October/November 2014Whatcom Watch4

Whatcom: Chronic & Acute

Robert A. Duke is author of “Waking Up Dying: Caregiving When There Is No Tomorrow,” he lives in Bellingham. His email: boshduke@gmail.com

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by Robert A. Duke

Some famous portals include Al-ice’s rabbit hole to wonderland, the Chronicles of Narnia’s wardrobe, and Star Trek’s many black holes. A patient’s portal is an online door or window into your electronic medi-cal records (EMR). It is where you can look at your medical records and see the same records your doc-tor sees on a computer screen -- a bit of electronic magic.

It is also a direct Internet link between you and your doctor or healthcare team from anywhere in the world. You can send and receive messages and consult about care and treatment all online.

The magic of health portals em-powers the rise of more e-patients to become effective soldiers in the healthcare reform battle.

The term “e-patient” was the

invention of the late Dr. Tom Ferguson, a pioneering physician, author, and researcher who studied and wrote about the “empowered medical consumer,” and about online health resources. In 1993, he organized the world’s first conference devoted to computer systems designed for medical con-sumers. He had a prolific career in consumer-focused medical writing as founder of Medical Self Care magazine.

Ferguson coined the term to describe individuals who are “equipped, enabled, empowered and engaged” in their health and care decisions.

According to WikipediaAn e-patient is a health consumer who participates fully in his/her medical care. Sometimes referred to as an “internet patient,” e-patients see themselves as equal partners with their doctors in the healthcare process. The term encompasses both those who seek guidance for their own ail-ments and the friends and family members (e-caregivers) who go online on their behalf. E-patients report two effects of their health research: better health informa-tion and services, and different (but not always better) relation-ships with their doctors.The “e” can stand for electronic but can also stand for:n Equipped with the skills to

manage their own condition.n Enabled to make choices about

self-care.n Empowered.n Engaged patients who are

engaged in their own care.n Equals in their partnerships

with the various physicians

involved in their care.n Emancipated.n Expert patients who can im-

prove their self-rated health status, cope better with fatigue and other generic features of chronic disease.

This is all available today, here and now in Whatcom County — if you are among the minority of pa-tients (about 25 percent) who have elected to use a portal by signing up for the free service.

Whatcom County patient por-tals include Family Care Net-work’s (FCN) InTouch1 and Peace-Health’s PatientConnection.2 Generally, your connection with your patient portal is through your primary care physician and which system he practices in.

Website www.healthit.gov de-scribes the typical patient portal available throughout U.S. health-care today:

A patient portal is a secure on-line website that gives patients convenient 24-hour access to personal health information from anywhere with an Internet con-nection. Using a secure username and password, patients can view health information such as:n Recent doctor visitsn Discharge summariesn Medicationsn Immunizationsn Allergiesn Lab results

Some patient portals also allow patients to:

n Exchange secure e-mail with their healthcare teams

n Request prescription refillsn Schedule non-urgent appoint-

mentsn Check benefits and coveragen Update contact informationn Make paymentsn Download and complete

formsn View educational material

EMRs, the foundation for portals, have been seen for some time as the means for modernizing and reforming healthcare and for pro-viding better care at a lower cost.

For example, Executive Inside advanceweb.com says:

The premise of the health infor-mation technology (IT) adop-tion programs funded by the US government is that health IT is a key enabler to bending the cost curve. The focus for the past several years has been on helping providers migrate from paper to electronic health records. This year (2014), the focus has shifted from Meaningful Use Phase One to the next level of requirements in Phase Two. In this second phase, providers are being asked not just to document the care they give in an electronic health record but also to begin sharing that information with others. In the first instance, the sharing has been between providers to ensure proper handoffs in the care deliv-ery process, for example, between

CMS Center for Medicare and Medicaid Services EP Eligible Professionals EHR Electronic Health Records EMR Electronic Medical Records FCN Family Care Network IT Information Technology KLAS Kent Gale, Leonard Black, Adam Gale and Scott Holbrook

founders

Acronyms

Patient Portal: A Magic Gateway to Healthcare Reform

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Log in is the page that results from an Internet search for InTouch or Family Care Network portal. The name presented in this screenshot is fictitious and for demonstration purposes only.

Courtesy of Family Care Network

Nooksack Salm-on Enhancement

Association

Community Work PartiesJoin the fall work parties and help restore streamside habitat for salmon. Tools and gloves will be provided — just wear sturdy shoes, long pants and weather appropriate clothing. Check in at the blue NSEA tent. Volunteers do not need to sign up with NSEA before a work party.

Questions?Email volunteer@n-sea.org or call 715-0283 X 112

October 18 - Whatcom Creek9:00 am – NoonBellingham Parks and the Nooksack Salmon Enhance-ment Association (NSEA) are back to Maritime to get this hillside under control! We’ll keep working at removing in-vasive ivy and planting native plants on the hillside above the hatchery. Park in the lot at the end of C Street, accessed from Holly Street.

Meeting at: Maritime Heri-tage Park, 500 W Holly St,Bellingham

October 25 (Make a Difference Day!)Schell Creek/Marsh9:00 am - NoonBe a part of Make a Difference Day and help plant native trees along the Schell Creek/Marsh to improve salmon habitat. From Bellingham, head North on I-5 and take exit #262 to W. Axton Rd./Main St. in Fern-dale. Continue on Main St., then take a left onto 1st Ave and take the 3rd left onto Cherry St. and look for the NSEA signs. Parking is avail-able at the Ferndale library.

Meeting at: Ferndale Li-brary, 2007 Cherry St., Fern-dale

November 1Squalicum Creek9:00 am – NoonJoin NSEA and Woodway Se-nior Living for a day of native tree planting, mulching and invasive plant removal along

October/November 2014 Whatcom Watch 5

general practitioners and special-ists. For this, standards have been developed as to what constitutes a useful summary of the patient’s care to the point of transfer, in-cluding the standardized medical summary and the standardized means to share it electronically.

Physician’s Practice.com says: Ninety percent of patients report wanting access to their health information online.

But according to the ihealthbeat.org website, KLAS Research of Orem, UT, found that (only slightly) more than half of sur-veyed hospitals, health systems and clinics had patient portals of some kind:

(Given) that a fi fth of physicians (typically) have access to these patient portals, this would mean that of the 550,000 eligible pro-fessionals (EPs) who can apply for government EHR incentives, roughly 100,000 physicians have portals today. Through the end of 2012, about 350,000 EPs — most of them doctors — had registered for the “meaningful use” incentive program, accord-ing to Centers for Medicare and Medicaid Services (CMS); about half of those eligible professionals had received incentive payments. If most of the EPs who have registered make it to Stage 2 of meaningful use, the number of doctors who have patient portals could triple in the next couple of years.

Other factors also will contribute to the spread of such portals, ac-cording to Graham Brown, vice president for clinical integration at The Camden Group, a health care consulting fi rm.

“For one thing, the primary care workforce is aging,” Brown said, “and as more older doctors retire and younger doctors replace them, they’re more technically adept, more eager and willing to rely on technology to facilitate their practices.

“The (consultants) concluded that the portal features regarded as the most important are:

n Connectivity with their care teams;

n The ability to view key compo-nents of their medical records and conduct clinical transac-tions online; and

n The ability to obtain informa-tion that helps them make better health decisions.”

Stage 1 of portal development occurred from 2011 to 2013, and Stage 2 is schedule to begin now, in 2014. PeaceHealth’s and FCN’s portals differ from each other as do all other portals vary from one another though in the same stage of development. For details, see

www.cms.gov/regulations-and-guidance tips sheet.

For PeaceHealth and FCN pa-tients, I recommend that you ask your provider for a demonstration and guided tour of the portal to be provided to you. The only portal you can obtain is the portal offered to you by your healthcare provider at whatever stage of development it has reached when you sign up for it.

Portal improvements are con-tinual and generally transparent to the user, but there is little support and it consists mainly of good intentions. I am a patient at FCN and signed up for InTouch in May 2012 when it was first offered. I’ve been told repeatedly that portal support was available from the practice offi ce where I receive treatment, but none has been available there as recently as the preparation of this article in August 2014. In the beginning I had to call InTouch IT directly.

In Whatcom County, Brian Ecker, FCN’s Director of Opera-tions said, “Since May 2012, FCN has signed up 23,000 patients or about 19 percent of our patients on our InTouch patient portal. Our goal is 25 percent of our 120,000 patients.”

Somewhat surprisingly, given the supposed resistance of older patients to computers and online and mobile information tech-nology, Ecker reported that the majority of InTouch patients are Medicare patients, age 65–75 years old.

“They are the highest utilizers of the system, probably because they are traveling and this pro-vides easy access,” he said. “As for patients opposed to or critical of the system, there are few and we’ve found no age pattern to criticism.

“How patients connect with us varies, it depends on the physi-cian,” he added. “The portal is fl exible. Some FCN physicians get your messages and input directly and deal with it directly; others prefer to have portal input go to what is called a share desk. A share desk is a workstation where a computer and other things are shared by your care team. That’s a team of providers whom you know

and who know you, who work as a team with your physician.”

PeaceHealth’s PatientConnec-tion portal is an EMR IT prod-uct called MyChart2 from Epic Systems Corporation, a privately held healthcare software company headquartered in Verona, Wis-consin. Epic makes software for mid-size and large medical groups, hospitals and integrated healthcare organizations.

Little information is available about PatientConnection at Peace-Health in Whatcom County be-cause, according to Amy Cloud, Sr. Public Relations and Market-ing Coordinator for St. Joseph Medical Center, no local support is available for PatientConnection in Whatcom County. All support and management for PatientCon-nection is based at PeaceHealth in Vancouver, WA. Cloud was unable to arrange an interview from of-fi cials in Vancouver in response to a written request in time for this article.

However, on my own, I was able to obtain a demonstration of the PatientConnection portal in order to compare it to FCN’s InTouch portal from a patient’s perspective.

Readers take note: that com-parison is only a lay evaluation as subjective as any patient’s is likely to be. I looked at the two portals with other patients, and we com-pared our opinions and discussed our fi ndings.

To repeat, all portals are differ-ent from each other according to how they were designed, devel-oped and implemented. All portals are required to provide the same basic functions as listed above. All portals are in varying stages of implementation, maintenance and modification. Comparing InTouch and PatientConnection is a superfi cial evaluation intended to prepare the reader for what he or she might encounter as a health-care patient in Whatcom County.

InTouchFCN’s patient portal is InTouch. I am an FCN patient and have used InTouch since May 2012. By any standard, it is basic, graphically plain and functionally rudimenta-ry. It calls itself a “bulletin board,”

and it reminds me of early Internet bulletin boards of the mid-1990s, precursors to today’s websites. This is a benchmark, not a fl aw.

This plain and simple design makes it easy to use and under-stand the portal’s information. Key information does not get lost in a page dense with graphics and generic information. Rather than trying to get everything onto one page, InTouch provides rationed amounts of information on many separate and unembellished pages.

On my home page, there are 11 tabs, like fi le folder tabs, across the top. The page is small, about half of an 8 1/2 x 11 printed page. Tabs and banners are blue, text and data are black and white. You open tabs according to what information you want to display. Some pages are subdivided into additional categories, which I fi nd easy to read and reference. Where there is a lot of information, it is usu-ally in the form of long columnar lists, such as medication lists, lab results or payment history. There are no dense paragraphs of small or voluminous text.

Like most portals, InTouch is not fully implemented and no date is set for full implementation. It is not fully functional. Some tabs are blank and there is no description of what will appear there when fully implemented. Missing are: My Online Forms, My Agree-ments, Clinical Documents and Medical Documents. Empty tabs give the impression that my portal may be missing information, but I have no way of knowing. Other patients viewing my portal with me agreed, and we would rather these tabs were eliminated.

FCN’s Brian Ecker does not know what might appear in these tabs when fully implemented, nor could he be certain that nothing might be missing.

“FCN’s portal software is a shared product (used by others) and FCN has no control over its content or development. I don’t believe we are using these tabs at this time,” Ecker said.

When I asked about Payment History under the Billing tab, he explained that the way InTouch is set up, the portal can only pro-vide a history of payments made through the portal. Payments by any other means are not viewable.

During our interview, I told him that, as a patient, I wanted to add items to my portal, in particular my HIPAA release form, Physi-cian Order for Life Sustaining Treatment (POLST) form and healthcare directive to be available on my portal. Ecker again cited the fact that the portal software is shared and not under FCN’s control. Implementation, he said, is a staged process and timing of changes and improvements is out of FCN’s hands.

“Presently all patient changes or additions must be submitted to FCN, through the portal or in person, to be posted to the portal,” he said.

PatientConnection

Endnotes1. InTouch was a registered trademark of Family Care Network for an in-house developed patient

portal that was replaced with the current system, which was purchased from an independent EMR developer. The InTouch name was preserved even though the original product was abandoned.

2. MyChart is a registered trademark licensed from Epic Systems Corporation.

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Courtesy of Family Care Network

Home is the page the patient sees after logging into InTouch.

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Home is the page the patient sees after the log in page.

October/November 2014Whatcom Watch6

Peace Arch Hosts Climate Change Rally

25 year herstory in Bellingham

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The rally was created in soli-darity with the massive People’s Climate March in New York City on Sunday, which drew 400,000 people, and was part of the Four Days of Action campaign aimed at protecting the Salish Sea. This campaign, organized and led by the Nawtsamaat Alliance, which plans to mobilize local citizens to help stop the large increase in fossil fuel projects in the Pacific Northwest and increase awareness of the risks and threats to the Salish Sea. Among them are the proposed Kinder Morgan Trans Mountain Pipeline expansion in British Columbia, the proposed export expansion at Cherry Point, the ris-ing number of oil trains, coal trains and tankers, said Jared Howe, an organizer for 350 Seattle.

In the Pacific Northwest, there are currently active proposals for five new coal terminals, three new oil pipelines, as well as six new natural gas pipelines. Together, these projects are capable of ship-ping an enormous amount of fossil fuels, which when burned would release 761 million metric tons of carbon dioxide into the atmosphere each year. This would be twelve times the amount of carbon dioxide emissions that Canada as a country currently emits each year, or 76 coal-fired power plants.

The occasion also marked the official launch of the Pledge to Save the Salish Sea, a campaign that calls on pledgers to act at criti-cal moments to stop key projects

and push for climate leadership in the region, organize cross-border delegations to speak to politicians and other decision makers and help organize future rallies.

Participants ended the rally in a ceremony of commitment to protect the Salish Sea by joining hands across the border.

“I think there needs to be some-thing done,” Mr. Ciprianio said. “I’m concerned for my daughter, so I’m marching for her. When she’s grown, I want to be able to tell her I did something about it.”

The event was co-sponsored by 350 Bellingham, the Nawtsamaat Alliance, Washington Environ-mental Council, Backbone Cam-paign, PIPE UP Network, Sierra

Club BC, LeadNow, Climate So-lutions, Faith Action Network,

Friends of the Earth, Sierra Club, and Greenpeace.

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PeaceHealth’s portal is PatientCon-nection. I am not a PeaceHealth primary care patient and so I do not have a PatientConnection portal I can access. (But because I have been a St. Joseph hospital patient and once had primary care at Madrona Medical Group, which was taken over by PeaceHealth, I think I am entitled to portal ac-cess to my PeaceHealth medical information.)

Thanks to concerned patients, I was treated to a demonstration of PatientConnection for purposes of this article. I saw a sample of all portal pages and discussed the contents of each page with the patient whose page I was viewing. With my own portal open on a laptop at the same time, we com-pared the two, side-by-side and page-by-page.

The PatientConnection portal is more elaborate than the InTouch portal, but each in its own way does the same job, as intended. Without ongoing access to Patient-Connection I cannot comment as thoroughly about it as I did about InTouch. My physical description of PatientConnection is necessarily restricted to the appearance of one page, “Appointment Details.”

The Appointment Details page is dense with information and graph-ics. It consists of four columns of text data and 19 rows of text and numerical information. Much of the information is general con-tent and formatting, which make finding and reading the pertinent information (the results of the ap-pointment) difficult. My patient-guide commented that with so much data displayed, he/she felt obligated to scan the document closely to avoid overlooking new information.

It wasn’t obvious how fully developed and implemented the PatientConnection portal is, but given the phased development of portals through Stages 1 and 2, and that Stage 2 is just beginning (see CMS information above) it is unlikely that PatientConnection has achieve its ultimate form.

Of particular interest was the availability of analytic tools for manipulating the wealth of data supplied by the portal. PeaceHealth patients can use their portals to examine test data and lab results according to their own criteria by changing the scale of graphs, expanding or contracting time frames and comparing measure-ments against different standards.

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Patients can ask and answer their own questions. They can mine their data for more information than standard test results offer.

We all agreed that both portals offered similar information but packaged it much differently. One was not substantially better or worse than the other. Having any

portal was a great advancement. We agreed that these are not for every patient, but for those who want to be fully informed and involved in their care and treat-ment, the portal is a breakthrough in creating the e-patient.

Patient Portal: A Magic Gateway to Healthcare Reform

Prescriptions is typical of the medical records information accessible to the patient at the InTouch portal. The name and medication presented in this screenshot is fictitious and for demonstration purposes only.

Courtesy of Family Care Network

Squalicum Creek. Parking is available at Cornwall Park off of Meridian St. Look for NSEA signs and shuttle.

Meeting at: Cornwall Park, 3424 Meridian St., Belling-ham

November 8Canyon Creek9:00 am – NoonCome out and help NSEA, Whatcom Land Trust, What-com Conservation District and Whatcom Public Works improve salmon habitat by planting native trees and shrubs at this incredible site! From Bellingham head east on WA-542 E/Mt Baker Hwy past the town of Maple Falls. Turn left on Glacier Springs Drive and look for the NSEA signs.

Meeting at: Canyon View Dr., Deming

November 15Little Squalicum Creek9:00 am – NoonJoin NSEA and Bellingham Parks in restoring this section of Squalicum Creek. We will plant native trees, remove inva-sive weeds, and spread mulch. Park in the lower Bellingham Technical College parking lot and follow the NSEA signs.

Meeting at: Bellingham Technical College, 3028 Lind-bergh Ave, Bellingham

November 22Landingstrip Creek9:00 am – NoonHelp NSEA and the Whatcom Land Trust as we work to plant native trees and shrubs along the banks of a South Fork Nooksack River tribu-tary stream located in Acme. From Bellingham, head east on WA-542 E/Mt Baker Hwy for about 15 miles, then turn right onto Hwy 9 just outside of Deming. Drive along this road for about 7 miles then turn right on Turkington Rd. Parking is available at Acme Elementary School. Look for the NSEA signs and shuttle.

Meeting at: Acme Elemen-tary School, 5200 Turkington Rd., Acme

December 6Padden Creek9:00 am – Noon We’ll be working in the park-land between Connelly Creek & Padden Creek tackling blackberry, planting and mulching. Park on the west end of the Whatcom Farm-ers Co-op and walk north on 30th, head west on Cowgill Avenue to the trail entrance. Watch for signs. Please do not park in the neighborhood where parking is limited.

Meeting at: Whatcom Farmers Co-op, 3125 Old Fairhaven Parkway, Belling-ham

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photo: Dena Jensen

Over 700 people from Canada and the U.S. spread out on the Peace Arch Park lawn on September 20th, while speakers were met with cheers and applause as they called for unprecedented unity for the well-being of the Salish Sea.