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.
Va open notes and blue button va ehealth university dec 2012
VA Blue Button & Open Notes VA Susan Woods, MD, MPH December 14, 2012
Patient centered care empowers patients to participate in theirhealth and healthcare. With more complete access to their healthinformation, 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*
Most patients and doctors agree that patientsshould be able to download their own healthinformation 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 32011-2012 2014 2016Post-Visit Secure AutomatedSummary Patient Blue Button Messaging Transmit + + View, Patient- Download, Generated Transmit Health Info
Top 5 Reasons for VA OpenNotesTechnology 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▼ YearUse search engine 91 2012Use e-mail 91 2011Get info on hobby or interest 84 2011Search for map or directions 84 2011Check the weather 81 2010Look for health information 80 2010Get info on something to buy 78 2010Get news 76 2011Go online for fun or to pass time 74 2011Buy a product 71 2011 http://www.pewinternet.org/
MyGroupHealth Use Over Time Ralston JD et al, Health Affairs 2010; 29:607-613
• Enhance patient autonomy • Improve patient-physician relationship • Serve as educational toolShenkin B, Warner D. New England Journal Medicine 1973
The evidence is in: benefits arehigh and risks are low.
Shared NHS Electronic Records3 London practices gave record access -HealthSpaceResults: 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
Patient Perceptions of Full Access toTheir Health Records through MHV Pilot 5 focus groupsPortland MHV Qualitative (30+ pts/ Pilot users Analysis caregivers)
Themes – Patient ViewsTheme 1: Better communication with provider, more prepared for visitsTheme 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 wedon’t have to spend as much time with themexplaining everything to me. And then, with my stresslevel up at the doctor’s office, I don’t hear half of itand then we may have to do it again and again andso, it helps us to have better communication”.
Knowledge and Self-Care“Made me feel more responsible for myself too, likethere’s no excuses. You know, it’s right there, youknow. You can’t use ‘the doctor didn’t tell you’.”“You could just pop over to Google or the library, adictionary in there, and check it out and see what it’ssaying instead of sitting there sweating it out trying tofigure 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. Icould see what was going on and I didn’t, I didn’tget stressed out waiting to hear back fromsomebody who might never call me.”
Patient Participation in Quality - as Reminder“I had an ultrasound on my liver and I saw the resultsonline. It said, ‘Re-do in 6 months’. Well, 6 months cameand 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, Iprobably wouldn’t have got it.”
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
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.