Patient Centered
Information Technology
C.T. Lin MD, FACP
Chief Medical Information Officer, University of Colorado Health...
I have nothing to disclose.
I have no relevant financial interest/arrangement or affiliation with
any organizations relate...
Learning Goals
Be able to define and describe:
• Patient Centered Information Technology
• Risks / benefits of online comm...
UCH 9th Avenue Campus
46 acres at 9th & Colorado
Vision 2020
Re-inventing health care for the next
century: from Bricks and Mortar to
Patient Centered Information Technolo...
One square mile; a health sciences city; 30, 000 employees when
complete, an opportunity to “re-invent healthcare” from th...
Outline
Patient Centered Information Technology
Paternalism?
Online communication
Access to health records
Social Media an...
Paternalism
(doctor-centered)
Knowledge is power. Respect my studies.
I am too important for clerical tasks
Patients do best when they do what I say
The...
Knowledge...power
I am too important
Pts…do what I say
Nothing wrong…
Collaboration is powerful
Communication improves saf...
Doctor-centered
Patient-centered
Doctor-
centered
Patient-
centered
Doctor-
centered
Patient-
centered
!!
Diabetes-STARCORHIOSPPARO
Advance Check-InDirect SchedulingMy Doctor’s Office CEO-email
satisfaction
Electronic Medical
Re...
• 82% of U.S. adults have Internet access
• Harris Interactive poll, July, 2010
• 90% of online patients want to e-mail th...
Online communication
(MD opinions)
“The floodgates will open”
“Patients will send chest pain
messages--at midnight!”
“Pati...
So, what happened?
After 6 months…
Patient satisfaction improved
Sending a message to Docs: 24%
Prescription refills: 19%
Appointment requests: 24%
Overall c...
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 ...
Patient perceptions
81% of MDO patients noted it saved them a
phone call to the clinic
33% noted it saved them a visit to ...
There is NO FLOOD
1 message per day per 250 patients
OR, about 10 messages a day per doc
Online Communication
Summary
• MDO patients are more satisfied with
communication and overall care
• Patients say it saves...
Online communication
Comments or questions
Online release of test results
“Patients will be
confused.”
“The only reason I will
participate is that you
are doing a ri...
Intervention
Selected Laboratory Tests
Online release of doctor notes
“Patients will act on
errors in transcripts.”
“Patients will be more
anxious”
“This is a cr...
So, what happened?
After 12 months…
“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 fe...
Physician debrief
• “The problems were minor.”
• “I thought I would change my dictations
for this, but I did not”
• “Alert...
Trust
Empowered
Felt understood
Adherence to treatment
Patient debrief
“I like going over the reports so that I have some
intelligent questions.”
“I probably don‟t remember half...
SPPARO Summary
NO: patient overuse or misunderstanding
NO CHANGE: health utilization (visits, calls)
physician documentati...
SPPARO update
Presenting this data to University audience
• Administration saw a competitive advantage
• Nursing saw a pat...
Study Results: SPPARO
Comments or questions
• More transparency
• Social Media: Peer to Peer technology
• A global community of patient
experience and knowledge
• Att...
Untethered Personal Health Reco
Untethered Personal Health Record (discontinu
Government sponsored, expert-driv
Non-profit, clearinghouse
For profit, expert mediated
For-profit, peer-to-peer
CT Lin MD
ct.lin@ucdenver.edu
Thank you!
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"
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iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"

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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 behavior

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  • For most of the history of the medical profession, PATERNALISM prevailed. The world was Doctor-Centric. But then, a slow, tectonic shift began in 1970 with patients gaining the right to access their own paper medical records, and accelerated with the world wide web in the 1990’s, and maturing with the adoption of Electronic Health Records and Patient Portals after 2000.
  • This has been a gradual shift, to a new paradigm of:
  • Researcher Ed Krupat calls these physicians who retain the old-world view DOCTOR CENTERED DOCTORS. (pause)This is in contrast to the newer model of PATIENT CENTERED DOCTORS, with more emphasis on informed patients; shared decision-making; transparency.
  • Now, throw patient attitudes into this mixture. You might imagine:--Doctor-centered doctors and like-minded Doctor-centered patients would have HIGH satisfaction. You would be right. --Patient-centered doctors and like-minded patients, also have HIGH satisfaction. --However, Doctor-centered doctors and Patient-centered patients think differently, and yes, satisfaction is LOW. --What happens when Patient-centered Doctors and Doctor-Centered Patients meet? Anyone? Anyone? SURPRISE. HIGH satisfaction!What happened here? We hypothesize that perhaps good listening skills of patient-centered doctors leads to adaptive behaviors and high satisfaction. We draw the conclusion that being PATIENT CENTERED is the right approach: it gains high satisfaction from nearly all patients.
  • (read)At the end of the study, ALL physicians, ALL nurses, and ALL patients agreed to continue and that this ‘transparency’ with TEST RESULTS was a good idea.
  • We did the same thing for doctors notes: discharge summaries, clinic notes, operation reports, a study over 12 months:
  • iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado Health "Patient Centered Information Technology"

    1. 1. Patient Centered Information Technology C.T. Lin MD, FACP Chief Medical Information Officer, University of Colorado Health Professor, University of Colorado School of Medicine iHT2 Health IT Summit July, 2013 Denver, CO
    2. 2. 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.
    3. 3. 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
    4. 4. UCH 9th Avenue Campus 46 acres at 9th & Colorado
    5. 5. Vision 2020 Re-inventing health care for the next century: from Bricks and Mortar to Patient Centered Information Technology
    6. 6. 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
    7. 7. Outline Patient Centered Information Technology Paternalism? Online communication Access to health records Social Media and Patients
    8. 8. Paternalism (doctor-centered)
    9. 9. 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
    10. 10. 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
    11. 11. Doctor-centered Patient-centered
    12. 12. Doctor- centered Patient- centered Doctor- centered Patient- centered !!
    13. 13. Diabetes-STARCORHIOSPPARO Advance Check-InDirect SchedulingMy Doctor’s Office CEO-email satisfaction Electronic Medical Records
    14. 14. • 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
    15. 15. Online communication (MD opinions) “The floodgates will open” “Patients will send chest pain messages--at midnight!” “Patients can reach me” “Less telephone tag!”
    16. 16. So, what happened? After 6 months…
    17. 17. Patient satisfaction improved Sending a message to Docs: 24% Prescription refills: 19% Appointment requests: 24% Overall care from the clinic 11% Overall communication 32%
    18. 18. 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
    19. 19. 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
    20. 20. There is NO FLOOD 1 message per day per 250 patients OR, about 10 messages a day per doc
    21. 21. 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
    22. 22. Online communication Comments or questions
    23. 23. 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.”
    24. 24. Intervention Selected Laboratory Tests
    25. 25. 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?”
    26. 26. So, what happened? After 12 months…
    27. 27. “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!
    28. 28. 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.”
    29. 29. Trust Empowered Felt understood Adherence to treatment
    30. 30. 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?‟”
    31. 31. 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)
    32. 32. 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
    33. 33. Study Results: SPPARO Comments or questions
    34. 34. • 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
    35. 35. Untethered Personal Health Reco
    36. 36. Untethered Personal Health Record (discontinu
    37. 37. Government sponsored, expert-driv
    38. 38. Non-profit, clearinghouse
    39. 39. For profit, expert mediated
    40. 40. For-profit, peer-to-peer
    41. 41. CT Lin MD ct.lin@ucdenver.edu Thank you!

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