Transcript Symposium - Tri-State Regional Extension Center

Role of Patient-Facing
Technologies in the Era of Health
Reform
David K. Ahern, PhD
Director, Health Information Technology Resource Center
(HITRC) for Aligning Forces for Quality of RWJF
Director, Program in Behavioral Informatics & eHealth
Department of Psychiatry, Brigham & Women’s
Hospital/Harvard Medical School
Senior Scientist, Abacus Management Technologies
Meaningful Use Conference
March 16, 2012
Disclosure
Co-founder and Principal of Abacus
Management Technologies LLC
The Good Health Gateway® is a
proprietary web portal platform of Abacus
Management Technologies LLC
Overview
Patients are using HIT in a variety of ways
Meaningful Use (MU) rule provides some
initial guidance for patient-facing
technologies
Requires a greater understanding of
patients’ wants and needs to determine
how these technologies can be utilized
effectively
Patient-Facing Technology?
Patient-Facing Technologies in Clinical
Care: Theoretical Framework
Patient Centered Care Model
Self-Management Support
Community
Decision Support
MDs
RNs
PATIENT
PROVIDER
Family
Care Management
Patient Navigator
Productive Interactions
Am Journal of Prev Med 2011; 40(5S2):S162-S172
Current Patient Uses of HIT
Seek health information for themselves, friends
and family
Access health services – appointment
scheduling, medication refills
Communicate with provider via secure
messaging regarding non-urgent health issues
Use Computerized Tailored Interventions (CTIs)
Current Patient Uses of HIT
(cont.)
Use a Personal Health Record (PHR) or patient
web portal
Use remote monitoring devices, wearable and
passive sensors
Seek social support and community
engagement via social networks and social
media
Value of Web Portals
Community
Patients/
Consumers
 rapidly deploy patient surveys and
evaluate patient experience
with care
Patients
& Providers
 interact with family
members’ providers
 easier access to patient's partial and downloadable
institutionally-based medical record, including
longitudinal vital signs, lipids, immunizations, etc.
 quicker access to lab/test results
 improve efficiencies in
and satisfaction with
communications between
patients and providers for
non-urgent medical advice,
prescription refills, referrals,
appointment scheduling
and other convenience
transactions
 increase patient
preparation with
pre-visit
questionnaires
Providers
 increase efficiencies in workflow for non-urgent
medical advice, prescription refills, referrals,
appointment scheduling and other
convenience transactions
 automate the provision of basic patient
information such as medical records, immunization
history, etc. and can assist in attainment of Stage 2
Meaningful Use with regards to patient electronic
access to medical record
 conduct eVisits in secure environment
 automatically populate secure message
communications into patient medical record
 integrate PHI with provider-based platforms for
behavior change, disease management,
self-monitoring/tracking and decision-making
to improve health outcomes
Web Portals
Value of PHRs
Community
 population-based research
 biosurveillance
Providers
Patients/
Consumers
 personally controlled platform with access to
protected health information (PHI)
 portable and accessible anywhere
 share PHI with friends/family/caregivers/
other providers
 platform for personal health applications
(i.e., mobile apps) for health improvement,
decision making about quality providers/
services and to support personalized medicine
 engagement in self-management and
prevention activities
 document alternative/complimentary therapies
and supplements
 enables remote monitoring (BP, weight,
hemoglobin A1c, etc.), exercise routines,
smoking cessation efforts, etc.
Patients
& Providers
 immediate access
to key PHI, especially
in emergencies
 greater patient
engagement in care and
collaborative selfmanagement/shared
decision making
 increased safety of care/
prevention of medical errors
and reduction of unnecessary
test duplication
 improved medication
management and
monitoring
 complete and accurate record of a patient’s
medical history stored in a single place
and accessible at the point of care
 review PHI from other providers
for accuracy and correct errors
 greater access to a patient’s
up-to-date medical record
 utilize PHI from other sources to
guide clinical decision-making
 reduce or eliminate costs of accessing patients’
medical records from multiple sources
 improve quality and control costs of care
What is Social Media?
Tools which harness and capitalize on the
robust aggregate of information and people
online
Shifts away from 3rd party media to user
generated content
Individually created and
controlled flow of content
(e.g., text, video, photos)
to others
Mobility and
Constant Access as Drivers
People who use Facebook on their mobile devices are
almost 50% more active on Facebook than non-mobile
users
Worldwide mobile traffic from each region has increased
at least 4x in the last two years, with 6x increase in
North America
“Having a smart phone increases sharing of all kinds.”
– Susannah Fox (2010)
Facebook (2009)
Admob.com (2010)
Pew Internet & American Life (2010)
Patient-Facing
Information and Services
Patient-Facing Technologies for
Meaningful Use
HIT Function
Patient Value
Potential Population Value
Health Information Transactions
Request appointment
Request health information
Update personal information
Better patient experience
Care convenience
More accurate information
Greater knowledge of Rx
Improved access
Improved care coordination
Shared Health Data
View medical chart notes
View problem lists, allergies
View test results
View after-visit summaries
Better patient experience
Greater knowledge of health
Enhanced self-care
More prepared for visits
Fewer repeated tests
Greater trust in clinician
Improved health outcomes
Improved delivery of preventive services
More efficient in-person visits
Professional Care
Secure messaging
eVisits
Home Monitoring with feedback
Health Risk Appraisal with feedback
Better patient experience
Greater knowledge of health
Enhanced self-care
More prepared for visits
Fewer repeated tests
Greater trust in clinician
Improved access
Improved self-management
Improved adherence
Improve health outcomes
Improved care coordination
Treatment & Intervention
Medication refills
Tailored Interventions
Better patient experience
Greater knowledge of health
Enhanced self-care
More prepared for visits
Improved adherence
Improved health outcomes
Self-Care & Community
Social Network Services
Links to Community Programs
Better patient experience
Greater knowledge of health
Enhanced self-care
Increased use of HIT
Improved self-management
Improved adherence
Improve health outcomes
Patient-facing Technology:
eBP Control Program
Principal Investigator: Charles Eaton, MD, MS
Co-Principal Investigator: David K. Ahern, PhD
Problem of Uncontrolled BP
35% of Americans with hypertension
optimally managed
25% are unaware of their diagnosis
These risk identification and treatment
gaps are greater for non-Hispanic blacks
and Mexican-Americans
Home BPM Lower than Office
On average, home BPs are lower than
office BPs by 5 mm Hg
– SBP home - 135 office - 140
– DBP home - 85 office - 90
Home BPM
Treatment Goals
BP goals for average risk
– SBP <135 mm Hg or DBP <85 mm Hg
BP goal for high risk (Cardiovascular Disease,
Chronic Kidney Disease, Diabetes Mellitus)
– SBP <125 mm Hg or DBP <75 mm Hg
BP goal for Left Ventricular Dysfunction
– SBP <115 mm Hg or DBP <75 mm Hg
Home BPM Device
Omron® BP monitor,
HEM-790IT
Patient Navigators
Good Health Gateway®
Entry Screen
Good Health Gateway®
Education
Good Health Gateway®
My Monitoring Page
Good Health Gateway®
Results
Good Health Gateway®
Patient Navigator View
WELCOME EDDIE B. PAGE
Patient Navigator Summary View
Centricity™
eBP Control Form
Joseph Wroblewski
Centricity™
eBP Follow-Up Form
Joseph Wroblewski
Overcoming Clinical Inertia
Red Light
HBP >140/90 for AR
HBP >130/80 for HR
HBP >120/80 for LVD
– The PN will send a flag to team nurse and
PCP, schedule an appointment as necessary
– PCP to escalate treatment - document in chart
Overcoming Clinical Inertia
All Lights Flashing
HBP >180/120
– PN to contact team nurse or
PCP for same day visit or ED visit
– PCP to evaluate for Hypertensive Urgency vs.
Emergency, and make appropriate triage
decision
– Document in chart
Table 1. Demographics of Participants in eBP Control Program (n=28)
Mean Age, yrs (SD)
58.5 (12.0)
Sex (%)
Female
Male
16 (57.1)
12 (42.9)
Ethnicity (%)
Non-Hispanic White
Non-Hispanic Black
Non-Hispanic Am. Indian
25 (89.3)
2 (7.1)
1 (3.6)
Education (%)
Less than HS
HS graduate
More than HS
2 (7.1)
9 (32.1)
17 (60.7)
Marital Status (%)
Partnered
Not Partnered
18
9
eBP= e-Health Blood Pressure
Chronology of systolic BP from research visits (RV), home monitoring (HM), and visits to primary care physician
(PCP) relative to home goal BP (135/85) for an average risk patient. Enrollment began on 9/15/2010 (1). Patient
randomized to gain access to patient navigator (PN), in addition to web portal, on 1/6/2011 (2). Between time
point (1) and (2), patient had access to only home monitoring. New medication was prescribed on 2/14/2011 (3).
Chronology of systolic BP from RV, HM, and visits to PCP related to home goal BP (135/85) for an average risk
patient. Enrollment began on 9/13/2010 (1). Patient randomized to gain access to only the web portal on
1/5/2011 (2). Between time point (1) and (2), patient had access to only home monitoring. Patient introduced to
PN on 4/4/2011 (3). New medications were prescribed on 4/7/2011 (4). Participant met with hospital social
worker to assist with health insurance 4/25/2011 (5).
Conclusions
Success of health reform is predicated on
improved health outcomes and reduced costs,
achievable only with engaged and activated
patients
Patient-facing technologies are likely to play a
critical role in supporting informed and activated
patients
Research is needed on comparative
effectiveness, ways to increase adoption and
minimize unintended consequences
Thank You
[email protected]
(617)525-6167
Twitter: dahern1