This document discusses informatics tools that can support patient-provider communication. Digital technology has changed how patients and providers communicate, with examples being patient portals, personal health records, and online patient communities. Practical considerations for these tools include health literacy, privacy, access, and adapting clinical culture. Studies found patients having access to their medical records improved communication with providers and engagement in their own care.

1. Patient-Centered Care
Unit 5: Patient-Provider Communication
Lecture c – Informatics Tools to Support Patient-Provider
Communications
This material (Comp 25 Unit 5) was developed by Columbia University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award
Number 90WT0006.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Patient-Provider Communication
Learning Objectives
• Objective 1: Explain the importance,
elements, and processes of patient-physician
communication (Lecture a)
• Objective 2: Discuss the concept of trust in
the context of health care interactions
(Lecture b)
• Objective 3: Describe various informatics
tools and the practical considerations to
support patient-provider communication
(Lecture c)
2

3. Physician-patient communication in
the e-Health context
5.10 Figure (Weiner, J, 2012)
Woods SS, Schwartz E, Tuepker A, Press NA, Nazi KM, Turvey CL, Nichol W.P Patient Experiences With Full Electronic
Access to Health Records and Clinical Notes Through the My HealtheVet Personal Health Record Pilot: Qualitative Study J
Med Internet Res 2013;15(3):e65 URL: http://www.jmir.org/2013/3/e65/
3

4. Communication
• Use of digital tools and facilitating
communication between patients,
caregivers, and health care providers to
improve data quality and access to health
care
4

5. The use of digital technology has
revolutionized how we communicate
5.11 Figure (Pew Research Center, 2011)
5

6. Connected generation: Perspectives from
tomorrow’s leaders in a digital world
• “Social media will continue to grow, both on a
personal and organizational level. The
Internet is now the new place where business
relationships are formed.” – United States
student, age 21
• “We stand on the precipice of a paradigm
shift into a fully connected society. We must
not be afraid to embrace change. Those who
can manage this will survive; those who don’t
will perish.” – United States student, age 30
• (IBM Global Business Services, 2012)
6

7. What does the data tell us?
• People are using digital and social media
to communicate more than ever before!
• Use of social media in government,
business, and health care
• By consumers and health care
practitioners
• And our communication preferences are
changing…
7

8. The mobile health (mHealth)
market will continue to grow
• New technologies
• Decreasing cost
• Increasing acceptance
• Population age
• Foundation in place
• Move to personalized care
• (Guillemi and Benedict, 2013)
8

9. mHealth as the future of health
care
• mHealth is not a separate industry, but
rather it’s the future of a health care
industry that’s evolving to care for patients
differently, putting them first to deliver
services better, faster, and less
expensively.
– (Gibbons, Wilson, Samal, et al. 2009)
9

10. General well-being motivates
health self-tracking
• 50% of consumers
track or monitor their
health, wellness, or
fitness measurements
• The old and sick often
utilize devices that
track health
measurements more
than the young and
healthy, demonstrating
adoption of this
technology for all age
groups
5.12: Figure (Manhattan Research, Cybercitizen
Health U.S., 2013) 10

11. How consumers seek out health
information
• 35% of U.S. adults say that at one time or another they have
gone online specifically to try to figure out what medical
condition they or someone else might have
– (Pew Research Center, 2013)
• One in five Internet users have consulted online reviews and
rankings of health care service providers and treatments
– (Pew Research Center, 2013)
• 18% of Internet users, or 13% of adults, have gone online to
find others who might have health concerns similar to theirs.
People living with chronic and rare conditions are significantly
more likely to do this.
– (Pew Research Center, 2011)
11

12. Examples of informatics tools to
support patient-provider
communication
• Patient portals
• Personal health records
• Online patient communities
12

13. Patient portal functionality
• Recent doctor visits
• Discharge summaries
• Medications
• Immunizations
• Allergies
• Lab results
• Exchange secure email
with health care teams
• Request prescription
refills
• Schedule non-urgent
appointments
• Check benefits and
coverage
• Update contact
information
• Make payments
• Download and
complete forms
• View educational
materials
13

14. Personal health records (PHR)
• Patient-initiated electronic record that is separate from
the EHR
• Contains information selected and added by the patient
• Allows the patient the ability to update and change their
health information at any time
• Provides the patient the ability to share this information
with anyone that they choose
• Patient may need to add health information manually
• Patient must manually update health information
• Limited ability for providers to send information directly to
PHR
14

15. Patient communities
• PatientsLikeMe® and their “Data for Good”
campaign to encourage health data
sharing to advance medicine
– More than 250,000 members are donating
their disease data to research via
PatientsLikeMe®
– To date, more than 21 million structured data
points contributed by patients about their
disease experiences
15

16. Practical considerations
• Health literacy
• Access to information
• Privacy and security
• Culture change
16

17. What is health literacy?
• The degree to which individuals have the
capacity to obtain, process, and
understand basic health information
needed to make appropriate health
decisions and services needed to prevent
or treat illness
– U.S. Department of Health and Human
Services, Health Resources and Services
Administration
17

18. The patient journey: care continuum,
literacy, and personal health
information
• Patient engagement / awareness and clinical knowledge
• Presentation and evaluation
– Symptoms, personal preferences, family history
• Diagnosis
– Patient / caregiver research
• Consideration of treatment options
– Shared decision-making
• Treatment decision
• Leverage digital / mobile communications and share data
– Adhering to / monitoring therapy
• (Rulon, 2014)
18

19. Other health literacy tools
• AHRQ’s Questions to Ask Your Doctor
• AHIP’s Choosing Wisely Doctor-Patient Lists
• AARP’s Ask the Right Questions and Get The
Most From Your Medicines
• Informed Medical Decisions Foundation’s
Shared Decision Making Resources
19

20. Patient access to their records
• Patients felt that seeing
their records:
– Positively affected
communication with
providers and the health
system
– Enhanced knowledge of
their health
– Improved self-care
– Allowed for greater
participation in the
quality of their care
– (Woods, Schwartz,
Tuepker, et al, 2013)
• Patients felt more in
control of their care and
reported increased
medication adherence
• Physicians did not report
longer visits and many
did not change
documentation content
or take longer to write
notes
• (Delbanco, Walker, Bell,
et al, 2012)
20

21. EHR information provided by the
patient can be valuable
• The longitudinal medical record (LMR) is often
incomplete
• Patient-reported data is a promising source of general
health information
• “Patients have important knowledge of their basic
health maintenance, and can and should assist
physicians in recording information. Patient access
will increase the quality of this data to help ensure that
the physician has the most comprehensive file
possible with which to work. In addition to quality
assurance, patient-provided data and patient access
to LMR data will help increase communication
between provider and patient.”
– (Wuerdeman et al., 2005)
21

22. Patient perceptions regarding
privacy and security are important
• If a person does not think that health care
providers have reasonable protections in place for
EHRs, they are:
– Over eight times more likely to have withheld
information from their provider, compared to someone
who does think there are protections
– Almost five times more likely to have withheld
information from their provider, compared to the
overall population
– (Hughes, Patel, Pritts, 2014)
• For more information on ensuring privacy and
security of shared data, please see component 22
unit 10
22

23. Culture change: physicians need
to adapt
• Dialogue
– “If you don’t mind, I am going to be typing as you speak.
I’m happy to show you what I’m writing”
– “I’m going to look up your test results. Would you like to
look at them together?”
• Caution
– Documenting socially stigmatizing health conditions
– Sensitivity to patient perceptions
• Patient engagement
– Improving management of chronic disease and mental
illness
– Patient-provider collaboration
• (White and Danis, 2013)
23

24. Themes
• Culture dominates
• “Listen first, listen fully”
• Patient engagement is a skill, not a trait
• Trust matters
• Prepared, engaged patients are a
fundamental precursor to high quality care,
lower costs, and better health
24

25. Unit 5: Patient-Provider Communication,
Summary – Lecture c, Informatics Tools to
Support Patient-Provider Communication
• Digital technology has changed how we communicate,
especially between patients and providers
• Mobile health and self-tracking of general well-being
will continue to grow
• Examples of informatics tools to support patient-
provider communication are patient portals, personal
health records, and online patient communities.
• Practical considerations for communicative informatics
and technology include access to data, health literacy,
privacy and security, and culture.
• Providing patients with access to their medical record
and the ability to contribute information could improve
their care
25

26. Unit 5 Summary: Patient-Provider
Communication
• Providers with good communication skills identify patients’
problems more accurately and their patients adjust better
psychologically and are more satisfied with their care
• Effective methods of communication skills are available and
the opportunity to practice them is essential
• Listen carefully to patients, treat them respectfully, be honest
and consistent, follow through on commitments, and have an
accepting attitude
• Digital technology has changed how we communicate,
especially between patients and providers and examples of
informatics tools to support patient-provider communication
are patient portals, personal health records, and online patient
communities
26

27. Patient-Provider Communication
References – Lecture c
References
Delbanco, T, Walker, J, Bell, SK, Darer, JD, Elmore, JG, Farag, N, Feldman, HJ, Mejilla,
R, Ngo, L, Ralston, JD, Ross, SE, Trivedi, N, Vodicka, E, & Leveille, SG. (2012).
Inviting patients to read their doctors’ notes. Annals of Internal Medicine. 157(7):461-
470.http://annals.org/article.aspx?articleid=1363511
Gibbons, MC, Wilson, RF, Samal, L, Lehman, CU, Dickersin, K, Lehmann, HP,
Aboumatar, H, Finkelstein, J, Shelton, E, Sharma, R, & Bass, EB. (2009). Impact of
consumer health informatics applications. Evid Rep Technol Assess. 188:1-546.
Guillemi, A, & Benedict, K. (2013). mHealth trends and strategies. A special report by
netcentric strategies.
Hughes, P, Patel, V, & Pritts, J. (2014). Health care providers’ role in protecting EHRs:
implications for consumer support of EHRs, HIE and patient-provider communication
ONC Data Brief Number 15.
http://www.healthit.gov/sites/default/files/022414_hit_attitudesaboutprivacydatabrief.p
df
IBM Global Business Services. (2012). Connected generation. Perspectives from
tomorrow’s leaders in a digital world. Insights from the 2012 IBM Global Student
Study
27

28. Patient-Provider Communication
References – Lecture c (Cont’d – 1)
References
Institute of Medicine. (2013). Partnering with patients to drive shared decisions, better
value and care improvement, meeting summary.
http://iom.edu/Reports/2013/~/media/Files/Report%20Files/2013/Partnering-with-
Patients/PwP_meetingsummary.pdf
https://www.patientslikeme.com/about
https://www.patientslikeme.com/join/dataforgood
Pew Research Center. (2013). Pew Research Internet Project: health fact sheet.
http://www.pewinternet.org/fact-sheets/health-fact-sheet/
Pew Research Center. (2013). Health online 2013.
http://www.pewinternet.org/2013/01/15/health-online-2013/
Pew Research Center. (2013). Peer-to-peer health care.
http://www.pewinternet.org/2013/01/15/peer-to-peer-health-care/
Rulon, MS. (2014). Engaging patients in their healthcare through health information:
why it’s important. Presentation. NYHIMA Conference.
White, A, & Danis, M. (2013). Enhancing patient-centered communication and
collaboration by using the electronic health record in the examination room. JAMA.
309(22).
28

29. Patient-Provider Communication
References – Lecture c (Cont’d – 2)
References
Woods, SS, Schwartz, E, Tuepke,r A, Press, NA, Nazi, KM, Turvey, CL, & Nichol, WP.
(2013). Patient experiences with full electronic access to health records and clinical
notes through the MyHealtheVet personal health record pilot: qualitative study J Med
Internet Res. 15(3):e65. http://www.jmir.org/2013/3/e65/
Wuerdeman, L, Volk, L, Pizziferrri, L, Tsurikova, R, Harris, C, Feygin, R, Epstein, M,
Meyers, K, Wald, JS, Lansky, D, & Bates, DW. (2005). How accurate is information
that patients contribute to their electronic health record? AMIA 2005 Symposium
Proceedings. http://www.ncbi.nlm.nih.gov/pubmed/16779157?dopt=Citation
.
29

30. Patient-Provider Communication
References – Lecture c (Cont’d – 3)
Charts, Tables, Figures
5.10 Figure: Weiner, J. (2012). Figure 1. Physician / patient communication in the “e-
health” context’. Israel Journal of Health Policy Research, 1(33).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461429/
5.11 Figure: Pew Research Center. (2011). Texting popular around globe.
5.12: Figure: Manhattan Research, Cybercitizen Health U.S. (2013). Reasons for
tracking health measurements.
30

31. Unit 5: Patient-Provider
Communication, Lecture c –
Informatics Tools to Support Patient-
Provider Communication
This material was developed by Columbia
University, funded by the Department of
Health and Human Services, Office of the
National Coordinator for Health Information
Technology under Award Number
90WT0006.
31