Guest guest Posted November 8, 2006 Report Share Posted November 8, 2006 We recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks. Larry Lindeman MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2006 Report Share Posted November 8, 2006 We have also found this to be useful, Larry. Our printout includes insurance info. If yours includes insurance info as well, I would suggest that you have the pt sign their summary (or their parent if they are a minor) to verify insurance is correct. We don’t routinely (or hardly ever, for that matter) check our pt’s insurance prior to their appt, and this helps catch updates, or show the pt they signed it as being correct (when it wasn’t) and they are responsible for the bill. A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O. Box 7275 Woodland Park, CO 80863 From: [mailto: ] On Behalf Of Larry Lindeman Sent: Wednesday, November 08, 2006 9:44 AM To: Subject: Patient summary We recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks. Larry Lindeman MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2006 Report Share Posted November 8, 2006 what larry has " stumbled on " is near and dear to my heart. this subject It gets framed for us PCPs as saftey and checking med lists . larry has learned rightly what I have been thinking about for a bit- it is best to pu t the r ecord really in the hands of the patietns. For years I have been amazed at th e lack of dialogue about outpatient docs's patietns ending up in er 's or specilaists' offices and the burden to the physcisna in those locations to have any idea what is going on with a med list allergies etc. While we refer patients to specilaists , ofyen patitens presetn themselves there and certainly we do not refer them in a prepared fashion to the er. No one ever talks about this. I have always wondered why a drive to change this has not come form ER docs. Then emrs came along and there was the hope of Interoperability. But this is america . Everyone buys their own emr just like everyone buys a different car and i cannot use your Saab's muffler on my jeep.. So now there is no realistic hope of interoperability( no realistic hope meaning not simple easy cheap accessible, maybe an expensive tedious fix but nothing soon and easily possible) so i have begun to think about a couple of things that follow from this -I went to my med staff mtg last month ( and this is a good time to ask people to take the poll i posted please, becasue i think it is important for us to see if we bring our voices to meetings where our practice style is not yet heard of) and I asked if we could begin a dialgue about outpatietn quality . Dishcarge summaries , the meds peopel leave hospitals on having no dx to explain them , Inter physician communication, every outpatietn phsyican reinventing the wheel about how to solve this stuff but no dialogue among the general staff. I got mostly blank stares .It was not hostility it was that they had no idea what to do with me. one person said it was nervy but fabulous i brought this up and one person who said yes maybe we can make some thigns quality indicatotrs to look at.mOSLTY THE response WAS WELL WE NEED AN EMR FOR THAT IT WILL TAKE YEARS AND/OR WELL WE SHOULD WORK harder? more? oops sorry about that darned caps lock.. Most of the outpatietn docs in my community however are never at the hospital meetings and do not see each other.So no dialogue about this area. I have broached to a consortium we have here called Th e Healthy Community Coalition, the idea of personal health records. Where larry says he wants to give patins a flash drive, my thought was get a grant to enroll people into putting phr info into a password protected site ( already availbale free on the internet at MYPHR.com) I HAVE HAD A GOOD RESPONSE ABOUT THIS AND THERE WILLBE A MEETING UPCOMING SOON TO SEE IF THIS hOPSITALS AREA CAN WORK ON THIS. oops caps lock. aLSO i HAVE BROACHED THIS TO THE TERTIATY CARE CENTER mAINE MEDICAL CENTER AND THEY HAVE RESPONDED QUITE cREATIVLY AND POSITIVEL;Y Darn that stupid caps lock button I am gonna excise it...Their idea had been to to credential me into their coutesy staff thus getting me access to their emr.The only holdup has been cost I cannot afford their dues at the momment! Why can't more docs do this ? That is If the systems are separate OK, but, what if any given doc only had to access two or three local hospitals systems.. we could make that work. In Whatcomb Co Washingotn an intiative was started to use PAPER -remember that stuff - and each patietn owned and brought with them to the doc their own record with meds/problems etc. I think much more can be done and done now and simple widespread iniatives like this would do an enormous amount to imporve care empower cpatietns and reduce errors. Larry thanks for bringing this up I just think this is a critical topic and who better than Practice improvement IMPs to press this forward? Patient summary We recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks. Larry Lindeman MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 Patient summary We recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks. Larry Lindeman MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 As an aside, docs in my community are required by hospital bylaws to attend staff meetings & serve on committees as part of being on their medical staff. I think I’m also required (or at least strongly encouraged) by insurance companies & my malpractice carrier to have staff privileges somewhere. So, I am surprised that so many said on the poll that they attend no staff meetings. Maybe they are all “courtesy staff” rather than “full active”? Patient summary We recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks. Larry Lindeman MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 Dear There are a lot of smart people in the techie world actively trying to make your dream a reality. Though I am a total newbie at this, I have learned enough to realize that they are concerned about the same problems. Gordon's recent release of the primary care experience in the western countries highlights the fact that in the US and Canada, we are technically naive. If you didn't read this -- consider it: The US and Canada lag far behind other major developed countries in many ways. Schoen C., Osborn R., et al. On The Front Lines Of Care: Primary Care Doctors’ Office Systems, Experiences, And Views In Seven Countries Country variations in primary care practices indicate opportunities to learn to improve outcomes and efficiency. Health Affairs Web Exclusive, Nov. 2, 2006 http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w555?ijkey=3YyH7yDwrJSoc & keytype=ref & siteid=healthaff For more information about the the technical standards, one great resource is our very own AAFP's Center for Health Information Technology (CHIT). My EMR's codesigner-president ( Tully- at ChartWare) spent about an hour on this subject at our last user's group meeting. ( Boyce is another IMP'er who uses ChartWare besides RJ and me.) Here are some basic resources you may be interested in: What is HL7 (Health Level 7) and why should I care? http://en.wikipedia.org/wiki/HL7 About a Continuity of Care Record (CCR) Standard http://www.centerforhit.org/x1750.xml CCR Compatible EHR Products http://www.centerforhit.org/x1556.xml ChartWare's Dedication to Continuity Standards http://www.chartware.com/partners.html In your local area, maybe you would consider 1) push for your hospitals, lab and X-ray providers to purchase or maintain HL7 compatible XML based interfaces for the transfer of data to and from your EMR and 2) make sure your EMR is on the compatible list and committed to keep up with the standards. Though the US is late to start in the EHR game, I believe we are nearing the tipping point. Almost a quarter of office-based physicians in the US are using EHR now, and another 30-40% are actively considering purchase in the next 12 months. I don't want to have to buy the same product Kaiser uses and vice versa. Larry's vision of a compatible record on a little flash drive on everybody's keychain is not too far off. Bob Forester wrote: Patient summaryWe recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks.Larry Lindeman MD Want to start your own business? Learn how on Yahoo! Small Business. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 From Drain, I've been talking about giving patients access to their records for years. If we can trust a pin number and a card to get access to our bank accounts, why can we not trust the same system to give access to our own medical records. I mentioned this in the first cohort call I was part of. The problem is, there is not an access system built into any EMR I know of, that would allow for that access to happen. Maybe we should purchase whatever system the banks use for their account information, and copy the medical record into that as if it were bank account information (joke). The point is, the technology is out there, the software is out there, and the only thing that is missing is the will to do it. I believe ( in my personal paranoia) that the current health care system is very uncomfortable with the patient reading the medical record any time they want to because we might not like to hear what the patient thinks about our opinions. Now, these people pay us for what we do and write, and so I believe the record belongs to the patient and only secondarily to me. I'd love to hear what other people think about this. Joanne Holland, the MD from Drain, Oregon wrote: Patient summaryWe recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks.Larry Lindeman MD Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 "So now there is no realistic hope of interoperability" look up CCHIT.org. They are an organization that was created to certify emrs to have a platform for interoperability. They have already certified 20-25 emrs. Not a perfect system, but many emrs have been written for this interoperability for some years now, and the presence of a certification body obviously pressures the others to comply. Not everything will be shared, just core data like med lists, problem lists, etc. wrote: Patient summaryWe recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks.Larry Lindeman MD Check out the all-new Yahoo! Mail beta - Fire up a more powerful email and get things done faster. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 RE pt summary and standards. Massachusets has developed something called tracking form for pts' meds - in AMNews Haven't checked yet, but look up at www.macoalition.org/Initiatives/docs/ambulatoryPatientMedList.doc Please note that I give each pt a folder for the past 2 years with a print out of the pt's visit with med and dx list; despite advising my regular pts to bring that to ALL specialist visits, ER visits, and return visits, I'd have to say maybe 50% of pts AT MOST return with them. USB drives -- careful that I doubt that any hospital IT person would allow such a key to be put into a hospital owned computer due to fear of computer virus, and confidentiality. Wallet card with standard format probably better idea -- low tech solution. There is a standard developed called CCR (Clinical Continuity Record) which as I understand would be a UNIVERSAL format -- the national EMR CCHIT committee has not supported this, instead they supported HL7 format, and "working on" a reconciliation of the 2 -- I expect that this will be ready maybe in 20 years (joke!) Look to the Med List thing, though. Dr Matt Levin Patient summaryWe recently stumbled on something useful. We have recently started some chronic disease management.To readily identify who has diabetes prior to the visit we have been printing out a patient summary on every patient the day before their visit. It was an easy way to plan ahead who needs what. Our patient summary lists the patient demographics along with a problem and meds list. Our ma soon discovered that it was useful to have the patient review this when they arrive to make sure that their address and insurance information is accurate. We then noticed that the patient was also reviewing the diagnosis and meds lists for accuracy. When I saw the patient they were telling me any meds they had gotten from the specialist that I didn't know about. We also give a copy of the patient summary to the patient after the visit to any one who is travelling or anyone who wants one. I would like to start giving people a flash usb drive with their summary in pdf format to keep with them on their keychain in case they end up in the er. We will probably start this next year. By the way I am finding chronic disease management both rewarding and disappointing. I love improving the care of my patients but I am disappointed at myself at all the patients I am discovering that have fallen through the cracks.Larry Lindeman MD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2006 Report Share Posted November 12, 2006 Thanks . I know when it is an e maill from caldwell that the topic is technical.. But see where we all get stuck then is not just the interoperability flash drive thing( and someone told me not that I have checked it out that now you cna get flash drives from medic alert just like you could get bracelets) is that we do not have a computer terminal in every ER cubilce. That is actually why paper still works for patietns. I agree a flash drive / a cd / and credit care swiper thing -a - ma - bob or a password proteted site all work . I really think this needs to be pushed becasue it si so possible and realitively low cost to institue in any one of these fashions and it would reduce errors and oincrease saftry yes? EVEN if each c9ommuity did different things or statewide we got something going? May be I should just get a bar code tatooed onto my wrist a nd they can scan me when I am admitted. Patient summary > > We recently stumbled on something useful. We have recently started > some chronic disease management.To readily identify who has diabetes > prior to the visit we have been printing out a patient summary on > every patient the day before their visit. It was an easy way to plan > ahead who needs what. Our patient summary lists the patient > demographics along with a problem and meds list. Our ma soon > discovered that it was useful to have the patient review this when > they arrive to make sure that their address and insurance information > is accurate. We then noticed that the patient was also reviewing the > diagnosis and meds lists for accuracy. When I saw the patient they > were telling me any meds they had gotten from the specialist that I > didn't know about. We also give a copy of the patient summary to the > patient after the visit to any one who is travelling or anyone who > wants one. I would like to start giving people a flash usb drive with > their summary in pdf format to keep with them on their keychain in > case they end up in the er. We will probably start this next year. By > the way I am finding chronic disease management both rewarding and > disappointing. I love improving the care of my patients but I am > disappointed at myself at all the patients I am discovering that have > fallen through the cracks. > > Larry Lindeman MD > Quote Link to comment Share on other sites More sharing options...
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