Throughout the course, you'll have a chance to hear about some of the excellent work in applied clinical informatics that leaders here at Hopkins are taking on each and every day. You're going to have a chance to hear from Kelly Gleason about patient portals and personal health records. She's sharing a bit about her work in leveraging patient portals for recruiting patients for clinical trials. Of course that's just one particular use of patient portals. These tools can also help patients view parts of their medical record rather than waiting for a paper copy to be printed off by a providers front office staff, patients can remotely log into a website that displays their test results, diagnoses, medications, immunizations. At Hopkins, rather than having to call and be put on hold or use non secure email to communicate with the healthcare team, patients can log into the portal and send secure messages for non urgent matters. There's also the capability of requesting appointments, viewing past ones, and looking at upcoming appointments. In an era where we're trying to push for patient engagement and self-management, patient portals have an important role to play. Of course an important question arises, who weighs in on what the interface looks like or what functions should be enabled versus restricted? If we're truly encouraging patients and families to be more involved in their own health care and health outcomes, shouldn't they also have a voice in these technological offerings? Well they absolutely should. Here at Hopkins, they do. We have a patient and family centered design committee. This is a team of multiple stake holders who invested in the design of interventions that are patient-facing or patient family-facing. Take a look at a discussion I recently had with the practicing physician here at Hopkins. He is not only a physician champion for our electronic medical record and he is not only a part of the ambulatory clinical decision support committee but he's also the co-chair of the patient and family centered design team, that oversees changes to our patient portal and other patient-facing interventions. Make sure you listen to some of the approaches he takes to engaging multiple stakeholders, overcoming resistance to change, and managing a variety of legal regulatory and compliance mandates. I'm here today with Dr. Howard Levy who's an internist, a geneticist, and the co-chair of the patient and family centered design team. Thanks a lot Dr. Levy for taking a few minutes to chat with me. My pleasure to be here. Now, your role, the patient and family centered design team, what exactly does that mean to be a co-chair of that? Can you explain to our students? The team is truly a multi-disciplinary team of everybody who has a stake in communication with our patients. So, we started historically as the committee that was overseeing the design of MyChart but we quickly realized that there's a lot more that's patient-facing than just MyChart. It's MyChart, it's the after visit summary, it's reminders of appointments, it's getting appointments scheduled, so, it has morphed into the patient and family centered team looking at the design of everything that is patient-facing, and patient and family are the critical words here, we have to include the patients and families as among the most important stakeholders here. Yeah, it's interesting because it seems like such an obvious statement but really when we're leading change through health IT, one of the biggest sources of angst maybe a decade ago was that providers weren't being included and that the clinicians weren't being included, so then there was a lot of championing for that cause. Exactly. But wow. We're still talking about the patient and the family here. So to me I've come to my perspective years ago. But for a lot of my colleagues it's still a new idea that medicine like so many other professions is a service industry, and our patients are actually our clients and if we aren't meeting their needs, they'll go somewhere else and find someone who meets those needs better. Doesn't matter how good we are at our jobs, if we don't give our consumer what they're looking for, we'll lose them. Yeah. So there's some things where we have to do what's medically right and we don't want to give our patients something that they think they want that might be bad for them. No one's suggesting that we just give people everything they want. But, a lot of times the concern on the provider's part is this is going to make my job harder and for crying out loud can't we just build it around my needs so that I can help more patients which is an understandable perspective. Right. But sometimes those are in conflict. There's almost always a compromise harmonized solution that can be found, and that's why again, our design team brings all the stakeholders to the table. We have patients, we have family members and other caregivers at the table. We have providers, physicians, physician assistants and nurse practitioners, nurses, social workers, everyone who's involved in caring for the patient as well as legal and regulatory and to some extent even third-party payers. Because everyone has a stake here that is their own view on how this needs to be configured, and our best chance of meeting everybody's need, especially our consumers need, is to have everybody at the table figuring out what works best for the big picture, for the enterprise and not just for the patient or not just for the provider. Now Dr. Levy a question for you is, how often does the team meet? At this point we have full team meetings twice a month. We have pre-meeting organizational meetings, planning meetings a few days before each larger group meeting, and then as needed ad hoc we'll break off smaller work groups or meet more frequently if difficult or challenging or exciting issues come up that we need to invest more time into. When we first were doing this it was every week and we had a huge backlog. Right. The good news is we've made lots of nice progress. We've been leaders nationally in some of the things that we've implemented within APEC. So now we're at a point where we've mostly caught up on important changes and fixes and we're able to think about future enhancements, new ways to make the system even more functional and robust and helpful to our patients. So at this point, twice a month but that's negotiable. Yeah. Now, one of the questions I wanted to ask you Howard is, tell me about what it's like to be a practicing provider who sometimes gets to hear some of the resistance to change from colleagues, yet you're so embedded in the clinical decision support teams, you're a big champion of the cause, what's that feel like? Well, it's fun like with anything else to be in the know and to understand when either a provider or a patient tells me an anecdote about something going wrong. Right. Sometimes I'm able to say oh, it's just not fully explained to you. Here's how to do it the way it was intended and I can very quickly make somebody happy. Other times it's really important to understand that something was designed in a way that doesn't really meet the needs of whoever that stakeholder may be, one of my colleagues or a patient. In those situations, I'm able to facilitate bringing that to the appropriate environment to see what we can do to make it better. Sometimes that's something internally we can fix, sometimes we have to wait for development outside of our walls coming from APEC or a third-party provider but whatever it is, it's great to have my finger on the pulse and really be able to understand what went wrong, why is this painful for somebody and then start brainstorming how do we make it better. Yeah. Well, fantastic. Thanks so much for taking the time to join me. Thank you for inviting me. Hope you enjoyed that discussion. I want to point out how one of the things Dr. Levy mentioned relates directly to one of the readings posted on the course website. You'll see the September 2018 article from Harvard Business Review titled What 21st century healthcare can learn from 20th century business. In that article, Michael Porter and Dr. Thomas Lee outlined how 'health care today has a complexity problem. Progress has produced major medical advances but healthcare's traditional organizational structure is buckling. The result, clinicians have trouble collaborating. Patients, have trouble navigating the system, and leaders have trouble leading'. It is this complexity that has necessitated so much change in health care. You just heard Dr. Levy talk about how the traditional approach to health care has been to organize around the needs of clinicians, their schedules, their locations, their needs, yet, 21st century health care is undergoing a revolution in which the needs of the patients are now being placed front-and-center. Dr. Levy described how clinicians are understanding that health care is a service industry with the patients, families, and caregivers as clients or customers. Hopefully you see the parallel between his sentiments and those expressed by Porter and Lee in their article from Harvard Business Review. In it they write, 'In many ways, health care today is where business was in the early and mid 20th century. It is becoming increasingly clear that today's organizational model is a major obstacle to meeting customers needs and supporting innovation. Results are defined by how often particular discrete services are delivered, not in terms of how well patients overall needs are met. ' As you embark upon your career in clinical informatics or advance in your career, keep looking for everyday examples of individuals leading change about the multiple stakeholders they are bringing to the table and the applications of their work in the realm of health care IT. Please keep in mind what Dr. Howard Levy said during my discussion with him. That patient and family are the critical words here. We have to include the patients and families as among the most important stake holders.
