How technology is changing rural medicine to improve outcomes and communication with patients:  Fact, not theory.

Plain Talk in Complex Times 2013:Communicating in a Time of ChangeSeptember 26-27, 2013  |  Arlington, VA

Christopher H. Tashjian, MD, FAAFP

Health IT fellow using electronic health records and practice innovations to increase participation in the Million Hearts® initiative and improve performance on the Million Hearts goal

Chief Medical Advisor WHITEC

Health literacy is dependent on individual and systemic factors:Communication skills of lay

persons and professionalsLay and professional knowledge

of health topicsCultureDemands of the healthcare and

public health systemsDemands of the situation/context

Health literacy affects people's ability to:

Navigate the healthcare system, including filling out complex forms and locating providers and services

Share personal information, such as health history, with providers

Engage in self-care and chronic-disease management

Understand mathematical concepts such as probability and risk

Who is at risk?

older adultsracial and ethnic minoritiespeople with less than a high

school degree or GED certificatepeople with low income levelsnon-native speakers of Englishpeople with compromised health

status.7 Education, language, culture, access to resources, and age are all factors that affect a person's health literacy skills.

EVERYONE!!!!

Modern SolutionsConversationPCMHEMR

◦After Visit Summary◦Patient Education◦Patient Portal

Smart Phone

Conversation

Patient Centered Medical Homeis a model of care that

emphasizes care coordination and communication to transform primary care into “what patients want it to be.”

NCQA Patient-Centered Medical Home (PCMH) Recognition is the most widely-adopted model for transforming primary care practices into medical homes.

HIGH TECHFirst need to acquire data and enter into EMR

Create Database

Generate Patient Lists

Use of Filters

Patient Scorecards

Results as of 8/1/2013 for Christopher Tashjian, MD

IVD

BP 99/104 95.2%

LDL 86/104 82.7

Aspirin 104/104 100%

Smoking 87/104 83.7

Hemoglobin A1C 82/104 78.8

Total (All 5) 57/104 55%

EMR – After Visit Summary

information and instructions containing the patient name, provider’s office contact information, date

and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other

EMR AVS (continued)instructions based on clinical

discussions that took place during the office visit

any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a

EMR AVS (continued)recommended appointment time

if not scheduled, list of other appointments and tests that the patient

needs to schedule with contact information, recommended patient decision aids, laboratory and other

diagnostic test orders

EMR Patient EducationRequired for Meaningful Use

◦Krames◦Exit Care

Standard content written at or below the 8th grade reading level

Easy-to-Read content written at or below the 4th grade reading level

Easy-to-Read documents include:

Need-to-Know and What-to-Do information

Simple words and sentences written in plain language

Ample white spaceSimple illustrationsUncluttered sectionsActive voice style writingQuality, clinician-reviewed

medical informationSpanish translations

Patient PortalPatient portal helps you easily

access your health information and contact your doctors and nurses. The patient portal empowers you to become an active participant in your care through a broad range of activities and services.

Key Benefits Patient Portal

Easy access to important health information

Secure communications with your doctor

Convenient appointment managementTools to manage your care and

improve your health

Medical Record Access

View your medical recordDownload a copy of your medical

recordShare your record with health care

professionals

Secure MessagingExchange secure messages with your

doctorReceive a convenient email

notification when you have a new message

Appointments

View appointment detailsReschedule or cancel an existing

appointmentSchedule a new appointmentSave appointments to your calendar

Online Forms

eVisitsPre-visit interviewsMedical history surveys

Smartphones- now above 61%

Medical Apps for Docs

Epocrates

The king of all medical apps, Epocrates enables physicians to review drug prescribing and safety information, select health insurance formularies for drug coverage information, perform calculations like BMI and GFR and access medical news and research. 

 Up To Date (Free)Along with Doximity, Up To Date

is the only app that doesn't appear on both the most-used apps for smartphones and tablets lists. Up To Date is a reference tool that comes with evidence-based recommendations, mobile-optimized calculators and a CME tracker.

Medical Apps for Docs

Up to Date

Up to Date is a reference tool that comes with evidence-based recommendations, mobile-optimized calculators and a CME tracker.

Medical Apps for PatientsPill ManagementChronic Disease Management

◦Diabetes◦Heart Disease

Diet ManagementExercise ManagementMore every day!

Bottom Line

Million Hearts®

• National initiative co-led by CDC and CMS• Partners across federal and state agencies and

private organizations

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Goal: Prevent 1 million heart attacks and strokes in 5 years

Key Components of Million Hearts™COMMUNITYPREVENTION

Changing the context

CLINICALPREVENTIONOptimizing care

Focus on ABCS

Health information technology

Clinical innovations

TRANSFAT

Join Us: Take the Pledge

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http://millionhearts.hhs.gov

For more information contact:

Chris Tashjian, MD, FAAFPctashjian@rfmc.org

Ellsworth Medical Clinic715-273-5041