CMIO’s take? ’nuff said.
Is the integration of an individual’s narrative into the Electronic Health Record FEASIBLE to Improve Person-Centered Care? (CT Lin: I’m excited to welcome Guest Blogger: Heather Coats PhD)
Person-Centered Care, a buzz word to refocus our Western (US) healthcare system on the user of the system, the person who has a health need. We as clinicians, use the word “patient” but they are a human, just like us the clinician. We all have past, present and future stories that make up “who we are” However, this whole self sometimes is seen as parts in our western medicine culture…the cancer patient in room 202, instead of Jon, the person…who is a grandpa, a dad, and businessman whose illness is impacting his ability to be all of these things.
In recent years, the shift in Western Medicine to incorporate the person’s experience has been moving upstream. The IHI (Institute for Health Improvement) “Person- and Family-Centered Care” domain–Putting the patient and the family at the heart of every decision and empowering them to be genuine partners in their care, goal is to develop “partnerships between clinicians and individuals where the values, needs, and preferences of the individual are honored; the best evidence is applied; and the shared goal is optimal functional health and quality of life” http://www.ihi.org/Topics/PFCC/Pages/default.aspx
Since 2015, the IHI helped share the practice of asking the individual receiving health care: a simple question…“What matters to you?” in addition to “What’s the matter?” This reframing of the clinician-person interaction orients the care being provided more to the whole person, to give a much different light to a plan of care that opens the door for opportunities to involve the person’s whole self. http://www.ihi.org/about/Documents/IHI_Timeline_2018.pdf.
Now, I do not want to diminish the physiological as an important component in the delivery of care. As clinicians, our expertise (life experiences, training) are grounded in knowledge of the physiological, but I would dare to ask, we are not the experts in the whole person who is sitting across from us. Second, when a person is facing an illness…cure of the illness may not be a reality, but healing of the self is still possible.
A recent NPR Morning Edition aired on their Morning Edition program (June 8, 2019): “Storytelling Helps Hospital Staff Discover the person within the Patient aired on June 8, 2019 on Morning Edition on National Public Radio.
Person-centered narratives are one proposed way to have dedicated tools to shift to more person-centered care.
An exemplar of this narrative shift, is the MyLife/MyStory program at the William S. Middleton Memorial Veterans Hospital in Madison, WI. https://www.youtube.com/watch?v=_Wy1aMXQCTk. This program has included over 2,000 person centered co-created narratives into the electronic health record since 2013. Their program has trained an additional 50 sites to implement programs similar to theirs.
This is where my “story” comes in, I had the pleasure to attend MyLife/MyStory training back in 2015, which allowed me to think about this type of program could be implemented outside the VA, and have a program of research that tested person centered narratives interventions to improve communication between clinician and persons receiving healthcare. My NIH/NINR funded research focuses on the implementation of a person centered narrative intervention that co-creates a first person narrative that is approved by the person, then uploaded into the person’s electronic health record for their healthcare team to learn more about “What matters to them?” The first phase of the program did prove to be feasible and acceptable by the individual- the person hospitalized for serious illness, their family, and their clinicians. Through this work, perhaps, there is just one more way to help shift Western healthcare to “truly” be person and family centered.
—Heather Coats, PhD, APRN-BC
Assistant Professor of Research
Office of Research and Scholarship
University of Colorado, College of Nursing
Nurse Practitioner, University of Colorado Hospital Palliative Care Consult Service (PCCS), Department of Medicine, Division of General Internal Medicine, University of Colorado, School of Medicine
I love this: giving advice is often not giving advice.
This Zen statement is not about Zen.
Our physician informatics credo emphasizes relationships .
“We improve physician and team wellness and effectiveness by building extraordinary relationships and innovative tools.”
Extraordinary Relationships come from excellent communication.
Excellent communication comes from listening well.
Listening well comes from a position of empathic understanding.
Empathy is what we all crave. We should all learn the skills to exhibit empathy to others; this is the only way we might receive some in return. This article is a start.
We are incredibly honored and humbled to be awarded Most Wired level 10 by CHIME: the College of Healthcare Information Management Executives.
We were one of the three organizations, out of thousands applying, to be awarded level 10, indicating the highest achievement in superior performance and process for information technology used to improve clinical care. This is the first year that CHIME separated out the awardees into levels 7, 8, 9, and 10.
See my last blog post for some of the details of our presentation at CHIME and some of the projects contributing to our success.
It was humbling to stand by the CIOs from Cedar Sinai and Avera Health to receive the honor. Link to article from CHIME below.
What I said in my acceptance comments, and I stand by them:
At UCHealth, Clinical and IT excellence arises from Partnerships:
1. Partnership between the CIO and CMIO and our teams. We make each other better than we could be alone.
2. Partnerships between UCHealth and our vendor partners: we know that there are more smart people who DON’T work for us, than who do.
3. Partnerships between UCHealth and the CHIME community. Healthcare CIO’s are a brilliant lot. We know we stand on the shoulders of giants.
Lastly, we want to pay it forward. More than 3 health systems deserve to be level 10. ALL patients deserve to be treated by a health system performing at its best and we want to see MANY MORE health systems on stage next year.
I’m at CHIME19 this week: the College of Health Information Management Executives, Fall Forum. Eight hundred Healthcare CIO’s and a growing number of CMIO’s are members. My CIO, Steve Hess and I are giving a talk called “Is this the End of Secrecy in Healthcare?” where we outline our (sometimes) rocky journey toward ever-increasing transparency for our patients.
We know that an informed patient is much more likely to be an engaged patient, and engaged patients have better health outcomes. So, how do we increase the information available to patients? We have to overcome inertia, fear, and sometimes, epithets.
We were interviewed by Kate Gamble of Health System CIO to preview the contents of our talk, see below.
Sometimes we have to look outside of healthcare for our inspiration:
Confused? Excited? Freaked out? So were we.
CMIO’s take? Is this the End of Secrecy? Yes. Yes it is.
Is this goofing off, or is this about personal resilience? Like the idea of “forest bathing” (youtube) or shinrin-yoku, I seek out opportunities during the day to pause and reflect, and walk where there are trees. Sometimes this ends up being an online article with lots of nature photos 😦 .
Hey, you do what you can.
The photos from this travelogue are pretty amazing.
And, did any of you watch the movie “Crazy Rich Asians”? The skyscraper-top boat-like structure in Singapore is apparently an Infinity Pool and is REAL (see the background in the photo at the top). Gotta put this on my bucket list.
CMIO’s take? Harken back to the tripartite model of physician burnout and resilience: a) develop a culture of wellness, b) work on improving practice efficiency and c) work on personal resilience. And ‘forest bathing’ belongs firmly on this list. Take a moment.
This is a passionate outcry from a patient and the daughter of a patient, to improve the state of healthcare today. Why does one need to win the “Doctor Lottery” to find a compassionate, caring physician with enough time to listen for the subtle clues that indicate distress, deterioration, and to save a life?
The author argues that patient engagement is a paradigm shift for many organizations, and that it is a clear win-win when done well.
Both of these articles are well written and more articulate than I am. I can say, in our organization, I routinely conducted bedside rounds, where residents and students presented the patient’s history, their examination findings and their assessments and plans in front of the patient and family, and we would discuss our plans together. Even in clinic, I have my students present their data and we have a discussion about the patient in front of the patient and family. This ALWAYS leads to better understanding by all parties, and has never been an obstruction to patient learning, or to student or resident training. And generally it does NOT take longer.
CMIO’s take? Healthcare technology and paternalistic traditions in healthcare both conspire to take us away from the bedside and risk impairing communication. Lets design better communication into everything we do.