TEPR+ update: Oregon clinic showcases the advantages of patient-centered care

PALM SPRINGS, CA – In Jill Arena's opinion, medical offices can sometimes get too ... medical.

Arena, COO of Greenfield Health in Portland, Ore., sees the nine-physician, two-office practice as an example of patient-centered healthcare. Founded in 2000, the practice is designed - both physically and operationally - with the patient experience in mind.

"What do we think patients really want?" asked Arena. "How do patients experience the physician's office? We need to take apart how we think we're doing business."

Arena was a featured speaker at this past week's Towards the Electronic Patient Record (TEPR+) conference and show in Palm Springs, Calif. The conference, presented by the Boston-based Medical Records Institute, attracted roughly 750 attendees and focused on, among other things, the emerging concept of "participatory medicine."

Arena sees Greenfield Health as a beta test of that concept. The practice, she said, was designed so that the patient can walk right in and see a physician or staff member without having to waste time in a waiting room.

"It's similar to what happens when somebody comes into your home," she said. "It's a lot less clinical. We tend to 'overmedicalize' the experience" of visiting a doctor's office.

Beyond the makeup of the physician's office, Arena said Greenfield Health makes every effort to involve the patient in all aspects of his or her healthcare. The practice has hundreds of thousands of dollars invested in information technology services that connect physicians with patients through electronic medical records, e-mail and phone systems and other services. Among the vendors involved in the 22 "moving parts" of the practice's IT system are GE Healthcare (whose Centricity platform is used) and Kryptiq, which is based in nearby Hillsboro and has been associated with the practice since its inception.

Arena said the practice has been giving patients their personal health records (PHRs) in three-ring binders "because it's their information." They've now developed an electronic PHR, moving those records this past June to Microsoft's HealthVault platform.

In terms of communications, Greenfield Health has set up its telephone system so that if an incoming call isn't picked up by the third ring, every phone in the office rings ("then it's all hands on deck," Arena says). In addition, the practice allows its patients access to the physicians' e-mail addresses.

"We've found that, after eight years (of e-mail contact between patient and physician), the relationships are richer," she said. "People will say more in an e-mail than they might say in person or over the telephone."

Arena said Greenfield Health charges a retainer fee of between $250 and $650 a year for its patients, and makes sure to limit the number of patients each physician sees to ensure that neither the patient nor the provider feels overwhelmed or ignored. This setup, she says, amounts to a roughly 20 percent decrease in the average annual cost of healthcare.

All in all, Arena says, the use of healthcare IT, ranging from EMRs to e-mail, allows about 80 percent of a patient's healthcare needs to be met electronically. That said, there is a concern that a patient might try to have all of his or her healthcare needs handled without ever stepping foot in the doctor's office.

"We have to be mindful of that and say, 'You have to get your body in here,'" Arena said.