Patient HIT, Value & Quality
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Transcript of Patient HIT, Value & Quality
Patient Digital Design & Services: The Next Generation of Quality
Susan Woods, MD, MPHOregon Health & Science University
Portland VA Medical Center
Points
• Consumer rise of digital tools
• PHRs = consumer meaningful use
• Portal use driven by value, access
• Patient & healthcare team benefit
• Participatory care is PHR 2.0
What do people want?
Access Great care Avoid costs
3
Information & Services
Transforming
Looking online for health information
Pew Research Center’s Internet & American Life Project, 2012 Survey. N = 3,014
Apr-06
Dec-07
Apr-08
Apr-09
Sep-09
May-10
Sep-10
May-11
Aug-11
Jan-12
Feb-12
Apr-12
Aug-12
Sep-12
Nov-12
Dec-12
Jan-13
May-13
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
73%
91%
58%
30%
37%
47%
61%
0.410.42
0.43
0.020.0500000000000001
0.190.26
0.0400000000000001
0.1
0.29 0.34
Cell Phone
Desktop
Laptop
Game console Tablet
eBook Reader
Adult Gadget Ownership Trends – Pew Surveys
http://www.pewinternet.org/Trend-Data-%28Adults%29/Device-Ownership.aspx
April-0
6
Decem
ber-0
7
April-0
8
April-0
9
Septe
mber
-09
May
-10
Septe
mber
-10
May
-11
Febru
ary-
12
April-1
2
Septe
mber
-12
Novem
ber-1
2
Decem
ber-1
2
May
-13
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
73% 75%78%
85% 84% 82%85% 83%
88% 88%85% 85% 87%
91%
0.35
0.45 0.46 0.45 0.47 0.45
0.56
Cell Phone and Smartphone Ownership, Over Time
% of American adults who own a cell phone or smartphone
http://www.pewinternet.org/Trend-Data-%28Adults%29/Device-Ownership.aspx
71%Got information or care from a health
professional for their last problem
MyGroupHealth Users and PHR Usage
KP.org reaches 65% -- 4 million +
http://thrive.kaiserpermanente.org/innovation
Patient Meaningful Use
Transactions
Expert Care
Shared Data
Self-Care
Community
Ahern DK, Woods SS, Lightowler et al. Promise of and potential for patient-facing technologies to enable meaningful use. Am J Prev Med. 2011
Usage Follows Value
Functions
•Test results•Secure email•Medication refills•Notes & summaries
Access
•Online authentication•Proxy access•Usability•Technical support
Observations on Secure Email
• Drives team-based care• Great for patients • Great for front-line staff• Know more between visits• Better in-person visits• Respectful of time• Rare inappropriate use (they call)
I started radiation treatment at the University Hospital, 5 times a week.
The cream you prescribed for my rash is helping, I don’t have refills.Thanks and have a happy holiday!
http://www.hsrd.research.va.gov/publications/esp/myhealthevet.cfm#.Ui_0Hj9-rQM
Patient-Facing Digital Services - Impact
Evidence LikelyMore accurate informationBetter experienceMore knowledge of problemsGreater self-careMore prepared for visitsMore efficient in-person visitsGreater trust in cliniciansImproved quality measuresImproved outcomesMore preventive servicesLess no-shows
Need to mitigate digital divide
PatientsImproved adherenceBetter caregiver knowledge/skillsFewer testsBetter care coordinationIncreased use of digital services
Healthcare Teams:Shifting workNeed different communication
Care Delivery:More visits for someLess visits for some
Shenkin B, Warner D. New England Journal Medicine 1973
A 40-year old idea….
• Enhance patient autonomy
• Improve patient-physician relationship
• Serve as educational tool
Communication
“I can go in and ask more intelligent questions and we don’t have to spend as much time with
them explaining everything to me.”
“I could see my results. I could see what was going on and didn’t get stressed out waiting to
hear back from somebody who might never call.”
Knowledge
Doctors aren’t real gabby and never tell you everything. Even if you ask questions, they’ll sort of slide around them. They don’t have time. I found stuff out that I was just truly amazed at about myself.
“You could pop over to Google….and see what it’s saying instead of sitting there sweating it out.”
Self-Care
“Made me feel more responsible for myself, like there’s no excuses. You know, it’s right there, you
know. You can’t use ‘the doctor didn’t tell you’.”
“You could pop over to Google or the library, and see what it’s saying instead of sitting there sweating it out trying to figure out what it is.”
Patient Participation in Care Quality
“I had an ultrasound on my liver and saw the results. It said, ‘Re-do in 6 months’. Six months came and nothing happened. So I called the doctor. He says, ‘Yeah, they did say that’. So, if I hadn’t reminded him, I wouldn’t have got it.”
“I’d like to know, what you think and what you know, and what you’re predicting. Rather than just write it in there, tell me and then write it.”
Patient Participation in Care Quality
% AgreePatients PCPs
Takes better care of self 70 28Better understand conditions 84 41Remembers care plan better 84 44More prepared for visits 73 36More in control of care 84 49Take medications better 60 31
Views after one year
Inviting Patients to Read Their Doctors’ Notes: A Quasi-experimental Study and a Look Ahead
Ann Intern Med, October 2, 2012 157(7):461-470
% AgreePatients PCPs
Felt offended 2 8More confusing than helpful 3 21Worries more 7 42Concerned about privacy 32 --
Views after one year
Inviting Patients to Read Their Doctors’ Notes: A Quasi-experimental Study and a Look Ahead
Ann Intern Med, October 2, 2012 157(7):461-470
It’s a good time to re-design our work.
32
Talk to Patients. They Know Cool Stuff You Don’t.
Thank you!
@[email protected]://www.sharedhealthdata.com