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Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
Large Group Lecture for Patient Portals
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Large Group Lecture for Patient Portals

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  • Embargos Legal Hippa What if patients read things first? Dealing with excessive patients
  • Include indivo, epic/mychart pamf online, my healthevet, dossia, the blue botton Add RelayHealth 2001
  • The median number of clinical messages per 100 actively enrolled patient per month in 2010 was 21.5 (IQR 3.5) for the hospital-based practice, 17.4 (IQR 3.6) for the satellite practice in an underserved area, and 5.9 (IQR 4.0) for the community health center (p<0.001).
  • Transcript

    • 1. Patient Portals: Can they improve YOUR care delivery? Let ’s find out... Bradley H Crotty, M.D. Instructor in Medicine , Harvard Medical School & Chief Resident, Beth Israel Deaconess Medical Center Ambulatory Care Conference, September 2011 Medicine & Technology Research Collaborative www.themetrc.org
    • 2. What is PatientSite?
    • 3. Residents will enroll in PatientSite to meet 3 needs… <ul><li>Future practice patterns likely will rely on information technology and electronic communication. </li></ul><ul><li>Professionalism, and </li></ul><ul><li>Systems Based Practice </li></ul><ul><li>Patient Engagement </li></ul><ul><li>“ Out of Visit” based care may be ideal for resident clinics </li></ul><ul><li>Standardization &amp; Satisfaction </li></ul>
    • 4. Our Agenda Today
    • 5. &nbsp;
    • 6. Learning Objectives <ul><li>After Today ’s session, you should be able to: </li></ul><ul><li>Give examples of how portals can engage patients with their healthcare </li></ul><ul><li>Compare different ways to communicate electronically with patients </li></ul><ul><li>Perform an ‘informed consent’ for electronic communication </li></ul>
    • 7. Learning Objectives <ul><li>After Today ’s session, you should be able to: </li></ul><ul><li>Sign onto PatientSite </li></ul><ul><li>Adjust settings as needed </li></ul><ul><li>Send and Receive Clinical Email </li></ul>
    • 8. What we thought six months ago…
    • 9. Personal Health Records
    • 10. 50K Medicine &amp; Technology Research Collaborative @ BIDMC www.themetrc.org © 2011 Bradley Crotty 1994 Microsoft® Money/Quicken 1998 Web Access to Financial Services 1991 E-Trade Electronic Trading 2011 2009 1970s-1980s Clinical E-Mail begins at BI &amp; BWH Patient Gateway 200 3 200 3 VA My Health e-Vet PING/Indivo 2000 2008 Google Health &amp; Microsoft HealthVault PatientSite 2000 2008 Dossia/Indivo EPIC/MyChart 2000 2007 2005 2003 2000 1995 1990 1980 1970
    • 11. PHRs are evolving.. Levy,P. Information in a Heartbeat. Running a Hospital. 10/17/2001. Accessed at http://runningahospital.blogspot.com/2007/10/information-in-heartbeat.html on 2/19/2011. (Archived by WebCite® at http://www.webcitation.org/5weE9BQmP)
    • 12. PHRs are evolving... Vincent et al. A patient-centric taxonomy for personal health records (PHRs). AMIA Annu Symp Proc (2008) pp. 763-7 Markle Foundation. Connecting Americans to their Health Care: A Common Framework for Networked Personal Health Information. 2006.
    • 13. Models of PHRs Vincent et al. A patient-centric taxonomy for personal health records (PHRs). AMIA Annu Symp Proc (2008) pp. 763-7 Type Data Example Stand-Alone Manual Entry Word Document
    • 14. Models of PHRs Vincent et al. A patient-centric taxonomy for personal health records (PHRs). AMIA Annu Symp Proc (2008) pp. 763-7 Type Data Example Stand-Alone Manual Entry Word Document Provider-Tethered Clinical  PHR PatientSite
    • 15. Models of PHRs Vincent et al. A patient-centric taxonomy for personal health records (PHRs). AMIA Annu Symp Proc (2008) pp. 763-7 Type Data Example Stand-Alone Manual Entry Word Document Provider-Tethered Clinical  PHR PatientSite Payer-Tethered Admin  PHR Harvard Pilgrim Health Connect
    • 16. Models of PHRs Vincent et al. A patient-centric taxonomy for personal health records (PHRs). AMIA Annu Symp Proc (2008) pp. 763-7 Type Data Example Stand-Alone Manual Entry Word Document Provider-Tethered Clinical  PHR PatientSite Payer-Tethered Admin  PHR Harvard Pilgrim Health Connect Third-Party Clinical  PHR Admin  PHR Google Health/ HealthVault
    • 17. Patient-Provider Communication
    • 18. Delbanco and Sands. Electrons in flight--e-mail between doctors and patients. The New England Journal of Medicine (2004) vol. 350 (17) pp. 1705-7
    • 19. Delbanco and Sands. Electrons in flight--e-mail between doctors and patients. The New England journal of medicine (2004) vol. 350 (17) pp. 1705-7
    • 20. <ul><li>Who will sign up, and why? </li></ul><ul><li>Who won ’t sign up, and why? </li></ul>
    • 21. Weingart et al. Who uses the patient internet portal? The PatientSite experience. J Am Med Inform Assoc (2006) vol. 13 (1) pp. 91-5 Patients were younger, healthier, whiter, insured
    • 22. A map of PatientSite Users Weingart et al. Who uses the patient internet portal? The PatientSite experience. J Am Med Inform Assoc (2006) vol. 13 (1) pp. 91-5 Crotty B, Tamrat Y, Mostaghimi A, Safran C, Landon BE. Clinical Messaging and Practice Variation. (unpublished data) Medically underserved areas are under-represented on PatientSite
    • 23. BIDMC Practices Crotty B, Tamrat Y, Mostaghimi A, Safran C, Landon BE. Clinical Messaging and Practice Variation. (unpublished data) P&lt;0.001 Practice Messages/enrolled patient/month (IQR) Hospital Based Practice 21.5 (3.5) Satellite Practice, underserved community 17.4 (3.6) Comm Health Center 5.9 (4.0)
    • 24. The Digital Divide <ul><li>Income </li></ul><ul><li>Race / Ethnicity </li></ul><ul><li>Education </li></ul><ul><li>Age </li></ul><ul><li>Medical Conditions </li></ul><ul><li>Sex </li></ul><ul><li>Rural//Suburban//Urban </li></ul>Difference of Resources Difference of Interest Lack of Time Difference in Use
    • 25. <ul><li>What do patient ’s want? </li></ul><ul><li>What will improve their healthcare experience? </li></ul><ul><li>Will the patient understand what I write? </li></ul>
    • 26. Information &amp; Communication Barriers Gérard Métrailler (used via Creative Commons License) http://www.flickr.com/people/gmetrail/ Patients PHRs &amp; Clinical Messaging Providers
    • 27. If You were a Patient:
    • 28. Patients want: <ul><li>To be able to email their doctor (70%) </li></ul><ul><li>Manage admin tasks online (if they use the web) </li></ul><ul><li>Have time to digest a visit, then ask questions </li></ul><ul><li>Prepare for visits, compensate for poor or complex communication </li></ul><ul><li>Unfettered access to their record </li></ul>Moyer et al. Bridging the electronic divide. Am J MC(2002) vol. 8 (5) pp. 427-33 Fisher et al. How patients use access to their full health records:JRSM (2009) vol. 102 (12) pp. 539-544 Tang et al. Meeting the information needs of patients: results from a patient focus group. Proc AMIA Annu Fall Symp (1997) pp. 672-6 Hassol et al. Patient exp and attit. about access to a PHR and electronic health linked web messaging. JAMIA(2004) vol. 11 (6) pp. 505-13 Walker et al. Insights for Internists: “I Want the Computer to Know Who I Am” JGIM (2009) vol. 24 (6) pp. 727-732
    • 29. If email wasn ’t available? Serrato et al. MyChart—a new mode of care delivery: 2005 personal health link research report. The Permanente Journal (2007) vol. 11 (2) Course of Action Called PCP for Advice 44% Scheduled an office visit 25% Called Nurse 18% Would make no contact 11% Walk in for unscheduled medical care 3%
    • 30. Satisfaction correlates with response times Serrato et al. MyChart—a new mode of care delivery: 2005 personal health link research report. The Permanente Journal (2007) vol. 11 (2)
    • 31. Pitfalls of Data <ul><li>More data is not always good: </li></ul><ul><li>The case of e-patient Dave: </li></ul>http://epatientdave.com/
    • 32. <ul><li>What do I have to do? </li></ul><ul><li>Will I be overwhelmed? </li></ul>
    • 33. What do patients write? <ul><li>70-80% Single Issue </li></ul><ul><li>25% New medical symptom </li></ul><ul><li>Most studies show no urgent messages (rate probably under 5%), though more among early adopters </li></ul>Byrne et al. Initial experience with patient-clinician secure messaging at a VA medical center. JAMIA (2009) vol. 16 (2) pp. 267-70 Houston et al. Experiences of patients who were early adopters of electronic communication with their physician: satisfaction, benefits, and concerns. The American Journal Of Managed Care (2004) vol. 10 (9) pp. 601-8 Rosen and Kwoh. Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery. Pediatrics (2007) vol. 120 (4) pp. 701-706
    • 34. What do patients write? Serrato et al. MyChart—a new mode of care delivery: 2005 personal health link research report. The Permanente Journal (2007) vol. 11 (2) (n=690 msgs) Primary Reason Discuss new condition 12% Report change in existing condition 16% Discuss need for new Rx 10% Discuss change in Rx dose 11% Request Rx renewal 8% Discuss lab results 14% Provide a health update/events 13% Discuss need for an appointment 5% Other 4%
    • 35. Crotty B, Tamrat Y, Mostaghimi A, Safran C, Landon BE. Clinical Messaging and Practice Variation. (unpublished data)
    • 36. Provider Impact <ul><ul><li>No decrease in physician productivity </li></ul></ul><ul><ul><li>Decreased call volumes </li></ul></ul><ul><ul><li>Generally faster than calls, but sometimes generates a call anyway </li></ul></ul>Liederman et al. Patient-physician web messaging. The impact on message volume and satisfaction. J Gen Intern Med (2005) vol. 20 (1) pp. 52-7 Zhou et al. Patient access to an electronic health record with secure messaging: impact on primary care utilization. AJMC(2007) vol. 13 (7) pp. 418-24 Rosen and Kwoh. Patient-Physician E-mail: An Opportunity to Transform Pediatric Health Care Delivery. Pediatrics (2007) vol. 120 (4) pp. 701-706
    • 37. Slack. A 67-year-old man who e-mails his physician. JAMA (2004) vol. 292 (18) pp. 2255
    • 38. E-Mail “Informed Consent” <ul><li>Establish turnaround time </li></ul><ul><li>Discuss not using email for urgent matters </li></ul><ul><li>Inform patients about privacy issues (security, indemnity, encryption waiver) </li></ul><ul><li>Establish permissible types of transactions </li></ul><ul><li>Escalation of communication </li></ul>Kane and DZ. White paper: guidelines for the clinical use of electronic mail with patients. J Am Med Inform Assoc (1998) vol. 5 pp. 104-11
    • 39. <ul><li>How can I engage my patients in their care? </li></ul><ul><li>How can I work with other team members and family? </li></ul>
    • 40. More changes were made, no outcome difference in A1c
    • 41. Osborn et al. Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review. Current diabetes reports (2010) pp. Generally Favorable Six Studies showed a reduction in A1c in Intervention vs. Control Groups. Most studies were small; had robust interventions
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    • 50. &nbsp;
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    • 53. &nbsp;
    • 54. &nbsp;
    • 55. &nbsp;
    • 56. Results are embargoed for a period of time:
    • 57. &nbsp;
    • 58. &nbsp;
    • 59. &nbsp;
    • 60. Logistics <ul><li>You should already have a PatientSite account created for you if you have a regular practice in HCA. </li></ul><ul><li>After today, you may begin encouraging patients to use PatientSite. </li></ul><ul><li>Your preceptor will be set to be copied on all messages sent to you. Please ‘accept task’ when you review a message so your preceptor knows that the message has been seen by you and acted upon if needed. </li></ul><ul><li>Set out of office alerts when you will be out of town, in the ICU, etc. Please tell patients when you will return, and that they should call the office (not email practice partners ) </li></ul><ul><li>Curriculum will be delivered during ambulatory block. </li></ul><ul><li>Survey and assessments at end of year. </li></ul>
    • 61. Accessing PatientSite <ul><li>Use the new portal, and add PatientSite for Providers to your “apps” </li></ul>
    • 62. Learning Objectives <ul><li>After Today ’s session, you should be able to: </li></ul><ul><li>Give examples of how portals can engage patients with their healthcare </li></ul><ul><li>Compare different ways to communicate electronically with patients </li></ul><ul><li>Perform an ‘informed consent’ for electronic communication </li></ul>
    • 63. <ul><li>Acknowledgements </li></ul><ul><li>Margaret Jeddry </li></ul><ul><li>Michael Howell, John Halamka, Larry Markson Tom Delbanco, Jan Walker, Russ Phillips </li></ul><ul><li>PatientSite Study Team: </li></ul><ul><li>Yonas Tamrat, Charles Safran, Arash Mostaghimi, Bruce Landon, George Silva </li></ul><ul><li>Carol Bates, Diane Brockmeyer, Kelly Graham Faith Hinton </li></ul>

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