Patient Engagement Tools

S. Trent Rosenbloom, MD MPH

Associate ProfessorDepartments of Biomedical Informatics, Internal Medicine and PediatricsVanderbilt University Medical Center

November 13, 2013Department of Biomedical InformaticsBMIF 300

Patient Engagement

• Guides patients to take an active role in their healthcare delivery, starting with information

• Improves patients’ understanding of their health and related conditions so they take a more active role in their health care

• Encourages involvement of patients’ families and support systems or caregivers

Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med. 2012 Oct 2;157(7):461-70.

Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med. 2012 Oct 2;157(7):461-70.

Palen TE, Ross C, Powers JD, Xu S. Association of online patient access to clinicians and medical records with use of clinical services. JAMA. 2012 Nov 21;308(19):2012-9.

Wade-Vuturo AE, Mayberry LS, Osborn CY. Secure messaging and diabetes management: experiences and perspectives of patient portal users. JAMIA. 2013 May 1;20(3):519-25.

Osborn CY, Mayberry LS, Wallston KA, Johnson KB, Elasy TA. Understanding patient portal use: implications for medication management. JMIR. 2013 Jul 3;15(7):e133.

Rosenbloom ST, Daniels TL, Talbot TR…Muse S, Jirjis J, Purcell Jackson G. Triaging patients at risk of influenza using a patient portal. JAMIA. 2012 Jul-Aug;19(4):549-54.

Rosenbloom ST, Daniels TL, Talbot TR…Muse S, Jirjis J, Purcell Jackson G. Triaging patients at risk of influenza using a patient portal. JAMIA. 2012 Jul-Aug;19(4):549-54.

Rosenbloom ST, Daniels TL, Talbot TR…Muse S, Jirjis J, Purcell Jackson G. Triaging patients at risk of influenza using a patient portal. JAMIA. 2012 Jul-Aug;19(4):549-54.

Rosenbloom ST, Daniels TL, Talbot TR…Muse S, Jirjis J, Purcell Jackson G. Triaging patients at risk of influenza using a patient portal. JAMIA. 2012 Jul-Aug;19(4):549-54.

Rosenbloom ST, Daniels TL, Talbot TR…Muse S, Jirjis J, Purcell Jackson G. Triaging patients at risk of influenza using a patient portal. JAMIA. 2012 Jul-Aug;19(4):549-54.

Rosenbloom ST, Daniels TL, Talbot TR…Muse S, Jirjis J, Purcell Jackson G. Triaging patients at risk of influenza using a patient portal. JAMIA. 2012 Jul-Aug;19(4):549-54.

• Flu Tool was deployed Feb 8 - Apr 13, 2011:– 1017 patients seen at VUMC and affiliated clinics

received an ICD-9 encoded diagnosis for influenza (i.e., ICD-9 codes 487.xx or 488.xx)

– Flu Tool accessed a total of 4040 times• 684 times within MHAV• 2928 times on the general VUMC website• 428 times on the general Children’s Hospital website.

MHAV Original 2004 Login Screen

MHAV Statistics

*Approximately 410,000 patients seen at Vanderbilt in the prior 12 months

• Purpose– The My Health at Vanderbilt Steering Committee is

charged with overseeing the structure, content, and usability of the Vanderbilt patient portal.

– This committee is also responsible for drafting and vetting policies and procedures for MHAV.

MHAV Steering Committee

Osborn CY, Rosenbloom ST, Stenner SP, Anders S, Muse S, Johnson KB, Jirjis J, Jackson GP. MyHealthAtVanderbilt. JAMIA. 2011 Dec;18 Suppl 1:i18-23.

The goal for My Health at Vanderbilt is for it to serve as a platform to:

– engage patients

– personalize care

– reduce disparities

– streamline intake

A vision for MHAV

AHRQ R18 HS019276-01, Disseminating Adapted Diabetes Evidence To Clinicians Through A Patient Portal, Rosenbloom PI.

Disparities in Adoption

Osborn CY, Idowu RT, Han X, Chen Q, Rosenbloom ST, Jackson GP. Disparities in access to care over three years: Patient portal usage versus outpatient care. NIH Summit on the Science of Eliminating Health Disparities Meeting; National Harbor, MD, Oct-Nov 2012.

Disparities in Adoption

• Age• Gender• Race and Ethnicity• Socioeconomic Status• Health Literacy• Computer Literacy• Health and Disease

Current MHAV Access Tiers• Tier I Access (partial access)– send secure messages – request appointments

• Tier II Access (full access)– view portions of the clinical record– view educational materials, lab interpretations– view past and upcoming appointments

Current MHaV Access Processes• Patient registers for Tier I access from anywhere

• Patient shows ID onsite to gain Tier II access

• Challenges -– Patients cannot easily get full access all at once onsite– Patients cannot get full access after leaving– Process requires manual steps and can be overlooked

Universal Full MHaV Access• Automatically provide Tier II access for ALL

patients as part of standard intake procedures.

• Simplify account creation steps for patients.

• Streamline MHaV account creation for patient services representatives and admissions staff.

Future Directions• Patient-completed forms, -reported outcomes• Medications, Problems, Allergies reconciliation• Medication refills• Expand available medical record data• Robust mobile presence• Patient-directed decision support, care plans• Prescribed educational materials• Integrated social networks

• A BIG thanks –– Gretchen Jackson– Chandra Osborn– Kevin Johnson– Sue Muse– Gaye Smith– Jim Jirjis– Amanda Scott– The MHaV Team– The iAdapt Team

– AHRQ R18HS019276

Questions?http://www.youtube.com/watch?v=5eT1_L-w1Mo

Happy to hear from you: trent.rosenbloom@vanderbilt.edu