When we think about information making our lives easier, it’s usually about gaining a few precious minutes in our daily schedule or saving a few dollars on a purchase. Hardly a matter of life and death. But what if a personal Internet knowledge-base could keep us informed about how much to lower our cholesterol, the proper dosage to take of a prescribed medication, when to see the doctor about a lump or a bruise, or a million other health and wellness matters that are infinitely more personal? In our world of specialized and often fragmented medical care, not every health care institution has enough information about its patients to maintain a personalized, health information system. But a Health Maintenance Organization (HMO) like Group Health Cooperative, by its very definition, maintains all that vital data. While you are reading this, Group Health is in the process of putting that information online!
We got together with Group Health Web Publisher Catherine Duke, and Dr. Ted Eytan, the Lead Physician for MyGroupHealth Internet Services and the organization’s Division of Medical Informatics, just as the HMO is preparing to implement one of the country’s most promising and exciting online health programs. You make the diagnosis.
Seattle24x7: How would you describe Group Health’s commitment to using the Web as a part of the health care system?
Dr. Ted: If you look at the Institute of Medicine’s “Bridging the Quality Chasm” report that just came out, they talk about the fact that one of the six rules of health care is that it must be available for patient use 24-hours a day, 365 days a year, wherever the patient needs it. Group Health has always had that model. We believe there is no single other intervention that will help us meet our quality of service and clinical goals than information technology.
Seattle24x7: Which areas of health care will most benefit from online access to information?
Cat: There are 10-12 areas that we call Strategic Populations. And we call them strategic because they’re populations of people that benefit from extra attention. For example, Diabetes, HIV/AIDS, Asthma, Senior Care, Breast Care. We hope to use information technology especially to help those populations.
Seattle24x7: You are also implementing new online Condition Centers?
Cat: That’s right. They house in-depth information around certain conditions. Mostly they are intended to address conditions that effect some of our larger “populations”, for example, pregnant women. We’re starting with Pregnancy and then were going to Diabetes, Sports and Fitness and Heart health.
We provide a lot of Group Health’s evidence-based information, as well as interactive tools, discussion groups that are moderated by Group Health doctors and health care providers. We also supplement our own health information with an incredibly comprehensive database, called Healthwise Knowledgebase ™. That contains more than 22,000 pages of information.
Seattle24x7: So you view the Web as an integral part of patient communication and education?
Dr. Ted: Frankly, a lot of the stuff we are doing, only we can do because all of our provider services and health plans are integrated. If you look at patients who get care at other organizations their care is, by default, fragmented. They may see a doctor at Facility X but their prescriptions are at Facility Y and the doctor can’t see what’s going on.
I practice in our Capitol Hill facility, and when the patient comes in I know every prescription they’ve ever received . I know which doctors they’ve seen, I know what the state of their care is, and when I talk to them, I can say ‘ I know what’s going on. Let’s see where we go from here.’ It’s such a different conversation than ‘What medicine are you on again?’
Seattle24x7: What kind of security precautions are being put in place?
Cat: In order to access their personal health information through secure messaging, members first need to come in to a medical center in person and provide identification verification. Then they get access to secure messaging and the services. When they do send information to us (online), it has to be very carefully documented. The doctors have to see it, sign off, all that kind of stuff. Other online business don’t have to worry about that, they don’t have to take all of those precautions. Security is huge for us; we need to make sure that every transaction is completely confidential.
Seattle24x7: How big is Group Health’s Web services department and when did the Web site first go online?
Cat: Our department as a whole, including programmers and a technical manager, has 32 total.
Dr. Ted: In all, there’s really 9,000 in the group because we are owned by Group Health Cooperative ( that’s the approximate number of employees at Group Health) and we differentiate ourselves from other Web sites in that we have a full delivery system behind us. A lot of the content that you see on the site is actually developed with specialists and doctors. We actually fund several physicians’ salaries outside of this building to work with us, a couple of engineers, and some writers in other departments.
Cat: The site went live in 1995. In fact, Group Health Cooperative in Seattle was one of the first health care organizations on the Internet.
Seattle24x7: How is your Website set up in terms of usability?
Cat: The Website is all about functionality. Essentially, we’re building a door onto a delivery system, and providing services that will enable people to do several things concerning their health care, such as consult their doctors online via secure messaging, request an appt online, and communicate with the consulting nurse. We have established a unique online service that allows patients to request a personal consultation with a Group Health wellness specialist and get recommendations on how to manage health-related lifestyle issues such as smoking, weight, and stress. We’re launching Pharmacy in the fall, which is part of a pretty big redesign — taking our site to the next step. Pharmacy will include the ability to refill a prescription, check status of the order, check out and print patient information on any drug, e-mail questions to a pharmacist. Drug interactions will be phase two, most likely in Q2 of 2002.
Seattle24x7: How is the new online experience personalized?
Cat: Currently, when somebody signs on to GHC.org, the public site looks very much like our member site. It does have a lot of our health information and there are an extended number of services that you get when you log on.
With our redesign, members will log on to access our online services and health information. They’ll get their own customized suite of services right on their homepage. We will also drive interest-specific information to them via our ATG Dynamo server. This is enabled through a profile the member voluntarily fills out then they register. We will eventually drive customized information via our baseline database that will tell us about the specific health needs of our members. We’ll know who their primary care doctor is, where they get their care, and if they belong to specific populations.
Seattle24x7: Are there other aspects of personalization?
Cat: For the personalization piece, we already provide an option for members to fill out a personal profile. With future functionality, patients will be able to opt-in to different services, identify personal health interests and needs. For example, they can tell us if they’re pregnant and when their due date is.
Seattle24x7: As a leader in data collection, there must come a point where through data mining and data modeling that you’re going to be able to make connections between illnesses and causes and all kinds of things that aren’t measurable or abstractable without the data?
Dr. Ted: We’re already doing that. Group Health has its own research institution, the Group Health Center for Health Studies www.centerforhealthstudies.org.
We have over 800 publications in medical literature. The University of Washington researchers review our data sets at all time. Research with patients is subject to committee approval that’s all federally regulated, and patients always have consent. The data is used with the explicit purpose of improving health care.
A good example is that in 1995, Nifedipine was a very popular blood pressure drug. Looking at our data set, because we had all the pharmacy data and we had the outcome data, we saw what happened to patients on this drug, it was shown that patients on this drug had more heart attacks than patients who weren’t taking this drug. That was published in the Journal of the American Medical Association. Through our integration, we were able to find all those patients in our system and take them off the drug.
Larry Sivitz is the Managing Editor of Seattle24x7.
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