AARP Bulletin - April 2009

monitor their own progress, schedule appointments and e-mail their doctors—and can do so from anywhere.

Hariteeny Fritz, 79, a retired banker from Bloomsburg, recalls the time she was in Bar Harbor, Maine, and developed double vision. Taken to a clinic there, she told the staff to use her password so they could access her entire medical record online. “There was this kind of disbelief,” she says. “But it saved them a good deal of time.”

Patients don’t see everything in their records that the doctor does. “One of the things we don’t share is physician’s notes,” e-health manager Jodi Norman says. Lab test results are posted quickly, but must be released by the doctor first. Sensitive results, such as HIV tests or just bad news, are withheld so that the doctor can discuss them in person with the patient.

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at Geisinger. “If you brought
your car in, told them to re-
build the transmission and a
week later the reverse gear
was slipping, you’d demand
they fix it because you paid
them good money to fix it
the first time.”
In 2006 Geisinger em-
barked on a bold gamble
to improve the situation.
Starting with elective cor-
onary bypass surgery, Ca-
sale and others drew up a
40-point checklist of best
surgical practices devel-
oped by the American Col-
lege of Cardiology and the
American Heart Associa-
tion. Each point on the list
has to be checked off before
a procedure begins, or it’s
canceled. Then Geisinger offered insur-
ers what is in effect a warranty: Pay a flat
price for each operation, and any further
treatment arising from complications that
put the patient back in the hospital within
90 days is free.

This system has so far succeeded in lowering the readmission rate by 44 percent and raised net hospital revenue by 7. 8 percent.

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E-records Ron Paulus, M.D. (top), helped design Geisinger’s medical records system. Patient Hariteeny Fritz made use of her own records during a medical emergency far from home.

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; Alpha Sudoku

ALPHA SUDOKU BY FRANK STOLZENBERG

Sudoku is a test of logic and patience, even with letters instead of numbers. Fill in the grid so that the letters B, D, E, I, L, Q, S, T and U appear only once in each row, column and 3x3 mini-box. The solution reveals a 9-letter phrase.

Patient involvement

“Where costs can really come down is in more engaged patients doing more preventive care for themselves,” says Paulus. But lifestyle changes—like losing weight—are a tall order for many.

Yet with help from the medical home staff, patients can learn the value of their own efforts—quite often with the subtle prod of seeing a cool graphic in their e-health record showing their progress.

In another innovation, patients facing hip and knee replacement surgery are offered a two-hour class in which the whole team—surgeon, anesthetist, pharmacist, physical therapist and social worker— demonstrate what’s in store and how they can improve the outcome.

Registered nurse Linda McGrail, who organizes the classes, says patients who take them are often ready to leave the hospital earlier and are less likely to be readmitted. That’s because individually tailored plans for coping after patients leave the hospital, and the exercises they’ve begun even before surgery, make them “more confident and better able to bounce back.” ;

; Parallel Thinking

Link the items in the group below, alternating between numbers and words. Each category should be in increasing numerical or alphabetical order. This exercise tests mental flexibility, concentration and visual acuity.

Electronic health records A vast room
filled with black consoles humming away
is the hub of Geisinger’s electronic record
system in Danville. Paulus says it allows
“every one of our 750 doctors, whether
they’re spread across 20,000 square miles
or right down the hall from one another,
to use the same health record with all the
information about a patient available at
the click of a mouse.”
Many patients are sold on it, too. About
119,000 have so far signed up to access
their own records through personal por-
tals. They track their medical test results,