The document describes the services of Jeffrey Harris and Untangled Healthcare, which assists communities in monitoring and improving healthcare. It provides Harris' contact information and outlines a syllabus for a patient advocacy training series. The series will cover levels of patient support based on needs, the advocates process, and a real case study from 2011 involving a woman with multiple medical and social issues. It describes using a patient advocate to conduct a full assessment, assist with insurance, primary care, and identifying community resources to create a comprehensive care plan.
Objective: baby sit and object for 3 months photographing it every week. Find a story for it to tell and make it into a booklet. Was great fun. Special thanks to Heather Burns for photography.
James Caringi, PhD Presentation at 2016 Science of HOPE
Description:
Secondary Traumatic Stress (STS) is defined as, “the natural and consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other, the stress resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995). Professionals and caregivers frequently work with individuals, families, groups, and communities who have experienced multiple adverse childhood experience (ACE) traumas and as a result, are at high risk for experiencing STS. Secondary Traumatic Stress can lead to personal health issues, loss of productivity, and turnover and therefore should be a concern for practitioners and administrators.
This presentation will address the causes of STS and offer ideas for both prevention and recovery. In addition, findings from empirical research projects examining STS, burnout, and peer support will be reviewed. Methods to create a trauma informed organization that can both prevent and mitigate the impact of STS will be reviewed and critiqued. Finally, the presenter will facilitate an action research process designed to enable participants to begin the development of self-care plans that they can use in their organizations.
Maidan Summit 2011 - Fred Coalter, University of SterlingMaidan.in
During his discourse at Maidan Summit 2011, Mr Fred Coalter made a presentation around the monitoring and evaluation of sport for development programmes, in reference to the mechanisms and processes of their development. He showed how the experience of sport (and not always, sport itself) may facilitate results, and how community empowerment can happen through this experience.
Mr Coalter also emphasised on crafting specific programmes based on different social relationships and environments, and delivered to specific target people.
Healthcare IT and Healthcare Services: The New Personalized Medicine Frontierthe Hartsook Letter
Presentation by LIsa Suennen co-founder and Managing Partner of Psilos from January 2012 presentation at the Personalized Medicine Conference Silicon Valley CA
Post-Traumatic Stress Disorder, or PTSD, is a serious and common condition that affects up to 20 percen of American adults. While we may feel like we should be able to carry on with life, sometimes traumatic memories become so disabling that we can no longer cope or function.
Preventing Compassion Fatigue and Promoting Compassion Satisfaction- Presentation at the American Psychological Association, 2011 ; A skill building workshop facilitated with Dr Ilene Serlin
An edited, and reedited, version of the story I wrote for RPS on the need for Person Centered Hospital Care in 2015. We ALL hope to avoid the past experiences of 4 point restraints, isolation rooms and punitive care that is so often experienced as re traumatization. It wasn't helpful for the clients or the staff either. That's what we are all working together to CHANGE.
Untangled healthcare lecture series patient advocacy series part oneJeffrey Harris
The first in a four part series integrating patient advocacy, care coordination, personal health records and other HIT components. For Nurses, Other Paraprofessionals
Objective: baby sit and object for 3 months photographing it every week. Find a story for it to tell and make it into a booklet. Was great fun. Special thanks to Heather Burns for photography.
James Caringi, PhD Presentation at 2016 Science of HOPE
Description:
Secondary Traumatic Stress (STS) is defined as, “the natural and consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other, the stress resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995). Professionals and caregivers frequently work with individuals, families, groups, and communities who have experienced multiple adverse childhood experience (ACE) traumas and as a result, are at high risk for experiencing STS. Secondary Traumatic Stress can lead to personal health issues, loss of productivity, and turnover and therefore should be a concern for practitioners and administrators.
This presentation will address the causes of STS and offer ideas for both prevention and recovery. In addition, findings from empirical research projects examining STS, burnout, and peer support will be reviewed. Methods to create a trauma informed organization that can both prevent and mitigate the impact of STS will be reviewed and critiqued. Finally, the presenter will facilitate an action research process designed to enable participants to begin the development of self-care plans that they can use in their organizations.
Maidan Summit 2011 - Fred Coalter, University of SterlingMaidan.in
During his discourse at Maidan Summit 2011, Mr Fred Coalter made a presentation around the monitoring and evaluation of sport for development programmes, in reference to the mechanisms and processes of their development. He showed how the experience of sport (and not always, sport itself) may facilitate results, and how community empowerment can happen through this experience.
Mr Coalter also emphasised on crafting specific programmes based on different social relationships and environments, and delivered to specific target people.
Healthcare IT and Healthcare Services: The New Personalized Medicine Frontierthe Hartsook Letter
Presentation by LIsa Suennen co-founder and Managing Partner of Psilos from January 2012 presentation at the Personalized Medicine Conference Silicon Valley CA
Post-Traumatic Stress Disorder, or PTSD, is a serious and common condition that affects up to 20 percen of American adults. While we may feel like we should be able to carry on with life, sometimes traumatic memories become so disabling that we can no longer cope or function.
Preventing Compassion Fatigue and Promoting Compassion Satisfaction- Presentation at the American Psychological Association, 2011 ; A skill building workshop facilitated with Dr Ilene Serlin
An edited, and reedited, version of the story I wrote for RPS on the need for Person Centered Hospital Care in 2015. We ALL hope to avoid the past experiences of 4 point restraints, isolation rooms and punitive care that is so often experienced as re traumatization. It wasn't helpful for the clients or the staff either. That's what we are all working together to CHANGE.
Untangled healthcare lecture series patient advocacy series part oneJeffrey Harris
The first in a four part series integrating patient advocacy, care coordination, personal health records and other HIT components. For Nurses, Other Paraprofessionals
Risk Management has been a valuable and essential subject in projects and financial businesses but it is new to health care management. This presentation will help you understanding basics of Risk Managment.
Natalie Grazin, Assistant Director at the Health Foundation, talks through the theories and evidence behind self management support of long term conditions.
Mercedes Serrano - Guía metabólica: empowerment through health 2.0 tools in ...WTHS
Presentation of Workshop on Technology for Healthcare and Healthy Lifestyle 2011
Thursday 1st Dec 2011
Session III
http://www.tsb.upv.es/wths2011
También en:
http://es.scribd.com/doc/73819171/Presentacion-Dra-Mercedes-Serrano-Guia-Metabolica-conferencia-Ideagoras-2011
Health (Well-being for us personally) must be taken from the domain of politics and re-defined by all of us as how we differentiate in moral standards: This is a difficult task for all please take this adventure with me. The first of a series describing our healthcare system as an event of business evolution with no clearly defined objectives. Comparisons between national projects with focus and those without.
Untangled health initial stages of patient engagement using duke medicine web...Jeffrey Harris
Initial stages of patient engagement using the Duke Medicine Web Portal.
In this case an apparently well middle aged patient describes the utility of the Duke PHR for appointment management, communication with her provider on patient-centered goal management, establishing a reconciled medication list with access to all physicians in the system of care and review of therapeutic outcomes in the form of outcome measure trending.A patient describes how she uses Duke Healthcares Portal
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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2. Syllabus
1. Defining a persons needs and the evolving National Health Information
Infrastructure
1. Defining an emerging Health Information Technology within the context of
the US HealthCare System
2. Support , Process and Use Case
1. Samples of Levels of Support Based on Functional Status
2. The Advocates Process
3. Real Use Case 2011
3. Personal Health Records
1. Selection
2. Components
3. Security
4. Process
4. A Transition Model
5. Why We Do It
11/23/2011 2
3. Untangled Healthcare Patient Advocacy Series
Part Two
1. Samples of Levels of Support
Based on Functional Status
2. The Advocates Process
3. Real Use Case 2011
11/23/2011 3
4. Untangled Health Patients
Have various support needs based on our social and physical, mental and social health
status
Care Cycle Ultimately we need major help in planning our lives
Assess
At times our conditions become unstable , and
Monitor Plan barriers to ‘getting better’ include lack or Care <management
Our Health-Care
support and a lack of understanding on how to
Level of Assistance Needed
Coordinate Plan System ‘STEPS
manage multiple problems UP’ and manages
Educate
our conditions
As we age and sometimes
sooner we develop Care Coordination and
Education
uncomplicated chronic Drs and their staff
conditions and monitoring collaborate, coordinate,
WE ALL HAVE needs teach and coach us,
addressing ALL OF OUR
Primary and Secondary Prevention Rights PROBLEMS
Sometimes we have acute Supported Self Management:
temporary conditions Engaged by our doctors and assisted by their
staff
Informed Self Service : Education and Self Service Instructions
Usual Care: Diagnosis & Treatment Services
Our Life Span
11/23/2011 4
5. The Patient Advocate Process
Assist with
reporting Bio-Psycho-Social History
outcomes to Discover Goals, Wants, Needs
PCP
Functional Status
Physical
Social Insurance Exchange
Cognitive
Monitor Activate Primary Care
Compliance
Comorbidity Medical Home
Patient Contract
Patient Compliance
Disease Self Mastery Identify and link
Learning Barriers community
resources:
Evaluate Assist Transportation,
Meals on Wheels,
Patient Peers
Primary and Secondary Prevention
Self Monitoring
Resource Utilization Educate
Urgent Care Guidelines
Communication Skills
11/23/2011 5
7. Functional Domains
Cognition
Problem Solving
Memory
Communication
Psychosocial
Expression
Emotional Status
Comprehension
Adjustment To Limitations
Reading
Self Care Mobility
Eating Transfers
Elimination Grooming Toilet
Bathing Shower
Sphincter Control
Dressing Car
Bladder
Toileting Locomotion
Bowel
Swallowing Walking/Wheelchair/St
airs
11/23/2011 Community Mobility 7
8. Activate
• If no insurance: Find a program e.g.
Medicaid, Safety Net Sliding Fee, Health
Choice, Insurance Exchange in 2014
• Patient and advocate select a PCP who
claims to be a Primary Care Medical Home
• During first visit: Suggest a compliance
contract between patient and physician e.g.
first point of contact unless life threatening
event
• Set follow up dates and responsibilities
(COACH)
11/23/2011 8
9. Assist
• Evaluate patient defined needs and goals:
• Educational barriers
• Educational Plan
• Address functional deficits in ADLs and
IADLs
• Connect to community resources
• Connect to peer support
• Follow-up several times per week in first
month then decrease encounter frequency
11/23/2011 9
10. Education
• Take learning barriers into account and use assistive
tools where necessary e.g. times medication
dispensing containers. Connect patient with
pharmacist if on more than five medications.
• If patient is responsive to internet health records set
up a PHR that exchanges data with physicians PHR or
Microsoft Health Vault if Physician has not installed e-
HR yet.
• Otherwise create a paper based notebook that is the
perpetual record of care and interventions and
outcomes.
• Test learning by return demonstration at least one
week post educational sessions.
• Don’t be afraid to involve family and friends
11/23/2011 10
11. Evaluate
• Review care plan with patient
• Make sure patient adds you to care team so you can access records
in patient portal at hospitals and practices and PHRs.
• First things first: What is highest priority
– Medication reconciliation with no gaps in long term medication fills
without physician order
– All testing appointments completed on time
– All follow up appointments completed on time
– Lifestyle changes are beginning to migrate into patients way of living
– Quantify use of hospital or ER services for inappropriate reasons and try
to define precipitating factors e.g. physician not available
– Compare medications to insurance formulary and if physician agrees
switch patient to lower tier medications to reduce cost for patient and
insurance company
– Assess any new functional limitations e.g. balance in the elderly and
visual acuity.
11/23/2011 11
12. Monitor
• Set up monitoring schedule with patient with goal
for complete independence if possible.
• Teach patient to self record data from home
medical devices and PHR tools.
• Teach patient how to use secure communication
tools with provider and yourself
• When comfortable discharge with assurance of
your availability when needed.
• Send report to physician. If physician using e-HR
and patient portal ask about submitting report
through portal.
11/23/2011 12
13. Case Example
Real Life 2011
In two years she:
1. Was a victim of domestic
violence
2. Transitioned from military to
public health systems
3. Was treated by 12 physicians
and surgeons and behavioral
health specialists
4. Was placed on twenty two
different medications some
of which were within the
same class and directly
contraindicated
5. Lost her ability to think
clearly
6. Lost her family
7. So here we are.
• Our friend with her treatment records
and medicine during data collection
step
11/23/2011 13
15. Use Case: Care Coordination, Management and Advocacy
Middle Aged Chronically Ill Woman Migrating To NC from Florida’s Safety Net
Patient Classification:
Demographic: 50 y/o Caucasian female
Bio- Complex comorbidity (degenerative spinal disease,
acute trauma with questionable TBI, constellation of
auto immune diseases
Psycho- History of episodic substance abuse ETOH and
prescription narcotics, depression, PTSD
Social- Indigent, Income= $1300/MO; homeless; divorce in
process, domestic violence victim, Medicare dually
eligible SSDI, Post graduate degree in behavioral
health
Functional- Mental: Cognitive defects memory and executive
function
Physical: Chronic pain limitations to locomotion and
IADL
Summary: Can’t work, can’t drive, can’t think = NO HOPE
11/23/2011 15
16. Given patient status how would the present clinical world
find all of this information during assessment?
Patient interview
Patient SS Dept. attempt to locate data
found on Repeated testing to R/O dx
street in
North Hospital Critical Path
Carolina Discharge to community
New Medical History Variant
Patient ER Disconnected from future episodes
Visit
Patient
Acute
Admission
Subjected
to DC
Planning
Process
DC next
lower level
care
Classic Scenario
Poor transition management
No portable record
11/23/2011 16
17. The Patient Advocate Process
Assist with
reporting Bio-Psycho-Social History
outcomes to Discover Goals, Wants, Needs
PCP
Functional Status
Physical
Social Insurance Exchange
Cognitive
Monitor Activate Primary Care
Compliance
Comorbidity Medical Home
Patient Contract
Patient Compliance
Disease Self Mastery Identify and link
Learning Barriers community
resources:
Evaluate Assist Transportation,
Meals on Wheels,
Patient Peers
Primary and Secondary Prevention
Self Monitoring
Resource Utilization Educate
Urgent Care Guidelines
Communication Skills
11/23/2011 17
18. Discovery and Documentation of
Baseline
Objective: My Medicare.Gov
1. Gather as much as possible and filter
for sentinel information
Claims extract
1. Diagnosis
2. Procedures
3. Providers
4. Medications
5. Hospitalization Episodes
2. Store Data in secure online Good for preventive svcs,
repository with proven connectors to providers
EMRs, PHRs and Vendor Hubs e.g. Hospitalizations and visits.
Quest, CVS Microsoft HealthVault
– Central Cloud Data Repository
– Using Standardized Clinical Mode
Mayo Clinic Personal Health
Record
11/23/2011 18
19. Assemble on-line health record
A repository that connects to multiple systems
A PHR that has built in decision support
Established Mayo Clinic
Attempt to connect Health-
Test Successful PHR and completed data
Vault to Mayo Clinic PHR
entry for patient
CVS used
Mayo PHR
as
Summary
Pharmacy of
Record
choice
11/23/2011 19
20. Patient Information Flow In Sample
Patient Advocacy Case
Primary Portal To Patient
Information
11/23/2011 20
21. Final Outcome
Combined Mayo Transported Patient to UNC HealthCare with
PHR with Manual Summary Documents and Films
Clinical Summary
Patient Team Today Mayo
PHR
Primary Care MD
Psychiatrist Health
Medicare
Vault
Physiatrist
Patient
Behavioral Health Program
Portable Health Record
Medications
Start = >20 CVS UNC
Today = 8
Functional Status
Independent all IADL
Self transportation
Self perceived health status improved
11/23/2011 21