Much of the attention around the OpenNotes movement, which gives patients direct access to parts of the physician documentation in their electronic health records (EHRs), has been around private health systems. But what about OpenNotes, in the context of the public hospital-/safety-net hospital-based healthcare system? Don’t the patients in public hospitals and clinics also deserve enhanced access to their own healthcare information?
The answer to that question, according to leaders in the Los Angeles County healthcare system, is a resounding “yes.” Los Angeles County’s four hospitals and 18 clinics are moving forward to provide increased patients’ access to their own health records, within the broader context of efforts to engage patients in order to enhance their health status.
Indeed, leaders at that county healthcare system have made a commitment to engage their patients far more fully in their care and health, recognizing the complexities of doing so when engaging populations facing issues around poverty, transience, social instability, and other challenges in their lives.
At Los Angeles County Department of Health Services, Anshu Abhat, M.D., M.P.H., the director of patient engagement in information technology, has been helping to lead a patient engagement initiative, one in which information technology has proven to be a vital facilitator of progress in this area. Dr. Abhat, a general internist who continues to practice primary care medicine at Harbor-UCLA Medical Center in Torrance, and in Harbor-UCLA’s outpatient clinics, and who teaches residents there in both the inpatient and outpatient settings, has been working with a variety of colleagues across the public hospital system to move things forward around IT-facilitated patient engagement. She spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland about this initiative, and its implications for patient engagement efforts healthcare system-wide. Below are experts from that interview.
Your team is a somewhat virtual, project-specific one?
Yes; my team was blank in the beginning. I work with a variety of different individuals in different areas within the system. There are the IT folks—I collaborate with the CMIOs at the different facilities, including the one over all of DHS, and also IT analysts; I also work with the local operational folks, including the primary care workforce—the primary care physician leaders, and specialty leaders. I also work with our CMO for the county, and more recently, have been working with the folks who handle the patient experience.
What are the backgrounds of the members of the patient experience team?
There’s one designated patient experience person at each of the hospitals. They’re generally not clinicians; some have more MBA backgrounds; others have had operational backgrounds, for example, one was an interim COO.
What areas have you been discussing with colleagues, per the patient experience, and how that might be enhanced?
There’s been a big focus on the social determinants of health side of things, and there are a couple of programs that really have formed our work. There have been a couple of grants, one around Whole Person Care. [As the California Department of Health Care Services notes on its website, “The overarching goal of the Whole Person Care (WPC) Pilots is the coordination of health, behavioral health, and social services, as applicable, in a patient-centered manner with the goals of improved beneficiary health and wellbeing through more efficient and effective use of resources. WPC Pilots will provide an option to a county, a city and county, a health or hospital authority, or a consortium of any of the above entities serving a county or region consisting of more than one county, or a health authority, to receive support to integrate care for a particularly vulnerable group of Medi-Cal beneficiaries who have been identified as high users of multiple systems and continue to have poor health outcomes.”] A grant is being administered by the state of California, with pilots focusing on the most marginalized Medi-Cal patients—homeless high-risk patients, patients involved with the justice system, mental health high-risk patients, substance-abuse high-risk patients, high-risk perinatal patients, and medically high-risk, high utilizers of healthcare. That’s an initiative run by a very innovative team here. So that’s one initiative going on.
How do you interface with them?
They’re fairly early on in working on the grant, about a year in, and they’re working in hospital settings, clinic settings, and in the community, around getting people more involved in their care. I’m starting to explore that with them myself. Right now, I don’t have a direct interface, but they’re doing a lot a work—a project called CHAMP, where they’re creating an EHR that spans all those areas of high risk, beyond the purely medical; I don’t think that’s been done before, so that’s innovative. And we have other folks working on system-wide social-determinant screenings, to better understand patients as they walk through the door. We need to understand which interventions will matter, and the EHR [electronic health record] can help us understand stratification of patients, and where we should focus our health efforts.
What has your particular focus been on as an individual?
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