This year was Chilmark Research’s third AHRQ’09 event. The previous two we attend in 2007 and 2008 left us, how shall we say it… underwhelmed and really did not have much intention of attending this year.  But that was before ARRA, before meaningful use, before certified EHRs, and certainly before we were asked if we would be interested in presenting and moderating a session entitled: PHRs, What are they good for?

Of course we accepted the invitation to present and moderate the PHR session and well, with so much else happening in DC right now, probably would have attended regardless to get a read on the market from the rarefied air of AHRQ grant recipients.

Unlike past events that were composed strictly of AHRQ grant recipients, AHRQ employees, and numerous beltway bandits (they prefer to be called govt. contractors), this event took quite a different tack casting a much broader net bringing in all sorts of presenters from government, academia, numerous NGOs, private sector, some patients, etc., all who have never received an AHRQ grant.  While I did not have a chance to interview the countless AHRQ grant recipients in attendance (still the majority) on this new format, those I did talk to found this new approach refreshing and enlightening.

From our perspective, this is now the best bang for the buck healthcare event today in the US (it is free after all), something we would not have said last year.  Congratulations to the AHRQ Team that pulled this together – you did a fabulous job in bringing a wide range of viewpoints and perspectives to this event and we are quite positive that all attendees came away with something of value.  Now, if we could just do something about that Godawful website of yours.  Suggest you pick up a copy of Don’t Make Me Think and give it to your Web development team – in fact, by a case of that book and distribute it throughout HHS as we find virtually all properties to hurt our feeble minds.

Key takeaways from the event:

Our concept to push beyond the PHR term and start talking about PHPs was very well received by many in the audience of the session we moderated.  Several came up to us afterwards and talked about their own “platform” initiatives.  Also, was surprised (probably shouldn’t have been) that Kaiser-Permanente is now looking beyond their successful Health Manager to a “Web Presence Platform” for their members.

Patient safety improves by leaps and bounds when transparency is applied and patients are provided a mechanism to report errors that are taken seriously.  Twenty-five percent of errors are easy to understand, report and rectify, its the other 75% that are extremely challenging. The best approach to address that 75% is through close collaboration between the patient and their care team. Unfortunately, there are few examples and mechanisms in place today as to how to facilitate this process.

University of Illinois – Chicago has done some absolutely amazing work on patient safety front with some very novel approaches, e.g. residents have to report at least five mistakes in a given period to move on and applying analytics/reporting to weed-out the physicians with the highest number of complaints and errors..  And guess what, their liability insurance coverage costs have plummeted.

Regarding patient safety, results of a large consumer survey found that consumers seek five key things:

• An explanation & recognition of responsibility,
• Accountability,
• Evidence of action taken to insure future risk in minimized,
• An apology,
• Personalized response to their specific case, no form letters!

Pretty commonsensical to us, but that is the funny thing about commonsense, it is rarely common.

HHS has some great people doing great things but HHS marketing S*ucks (don’t believe us, go back and just look at their websites and take it from there).  This results in few knowing of the good work and initiatives occurring within HHS.  For example, the creator of healthfinder.gov spoke about how they looked closely at user interactions to improve the site and also how they rebuilt it to address prevention rather than disease.  Healthfinder.gov has a wealth of information that has been fully vetted, really a great resource, and even better, its for free.  At AHRQ’09, Healthfinder told us they are now developing a widget that can be freely installed on any website, which will allow a user to enter very basic demographic info and get preventative health content that is relevant to them.  So all you small start-ups, you don’t need to begin paying for content via third parties such as Healthwise but instead could begin by installing the new healthfinder widget for fully vetted health prevention content.

GE launched a global initiative across all sites with 100 or more employees entitled “Healthy Worksite”.  Currently 95% of sites are participating.  In the future, GE will “certify” sites if they meet certain metrics such as:

• Insuring that 70% of food served at the onsite cafeteria are healthy and providing a 20% discount to employees for purchasing “healthy food.”
• Site has an active smoking cessation program in place.
• Site provides incentives for employees to participate in fitness programs.

In return for being certify, not only will the worksite be a good corporate citizen of GE, but will receive worksite bonuses/paybacks in the form of lower healthcare costs (premiums) they’ll have to pay.

An interesting aspect of the GE program is no support for an employee sponsored PHR.  Rather, GE will simply provide employees links to various sites (both payer-centric, e.g. Optum or independent e.g. WebMD or provider, e.g., Mayo or Cleveland Clinic) and let the employee chose whether or not to participate.  And in a change from the norm, GE plans to measure net employee participation in prevention programs rather than more specific health information to avoid the nasty tangle of PHI.  Not sure how they’ll do this as in 2010, they’ll be launching a company-wide health risk assessment (HRA) program.

Lastly, coming out of the PHR session we moderated was the finding from Group Health that After Visit Summaries (AVSs) provided to patients after a visit have been transformative to care. Maybe, just maybe there may be a tie-in between what the Univ. of Chicago has done on the patient safety reporting front and what GHC has done with AVS.  The parallels are there. Both rely on close, collaborative and honest communication, both are transformative to the practice and delivery of care. Both need the patient and at times, the family involved – they need their input, their voice. Both lead to the opportunity to lower errors and improve outcomes and in doing so provide the opportunity to lower healthcare costs.