends and colleagues Jan Oldenburg and Kate Christensen invited me to a Northern California HIMSS conference, Transforming Healthcare Through Digital Patient Engagement. It was one of the best patient/consumer oriented days I’ve had in a long time. A huge thanks go out to all the organizers, speakers and attendees. Let’s figure out how to clone it, grow it, scale it, disseminate it!

Jan, the President of the N. California HIMSS Chapter, started the day in Fairfield, California, saying

Patient engagement is about creating the world we want to live in.

Jan also rightly promoted her new book, Engage! Co-authored by Kate, Dave Chase and Brad Tritle, promotes consumer-facing health IT as a means to empower, engage and strive for patient contribution.

Regina Holliday set the stage for the day, and riveted the audience with her personal story and powerful messages — about the we-can’t-stop demanding transparency and quality health care that meets our needs. (Standing ovation – what’s new?) painted two fabulous works of art, The Heart of the Matter, and Sky. My favorite Reggie quote of the day was

You must treat every patient as the wonderful, unique person that they are


The power of social media was discussed by Ileana Balcu, Social Media & Communications Lead for the Society of Participatory Medicine, and Brad Tritle, Director of Business Development at Vitaphone USA. All eyes and ears were on Liz Salmi, a young adult cancer survivor and blogger on TheLizArmy.com who shared her journey of finding other cancer survivors who just weren’t like her == leading her to do more tailored networking to make her patient experience have more value.

The power and vulnerability of the caregiver was told by Nancy Burghart-Hall, CIO at MedAmerica, who shared her experience of dealing with very non-patient-centered emergency services.

I had the pleasure of co-presenting with Kate Christensen, who just retired from Kaiser as Director of Internet Services. She’s been a champion for patient digital services before most of us knew what a portal was. Now millions of Kaiser enrollees use kp.org to meet their needs, thanks to Kate’s vision, leadership and steady hand. Ted Eytan did a lovely post about Kate and her recent transition.

I got to boast about the VA’s recent expansion of personal health record data sharing — the opening of all clinical notes with patients using the PHR, My HealtheVet. We recently published a qualitative study on patient experiences of reading their notes, and Engage! pretty much sums it up. After OpenNotes, where do we go? Patient Generated Data…and participatory design.

The last group to talk was just as exciting as the first, and included Neng Bing Doh, CEO of the texting platform start-up, Healthcrowd. Neng gave us a glimpse of a potentially powerful engagement tool: using SMS feedback to segment the consumers and optimize usage. We also heard from Elise Singer from Share the Visit; Sonia Samagh from Ellipsis Health; Ron Leutmer of Healthcare Anytime; Kerri Hickey from Mobile Heartbeat; and Jeff Pollard from 23andMe.

The day was short but oh so sweet. Thank you, Jan, for allowing me to connect, participate and spread the KoolAid. 🙂