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The Health Information Technology Resource Center provides technical assistance for Aligning Forces for Quality, a national initiative of the Robert Wood Johnson Foundation.

Using Health

Information Technology

in Consumer Engagement

David K. Ahern, Ph.D.Director, Health Information Technology Resource Center

(HITRC)

Brigham and Women’s HospitalHarvard Medical School

May 14, 2009

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Overview• Opportunities for near term value of health

information technology (HIT) in light of ARRA

• Optimal development approach to creating effective HIT tools for CE

• Theory- and evidence-based principles for HIT-enabled CE

• Examples of HIT opportunities to support CE goal for AF4Q

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Definition

HIT is the use of technology platforms, tools and programs (i.e., emerging interactive technologies)to enable healthimprovement andhealth care services

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• Electronic Records (EHRs, EMRs, PHRs)with Decision Support

• Web Portals

• Internet-Enabled Mobile Devices

• Medical Devices

• Computerized Tailored Interventions (CTIs)

• Web 2.0 (social media, user contributedcontent)

HIT Tools and Platforms

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Current U.S. Stats

• 22% of Americans use social networking sites

• 70 million blogs exist worldwide and 15-30 million of those are authored by U.S. Internet users

• 80% of active internet users will have an ‘avatar’ or virtual world presence by 2011

• 85% of Americans own a mobile phone and 71% have a landline

• 10 billion text messages are sent from American cell phones each month (250% increase each year for the past two years)

• 17 million Americans have downloaded a podcast at least once

• 25% of Internet users have tagged or categorized content online

• 200,000 eCards are sent monthlyNational Center for Health Marketing, CDC

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Meaningful Use in ARRA

Meaningful use is one required component ofbeing a meaningful user. In order to receive incentive payments created by ARRA, a provider must be a meaningful user, defined by:

• Meaningful use of certified EHR technology

• Participation in exchange of health information

• Reporting on clinical quality measures using the EHR

from eHealth Initiative webinar, 4/15/09

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Actions That Constitute Meaningful Use

• Electronic prescribing (Meet MIPPA requirements) -89%

• Warning of drug interactions - 80%• Viewing lab and imaging results - 79%• Computerized orders - 74%• Problem lists and diagnoses - 73%• Allergies - 73%• Integrating data from multiple sources - 63%• Clinical notes - 60%• Results management - 60%

from eHealth Initiative webinar, 4/15/09

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Actions That Constitute Meaningful Use (Cont.)

• Decision Support - 58%

• Orders sent electronically - 58%

• Performance measurement - 54%

• Order entry - 52%

• Health info and data - 49%

• Clinical messaging - 46%

• Reminders – 42%

• Exchanging data with patients/consumers - 35%

• Other - 29%from eHealth Initiative webinar, 4/15/09

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Relevance of HIT to Chronic Care Model

Chronic Care Model

Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1:2-4.

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Web Portals

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Personal Health Records

Project HealthDesignwww.projecthealthdesign.org

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Social Media• Increasingly, people are using (are in) social media

• AF4Q should be (must be) where people are

• Social Media attributes relevant to health marketing:

– Facilitates interactive communication and community

– Increases the dissemination and potential impact

– Leverages unique characteristics of emerging channels (user engagement, user-generated content, voting, mapping, etc.)

– Reaches diverse audiences

– Allows tailored communications/marketing

– Has potential to empower users to make healthier and safer decisions

National Center for Health Marketing, CDC

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Meeting People Where They’re At

AF4Q Communities

National Center for Health Marketing, CDC

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Approach to Creating HIT Tools

• Phase I – Design Phase– User-centered design analysis

• Facilitated focus groups and structured interviews with consumers and healthcare providers

– Technology Scan• Identify possible technical solutions to user needs

currently available and in the future

– Review of available literature on topic

– Review/analyze focus group/interview data

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• Phase II – Prototyping– System Development

• Develop tools concepts to address behavioral targets

– User-centered Testing• Develop prototype scenarios focused on major

components and processes

• Conduct an iterative approach to testing consumers (N=6) and healthcare providers (N=2)

– Synthesize findings and create an enhanced design statement

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• Phase III – Development– Programming

• Coding of technical/functional requirement

– Version Testing• Develop beta version

• Conduct iterative testing

• Develop alpha version

• Conduct iterative testing

– Release final version

– Bug tracking/Debugging and Enhancements

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Social/Behavioral Principles

• Patient Activation

• Self-Efficacy

• Autonomy Support

• Competence

• Relatedness/Social Support

• Reinforcement

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Effective Behavior Change Process

• Define and target

• Reduce barriers

• Observe and measure

• Feedback, coaching

and support

• Positive reinforcement

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Effective HIT Programs

• QuitNet

• CHESS

• Pro-Change

• HealthMedia

• My HealtheVet

• ACOR

• Chronic Disease Self-Management Program

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Important Features of Effective Programs

• Content aimed toward personal demographics

• Salient and timely messaging

• Cultural Relevance

• Remote Monitoring

• Social support

• Incentives

• Support forself-management

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Messaging

• Age

• Race

• Gender

• Ethnicity

• Sexual Orientation

• Primary Language

Tailored messaging can be based upon such personal characteristics

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Addressing Health Disparities

• Targeting and Tailoring Incentives

• TranslatingResearch into Practice

Photo Source: USDA/ARS

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Barriers to Adoption• Limitations of Access

• Cultural Relevance

• Privacy and Security

• Health and Technology Literacy

• Cost

• Quality

• Interoperability

• Infrastructure

• Integration

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Example of Targeted and Tailored HIT Program

• Enhanced Patient Activation• Provider Communication/Guideline Implementation

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Proportion of US Adults at Recommended Lipid Levels

Michael O’Riordan, theheart.org by WebMD. AUGUST 19, 2008.

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Participants included 55 physicians, 10 midlevel providers, approximately 106 staff and medical records from 4,110 patients.

Provider/PatientEnrollment in RCT

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User-Centered Design

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HeartAge: Patient-Provider Shared Decision making page

Provider PDA Tool

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• Hypothesis 1: Primary Care Providers in the intervention practices willincrease the proportion of patients that are at ATP III recommended LDL cholesterol levels compared to control providers.

– At the end of intervention, 77% of intervention patients were at their ATP III LDL goals compared to 72% in the control practices, p=.07 using generalized linear mixed models to adjust for clustering.

– For CHD equivalent risk, 63% of intervention patients were at goal their LDL goal compared to 55% of controls after one year of intervention.

– Comparing providers who used the intervention tool at least 3 times per week to controls or low level users, those using the tool had increased odds of there patients being at there LDL cholesterol goal, OR=1.58 95% CI 1.17-1.63.

– Compliance analysis showed that intervention patients were more likely to be at their LDL goals after one year, OR=1.19 95% CI 1.00-1.40.

Study Results – RCT

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• Hypothesis 2: Primary Care Providers in the intervention practices will increase the proportion of patients that are screened for hypercholesterolemia using a fasting lipid profile compared to control providers.

– The intent to treat analysis found no difference in screening between the intervention and control practices.

– Compliance analysis comparing practices with 80 or more users ofthe patient activation tool peer per week per 1000 patients (median value) were significantly more likely to have there patient screened using a full lipid profile; OR=2.43, 95% CI 1.87-3.15.

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• Hypothesis 3: Primary Care Providers will diagnosis and treat a greater proportion of patients with lipid disorders according to the ATP III Cholesterol Guideline recommendations in the intervention practices compared to control providers.

– At the end of intervention among those with diagnosed lipid disorder, 74% of intervention patients were at their ATP III LDL goals compared to 68% in the control practices, p=.05 using generalized linear mixed models to adjust for clustering.

– Comparing providers who used the intervention tool at least 3 times per week to controls or low level users, those using the tool had increased odds of there patients being at there LDL cholesterol goal, OR=1.02 95% CI 0.80-1.29.

– Evaluating non-HDL cholesterol 74% of intervention patients were at goal compared to 67% of controls after one year of intervention,p=0.03. Compliance analysis showed that intervention patients were more likely to be at their non-HDL goals after one year, OR=1.27 95% CI 1.02-1.58.


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HIT Opportunitiesto Support CE Goal

• Evolve consumer facing portals to include more tailored content and interactive tools

• Create a searchable “Story Bank” of successful consumer experiences in using comparative performance information

• Employ principles of video games to increase engagement

• Employ social media and user-contributed content to build “autonomous communities”

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HIT Resource Center

• Support and advance Alliances’ work towards achieving AF4Q goals

• Needs assessment in early summer

• Individual HIT TA/consulting

• Partnerships, resources and learning opportunities

• Time sensitive requests – contact us

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Conclusions

User-Centered HIT tools can help diverse consumers to become:

• more informed and knowledgeable about their health

• activated in addressing their health concerns with their providers

• skilled in self-management

• competent in using performance and comparative health information to make informed decisions

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Contact Information:

[email protected](617) 525-6167

Thank You

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