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 thei...
 Over 1.9 million registered users 0.9 million authenticated users More than 76 million visits 33.5 million Prescripti...
My HealtheVet & VA Blue Button Today    VA Medication History    VA Appointments*    VA Laboratory Results: Chemistry/Hema...
165k Downloads in October 2012
Coming Soon : More VA DataDEMOGRAPHICS     PROBLEM   PROGRESS      VITALS      MICRO-                   List     Notes    ...
PATIENTS &                PROVIDERS          CARE-GIVERS                                CAREGIVERSAPPS  Blue Button is pat...
http://www.healthit.gov/patients-families/video/preview-health-it-you-giving-you-access-your-medical-records
Most patients and doctors agree that patientsshould be able to download their own healthinformation      www.markle.org/si...
Office of Civil Rights Memorandum              All patients have a              right to get their              health rec...
Meaningful Use Stage 1         Stage 2        Stage 32011-2012         2014           2016Post-Visit       Secure       Au...
Top 5 Reasons for VA OpenNotesTechnology changes patients’ lives and role in care.  Shared records: an idea whose time has...
Technology changes patients’ lives,and their role in their care.
What Internet Users Do Online                                    % Adults who do        Survey  10 Most Common Activities ...
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 toolShenkin B, Warner D...
The evidence is in: benefits arehigh and risks are low.
Shared NHS Electronic Records3 London practices gave record access -HealthSpaceResults:     86% accessed records     Age...
Patient Perceptions of Full Access toTheir Health Records through MHV Pilot                5 focus groupsPortland MHV     ...
Themes – Patient ViewsTheme 1: Better communication with provider,          more prepared for visitsTheme 2: Enhanced know...
Communication…“I can go in and ask more intelligent questions and wedon’t have to spend as much time with themexplaining e...
Knowledge and Self-Care“Made me feel more responsible for myself too, likethere’s no excuses. You know, it’s right there, ...
Participation in Care – Patient Decisions“I don’t think I had to go as often [to the doctor]because…yeah, because I could ...
Patient Participation in Quality - as Reminder“I had an ultrasound on my liver and I saw the resultsonline. It said, ‘Re-d...
Open Notes Study• RWJF Pioneer Portfolio• Beth Israel Deaconess, Harborview, Geisinger• 100 providers and 20,000 patients•...
Patient and PCP Views of Open Notes after 1 Year                                        % Agree                           ...
Patient and PCP Views of Open Notes after 1 Year                                      % Agree                             ...
Clinician Concerns            Notes   Stress               Workload
Listen to Patient Voices: it’s what theywant.
73 cents, Regina Holliday, Patient Advocate, Artist                 http://reginaholliday.blogspot.com        http://www.s...
Voice of the Veteran: What They Want…Notify me.Let me see all my health records.Help me understand my information.Let me a...
It’s a good time to re-design our work.
e-PatientDave:“LetPatientsHelp”
Toward patient participation                                       Participatory                                       Des...
“As younger generations embracetechnology, one of the oldest tools in medicine, the doctor’s note, is in its         infan...
Talk to Patients. They Know Cool Stuff You Don’t.
Va open notes and blue button va ehealth university dec 2012
Va open notes and blue button va ehealth university dec 2012
Va open notes and blue button va ehealth university dec 2012
Va open notes and blue button va ehealth university dec 2012
Va open notes and blue button va ehealth university dec 2012
Va open notes and blue button va ehealth university dec 2012
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Va open notes and blue button va ehealth university dec 2012

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  • 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

    1. 1. VA Blue Button & Open Notes VA Susan Woods, MD, MPH December 14, 2012
    2. 2. 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
    3. 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. 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*
    5. 5. 165k Downloads in October 2012
    6. 6. Coming Soon : More VA DataDEMOGRAPHICS PROBLEM PROGRESS VITALS MICRO- List Notes & Readings Biology PATHOLOGY EKG RADIOLOGY CONTINUITY of CARE Surgical, List Reports DOCUMENT Cytology, EM CDA File
    7. 7. PATIENTS & PROVIDERS CARE-GIVERS CAREGIVERSAPPS Blue Button is patient centered,and directly controlled by the patient. ...permissions & privacy and data-sharing are easier!
    8. 8. http://www.healthit.gov/patients-families/video/preview-health-it-you-giving-you-access-your-medical-records
    9. 9. 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
    10. 10. 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.
    11. 11. 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
    12. 12. 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.
    13. 13. Technology changes patients’ lives,and their role in their care.
    14. 14. 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/
    15. 15. MyGroupHealth Use Over Time Ralston JD et al, Health Affairs 2010; 29:607-613
    16. 16. http://participatorymedicine.org/
    17. 17. Shared records aren’t a new idea,but an idea whose time has come.
    18. 18. 40 Years Ago….……there was a ‘Proposal’
    19. 19. • Enhance patient autonomy • Improve patient-physician relationship • Serve as educational toolShenkin B, Warner D. New England Journal Medicine 1973
    20. 20. The evidence is in: benefits arehigh and risks are low.
    21. 21. 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
    22. 22. Patient Perceptions of Full Access toTheir Health Records through MHV Pilot 5 focus groupsPortland MHV Qualitative (30+ pts/ Pilot users Analysis caregivers)
    23. 23. 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
    24. 24. 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”.
    25. 25. 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.”
    26. 26. 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.”
    27. 27. 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.”
    28. 28. 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
    29. 29. 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
    30. 30. 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
    31. 31. Clinician Concerns Notes Stress Workload
    32. 32. Listen to Patient Voices: it’s what theywant.
    33. 33. 73 cents, Regina Holliday, Patient Advocate, Artist http://reginaholliday.blogspot.com http://www.slideshare.net/ReginaHolliday/vision-14132302#btnNext
    34. 34. 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.
    35. 35. It’s a good time to re-design our work.
    36. 36. e-PatientDave:“LetPatientsHelp”
    37. 37. Toward patient participation Participatory Design Participatory Patient Care Centered Teams Informed Patient
    38. 38. “As younger generations embracetechnology, 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
    39. 39. Talk to Patients. They Know Cool Stuff You Don’t.

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