iht² health it summit denver 2013 - c.t. lin, cmio, university of colorado health "patient...
DESCRIPTION
iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology" Be able to define and describe: ∙ Patient centered information technology ∙ Risks and benefits of communication between patients and providers online ∙ Risks and benefits of online release of test results and disease management ∙ Impact of social media on patient online behaviorTRANSCRIPT
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Patient Centered
Information Technology
C.T. Lin MD, FACPChief Medical Information Officer, University of Colorado Health
Professor, University of Colorado School of Medicine
iHT2 Health IT SummitJuly, 2013
Denver, CO
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I have nothing to disclose.
I have no relevant financial interest/arrangement or affiliation with
any organizations related to commercial products or services to be
discussed at this program.
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Learning Goals
Be able to define and describe:
• Patient Centered Information Technology
• Risks / benefits of online communication
between patients and providers
• Risks / benefits of online release of results
• The impact of social media on patients
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UCH 9th Avenue Campus
46 acres at 9th & Colorado
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Vision 2020
Re-inventing health care for the next
century: from Bricks and Mortar to
Patient Centered Information Technology
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One square mile; a health sciences city; 30, 000 employees when
complete, an opportunity to “re-invent healthcare” from the ground up.
Former Fitzsimons Army Base, now Anschutz Medical Campus
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Outline
Patient Centered Information Technology
Paternalism?
Online communication
Access to health records
Social Media and Patients
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Paternalism(doctor-centered)
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Knowledge is power. Respect my studies.
I am too important for clerical tasks
Patients do best when they do what I say
There is nothing wrong with the way I work
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Knowledge...power
I am too important
Pts…do what I say
Nothing wrong…
Collaboration is powerful
Communication improves safety
Connection fosters participation
Change requires a burning
platform
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Doctor-centered
Patient-centered
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Doctor-
centered
Patient-
centered
Doctor-
centered
Patient-
centered
!!
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Diabetes-STARCORHIOSPPARO
Advance Check-InDirect SchedulingMy Doctor’s Office CEO-email
satisfaction
Electronic Medical
Records
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• 82% of U.S. adults have Internet access • Harris Interactive poll, July, 2010
• 90% of online patients want to e-mail their doctor
• 56% of online patients say e-mail access would
influence their choice of doctor• Harris Interactive poll, April, 2002
Online communication
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Online communication
(MD opinions)
“The floodgates will open”
“Patients will send chest pain
messages--at midnight!”
“Patients can reach me”
“Less telephone tag!”
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So, what happened?
After 6 months…
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Patient satisfaction improved
Sending a message to Docs: 24%
Prescription refills: 19%
Appointment requests: 24%
Overall care from the clinic 11%
Overall communication 32%
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Most messages were sent after hours
0
2
4
6
8
10
12
14
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Time of Day
Only 27% of messages were
sent during clinic hours
50% from 5pm-MN
% of
messages
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Patient perceptions
81% of MDO patients noted it saved them a
phone call to the clinic
33% noted it saved them a visit to the clinic
86% preferred the MDO to the telephone to
communicate non-urgent messages
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There is NO FLOOD
1 message per day per 250 patients
OR, about 10 messages a day per doc
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Online Communication
Summary
• MDO patients are more satisfied with communication and overall care
• Patients say it saves phone calls, visits
• Physicians are neutral to positive
• Messaging volume is modest
– 1 message for 250 patients online
• 2013: 42,000 patients enrolled
– 10,800 unique logins per month
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Online communication
Comments or questions
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Online release of test results
“Patients will be
confused.”
“The only reason I will
participate is that you
are doing a rigorous
study.”
“Patients will be better
participants in their
care.”
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Intervention
Selected Laboratory Tests
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Online release of doctor notes
“Patients will act on errors in transcripts.”
“Patients will be more anxious”
“This is a crazy idea; the phone will ring off the hook.”
“Patients can already
request their paper
chart. Why not?”
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So, what happened?
After 12 months…
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“I am quicker to notify my patients of their
results. Before, if I was busy, I might let a
result wait on my desk for a few days. Now,
because the patient might already have
seen it, I will make a phone call, or send an
online comment.”
Surprise!
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Physician debrief
• “The problems were minor.”
• “I thought I would change my dictations
for this, but I did not”
• “Alerting patients to look at their
notes, both the physicians and staff can
do a better job. I think the patient has a
right to understand what is going on.”
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Trust
Empowered
Felt understood
Adherence to treatment
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Patient debrief
“I like going over the reports so that I have some
intelligent questions.”
“I probably don‟t remember half of what they said. So,
this gives me the chance to go back and pick up things I
had forgotten or missed.”
“I feel like I‟m having a more active role. My health is my
responsibility.”
“I lost my luggage while traveling. I went to a local doc
and said: „If you have Internet Explorer, I can show you
my chart. Could I have a few days of my meds?‟”
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SPPARO Summary
NO: patient overuse or misunderstanding
NO CHANGE: health utilization (visits, calls)
physician documentation
MD, RN, patient satisfaction
IMPROVED: Patients felt more empowered
Patients felt more in control
Patients felt more trust in their doctors
Patients described many uses for their records
(travel, clarification, learning, error checking)
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SPPARO update
Presenting this data to University audience• Administration saw a competitive advantage
• Nursing saw a patient education tool
• Physicians saw “no clinical benefit”
Study completed 2002, after 6 years of lobbying• My Medical Record launched in July 2008, house-wide
• Patient access to lab (exclude new HIV), rad, path
• No delay for labs, 1 wk for CT/MRI, 2wk for Path
After 4 years of patient utilization: • 42,000 patient accounts (minimal advertising)
• Over 1.3 million web pages of results viewed by patients
• 1 PET scan incident, 1 Dilantin level incident
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Study Results: SPPARO
Comments or questions
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• More transparency
• Social Media: Peer to Peer technology
• A global community of patient
experience and knowledge
• Attitude shift from privacy to sharing
• “My Doctor in my pocket”
What is the future of Patients Online?
Jum
p
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Untethered Personal Health Record
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Untethered Personal Health Record (discontinued)
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Government sponsored, expert-driven
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Non-profit, clearinghouse
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For profit, expert mediated
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For-profit, peer-to-peer