1) The document discusses patient portals and how they can improve patient care and engagement. It provides examples of how portals allow patients to communicate electronically with their doctors, access their health records, and manage their care outside of visits. 2) Studies show portals may help reduce A1c levels in diabetes patients through more engaged care, though more research is still needed. 3) Doctors are advised to obtain informed consent from patients for electronic communication and establish response times to improve satisfaction. When set up properly, portals can enhance care without overburdening physicians.

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?

4. Our Agenda Today

8. What we thought six months ago…

9. Personal Health Records

10. 50K Medicine & 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 & BWH Patient Gateway 200 3 200 3 VA My Health e-Vet PING/Indivo 2000 2008 Google Health & 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

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<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)

26. Information & Communication Barriers Gérard Métrailler (used via Creative Commons License) http://www.flickr.com/people/gmetrail/ Patients PHRs & Clinical Messaging Providers

27. If You were a Patient:

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)

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)

37. Slack. A 67-year-old man who e-mails his physician. JAMA (2004) vol. 292 (18) pp. 2255

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

56. Results are embargoed for a period of time: