Working in the margins...

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Train travel allows for contemplative thinking and lots of reading! I bring a healthy stack of reading in the form of books and articles (usually the print copies) when I am commuting to a meeting or news briefing. I am not an avid user of e-book formats or online reading. Amtrak applauds this and resists adding wi-fi to all of the DC and NYC bound trains--I am sure of it.

This morning I opened up the books and notes from my recent trip and realized that relevant insights or lingering questions are often sketched into the margins. The easy work is reading through the content but the relevant work consists of contextualizing the research findings or the position pieces. All content clearly is not created equal and opinions run strong on health policy issues, EHR integration, and especially the cost of drugs in US markets. I look to the notes in the margins to connect the dots back to industry insights.

The quieter message reveals biases that often influence headlines or distract from true reform. Physicians know this and are also seeking out hidden benefits in their notes by participation in a new program for sharing notes with patients.

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This kind of note-sharing got a kick-start five years ago when researchers from Harvard Medical School joined forces with the Pennsylvania-based Geisinger Health System and Harborview Medical Center in Seattle to launch a high-profile pilot program called Open Notes. The initiative focused on encouraging health care providers to give patients access to doctors’ office notes and then tracked what happened when patients read them. Even before the project, some providers had independently shared notes, but since the organized effort began, interest has grown.

Now, Open Notes estimates about 5 million people see physicians who share notes as part of the initiative, said Tom Delbanco, a professor at Harvard Medical School who has been with the project since it launched. That includes doctors from more than 20 institutions across the country, consisting of major academic medical centers and health systems ranging from the Cleveland Clinic to the Veterans Health Administration to Wellspan, in Maryland and Pennsylvania. And even beyond the project’s participants, there is a trend among physicians — such as Gordon’s doctor — to move in this direction, too.

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The importance of providing context and careful thought to what we read or consume from the fire-house of digital media is clear. The ability to read and ask questions and provide your personal brand or insight creates your unique voice. Those of us in the creative space shouldn't be thought of as providing solutions. Who among us should dare to know the right answers even if we have decades of experience in our chosen niche. What we should be doing is asking the right questions. Pay attention to the margins. 

What do you feel is important? What questions are you forgetting to ask?

“Open notes create partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information”
– Tom Delbanco, MD, Beth Israel Deaconess Medical Center

Thoughtful discussions about content development and outcomes analytics that apply the principles and frameworks of health policy and economics to persistent and perplexing health and health care problems