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Cory Jecmen, MAc, LAc: An Acupuncturist/Tech Player in Casey Health Institute's Integrative PCMH PDF Print E-mail
Written by John Weeks   

Cory Jecmen, MAc, LAc: An Acupuncturist/Tech Player in Casey Health Institute's Integrative PCMH

This article is produced as part of a recent partnership between the Project for Integrative Health and the Triple Aim (PIHTA) and the Casey Health Institute (CHI) for which the Integrator is providing media support. The goal of the PIHTA-CHI partnership is to stimulate understanding of integrative patient centered medical homes (PCMH) via a multi-faceted look at the model CHI is creating. PIHTA is an initiative of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC).
Other articles in the series:
Jecman: LAc and tech guy
I initiated this interview with Cory Jecmen, MAc, LAc by noting how unusual it is to find the same individual wearing the dual hats of clinical acupuncturist and electronic medical record (EMR) techie. Jecmen laughed, reflecting on the integrated environment of which he is part at Casey Health Institute: "You could probably use all fingers to list my roles."

Jecmen, whose professional background includes undergraduate studies in biology and chemistry, has prior experience in a major medical delivery organization. He
previously served at Veteran Affairs Medical Center in Washington D.C. as an acupuncturist and research program coordinator for the War Related Illness and Injury Study Center.
Clinical Experience as an Acupuncturist at CHI

We first checked in on his half-time work as a licensed acupuncturist. He is one of two acupuncturists among Casey's
four primary care integrative medical doctors, nurse practitioner, naturopathic doctor, two psychologists, Reiki master/massage therapist, Yoga therapist, nutritionist, and nurse care coordinator.

Jecmen volunteered how important provider selection has been to developing the Casey team: "One of best things we do here is in the people we hire." 
The Casey Health hiring process is lengthy and involves interviews not just with medical directors but with all the team members. Jecmen says he's never worked "with a group of medical doctors who are more focused and interested" in what he and his other integrative colleagues have to offer. He notes a benefit for patients: "I get really pinpoint referrals."

So what kind of patients is he seeing? Jecmen says they are "not who I would be seeing if I was just hanging up a shingle" and working in a solo practice like most licensed acupuncture and Oriental medicine practitioners. Instead of treating people who on their own have chosen to try acupuncture for a condition, he is seeing patients who arrive for care "because my primary care physician said to come." He estimates that only 5% of his patients come through the door for acupuncture first. The other 95% are via referral from practitioners. In fact, perhaps 90% have not heard about acupuncture. 

He says he sees a lot of behavioral health, sleeplessness, adrenal fatigue, irritable bowel and digestive conditions, for instance. Notably, structural pain conditions are not among those that first came to
Jecmen's mind.

He provides some specifics. "With behavioral health, [the mental health practitioners] might think that their work will be easier if acupuncture can turn down the volume a bit." If the patient is less stressed constitutionally, advances might be assisted elsewhere. Success in working on sleeplessness can support that kind of healing process, for instance. He said he pairs with the chiropractor and the naturopathic doctor on various patients: "What we do best [at Casey Health Institute] is find the constellation of practitioners that are best for each patient."

Jecmen spoke to his experience with the "speed-dating" sessions used in by Casey Health as a method of stimulating team care: "It's evolved a lot. Sometimes its more regimented, with a time-keeper. Now usually people come with an agenda. It's a more free-form style."

Building Out an Integrative Electronic Health Record

On the tech side,
Jecmen says that he is pleased with working in the AthenaHealth system after CHI survived "a disastrous experience" with an initial vendor of an EMR. He said that before Athena was selected, a list of potential suppliers was whittled down then "every clinician test drove" the top 3 contenders before AthenaHealth was selected.

"Basically we took a pre-built EMR and we contort it - we have to bend it and twist it to accommodate" what the integrative environment needs,
Jecmen explains. CHI's data strategy is multi-pronged. They plan to implement PROMIS 29 for patient-reported outcomes measures throughout the system. Jecmen says he is also "hijacking" a few other of the EMR's built-in functions "that we don't use to use for other things that we do need a solution for." In addition, he is creating some distinct features for the CHI system. Jecmen has worked with members of other professions to build data capturing tools in the medical record that each different type of practitioner wants to ask. In the case of the acupuncturists, for instance, he has built in a chance to see "the map of what points I have used" in sequential visits with patients: "I wanted to see flow sheets for acupuncture points that simply don't exist in [a usual] EMR."  

Partner on integrative PCMH project
Most patient-centered medical homes choose one or more conditions on which they will seek to measure quality improvements.
CHI is exploring the key health indicators on which they will focus. Examples under consideration are A1C levels, anthropometic measures of hip to waist ration and BMI, as well as heart rate variability. Jecmen looks forward to the day when CHI will be able to compare real outcomes, and analyze "decision trees that lead to our choice of a particular care plan strategy, why and when we go from chiropractic to acupuncture, or chiropractic to massage, and vice versa." He guess that this is still a year or more out.

Jecmen has been enjoying the process of beginning to work with EMR colleagues at the other primary care clinics that are part of the emerging accountable care organization of which Casey is part. Eventually, Casey Health Institute's outcomes will be "matched up with those of other primary care clinics that don't do what we do" with the integrative components of CHI's teams. CHI's co-founder David Fogel, MD is on record betting that CHI's team will perform well on these value indicators.

Despite his skills as a tech person,
Jecmen has not found the EMR environment an easy shift as a clinician: "I try to stay as low tech as possible." Jecmen, like each of Casey Health's other practitioners, moves room-to-room with a lap-top: "It's been a big step to artfully bring the lap-top in the visit room." 

Comment: The set of patients
Jecmen sees reminds me of a designation of patients accepted into a diabetes pilot at Group Health Cooperative in Seattle on naturopathic adjunctive care. The research team sought "naturopathically naive" patients. The vast majority of Jacman's patients are "acupuncture-naive." Thus, because they are not"acupuncture-disposed" individuals who would already have their placebo potential on full shimmy, outcomes of acupuncture treatment on them are more likely to be of interest to the research and population health communities. A terrific research population.

The potential practical outcomes for members of
Jecmen's profession are particularly compelling. Increasing employment opportunities for acupuncturists is, for instance, a priority behind a new credentialing and privileging project of the National Certification Commission for Acupuncture and Oriental Medicine. For acupuncturists and acupuncture students who look forward to the day when more positions of employment in health and medicine are open to them, what CHI is doing and measuring in their PCMH/ACO environment could be a major door opener.

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