Team Name: Medgate
Date of Interview: Sept 18, 2016 Conducted By: Samantha Interviewee: Jen Late 40’s, Financial Analyst, same insurance for 15 years. Why/how we interviewed this person: In person, casual setting at her home. I wanted a consumer view of the ease of transfer with medical history forms and what she would change What hypothesis did we test? People want to have control over their medical information. We really wanted to learn about this: I wanted to talk to a consumer to get an idea as to whether collecting her own medical history would be important /useful to her. She has had Blue Cross for over 15 years, PPO. She reported no online portal to look up her medical information; “At least if there is, I don’t know about it.” We learned from the interview: She had to change her OBGYN after 15 years because the MD retired. The doctor supplied a list of recommended MDs to transfer her care to. When the time came, she found it to be seamless because the clinic was able to transfer all of her old history to the new MD. She doesn’t think it would have been as easy if she chose an MD not on the list. Even though the MD had the information, she didn’t feel they read it. “I felt like I was starting all over when I met this MD even though they had this information.” We also discussed having easy access to blood type, allergies, medications (possible negative reactions to other meds) –she suggested swiping a bar code on your phone in emergency situations which I thought was a good idea. “I would like to have my information in a cloud that is accessible to an MD and myself and have the power to opt in any providers to have a centralized location where everything went. I would want to be able to dictate how the info was accessed or shared-grant in and out permission and have a record of who is looking at what, and would want to know it is secure. I would also want privacy from insurance companies who may try to use my medical history against me. “ We were surprised by: I asked her what she would do if she had a medical emergency and how she would access records. She hadn’t thought of it and reported she has an allergy to penicillin, but a practitioner outside her network wouldn’t know this if she was in an emergency situation/unconscious which could be detrimental to her health. Other interesting outcomes; what did you learn about interviewing It surprised me that people don’t think about their health when traveling out of state or abroad. If there was an emergency situation, the practitioner would know nothing about her history, allergies or medication. This interview was less concise but I felt there was good storytelling which painted an interesting view.
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Team Name: Medgate
Date of Interview: Sept 14, 2016 Conducted By: Samantha Interviewee: Steve Background: Mid to Late 30’s, Chief Resident in Orthopedics and has practice in both private and public sectors Why/how we interviewed this person: Face to face in clinic. I wanted a surgeon’s view of how difficult/easy it is to retrieve medical information about the patient when needed. What hypothesis did we test? Hypothesize that it is difficult to retrieve the patient’s medical information especially if they have changed hospital systems. We really wanted to learn about this: What systems does he use currently in the different hospital systems? What does he like/dislike about these systems? We learned from the interview: For the first time, I learned about Care Everywhere. This is a system he is able to use through the UCSF system that links information from outside hospital systems. He said, “if the patient was previously a Kaiser patient and is now at UCSF, I can see the Kaiser records through the Care Everywhere Portal. This is a big game changer. At ZSFGH, I am currently using EClinical Works which is awful. It is not intuitive, and it is difficult and time consuming to find the information I need about the patient including MRI/XRAY results, current updated medication and past history of surgeries.” We were surprised by: Care Everywhere. I did not know this existed, and solves a big problem of different hospital systems now being able to connect with each other. This will improve information transfer reliability and ultimately help the patient’s care. Other interesting outcomes; what did you learn about interviewing I was surprised that he disliked E-clinical Works so much, but the ZSFGH system is going to change to EPIC which he said is more intuitive, efficient and will hopefully allow for Care Everywhere at this hospital system in the future. Team Name: Medgate
Date of Interview: Sept 13, 2016 Conducted By: Samantha Interviewee: Itoro Background: 25-30 year old Healthcare Practitioner (Physical Therapist) who has worked in both the private and public sectors for 7 years. Why/how we interviewed this person: Conducted in person at work during break. I wanted to gain insight into a medical practitioner’s view of information exchange when receiving a patient’s medical history. What hypothesis did we test? Testing hypothesis that people tend to report a less reliable medical history than they realize. I.E. leaving out a history of surgeries, important medications, etc. We really wanted to learn about this: Do practitioners feel they are getting consistent, reliable medical histories from their patients? How can we improve this process? We learned from the interview: This clinician sees new patients daily, and consistently sees discrepancies between the patients’ actual medical history (in past computer records) and reported medical history, which inhibits proper care at times. “If a patient has changed MDs, it is difficult to get that information. The patient has to sign a release form, and either directly request those forms and bring them to our next appointment, or I have to contact the previous provider to discuss the patient’s history and receive past records. This is time consuming and inefficient on the practitioner and patients sides.” We were surprised by: The fact that this clinician still uses paper charting, where the hospital scans the documents and uploads them onto the EMR system. The patient is unable to access their records online within this system unlike UCSF MyChart and other online portals. Other interesting outcomes; what did you learn about interviewing This clinician had a good idea about keeping an online PMH form very concise-a snapshot view of the pertinent medical history, medication and surgeries. If the clinician wanted more information, they can click on that link and see more specific, detailed information as needed. Interviewer: Megan Miller
Interviewee: Maggie Miller, Elementary School Teacher in CA Date: 9/20/16 Why/how? Maggie, my mom, is a second grade teacher in Southern CA. She has been teaching young children in public schools for over 30 years. I conducted this interview over the phone. What hypothesis? Because she is integrated in many aspects of her young students lives and herself is very involved with her health, I thought she would be a good resource of information for our project. What I wanted to learn? What is the school nurse's role in the children's health? What kind of records do they keep? How to they relay that information to the teachers who are with the kids for a majority of the day? What did I learn? Each student (@ the public school) needs to report their immunization records. She was unsure how the records were kept at the school, but is going to ask the nurse today. In addition, each teacher gets a print out at the begining to the school year of the kigs who have allergies and/or speical medical issues. She keeps the paper on her desk so she can refer to it if needed. Surprises? As a HMO subscriber, Maggie has had the ability to view her records in a consolidated location for many years now using Follow My Health (https://www.followmyhealth.com/Login/Home/Index?authproviders=0&returnArea=PatientAccess#/default and https://itunes.apple.com/us/app/followmyhealth-mobile/id502147249?mt=8) - another competitor. The app/service shows results, vitals, plots charts, etc. But this is only available for her years under HMO. What about all the previous records? She would like to see that as well. I think this tells us 2 things: PPO clients would find our product more useful as HMO patients already have trusted resources, but these HMO patients would still like more out of their service. Other interesting outcomes? In addition to talking about the school procedure, she had a lot to say about her own medical experience. I think this points to the fact that this is a passionate subject: some people really care about their health, tracking it, etc. and others do not. It's not a universal interest. Also, she brought up another good point -- "What about other countries that provide health care for all their citizens? What kind of records do you think they have?" Interesting to think about the global implications. Interviewer: Christine Jiang
Interviewee: Nina, previously Nurse in long-term care, OR, Critical Care Unit, and Endoscopy. Currently Clinical Application Analyst at Sutter Health Date: 9/20/16 Why? Nina was previously a nurse that interacted directly with patients. She is now a Clinical Application Analyst working more in analytics and systems. What hypothesis? Nurses utilize the information that's provided to them and fill in the blanks of what's missing with the patient during intake. Future interactions with the patient would no longer require a whole intake process. What did you learn? When a patient arrives, they are required to do their own assessment event if the patient came with all of their most current papers. Once the patient is in the system, future updates are required but not whole assessments. What would be helpful is if they had a copy of their procedure and past record of their past surgical procedures or record of family medical history. Information helps them assess a symptom that they're coming in for. This may help providers pinpoint why they're feeling a certain way. Are the issues due to surgery complications? Blood work and recent labs are helpful. Also if they have medication brought in in person. Usually they take too many or too little and the timing when they take it is wrong. At times the medication is expired and they should have stopped taking it but if the pharmacy kept filling it, they would keep taking it. Additionally, some barriers to fully proper treatment surfaces if they are rushed or if there are barriers to communication with the patient, the information collected is incomplete. Surprises? Budgets play a large role in how robust of a system a hospital purchases. Some hospitals will go with free EMRs because, they're free! If a hospital does purchases an EMR, they have to decide which version to purchase as the basis and then ensure that they have funds to perform the right maintenance and updates. If the purchase the most basic level, they are often times constantly trying to keep up with the updates and/or end up purchasing an outdated update. Other interesting outcomes? Learn anything about interviewing? When a hospital goes electronic, it doesn't necessarily mean the whole hospital is suddenly electronic. There are certain departments that remain using paper charts. Usually the Operating Room remains on paper because of the fast-paced environment and the need for records to be 100% available at all times. They can't afford to have a system go down during an operation. Interviewer: Christine Jiang
Interviewee: Danessa, Nurse and Pharmacist Date: 9/20/16 Why? Danessa is a part time nurse and pharmacist. She has various experiences in the medical field within the US as well as abroad and with the VA. What hypothesis? Pharmacists and general practitioners have different needs in an EMR system. They may utilize different information and provide different types of care to a patient. What did you learn? Healthcare providers don't expect patients to know a lot. Ideally, they would know what symptoms are having but providers would rather patients worry about the socioeconomic environment and leave the medical treatments to them. With the internet today, patients try to self diagnose prior to seeing a practitioner and it could be problematic if they are unwilling to trust in their healthcare team. She finds that 70% of the information that patients provide or arrive with is reliable but the other 30% needs to be obtained or vetted with family, etc. It depends on the stat in which the patient arrived. For example, if they have a mental illness, are unconscious, or have a language barrier, there are issues with obtaining additional information from them. Additionally, the past and future environment or socioeconomic environment of a patient can impact the care that's provided. For example, "information from before hospital entry and after hospital exit would be helpful. What environment do they live in? Do they live alone? Do they have transportation? Can they walk? Can they take care of themselves? If we have the past and subsequent follow up of future state of a patient, it would help us provide better care or prescribe better treatment plans." Surprises? It appears that different hospitals using the same brand in EMR can't transfer information easily. For example, Sutter Health may be using one version of the EPIC system with the bare minimum requirements needed by the hospital and Kaiser may be using the most advance version. Even though they are both EPIC, Sutter will not be able to electronically transfer the data to Kaiser, and vice versa. They would have to print the medical records and the receiving institution would have to scan in the papers. This makes the records essentially unsearchable. Additionally, the EMRs have a lot of capabilities that are being underutilized. The training on the systems and understanding of its capabilities are not sufficient. Other interesting outcomes? Learn anything about interviewing? The most interesting thing I found out was that Taiwan is already on a similar model where the entire country is on 1 EMR system. However, I'm not sure of it's capabilities in bringing in information from out of country institutions. Is it paper scans like other hospital record transfers? Interviewer: Christine Jiang
Interviewee: Jerry @ Kaiser, Redwood City Date: 9/19/16 Why? Jerry is a surgeon in the Kaiser system and has done internships/residencies in Southern California. He is a user of the output and provider of the input to medical records. What hypothesis? Surgeons need a quick way to document their procedures in the OR and aren't keen on the bells and whistles of an EMR. They would probably only care about a system that can help them document and archive. What did you learn? The Kaiser medical record keeping system is very robust. 99.9% of Jerry's patients are within the Kaiser system and he receives most, if not all the necessary patient information when they reach him. By the time he meets the patient, he has already been able to review their entire history and imaging through the Kaiser system. Surprises? Within Kaiser's EMR, practitioners can search for a specific term and the system (EPIC) can pull up all instances of the specific term and related terms. For example, "Charts are hundreds of pages long but with EMRs they can search for singular words, etc. (i.e. if they type in colonoscopy, it will find all occurrences and similar related issues that the patient had)." Other interesting outcomes? Learn anything about interviewing? It appears that practitioners within the Kaiser system have different experiences. Kim was also a practitioner at Kaiser but didn't feel the system was as user friendly. However, both agreed that when there's system maintenance or if the system goes down, they are out of luck. They're unable to pull records and have to rely on paper charts to document their current assessments, and who knows where those end up! Team Name - Medical Gatekeeper
Interviewer - Abhijeeth Linganagari Interviewee - Ashvitha Kamatala Engineer at Wipro Date of Interview - 09/20/2016 Why/how we interviewed this person? Ashvitha fits our customer profile of someone who has switched insurances and health care providers depending on the service quality, proximity to home and costs as his family has grown over the past decade. (Phone Interview) What hypothesis did we test? With a growing family, we often see changes made to health care providers to suit the family’s needs. They constantly face challenges with accessing and transferring medical records across health care providers. We really wanted to learn about this: The pitfalls in accessing, transferring and keeping track of the family’s medical records. How important is access to medical records for a growing family ? We learned from this interview: Most of the health care providers had online access to records while the patient was working with them. As long as the family was healthy and had no major issues, they do not see it as important to keep personal records of their medical history. They believe that they will have relatively easy access to it as and when they need it. Families with little children usually like to have all their medical records in the same place, making it easy for the parents to track. We were surprised by: It was surprising to know that even for Ashvitha the kids immunization records were the most important medical records and they maintained it with a yellow card. Other interesting outcomes; what did you learn about interviewing “I have switched multiple doctors within the same health care provider and sometimes across healthcare providers but in general never accessed my records unless the results from tests had a red flag pointed out by the doctors office”. They usually feel confident with the doctor having access to their information and trust their medical judgements. Team Name - Medical Gatekeeper
Interviewer - Abhijeeth Linganagari Interviewee - Jason Zhang Sr Technical Lead Engineer, Cisco Date of Interview - 09/19/2016 Why/how we interviewed this person? Jason has been living in the bay area for over 2 decades. He has remained with a single service provider (kaiser) for about 20yrs and only recently moved to another insurance provider for his daughter after she moved to east coast for college. He fits our customer profile of someone who hasn’t made too many changes to his health care provider so that he can maintain all his records in one place.(In Person Interview) What hypothesis did we test? It may not be really beneficial for customers who may change doctors but remain within a single service provider to have access to medical records online. We really wanted to learn about this: How often do folks look up their past medical records and track their progress regularly ? Will having access via apps be beneficial for older patients ? We learned from this interview: It reconfirmed our opinion that patients who are relatively healthy and fit do not access their records more than once or twice a year, which is usually around the time of their physical exam. Although Jason liked the idea of having continuous access to his medical records he felt more comfortable with having personal control over his medical records rather than having it in the cloud. We were surprised by: It was surprising to notice that even though Jason is technically savvy, he would prefer to not have his records in the cloud and has no preference to having access via mobile apps etc;. Team Name - Medical Gatekeeper
Interviewer - Abhijeeth Linganagari Interviewee - Arvind Sharma Technical Lead Engineer, Cisco Date of Interview - 09/19/2016 Why/how we interviewed this person? Arvind fits our customer profile who has switched insurances and health care providers depending on the service quality, proximity to home and costs as his family has grown over the past decade. (In Person Interview) What hypothesis did we test? With a growing family, we often see changes made to health care providers to suit the family’s needs. They constantly face challenges with accessing and transferring medical records across health care providers. We really wanted to learn about this: The pitfalls in accessing, transferring and keeping track of the family’s medical records. How important is access to medical records for a growing family ? We learned from this interview: Most of the health care providers had online access to records while the patient was working with them. As long as the family was healthy and had no major issues, they do not see it as important to keep personal records of their medical history. They believe that they will have relatively easy access to it as and when they need it. Families with little children usually like to have all their medical records in the same place, making it easy for the parents to track. We were surprised by: It was surprising to know that outside of the immunization records and other shots information of the kids, Arvind did not feel other medical information was that useful, that they needed to keep personal records. Other interesting outcomes; what did you learn about interviewing: It was interesting to know that customers aren’t aware their medical records are not stored forever by previous health care providers. “Ohh I was under the impression that I can collect my medical records as and when I needed them. I did not know that they will be lost after certain period of time from my last date with the health care provider.” |
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