Home health care & long-term conditions: How to succeed with personal health records
Upcoming SlideShare
Loading in...5
×

Like this? Share it with your network

Share

Home health care & long-term conditions: How to succeed with personal health records

  • 1,076 views
Uploaded on

Dr Mohammad Al-Ubaydli (CEO of Patients Know Best) ...

Dr Mohammad Al-Ubaydli (CEO of Patients Know Best)
Dr Al-Ubaydli is author of the book "Personal health records: A guide for clinicians", in which he surveyed the different ways in which patients can work with their clinical team using software. A new generation of tools allows patients to manage their health and Mohammad will cover some of these in his talk, including products by large US companies like Google and Microsoft, as well as the UK software industry. He will also describe the experiences of his own company, Patients Know Best, which integrates its patient-controlled medical records platform into the NHS secure network.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
1,076
On Slideshare
1,067
From Embeds
9
Number of Embeds
3

Actions

Shares
Downloads
20
Comments
0
Likes
1

Embeds 9

http://www.slideshare.net 6
http://wiki.patientsknowbest.com 2
http://www.linkedin.com 1

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Home health care & long-term conditions How to succeed with personal health records
  • 2. The power of choosing who to learn with
  • 3. A bit about me… Trained as physician at the University of Cambridge. Trained as programmer and worked as NIH Staff Scientist. Honourary Senior Research Associate, UCL Medical School. Continuing research on PHRs from 2,700 US hospitals, new book in 2010: book.patientsknowbest.com
  • 4. The banality of good I like to focus on low-brow tips rather than high-brow hype Computer originally seen as barrier between patient and GP But you just had to turn the monitor around Computer becomes a bridge, not a barrier But the future really is wonderful because of participatory medicine
  • 5. Roadmap How to succeed with PHRs 1. Basics: definitions, and why do this at all? 2. Clinical tips 3. Social factors 4. Finances
  • 6. Roadmap 1. Basics: definitions, and why do this at all? 2. Clinical tips 3. Social factors 4. Finances
  • 7. Some definitions Clinicians Patient Electronic patient records Patient portals Personal health records Personal records
  • 8. Some definitions Clinicians Patient Electronic patient records Patient portals Personal health records Personal records Data by clinicians for clinicians
  • 9. Some definitions Clinicians Patient Electronic patient records Patient portals Personal health records Personal records Easing the patient’s burden Scheduling appointments Ordering medication refills Secure messaging Access to the EPR See: Pyer et. al 2004, Ralston et. al 2007.
  • 10. Some definitions Clinicians Patient Electronic patient records Patient portals Personal health records Personal records Data by patient for patient Powerful but unstructured NHSmail users have mailbox shrunk 06 Feb 2008 NHS staff who use the health service’s email service NHSmail have been informed that after a recent move to Microsoft Exchange their mailbox size has been capped. Some 80% of NHS accounts have been capped at just 200Mb, which appears miserly compared with the hefty 6Gb offered by Gmail for free, or the 5Gb offered for free on Windows Live Hotmail.
  • 11. Facebook cost < $1 per person to build Each minute, it sends out the equivalent of one X-ray for each of UK’s 60 million citizens
  • 12. Some definitions Clinicians Patient Electronic patient records Patient portals Personal health records Personal records Markle Foundation’s ideal PHR: Access controlled by patient Lifelong records Information from all Universal access Private and secure Transparent Easy exchange See: Connecting for Health, 2004
  • 13. Some definitions Clinicians Patient Electronic patient records Patient portals Personal health records Personal records Our PHR helps clinicians help patients
  • 14. Why do this at all? There is no other way to cope Aging and obesity mean more illnesses per patient Modern medicine means more clinicians per patient Budgets and workforce have reached their limits Your patient is the newest and best member of your team Google means patient more useful than ever Work together online to reduce stress in clinic See: Chen 2009
  • 15. The VA’s experience   25% reduction in bed days of care   20% reduction in numbers of admissions   86% mean satisfaction score rating   Population was above national average for: age, poverty, rural Source: VA Care Coordination/Home Telehealth Studies 2004-007, in Darkins et al. Telemedicine and e-Health, Dec 2008
  • 16. The VA’s experience Condition # of Patients % Decrease Utilization Diabetes 8,954 20.4 Hypertension 7,447 30.3 CHF 4,089 25.9 COPD 1,963 20.7 PTSD 129 45.1 Depression 337 56.4 Other Mental Health 653 40.9 Single Condition 10,885 24.8 Multiple Conditions 6,140 26.0
  • 17. Roadmap How to succeed with PHRs 1. Basics: definitions, and why do this at all? 2. Health 2.0 for co-creation 3. Patients Know Best 4. Personal health records’ possibilities
  • 18. PatientsLikeMe: co-creation
  • 19. NHS is the platform for co-creation   Doctors and patients must both use a PHR for it to be useful   Otherwise: Google Health’s dirty secret   UK has much higher usage than USA   GP EHRs: 95% vs 5%   Hospital EHRs: 50% vs 20%   UK broadband and mobile > UK   NHS brand and N3 network are platforms for trust   Trust = co-operation = co-creation
  • 20. Our platform
  • 21. Bupa and Great Ormond Street hospital share data with patient (15 NHS hospitals to join)
  • 22. Detailed explanations for patient save clinician’s time
  • 23. Roadmap 1. Basics: definitions, and why do this at all? 2. Clinical tips 3. Social factors 4. Finances
  • 24. Stick to patients you know Safest for known patients Explain that service is not for emergencies Have a low threshold for asking patient to come in, e.g. because an examination may uncover something that would change your management The longer your team has worked with the patient the less likely they will leave out important information Services do exist for new patients For example, 3G Doctor has detailed questionnaire followed by video phone consultation
  • 25. Assume your writing is read Your existing notes are already owned by the patient See: Data Protection Act and GMC guidelines Data Protection Act 1998: All your notes may be read by a lawyer one day Responding to access requests So write as though everyone is reading everything 5. A request for access must be made in It is not hard to write transparently writing, and no reason need be given. Bad news is fine if it is written objectively, e.g. “Child Subject to any applicable exemption, is dysmorphic”, or “I have no evidence that what patient said is true” the applicant must be given a copy of You must write complete notes as part of your duties as the information and, where the data is a doctor: do not hide the clinical truth not readily intelligible, an explanation Protect confidential information by separate set of (eg of abbreviations or medical notes, just like GU specialists keep their notes separate terminology).
  • 26. Say sorry and thank you (early and often) The medical notes are full of errors E-patient Dave* showed the errors in insurance-based medical records About 30% of medical notes have errors in them Finding and fixing these errors is important but laborious Your patient will gladly help if you say sorry and thank you Sorry works (see: www.sorryworks.net), no one expects perfection or cares about blame, but your reaction determines the patient’s reaction Saying thank you means the patient will help you even more next time * Dave deBronkart and I are on the Editorial Board of the Journal of Participatory Medicine
  • 27. Learn from patients Online forums by and for patients teach thousands of clinicians already Ask your specialist nurse to spend time on a forum and then teach the rest of the team what he / she learned
  • 28. Roadmap 1. Basics: definitions, and why do this at all? 2. Clinical tips 3. Social factors 4. Finances
  • 29. Protect patients from relatives… Relatives may bully patient You must assess whether or not the patient can make independent decisions from their relatives Young and disabled particularly vulnerable If in doubt, do not grant access Use in-person authentication Mailing passwords means relatives can get access Once you have in-person authentication you can continue with electronic communication alone
  • 30. …but make full use of relatives Relatives are wonderfully helpful They often care more about the patient’s health than the patient does They would like to help but have lacked the legal and technical tools to pitch in With consent, online work is excellent use Help the family Chief Medical Officer Typically female, forty and very busy They have to manage the health information of parents, children and spouse, often while employed
  • 31. Roadmap 1. Basics: definitions, and why do this at all? 2. Clinical tips 3. Social factors 4. Finances
  • 32. Doctors want to be paid “I currently help my patients despite my department’s best interest. Problem is there is no telemedicine tariff in NHS, so if patient comes to hospital, we get paid, but if I call patient, we don't get money, so the hospital is disincentivized from investing” Consultant, Norfolk & Norwich Hospital
  • 33. Nurses worried about budgets “I know many of our patients will want to use the secure messaging service because they travel from afar and they can self-manage by asking questions. But then we will get fewer clinic appointments and our budget will be cut for helping these patients.” Specialist nurse, Addenbrooke’s Hospital
  • 34. My advice: start asking for payment US payers recognize the value of working online by paying for it Best outcomes when payer and clinician work together Early adopters began before getting payments Now get paid less for online consultations but these take less time than in-person consultations do No one will pay you… at first If you don’t ask, you will never be paid When you ask, you will still not be paid But if you ask, then start doing the work, and have results to show for it, you can get paid
  • 35. Commissioners already have tools Lambeth PCT could save £320k if switched 269 young patients with chronic diseases to using online consultations Top 5 chronic diseases, excluding kidney (because dialysis is disproportionately expensive) Age less than 50 (to avoid typical but misguided objection that elderly do not use computer) More than 10 outpatient appointments per annum
  • 36. We built our software for this Secure web site, already integrated with NHS, available globally Patient writes message to you Ticks box for topic: this is what you use for analysis in the future
  • 37. Mohammad Al-Ubaydli Patients Know Best team@patientsknowbest.com www.patientsknowbest.com Thank you for listening