Exceptional Experiences at Community Health Network

In the latest issue of Wired (Alright, I’m still catching up on my reading.), there is a mention about an online article about Gary Gygax written before he passed away.  I was doing some reminiscing about the time I played Dungeons & Dragons (I actually played and preferred Advanced D & D.  I quit playing around the time that the 2nd edition came out, a long time ago.) and I realized that all that role playing in my teen years has helped or shaped my skills for my current position.  Yes, that’s right, playing D & D is like programming.

The rules can be compared to a programming language that a Dungeon Master creates a scenario with.  Just like a programmer writes an application from a set of rules or a programming language.  Other players play the scenario the Dungeon Master created with their characters or roles.  Users interact with an application attempting to perform a task and in usability terms have a role or a set of defining characteristics about their experience, etc.

My playing of AD & D in my teens has prepared me to be a productive member of society with a paying job (after a detour of several years).  Who would have thought?

If you liked this post, stay tuned for next time when I explain how an action film has the same structure as a musical!

(I had the chance to meet Gary Gygax when I went to a GenCon conference in Wisconsin.  My friend and I decided not to stand in line to meet him because we didn’t have anything to say to him other than I like your game, etc.  The same stuff that everyone else says to him.  And being “cool” teenagers we didn’t want to act like everyone else and look stupid.)

(I think I still have my dice I used to play AD & D with somewhere in my house.)

(Once you read the Wired article about Gygax, you’ll realize that a 20-sided die is revolutionary. I first learned about probability and bell curves from this game.)

I just read an extremely interesting article in last month’s Wired magazine, “Free! Why $0.00 Is the Future of Business.”  (Yes, I am behind on my reading.) I started to think about how I could apply it to my work and projects.  We offer a free consumer health library and a free medication library for anyone to use.  I would be against any attempt to charge a subscription fee to get to those services.  When I was in graduate school I remember discussing the subscription model on the Internet as a business model that doesn’t work.  I’ve seen that most organizations (especially newspapers) have tried this model and have moved to free online access to archives.

We offer these applications (and many others as part of the free myCommunity membership) as a service to our patients and hope that users who are not currently patients will consider these services when selecting a health care provider.  But these services are available to people outside of the Indianapolis area who may never be able to use our hospitals.  They are still allowed and encouraged to use our site.

In addition some applications like health information are becoming the standard for health care providers like ATMs are now a standard for banks to offer.  By paying attention to these services the health care organization can increase their reputation and trustworthiness, and secure a patient’s attention.  Just like Chris Anderson writes:

“The word is externalities, a concept that holds that money is not the only scarcity in the world. Chief among the others are your time and respect, two factors that we’ve always known about but have only recently been able to measure properly. The “attention economy” and “reputation economy” are too fuzzy to merit an academic department, but there’s something real at the heart of both.”

We provide free services but also use free services.  We use Google Analytics as another source for web statistics, we use Feedburner to help manage our RSS feeds and we use Google Maps in our Find a Doctor application.  There is tons of free services available we could use but have chosen not to because they can be overwhelming to manage and get value from.

It makes me wonder what else we could offer for free that would return value through other avenues.

I love reading Wired for articles like this.  I read about The Long Tail some time before it became popular in this magazine.  Who knows, maybe this will be the next big idea?

An interesting perspective on physician use of online medical content to inform medical decision-making in order to provide high quality patient care.

“Every day, in hospitals and physicians’ offices across America and increasingly around the world, medical practitioners are doing something revolutionary: They are turning to the Internet for information to enable them to make more informed decisions for their patients.”

Watch streaming video webcast or read transcription at
http://www.medscape.com/viewarticle/548888

At www.eCommunity.com/health we offer a health information library that provides health information for the consumer. The library comes from a third-party provider and most content is reviewed and updated quarterly. Topics are grouped into adult and pediatric health, ranging from allergies to women’s health and everything in between.

Questions: In the future will we need to provide physicians and caregivers within our hospitals with online health information to be used for medical decision-making? Will we do this in an effort to control the content and possible ramifications of finding and relaying inaccurate information to patients? How will newcomer health information Web sites geared toward a physician audience be screened or deemed reputable?

Part of our larger content plan for the year is to conduct usability testing across our suite of online tools/applications and our network Web site, www.eCommunity.com. The purpose is to get feedback from as many audiences as possible and use that feedback to make our applications and Web site easier to use.

Last week I went to Community Regional Cancer Center on our Community Hospital North campus and met with three patients who worked with our SharingSite application. SharingSite is an online blogging tool for patients, family members or caregivers. The owner of the SharingSite can post updates and upload photos for their invited list of folks to see. It’s a convenient way for people who are distributed across the country to get updates on a loved one’s care. Lots of new parents have been using SharingSite to share photos of new babies and family.

With the help of our “portable usability lab” (thanks to Brian for helping me with that setup) I videotaped each patient’s session and also ran a screencapture program in the background of the computer to record mouse movement, clicks, etc.

Overall patients praised the concept of SharingSite as a mechanism for sharing information about patient progress or medical conditions and procedures. There were also usability issues that I will take back to the team with recommendations for fixes. It is a real eye-opener to watch users who are self-proclaimed computer novices and in an older age group work with an application like SharingSite. This experience encourages me to think about better ways to design our tools for seniors in particular.

Thank you to the patients, Community Regional Cancer Center, and my team who helped this project happen!

Interested in participating in a usability session for Community Health Network? Please leave me a comment if you are interested in participating in a usability session for one of our applications. A typical session takes about an hour and participants are compensated with a gift card.

Lately I’ve been hearing a lot about Personal Health Records (PHRs).  There’s been recent interest in PHRs and many big names getting into the PHR game:  Microsoft with HealthVault, Google, Revolution Health.

Like I’ve posted before think of PHRs like a bank. To be truly valuable a PHR needs to use the Electronic Medical Record (EMR) as a reference.  Can the big names do this?

The ideal PHR is editable by the patient.  The patient would be able to add new items or items from their EMR that they can reference.  They are able to share or not share items in the records that they feel is appropriate.  The items in the patient’s PHR are linked to a content library so that they patient can look up more information about their conditions or find drug interactions that may have been missed.  If a patient changes health networks or hospital organizations that record is able to be copied to another organization’s PHR.

I believe patients will use the one attached to their health network and then if they move the record needs to be portable to another organization.  Maybe this is the role of the big names?

I think my blog has been banned from Technorati.  It was in there and now it’s not.  I tried to resubmit the url and it’s still not in there.  I suspect it might be the way this blogging application works to create many categories with the same post in multiple categories that appear to be other blogs?  Anyone else have any ideas?

I didn’t post any this week after posting at least twice a week for a month.  I’m not sure what happened.  I think my week was exceptionally busy and I really didn’t have anything to say.  This experience is in stark contrast to my post about writing and blogging.  I’m not sure that anyone is reading this so I feel a lot like the crazy man yelling in the wilderness. I submitted my blog to Technorati and it was there for a little bit and now it’s gone from the search.  I’m not sure what happened to remove this blog from Technorati’s listings.

In the context of this post email means: email between physicians, physician office to physician office email and organization email  to physician email.
There is a wide spectrum of technology adoption (AKA browser, keyboard and email comfort level) by physicians affiliated with our organization. There are those who do not use email and have no desire to use ever it (this is a minority) In contrast there are physicians that use email every day, even throughout the day via notebook pcs and  hand held devices such as the Treo, Blackberry or iPhone.

The physicians’ comfort level and skill with the keyboard, mouse and Internet browser is significantly inter related to their perception of web application and intranet usability. Further, this mouse and browser comfort level is influential to the physician adoption of email into their respective daily work flow.

In our organization all physicians either have a corporate email address or are entitled to have one upon request. Corporate email addresses are more frequently used by physicians who have dual administrative  and clinical roles or frequent business communication within the organization. It would be a generalization, but relatively safe to state that the largest volume of physicians using corporate email to communicate are the financially integrated physicians. While general medical staff and specialty physicians tend to use personal email addresses to communicate with one another about non clinical topics.

To assure the protection of personal health information (PHI) our organization utilizes a secure email gateway. This provides a solution for a physician with a corporate email account to send confidential, private communications and information that may due to its referral or collaborative purpose, contain personal health information securely to another physician. The physician receiving the secure email can be using a personal email account to receive the prompt that they need to securely access the gateway to read the content within the message. For example, a physician can send a secure email by simply prefacing his / her email’s subject line with the text “secure:”. An example subject line might read, “secure: Patient j jones blood work results”.

Most physicians affiliated with our network have personal email accounts such as Yahoo, MSN, AOL. These email accounts may be specific to the physician or be a family email account that is shared. As well these personal email accounts change, new ones are added.

This train of thought leads to the discussion of; what data / information should be communicated via email and what data/information should be communicate via the intranet or a portal? Further, what criteria should be used to discern this question and whom can or should make this final determination?

We identify the categories of physician work processes that can be facilitated by intranet/portal as:   Communication, news (customized to the physician), relationship management information, business operations (meeting minutes, forms) and quick access to Clinical systems.

Our physician’s regularly remind us that in their view a physician portal has to be: simple, easy to get to, clean, few clicks, and everything is right on the home page. Of course this seems logical to them, its not always realistic, when it comes to managing intranet real estate. Our physicians also, rightfully so want single sign  for all systems and applications. Physicians, practice managers and office staff have various system access or short cuts on their respective personal computers (PCs) to specific clinical systems and business systems to get their work done. We are currently striving to create a “most convenient” manner to access that is specific to role and a single sign on solution, but there are many security operations management tasks to address. In the end, it becomes a question how secure is secure enough balance with a favorable physician experience that will stimulate greater online engagement.