Optimizing your EHR Value through Patient Engagement


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Focusing on the transformed healthcare system enabled by ARRA, hear ideas on how patients can help realize the value of your EHR and help you achieve meaningful use.

Deputy National Coordinator for Programs and Policy, Office of the National Coordinator for HIT

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Optimizing your EHR Value through Patient Engagement

  1. 1. Optimizing your EHR Valuethrough Patient EngagementJudy Murphy, RN, FACMI, FHIMSS, FAANDeputy National Coordinator for Programs and Policies, ONCHIMSS 2012Physician IT Symposium
  2. 2. Conflict of Interest DisclosureJudy Murphy, RN, FACMI, FHIMSS, FAAN Has no real or apparent conflict of interest to report.
  3. 3. Objectives• List the Stage 1 and Stage 2 Meaningful Use objectives that fall under the National Patient Priority of "Engaging Patients and Families"• Describe ways in which physicians can use HIT to facilitate patients and families to become an integral part of the care team• Identify ways for physicians to prioritize use of PHRs, including consumer portals for improving access to healthcare and engaging with consumers in managing their health• ONC Program Update 2
  4. 4. Back in the Day… “The obedience of a patient to the prescriptions of his physician should be prompt and implicit. [The patient] should never permit his own crude opinions as to their fitness to influence his attention to them.” -- AMA’s Code of Medical Ethics (1847) 3
  5. 5. And Now…“Patients share theresponsibility for theirown health care….” --AMA’s Code of Medical Ethics (current) “Patients can help. We can be a second set of eyes on our medical records. I corrected the mistakes in my health record, but many patients dont understand how important it will be to have correct medical information, until the crisis hits. Better to clean it up now, not when there’s time pressure.” – Dave deBronkart (ePatient Dave) 4
  6. 6. Why Should You Use Health ITto Engage Your Patients? • Patient as Partner • Engaged patients demonstrate better health outcomes • Patients increasingly expect engagement via IT, as in many other aspects of their lives • Meaningful Use criteria 66% of Americans say they would consider switching to a physician who offers access to medical records through a secure Internet connection – according to a 2011 Deloitte Survey 5
  7. 7. Stage 1 and Draft Stage 2 MU Objectives From the June 8, 2011 HITPC Meeting Engaging Patients and FamiliesStage 1 Final Rule HITPC Proposed Stage 2 Key: Red indicates proposed change based on HITPC 5/11 commentsEH: Provide >50% of all discharged Hospitals: ≥ 25 patients receive electronic discharge instructions at time of dischargepatients patients with an electroniccopy of their discharge instructions Hospitals: 10% of patients/families view and have ability to download [took out “relevant”] information about a hospital admission; information available for all patients within 36 hours of the encounterEH Menu: Provide >10% of all unique Move to Core: EPs: >10% of patients/families view & have ability to download theirpatients with timely electronic access longitudinal health information; information available to all patients within 24 hours of anto health information (EP) encounter (or within 4 days after available to EPs) [P&S TT to consider whether a P&S warning should be put in S&C criteria]EP: Provide Clinical Summaries to EPs: patients are provided a clinical summary after 50% of all visits, within 24 hourspatients for >50% of all office visits (pending information, such as lab results, should be available to patients within 4 days ofwithin 3 business days becoming available to EPs; (electronically accessible for viewing counts)EP Menu: Use certified EHR Move to Core: Both EPs and hospitals: 10% of patients are provided with EHR-enabledtechnology to identify patient-specific patient-specific educational resources; make core; take out “if appropriate” instead of raisingeducational resources and provide to thresholdpatient if appropriate for >10% of allunique pts. EPs: patients are offered secure messaging online and at least 25 patients have sent secure messages online EPs: Patient preferences for communication medium recorded for 20% of patients Stage 3: Provide mechanism for patient-entered data (supply list); consider “information reconciliation” for stage 3 to correct errors 6
  8. 8. How can you use Health IT toSupport Patient Engagement?  Within the clinical encounter  Between clinical encounters 7
  9. 9. Within the Clinical EncounterSome Relevant Information2011 ONC-funded survey & focus group research on EHRs (by Mathematica):• Most patients have favorable perceptions of EHRs• Majority believe EHRs improve quality of care• < 5% lack confidence in security of EHRs• < 10% feel computer in exam room negatively impacts interaction/quality of careTop perceived benefits of EHRs:• Convenience to patients• < Efficiency and accuracy of recording information and tracking patient progress• Better coordination of careTop perceived potential drawbacks of EHRs:• System breakdowns• Privacy concerns• Inability to completely eliminate human error• Inability of systems to communicate with each other 8
  10. 10. What You Can Do • Arrange the exam or hospital room so you and the patient can both see the computer screen/device • Sit at the same height as or lower than the patient to make them feel at ease • During the transition from paper, explain that you’re still learning and there may be some bumps while your practice is “under construction” • Less important than any technology is the sense of connection you create through empathy, posture, gesture and tone of voice (It’s not about the EHR!) • Customize delivery of information to the patient - electronic copy of discharge instructions and summary of care • Advocate for use of portal/PHR during clinic encounter or hospitalization 9
  11. 11. Between Clinical EncountersSome Relevant Information• Approximately 50 million Americans (roughly 20%) have accessed their health information online . (Manhattan Research, 2011)• More than half (52%) of Americans say they would use a smart phone or PDA to monitor their health if they were able to access their medical records and download information about their medical condition and treatments. (Manhattan Research, 2011)• 26% of Americans use mobile phones for health. This has more than doubled since the previous year. (Manhattan Research, 2011)• Remote patient monitoring is expected to grow by 25% per year (Kalorama Information, 2011) 10
  12. 12. What You Can Do• “Patient as Partner” - increase patient accountability for and participation in their own health and wellness care• Give patients easy, electronic access to their own health information (portal, “blue button”, tethered PHR)• Encourage patients to look at their information and ask questions, help identify and fix data quality issues • Use electronic reminders to help patients schedule a screening or regular checkup • Communicate via e-mail (or text) using recommended best practices (See next slide) • Participate in health information exchange activities – EHRPHR, EHREHR, EHRpublic health, etc. • Improve care coordination between all care venues - hospitals, clinics, physicians, home care, pharmacies 11
  13. 13. Best Practices forProvider eMail Use*• Establish a turnaround time for messages (don’t use for urgent matters)• Talk to patients re privacy issues, such as who will see the messages• Use subject lines to help filter (e.g. “prescription”)• Configure automatic reply to acknowledge receipt of message• Save and file e-mails in a folder for each patient• Make sure the patients name and yours are on each message• Be careful about sending messages to more than one patient at a time (they may see each other’s e-mail addresses)• Do not deliver bad news via e-mail• Establish clear guidelines patients should use, and remind them when they do not adhere to them* Developed by Danny Sands, MD and Beverly Kane, MD for the AMIAInternet Working Group (this is a partial list) 12
  14. 14. ONC Consumer Pledge Program Join ONC’s Pledge Program! www.healthit.gov/pledge ONC’s Consumer Pledge Program is designed to support organizations that are working to empower individuals to be partners in their own health and health care. There are two types of pledges: 1. Data holders -- Make it easier for individuals to get secure electronic access their health info (through Blue Button or Direct) – and encourage them to do it. 2. Non-data holders – Spread the word about the importance of getting access information, and develop tools to make that information actionable. 13
  15. 15. Pledge ProgramMore than 250 organizations have taken the Pledge.Collectively, they will provide access to personal healthinformation to 100 million (1/3 of) Americans… 14
  16. 16. Benefits of Pledge Program • Public recognition of consumer access to/use of information efforts • Opportunities to network and partner with other organizations who share a similar goal of greater consumer engagement in health • A forum to elevate issues and provide input on policy barriers/challenges for the federal government to address • Input into the development of and access to materials/tools to spread the word • Opportunities to exchange best practices and learn from leaders in consumer engagement 15
  17. 17. Pledge Participation…To learn more or to take the pledge: www.healthit.gov/pledge 16
  18. 18. ONC Program Update• ONC Websites• Putting the “I” in Health IT Campaign• Meaningful Use Update - Attestation Activity• AHA Survey – Health IT Supplemental Questions• Health IT Resource Center• Health Information Exchange• Beacon Communities• Workforce Training• The HITECH Story and Three Part Aim 17
  19. 19. HealthIT.hhs.gov website18
  20. 20. HealthIT.gov website19 19
  21. 21. Health IT Buzz Blog20 20 http://www.healthit.gov/buzz-blog/from-the-onc-desk/consumer-health-information/
  22. 22. 21
  23. 23. 22
  24. 24. ePatient Dave Cancer Survivor and Proud Father 23
  25. 25. Nikolai “Koyla” Kirienko Crohn’s Disease Patient and Trailblazer 24
  26. 26. Lillianne Smith Diabetes Patient and Loving Mother 25
  27. 27. Donna Cryer Liver Transplant Survivor and Style Maven 26
  28. 28. HITECH Framework for MU of EHRs Taken from: Blumenthal, D. “Launching HITECH,” posted by the NEJM on 12-30-2009.27
  29. 29. Meaningful Use Takes Off– 52% percent of office-based physicians intend to take advantage of EHR incentives– The percentage of primary care providers who have adopted EHRs in their practice has doubled from 20% to 40% between 2009 to 2011– ONC’s Regional Extension Centers (RECs) have signed up more than 100,000 primary care providers– This means that roughly one third of the nation’s primary care providers have committed to meaningfully using EHRs by partnering with their local REC. Momentum is building!– Hospital adoption has more than doubled since 2009, increasing from 16% to 35%– Most (85%) of hospitals intend to attest to Meaningful Use by 2015 28
  30. 30. 2011 Medicare and Medicaid Eligible Provider EHR Incentive PaymentsNote: Figures reflect number of uniqueprofessionals who have registered orreceived a payment from either theMedicare or Medicaid EHR IncentivePayment Programs. Figures may beslightly different than the number ofpayments that have been made toeligible professionals by the programs.Source: Number of professionalsregistered and paid are from CMS EHRIncentive Program Data as of12/31/2011. 29
  31. 31. 2011 Medicare and Medicaid Eligible Hospital EHR Incentive PaymentsNote: Figures reflect number ofunique hospitals that havereceived a payment from eitherthe Medicare or Medicaid EHRIncentive Payment Programs.Figures are different than thenumber of payments that havebeen made to eligible hospitals bythe programs because hospitalscan receive payments under bothprograms.Source: Number of hospitalsregistered and paid are fromCMS EHR Incentive ProgramData as of 12/31/2011. 30
  32. 32. 2011 AHA Survey Data Key points – in one year, from 2010 to 2011: • Hospitals increased their use of Basic EHRs from 19% to 35% (84%) • Hospitals doubled their use of Comprehensive EHRs from 4% to 9% (125%) 40 35 35 30 27Percent of hospitals 25 19 20 16 14 15 13 10 9 10 8 4 5 2 3 0 2008 2009 2010 2011 At Least Basic At Least Basic (Rural Hospitals) Comprehensive 31
  33. 33. AHA Survey – implementation %by state of at least Basic EHR 32
  34. 34. Health IT Resource Center Work with REC Work with external community and shares communities and shares knowledge knowledge Tools BeaconHIE REC Resources Communities CCC SHARP of Practice National (CoPs) Learning System 33
  35. 35. HITRC Resources Customer Relationship Knowledge Sharing Communities of Management Network (KSN) Practice (CoPs) (CRM) Learning Practice Training Services Transformation Systems Support Tools &Support Collaboration Public Website for Adoption Portal and MU 34
  36. 36. Health Information Exchange Number of e-Prescribers in US by Method of Prescribing 400,000 350,000 300,000 250,000 Stand-alone 200,000 e-Rx System EHR 150,000 Total 100,000 50,000 0 Oct-07 Oct-08 Oct-09 Oct-10 Dec-06 Dec-07 Dec-08 Dec-09 Dec-10 Aug-07 Aug-08 Aug-09 Aug-10 Apr-07 Apr-08 Apr-09 Apr-10 Apr-11 Feb-07 Feb-08 Feb-09 Feb-10 Feb-11 Jun-07 Jun-08 Jun-09 Jun-10 Jun-11When will we see this Curve for Transition of Care Summaries or LabExchange? 35
  37. 37. Hospital Exchange Activity withAmbulatory Care Providers 60.0 54.0 53.1 51.9 50.0Proportion of U.S. Hospitals 42.0 40.7 40.0 33.7 34.3 30.0 28.5 19.4 20.0 18.0 10.0 0.0 Patient Demographics Radiology Reports Lab Results Medication History Clinical Care Records Within system 2010 Outside system 2010 36
  38. 38. 17 Beacon Communities Eastern Maine Healthcare Systems Western NY Clinical Brewer, ME Information Exchange Buffalo, NY Inland Northwest Health Services Mayo Center Clinic Rhode Island Quality Institute Southeastern Michigan Spokane, WA Rochester, MN Providence, RI Health Association Detroit, MI Geisinger Clinic Indiana HIE Danville, PA Indianapolis, IN HealthInsight Salt Lake City, UT HealthBridge Rocky Mountain HMO Cincinnati, OH Grand Junction, CO Southern Piedmont Community Care Plan Community Services Concord, NC The Regents of the Council of TulsaUniversity of California Tulsa, OK San Diego, CA Delta Health Alliance Stoneville, MS University of Hawaii at Louisiana Public Health Institute Hilo New Orleans, LA 37
  39. 39. Sample Beacon Early Results Colorado Beacon Consortium Bangor Maine Beacon Community Uncontrolled Diabetes Admissions Cardiovascular Disease: Blood Pressure Control (AHRQ PQI #14) (< 140/90 mmHg) 100 6.0 94 90 92 5.18 85 5.0 80Rate (per 100,000) 70 4.0 4.19 Rate (%) 60 3.34 50 3.0 40 2.0 30 20 1.0 10 0.0 0 1 2 3 1 2 3 Measurement Period Measurement Period Utah IC3 Beacon Community Diabetes Control: HbA1c (575) < 8 100 90 80 70 60 58 Rate (%) 52 54 50 Source: Self-reported 40 30 data from Beacon 20 Program Quarterly 10 0 submission. 1 2 3 Measurement Period 38
  40. 40. Community College Consortia Workforce Program REGION A REGION C REGION EREGION B • 5 regions REGION D • $6 – $ 21 M per region • April 2010 award • 2 Years • 10,500 to be trained 39
  41. 41. Workforce TrainingEnrollment and Graduation Community College Students 6,000 November 2011 5,000 917 Students Enrolled or Completed: 16,065 Attrition Rate: 18% 4,000 750 1018 3,000 375 3322 813 720 2253 2,000 1441 1107 1,000 2104 1370 1252 1398 1005 0 Bellevue Los Rios Cuyahoga Pitt Tidewater (8 Colleges) (13 Colleges ) (17 Colleges) (20 Colleges) (22 Colleges) Successfully Completed* Actively Enrolled Dropped-out * Enrollment to date includes unique students reported in December 2011 cycle 40
  42. 42. Community College Consortia Students Enrolled and Students Completed (Cumulative) 25,000 21,022 20,000 15,000 10,000 7,129 5,000 0 May-11 Jun-11 Nov-10 Nov-11 Feb-11 Sep-11 Sep-10 Jan-11 Aug-11 Aug-10 Jul-11 Oct-10 Oct-11 Mar-11 Dec-10 Apr-11 Enrolled Completed 41
  43. 43. In Summary … the HITECH Story Why does America need to modernize using Health IT? What is America doing to modernize its Healthcare System• Enable providers to securely through Health IT? and efficiently exchange patient health information. Showing• Give providers the right Outcomes information, at the right time to offer their patients the Engaging right care. Consumers• Give consumers tools to know their health information so Promoting that they can improve their Exchange Keeping health. Patients Safe• Foundational to building a Protecting truly 21st century health Privacy and Accelerating Security system where we pay for the Meaningful Use right care, not just more care. How is ONC - Promoting Standards & Interoperability (HIE) helping - Stimulation Innovation (Beacon, Sharp) America - Helping Providers Adopt (REC, Workforce) modernize? 2012 42
  44. 44. Health IT lays the Foundation forNew Payment and Delivery Modelsto Enable the Three-Part Aim Better healthcare Improving patients’ experience of care within the Institute of Medicine’s 6 domains of quality: Safety, Effectiveness, Patient- Centeredness, Timeliness, Efficiency, and Equity. Better health Keeping patients well so they can do what they want to do. Increasing the overall health of populations: address behavioral risk factors; focus on preventive care. Reduced costs Lowering the total cost of care while improving quality, resulting in reduced monthly expenditures for Medicare, Medicaid, and $ CHIP beneficiaries. Health Information Technology 43
  45. 45. Thanks!Judy Judy.Murphy@hhs.gov