SlideShare a Scribd company logo
1 of 45
Download to read offline
VA Blue Button & Open
        Notes

          VA


 Susan Woods, MD, MPH
   December 14, 2012
Patient centered care empowers
   patients to participate in their
health and healthcare. With more
  complete access to their health
information, patients can become
    active partners in their care.
2
 Over 1.9 million registered users
 0.9 million authenticated users
 More than 76 million visits
 33.5 million Prescription Refills
 479,000 opted in for Secure Messaging
My HealtheVet & VA Blue Button Today
    VA Medication History

    VA Appointments*

    VA Laboratory Results: Chemistry/Hematology*

    VA Allergies and Adverse Reactions*

    VA Wellness Reminders (MHV Clinical Reminders)*

    VA Immunizations*

    DoD Military Service Information*
Va open notes and blue button va ehealth university dec 2012
165k Downloads in October 2012
Coming Soon : More VA Data


DEMOGRAPHICS     PROBLEM   PROGRESS      VITALS      MICRO-
                   List     Notes     & Readings     Biology




   PATHOLOGY        EKG      RADIOLOGY    CONTINUITY of CARE
    Surgical,       List      Reports        DOCUMENT
  Cytology, EM                                CDA File
PATIENTS &                PROVIDERS
          CARE-GIVERS
                                CAREGIVERSAPPS




  Blue Button is patient centered,
and directly controlled by the patient.

       ...permissions & privacy
     and data-sharing are easier!
http://www.healthit.gov/patients-
families/video/preview-health-it-you-giving-
you-access-your-medical-records
Most patients and doctors agree that patients
should be able to download their own health
information




      www.markle.org/sites/default/files/20101007_bluebutton_summary_1.pdf
Office of Civil Rights Memorandum

              All patients have a
              right to get their
              health record.

              Patients denied or
              obstructed may file a
              complaint with OCR.
Meaningful Use
 Stage 1         Stage 2        Stage 3
2011-2012         2014           2016
Post-Visit       Secure       Automated
Summary          Patient      Blue Button
                Messaging      Transmit
                   +              +
                   View,       Patient-
                Download,     Generated
                 Transmit     Health Info
Va open notes and blue button va ehealth university dec 2012
Top 5 Reasons for VA OpenNotes
Technology changes patients’ lives and role in care.

  Shared records: an idea whose time has come.

The evidence is in: benefits are high and risks low.

       Veterans Voices: it’s what they want.

          It’s time to re-design our work.
Technology changes patients’ lives,
and their role in their care.
What Internet Users Do Online
                                    % Adults who do        Survey
  10 Most Common Activities ▼
                                        this▼               Year
Use search engine                         91                 2012
Use e-mail                                91                 2011
Get info on hobby or interest             84                 2011
Search for map or directions              84                 2011
Check the weather                         81                 2010
Look for health information               80                 2010
Get info on something to buy              78                 2010
Get news                                  76                 2011
Go online for fun or to pass time         74                 2011
Buy a product                             71                 2011
                                        http://www.pewinternet.org/
MyGroupHealth Use Over Time




           Ralston JD et al, Health Affairs 2010; 29:607-613
http://participatorymedicine.org/
Shared records aren’t a new idea,
but an idea whose time has come.
40 Years Ago….
……there was a ‘Proposal’
• Enhance patient autonomy
     • Improve patient-physician relationship
     • Serve as educational tool




Shenkin B, Warner D. New England Journal Medicine 1973
The evidence is in: benefits are
high and risks are low.
Shared NHS Electronic Records
3 London practices gave record access -HealthSpace
Results:
     86% accessed records
     Age, ethnicity not associated with frequency
     Poorer health - more frequent access
     38% found errors (48% did not take action)
     76% felt more involved in care
     9% more worried about health
     75% felt more confident in GP (3% less confident)
                      Bhavnani et al. Family Practice 2010; 28:188-19423
Va open notes and blue button va ehealth university dec 2012
Va open notes and blue button va ehealth university dec 2012
Patient Perceptions of Full Access to
Their Health Records through MHV Pilot

                5 focus groups
Portland MHV                     Qualitative
                   (30+ pts/
  Pilot users                     Analysis
                  caregivers)
Themes – Patient Views
Theme 1: Better communication with provider,
          more prepared for visits


Theme 2: Enhanced knowledge and self-care

  Theme 3: Patient participation in care and
                   quality
Communication…


“I can go in and ask more intelligent questions and we
don’t have to spend as much time with them
explaining everything to me. And then, with my stress
level up at the doctor’s office, I don’t hear half of it
and then we may have to do it again and again and
so, it helps us to have better communication”.
Knowledge and Self-Care

“Made me feel more responsible for myself too, like
there’s no excuses. You know, it’s right there, you
know. You can’t use ‘the doctor didn’t tell you’.”

“You could just pop over to Google or the library, a
dictionary in there, and check it out and see what it’s
saying instead of sitting there sweating it out trying to
figure out what it is.”
Participation in Care – Patient Decisions

“I don’t think I had to go as often [to the doctor]
because…yeah, because I could see my results. I
could see what was going on and I didn’t, I didn’t
get stressed out waiting to hear back from
somebody who might never call me.”
Patient Participation in Quality - as Reminder

“I had an ultrasound on my liver and I saw the results
online. It said, ‘Re-do in 6 months’. Well, 6 months came
and nothing happened. So I called the doctor and I say,
‘Well, it said here 6 months, re-do’. He says, ‘Oh yeah,
they did say that’. So, if I hadn’t reminded him, I
probably wouldn’t have got it.”
Va open notes and blue button va ehealth university dec 2012
Open Notes Study

• RWJF Pioneer Portfolio
• Beth Israel Deaconess, Harborview, Geisinger
• 100 providers and 20,000 patients
• Access provider notes through patient portal
• Email notification with new note upload
• 2010 to 2011 (access continues)
• Baseline and follow-up surveys
Patient and PCP Views of Open Notes after 1 Year
                                        % Agree
                                    Patients      PCPs
  Takes better care of self             70         28
  Better understand health conditions 84           41
  Remembers care plan better            84         44
  More prepared for visits              73         36
  More in control of care               84         49
  Take medications better               60         31



       Delbanco T et. al. Ann Intern Med, 2012
Patient and PCP Views of Open Notes after 1 Year

                                      % Agree
                                  Patients    PCPs
  Felt offended                        2        8
  More confusing than helpful          3       21
  Worries more                         7       42
  Concerned about privacy             32        --




                Delbanco T et. al. Ann Intern Med, 2012
Va open notes and blue button va ehealth university dec 2012
Clinician Concerns


            Notes


   Stress

               Workload
Listen to Patient Voices: it’s what they
want.
73 cents, Regina Holliday, Patient Advocate, Artist




                 http://reginaholliday.blogspot.com
        http://www.slideshare.net/ReginaHolliday/vision-14132302#btnNext
Voice of the Veteran: What They Want…
Notify me.
Let me see all my health records.
Help me understand my information.
Let me add to the record.
Help me care for myself.
Help me manage my medications.
Help me manage my appointments.
Help my family caregivers help me.
Help me connect with other Veterans.
Make it easy for me to send you information.
Let me share my information outside the VA.
It’s a good time to re-design our work.
e-Patient
Dave:
“Let
Patients
Help”
Toward patient participation


                                       Participatory
                                       Design
                       Participatory
            Patient    Care
            Centered
            Teams
 Informed
 Patient
“As younger generations embrace
technology, one of the oldest tools in
 medicine, the doctor’s note, is in its
         infancy of reform.”
         TW Feeley and KI Shine,
     Annals of Internal Medicine, 2011
Talk to Patients. They Know Cool Stuff You Don’t.

More Related Content

What's hot

Tips for patient family engagement with health authorities to improve patient...
Tips for patient family engagement with health authorities to improve patient...Tips for patient family engagement with health authorities to improve patient...
Tips for patient family engagement with health authorities to improve patient...Canadian Patient Safety Institute
 
Commentary - Homeless Health
Commentary - Homeless HealthCommentary - Homeless Health
Commentary - Homeless HealthPete Mathes
 
Crotty engaging patients in new ways from open notes to social media
Crotty  engaging patients in new ways from open notes to social mediaCrotty  engaging patients in new ways from open notes to social media
Crotty engaging patients in new ways from open notes to social mediaTrimed Media Group
 
Patient- and Family Centered Care: "Resident Performance from the Patient's V...
Patient- and Family Centered Care: "Resident Performance from the Patient's V...Patient- and Family Centered Care: "Resident Performance from the Patient's V...
Patient- and Family Centered Care: "Resident Performance from the Patient's V...hanscomhh5
 
SCC 2012 Give me your brain: communicating tricky topics
SCC 2012 Give me your brain: communicating tricky topicsSCC 2012 Give me your brain: communicating tricky topics
SCC 2012 Give me your brain: communicating tricky topicsBritish Science Association
 
Patient and Family Centered Care
Patient and Family Centered CarePatient and Family Centered Care
Patient and Family Centered CareDoug Della Pietra
 
Methods for Fostering the Widespread Implementation of Shared Decision Making
Methods for Fostering the Widespread Implementation of Shared Decision MakingMethods for Fostering the Widespread Implementation of Shared Decision Making
Methods for Fostering the Widespread Implementation of Shared Decision MakingInformed Medical Decisions Foundation
 
DayOne Accelerator 2019/20 shortlisted projects
DayOne Accelerator 2019/20 shortlisted projectsDayOne Accelerator 2019/20 shortlisted projects
DayOne Accelerator 2019/20 shortlisted projectsDayOne
 
Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...
Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...
Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...Canadian Patient Safety Institute
 
Shared decision making
Shared decision makingShared decision making
Shared decision makingChai-Eng Tan
 
090714 los pacientes como protagonistas de la investigación clínica
090714 los pacientes como protagonistas de la investigación clínica090714 los pacientes como protagonistas de la investigación clínica
090714 los pacientes como protagonistas de la investigación clínicaJosè Leonardo Piscoya Arbañil
 
Improving the Patient Experience with HIT Webcast
Improving the Patient Experience with HIT WebcastImproving the Patient Experience with HIT Webcast
Improving the Patient Experience with HIT WebcastIatric Systems
 
Leveraging the Least Utilized Resource: How patients can help improve quality...
Leveraging the Least Utilized Resource: How patients can help improve quality...Leveraging the Least Utilized Resource: How patients can help improve quality...
Leveraging the Least Utilized Resource: How patients can help improve quality...Daniel Sands
 
Complex Patient Journeys
Complex Patient Journeys Complex Patient Journeys
Complex Patient Journeys Matt Hall
 
Better Knowledge. Better Health? Making Research Relevant, Accessible, and P...
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and P...Better Knowledge. Better Health?  Making Research Relevant, Accessible, and P...
Better Knowledge. Better Health? Making Research Relevant, Accessible, and P...Marie Ennis-O'Connor
 

What's hot (20)

Tips for patient family engagement with health authorities to improve patient...
Tips for patient family engagement with health authorities to improve patient...Tips for patient family engagement with health authorities to improve patient...
Tips for patient family engagement with health authorities to improve patient...
 
Commentary - Homeless Health
Commentary - Homeless HealthCommentary - Homeless Health
Commentary - Homeless Health
 
Crotty engaging patients in new ways from open notes to social media
Crotty  engaging patients in new ways from open notes to social mediaCrotty  engaging patients in new ways from open notes to social media
Crotty engaging patients in new ways from open notes to social media
 
Patient- and Family Centered Care: "Resident Performance from the Patient's V...
Patient- and Family Centered Care: "Resident Performance from the Patient's V...Patient- and Family Centered Care: "Resident Performance from the Patient's V...
Patient- and Family Centered Care: "Resident Performance from the Patient's V...
 
SCC 2012 Give me your brain: communicating tricky topics
SCC 2012 Give me your brain: communicating tricky topicsSCC 2012 Give me your brain: communicating tricky topics
SCC 2012 Give me your brain: communicating tricky topics
 
Workshop on Patient Engagement
Workshop on Patient EngagementWorkshop on Patient Engagement
Workshop on Patient Engagement
 
Patient and Family Centered Care
Patient and Family Centered CarePatient and Family Centered Care
Patient and Family Centered Care
 
Keynote Address: Jack Wennberg
Keynote Address: Jack WennbergKeynote Address: Jack Wennberg
Keynote Address: Jack Wennberg
 
The 2014 Digital Patient Journey
The 2014 Digital Patient JourneyThe 2014 Digital Patient Journey
The 2014 Digital Patient Journey
 
Methods for Fostering the Widespread Implementation of Shared Decision Making
Methods for Fostering the Widespread Implementation of Shared Decision MakingMethods for Fostering the Widespread Implementation of Shared Decision Making
Methods for Fostering the Widespread Implementation of Shared Decision Making
 
DayOne Accelerator 2019/20 shortlisted projects
DayOne Accelerator 2019/20 shortlisted projectsDayOne Accelerator 2019/20 shortlisted projects
DayOne Accelerator 2019/20 shortlisted projects
 
Implementation of Shared Decision Making: Measuring Success
Implementation of Shared Decision Making: Measuring SuccessImplementation of Shared Decision Making: Measuring Success
Implementation of Shared Decision Making: Measuring Success
 
Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...
Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...
Think Global, Act Local: Patient and Family Engagement Strategies & Contribut...
 
Shared decision making
Shared decision makingShared decision making
Shared decision making
 
090714 los pacientes como protagonistas de la investigación clínica
090714 los pacientes como protagonistas de la investigación clínica090714 los pacientes como protagonistas de la investigación clínica
090714 los pacientes como protagonistas de la investigación clínica
 
Evisit Mneug B
Evisit Mneug BEvisit Mneug B
Evisit Mneug B
 
Improving the Patient Experience with HIT Webcast
Improving the Patient Experience with HIT WebcastImproving the Patient Experience with HIT Webcast
Improving the Patient Experience with HIT Webcast
 
Leveraging the Least Utilized Resource: How patients can help improve quality...
Leveraging the Least Utilized Resource: How patients can help improve quality...Leveraging the Least Utilized Resource: How patients can help improve quality...
Leveraging the Least Utilized Resource: How patients can help improve quality...
 
Complex Patient Journeys
Complex Patient Journeys Complex Patient Journeys
Complex Patient Journeys
 
Better Knowledge. Better Health? Making Research Relevant, Accessible, and P...
Better Knowledge. Better Health?  Making Research Relevant, Accessible, and P...Better Knowledge. Better Health?  Making Research Relevant, Accessible, and P...
Better Knowledge. Better Health? Making Research Relevant, Accessible, and P...
 

Viewers also liked

OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013
OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013
OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013Susan Woods
 
Health 2.0 northwest
Health 2.0 northwestHealth 2.0 northwest
Health 2.0 northwestSusan Woods
 
Patient HIT, Value & Quality
Patient HIT, Value & Quality Patient HIT, Value & Quality
Patient HIT, Value & Quality Susan Woods
 
Va e health university 2010
Va e health university 2010Va e health university 2010
Va e health university 2010Susan Woods
 
Behavioral Scientists and Consumer Informatics
Behavioral Scientists and Consumer InformaticsBehavioral Scientists and Consumer Informatics
Behavioral Scientists and Consumer InformaticsSusan Woods
 
Patient HIT, Value & Quality
Patient HIT, Value & QualityPatient HIT, Value & Quality
Patient HIT, Value & QualitySusan Woods
 
Himss calif 04.11.13
Himss calif 04.11.13Himss calif 04.11.13
Himss calif 04.11.13Susan Woods
 
Project on Gillette
Project on GilletteProject on Gillette
Project on GilletteMrinal
 
The Outcome Economy
The Outcome EconomyThe Outcome Economy
The Outcome EconomyHelge Tennø
 

Viewers also liked (9)

OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013
OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013
OHSU Grand Rounds - OpenNotes - Yackel & Woods December 2013
 
Health 2.0 northwest
Health 2.0 northwestHealth 2.0 northwest
Health 2.0 northwest
 
Patient HIT, Value & Quality
Patient HIT, Value & Quality Patient HIT, Value & Quality
Patient HIT, Value & Quality
 
Va e health university 2010
Va e health university 2010Va e health university 2010
Va e health university 2010
 
Behavioral Scientists and Consumer Informatics
Behavioral Scientists and Consumer InformaticsBehavioral Scientists and Consumer Informatics
Behavioral Scientists and Consumer Informatics
 
Patient HIT, Value & Quality
Patient HIT, Value & QualityPatient HIT, Value & Quality
Patient HIT, Value & Quality
 
Himss calif 04.11.13
Himss calif 04.11.13Himss calif 04.11.13
Himss calif 04.11.13
 
Project on Gillette
Project on GilletteProject on Gillette
Project on Gillette
 
The Outcome Economy
The Outcome EconomyThe Outcome Economy
The Outcome Economy
 

Similar to Va open notes and blue button va ehealth university dec 2012

Tom Deblanco: maximising patient engagement
Tom Deblanco: maximising patient engagementTom Deblanco: maximising patient engagement
Tom Deblanco: maximising patient engagementNuffield Trust
 
Patients 2.0 Introducing The Empowered Patient
Patients 2.0 Introducing The Empowered PatientPatients 2.0 Introducing The Empowered Patient
Patients 2.0 Introducing The Empowered PatientMarie Ennis-O'Connor
 
iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H...
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H... iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H...
iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H...Health IT Conference – iHT2
 
e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014
e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014
e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014e-Patient Dave deBronkart
 
Consumer Attitudes About Comparative Effectiveness
Consumer Attitudes About Comparative EffectivenessConsumer Attitudes About Comparative Effectiveness
Consumer Attitudes About Comparative EffectivenessMSL
 
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...Plain Talk 2015
 
"Patient Engagement is Changing What’s Possible" - Alberta Health Services ...
"Patient Engagement is Changing What’s Possible" - Alberta Health Services ..."Patient Engagement is Changing What’s Possible" - Alberta Health Services ...
"Patient Engagement is Changing What’s Possible" - Alberta Health Services ...e-Patient Dave deBronkart
 
AMSA OpenNotes / Let Patients Help speech, March 2014
AMSA OpenNotes / Let Patients Help speech, March 2014 AMSA OpenNotes / Let Patients Help speech, March 2014
AMSA OpenNotes / Let Patients Help speech, March 2014 e-Patient Dave deBronkart
 
Sophia Zilber - Mito research and data webinar - June 3, 2021
Sophia Zilber - Mito research and data webinar - June 3, 2021Sophia Zilber - Mito research and data webinar - June 3, 2021
Sophia Zilber - Mito research and data webinar - June 3, 2021SophiaZilber
 
Patient Engagement and Empowerment: A Culture War Begins
Patient Engagement and Empowerment: A Culture War BeginsPatient Engagement and Empowerment: A Culture War Begins
Patient Engagement and Empowerment: A Culture War Beginse-Patient Dave deBronkart
 
Online patients: characteristics and behaviour on health social networks - fe...
Online patients: characteristics and behaviour on health social networks - fe...Online patients: characteristics and behaviour on health social networks - fe...
Online patients: characteristics and behaviour on health social networks - fe...Ricardo Sousa
 
What Do Patients Really Want Out Of Adherence Technology?
What Do Patients Really Want Out Of Adherence Technology?What Do Patients Really Want Out Of Adherence Technology?
What Do Patients Really Want Out Of Adherence Technology?Inspire
 
e-Patient Dave IHS Best Practices Sacramento May 2016
e-Patient Dave IHS Best Practices Sacramento May 2016e-Patient Dave IHS Best Practices Sacramento May 2016
e-Patient Dave IHS Best Practices Sacramento May 2016e-Patient Dave deBronkart
 
"The Changing World Is Enabling New Patient Partnerships"
"The Changing World Is Enabling New Patient Partnerships""The Changing World Is Enabling New Patient Partnerships"
"The Changing World Is Enabling New Patient Partnerships"e-Patient Dave deBronkart
 
Enable the Rise of the Participatory Patient
Enable the Rise of the Participatory PatientEnable the Rise of the Participatory Patient
Enable the Rise of the Participatory Patiente-Patient Dave deBronkart
 

Similar to Va open notes and blue button va ehealth university dec 2012 (20)

Tom Deblanco: maximising patient engagement
Tom Deblanco: maximising patient engagementTom Deblanco: maximising patient engagement
Tom Deblanco: maximising patient engagement
 
Patients 2.0 Introducing The Empowered Patient
Patients 2.0 Introducing The Empowered PatientPatients 2.0 Introducing The Empowered Patient
Patients 2.0 Introducing The Empowered Patient
 
iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H...
 iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H... iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H...
iHT² Health IT Summit Denver 2013 - C.T. Lin, CMIO, University of Colorado H...
 
e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014
e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014
e-Patient Dave's talk at NQF Annual Meeting Feb 13, 2014
 
Consumer Attitudes About Comparative Effectiveness
Consumer Attitudes About Comparative EffectivenessConsumer Attitudes About Comparative Effectiveness
Consumer Attitudes About Comparative Effectiveness
 
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...
Susan Dentzer - "Plain Talk" with U.S. Consumers and Patients About the Tripl...
 
"Patient Engagement is Changing What’s Possible" - Alberta Health Services ...
"Patient Engagement is Changing What’s Possible" - Alberta Health Services ..."Patient Engagement is Changing What’s Possible" - Alberta Health Services ...
"Patient Engagement is Changing What’s Possible" - Alberta Health Services ...
 
AMSA OpenNotes / Let Patients Help speech, March 2014
AMSA OpenNotes / Let Patients Help speech, March 2014 AMSA OpenNotes / Let Patients Help speech, March 2014
AMSA OpenNotes / Let Patients Help speech, March 2014
 
Health Literacy for COPD Educators
Health Literacy for COPD EducatorsHealth Literacy for COPD Educators
Health Literacy for COPD Educators
 
Sophia Zilber - Mito research and data webinar - June 3, 2021
Sophia Zilber - Mito research and data webinar - June 3, 2021Sophia Zilber - Mito research and data webinar - June 3, 2021
Sophia Zilber - Mito research and data webinar - June 3, 2021
 
Ethical Issues In Care Essay
Ethical Issues In Care EssayEthical Issues In Care Essay
Ethical Issues In Care Essay
 
Patient Engagement and Empowerment: A Culture War Begins
Patient Engagement and Empowerment: A Culture War BeginsPatient Engagement and Empowerment: A Culture War Begins
Patient Engagement and Empowerment: A Culture War Begins
 
Online patients: characteristics and behaviour on health social networks - fe...
Online patients: characteristics and behaviour on health social networks - fe...Online patients: characteristics and behaviour on health social networks - fe...
Online patients: characteristics and behaviour on health social networks - fe...
 
What Do Patients Really Want Out Of Adherence Technology?
What Do Patients Really Want Out Of Adherence Technology?What Do Patients Really Want Out Of Adherence Technology?
What Do Patients Really Want Out Of Adherence Technology?
 
Vidatak EZ Board
Vidatak EZ BoardVidatak EZ Board
Vidatak EZ Board
 
e-Patient Dave IHS Best Practices Sacramento May 2016
e-Patient Dave IHS Best Practices Sacramento May 2016e-Patient Dave IHS Best Practices Sacramento May 2016
e-Patient Dave IHS Best Practices Sacramento May 2016
 
Sally Okun
Sally OkunSally Okun
Sally Okun
 
"The Changing World Is Enabling New Patient Partnerships"
"The Changing World Is Enabling New Patient Partnerships""The Changing World Is Enabling New Patient Partnerships"
"The Changing World Is Enabling New Patient Partnerships"
 
Patient experience: where can we improve?
Patient experience: where can we improve?Patient experience: where can we improve?
Patient experience: where can we improve?
 
Enable the Rise of the Participatory Patient
Enable the Rise of the Participatory PatientEnable the Rise of the Participatory Patient
Enable the Rise of the Participatory Patient
 

Va open notes and blue button va ehealth university dec 2012

  • 1. VA Blue Button & Open Notes VA Susan Woods, MD, MPH December 14, 2012
  • 2. Patient centered care empowers patients to participate in their health and healthcare. With more complete access to their health information, patients can become active partners in their care. 2
  • 3.  Over 1.9 million registered users  0.9 million authenticated users  More than 76 million visits  33.5 million Prescription Refills  479,000 opted in for Secure Messaging
  • 4. My HealtheVet & VA Blue Button Today VA Medication History VA Appointments* VA Laboratory Results: Chemistry/Hematology* VA Allergies and Adverse Reactions* VA Wellness Reminders (MHV Clinical Reminders)* VA Immunizations* DoD Military Service Information*
  • 6. 165k Downloads in October 2012
  • 7. Coming Soon : More VA Data DEMOGRAPHICS PROBLEM PROGRESS VITALS MICRO- List Notes & Readings Biology PATHOLOGY EKG RADIOLOGY CONTINUITY of CARE Surgical, List Reports DOCUMENT Cytology, EM CDA File
  • 8. PATIENTS & PROVIDERS CARE-GIVERS CAREGIVERSAPPS Blue Button is patient centered, and directly controlled by the patient. ...permissions & privacy and data-sharing are easier!
  • 10. Most patients and doctors agree that patients should be able to download their own health information www.markle.org/sites/default/files/20101007_bluebutton_summary_1.pdf
  • 11. Office of Civil Rights Memorandum All patients have a right to get their health record. Patients denied or obstructed may file a complaint with OCR.
  • 12. Meaningful Use Stage 1 Stage 2 Stage 3 2011-2012 2014 2016 Post-Visit Secure Automated Summary Patient Blue Button Messaging Transmit + + View, Patient- Download, Generated Transmit Health Info
  • 14. Top 5 Reasons for VA OpenNotes Technology changes patients’ lives and role in care. Shared records: an idea whose time has come. The evidence is in: benefits are high and risks low. Veterans Voices: it’s what they want. It’s time to re-design our work.
  • 15. Technology changes patients’ lives, and their role in their care.
  • 16. What Internet Users Do Online % Adults who do Survey 10 Most Common Activities ▼ this▼ Year Use search engine 91 2012 Use e-mail 91 2011 Get info on hobby or interest 84 2011 Search for map or directions 84 2011 Check the weather 81 2010 Look for health information 80 2010 Get info on something to buy 78 2010 Get news 76 2011 Go online for fun or to pass time 74 2011 Buy a product 71 2011 http://www.pewinternet.org/
  • 17. MyGroupHealth Use Over Time Ralston JD et al, Health Affairs 2010; 29:607-613
  • 19. Shared records aren’t a new idea, but an idea whose time has come.
  • 20. 40 Years Ago…. ……there was a ‘Proposal’
  • 21. • Enhance patient autonomy • Improve patient-physician relationship • Serve as educational tool Shenkin B, Warner D. New England Journal Medicine 1973
  • 22. The evidence is in: benefits are high and risks are low.
  • 23. Shared NHS Electronic Records 3 London practices gave record access -HealthSpace Results:  86% accessed records  Age, ethnicity not associated with frequency  Poorer health - more frequent access  38% found errors (48% did not take action)  76% felt more involved in care  9% more worried about health  75% felt more confident in GP (3% less confident) Bhavnani et al. Family Practice 2010; 28:188-19423
  • 26. Patient Perceptions of Full Access to Their Health Records through MHV Pilot 5 focus groups Portland MHV Qualitative (30+ pts/ Pilot users Analysis caregivers)
  • 27. Themes – Patient Views Theme 1: Better communication with provider, more prepared for visits Theme 2: Enhanced knowledge and self-care Theme 3: Patient participation in care and quality
  • 28. Communication… “I can go in and ask more intelligent questions and we don’t have to spend as much time with them explaining everything to me. And then, with my stress level up at the doctor’s office, I don’t hear half of it and then we may have to do it again and again and so, it helps us to have better communication”.
  • 29. Knowledge and Self-Care “Made me feel more responsible for myself too, like there’s no excuses. You know, it’s right there, you know. You can’t use ‘the doctor didn’t tell you’.” “You could just pop over to Google or the library, a dictionary in there, and check it out and see what it’s saying instead of sitting there sweating it out trying to figure out what it is.”
  • 30. Participation in Care – Patient Decisions “I don’t think I had to go as often [to the doctor] because…yeah, because I could see my results. I could see what was going on and I didn’t, I didn’t get stressed out waiting to hear back from somebody who might never call me.”
  • 31. Patient Participation in Quality - as Reminder “I had an ultrasound on my liver and I saw the results online. It said, ‘Re-do in 6 months’. Well, 6 months came and nothing happened. So I called the doctor and I say, ‘Well, it said here 6 months, re-do’. He says, ‘Oh yeah, they did say that’. So, if I hadn’t reminded him, I probably wouldn’t have got it.”
  • 33. Open Notes Study • RWJF Pioneer Portfolio • Beth Israel Deaconess, Harborview, Geisinger • 100 providers and 20,000 patients • Access provider notes through patient portal • Email notification with new note upload • 2010 to 2011 (access continues) • Baseline and follow-up surveys
  • 34. Patient and PCP Views of Open Notes after 1 Year % Agree Patients PCPs Takes better care of self 70 28 Better understand health conditions 84 41 Remembers care plan better 84 44 More prepared for visits 73 36 More in control of care 84 49 Take medications better 60 31 Delbanco T et. al. Ann Intern Med, 2012
  • 35. Patient and PCP Views of Open Notes after 1 Year % Agree Patients PCPs Felt offended 2 8 More confusing than helpful 3 21 Worries more 7 42 Concerned about privacy 32 -- Delbanco T et. al. Ann Intern Med, 2012
  • 37. Clinician Concerns Notes Stress Workload
  • 38. Listen to Patient Voices: it’s what they want.
  • 39. 73 cents, Regina Holliday, Patient Advocate, Artist http://reginaholliday.blogspot.com http://www.slideshare.net/ReginaHolliday/vision-14132302#btnNext
  • 40. Voice of the Veteran: What They Want… Notify me. Let me see all my health records. Help me understand my information. Let me add to the record. Help me care for myself. Help me manage my medications. Help me manage my appointments. Help my family caregivers help me. Help me connect with other Veterans. Make it easy for me to send you information. Let me share my information outside the VA.
  • 41. It’s a good time to re-design our work.
  • 43. Toward patient participation Participatory Design Participatory Patient Care Centered Teams Informed Patient
  • 44. “As younger generations embrace technology, one of the oldest tools in medicine, the doctor’s note, is in its infancy of reform.” TW Feeley and KI Shine, Annals of Internal Medicine, 2011
  • 45. Talk to Patients. They Know Cool Stuff You Don’t.

Editor's Notes

  1. On this transformational journey, VA’s primaryfocus is patient engagement and empowerment. We’ve learned patients and families can and want to participate as active members in their health and their health care.One best way to empower patients as partners on our healthcare teams is to provide them with their own health information – easily and readily.