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Patient-Centered Transformation:

Miller discusses physician PHR fears

A recent HealthLeaders Media article looked at concerns physicians have about PHRs--personal health records that are created and controlled by patients. Holly Miller, MD, MedAllies’ chief medical officer, pointed out that early experiences with PHR models have shown physicians will not trust any model that depends on the patient entering data. It is far too easy to enter incorrect or incomplete data. She also pointed to a more subtle fear: loss of control. For example, many physicians don't like the idea of patients getting instant access to lab results without first talking to a doctor. She noted, however, research shows physicians actually saved time by allowing lab results to be released to the PHR rather than calling the patient. But physician adoption will depend, in part, on the PHR being automatically generated through the EMR. (HealthLeaders Media)

 

Hudson Valley's health IT-driven transformation focus of keynote

By providing vital clinical information to care providers as patients transition across care environments, Direct technology will transform health care delivery, resulting in improved quality, decreased costs, increased care efficiency and greater patient satisfaction. That’s the message Holly Miller, MD, MBA, FHIMSS, chief medical officer of MedAllies, will deliver in her keynote address at the Delaware Valley Healthcare Information Management System Society Winter Symposium on Jan. 19, 2012.  The Winter Symposium, to be held at the Microsoft Technology Center in Malvern, Penn., focuses on the rapidly changing health information exchange environment in the Delaware Valley and will offer practical insights on the technologies being advanced. (Marketwatch)

 

Wiring the Valley:

MedAllies to demo its Direct HISP Solution at HIMSS

MedAllies has been selected to participate in the HIMSS12 Interoperability Showcase, demonstrating its Direct HISP Solution. MedAllies, along with health IT vendors NextGen Healthcare and Greenway Medical Technologies, will demonstrate the capabilities of this technology in the ONC area of the Showcase Feb. 21-23, 2012. The demonstration will repeat the one they presented at November’s ONC Annual Grantees meeting in Washington, D.C. In a recent interview with CMIO, MedAllies CEO A. John Blair III, MD, explained that MedAllies’ Direct Project is a protocol and standards-based project. “Direct is focusing our attention on EHRs and transitions of care, including reconciliation and medication lists so that patients have the necessary information before they are transferred off the hospital floor and discharged.” (Marketwatch)

 

CMS pilot to focus on using HIT to deliver at-home care

A new CMS demonstration, Independence at Home, will use electronic health information systems, remote monitoring and mobile diagnostic technology to deliver care at home to patients with chronic conditions. To participate, practices must include physicians or nurse practitioners who have experience delivering home-based primary care. Applications and Letters of Intent, if applicable, are due Feb. 6, 2012. (Healthcare IT News; CMS factsheet)

 

Profile in Change: 

Linda Castillo, RN, BSN, CCM

Linda Castillo, RN, BSN, CCM, is an embedded case manager,  Mount Kisco Medical Group Linda Castillo, RN, BSN, CCM, is an embedded case manager at Mount Kisco Medical Group Internal Medicine Department in Fishkill, working with Dr. Imtiaz Mallick. She is one of several embedded case managers throughout the Hudson Valley involved in the Taconic IPA's growing Advanced Primary Care Program. Of particular note--and not mentioned in the interview--is that Castillo is a native Spanish speaker, which helps her overcome language barriers for many of her patients 

 

Connector: Can you describe a typical-- or at least respresentative-- day?

 

Castillo: I start the day by looking at my daily list of patients I need to follow up with. I identify those who needed labs or diagnostic procedures and make sure they had those done. Additionally, each day the doctor gives me a list of patients who were admitted or readmitted to the hospital, went to the ER, etc. I reach out to them and coordinate services.

 

In between, I provide reports to the doctor about the patients we’re following and make recommendations for a plan of care. If the doctor is agreeable, we come up with goals the patient is willing to accept as his or her plan of care. But before setting goals or creating a plan, I talk to the patients to see what’s going on with them -- and help identify the important thing affecting them in their care. Then I bring it to the table and explain to the physician why I advocate the approach I do. The physician may have something different in mind–perhaps more ambitious goals. But to meet those goals, we have to take baby steps. So in those meetings with the physician, I advocate for the patient.

 

Connector: What is your role on the care team? Why is it important to have a defined role?

 

Castillo: It’s very significant that each of us has a defined role. For instance, when a patient comes in, the staff nurse gets the vital signs and starts the process. If it’s a patient who needs a case manager, I come in and we work jointly with the patient so we aren’t duplicating services. It’s more efficient: She plays her role to prep the patient for the physician while I play mine--assessing and educating the patient. That way, we don’t delay the schedule.

 

In my role I advocate for the patient; I am the liaison between patient/caregiver and the other members of the team–the physician, nurse, staff, medical assistant, receptionist, etc.

 

Working together we can improve the treatment, achieve adherence, promote behavior change and improve patient satisfaction–and we can do this because each team member has a defined role--that’s very important.

 

I should add that there’s also a team approach to the Taconic IPA (TIPA) cadre of case managers. We each have the opportunity to perform different roles. For example, I will be going to Emory University to get a wound care certification. Another TIPA case manager is going for her diabetes certification. Each of us can consult with the other case managers, sharing that expertise across all the participating practices.

 

Connector: What training did you and the team undergo to ensure you were working together?

 

Castillo: The case managers had rigorous training at Geisinger in its Proven Health Navigator model. We went to Pennsylvania and shadowed case managers; we saw how they interact with patients, providers and other members of the team. It was a wonderful hands-on experience. Taconic IPA then expanded that approach to fit this community. It’s been working beautifully.

 

Here, we have ongoing support and training through in-services, webinars, Web-based programs, teleconferences, etc. We also have a lot of resources, including continuing education opportunities and the CMBOK [Case Management Body of Knowledge] from the Commission for Case Manager Certification.

 

We also participated in two months of training to learn how to become part of the team. At the beginning, joining an existing team was a little bit challenging; I was coming in as an outsider. Once they saw I could enhance their work, they opened their arms and were very welcoming and very supportive. They now see me as an added resource.

 

News to Know:  

Hudson Valley Pediatrics joins Crystal Run Healthcare

Hudson Valley Pediatrics has joined Crystal Run Healthcare's multi-specialty group medical practice. Hudson Valley Pediatrics, the latest practice to join Crystal Run, has provided local pediatric care for more than 37 years. The pediatricians and staff will continue to see patients at their current Wallkill location. (Times Herald Record)

 

Health Affairs covers NYSHealth's Diabetes Campaign

An article in this month’sHealth Affairs looks at  NYSHealth’s Diabetes Campaign. The  five-year long Campaign has worked to improve health care and health outcomes for New Yorkers with diabetes by advancing prevention and management initiatives. The article focuses on the Campaign’s goal to improve clinical care by helping 3,000 primary care clinicians attain diabetes recognition under the National Committee for Quality Assurance’s or Bridges to Excellence’s diabetes recognition programs. The article also features NYSHealth grantees’ and staff members’ perspectives on the challenges, opportunities, and results of the Campaign’s efforts to combat the disease. (New York State Health Foundation; Health Affairs)

 

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