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Patient HIT, Value & Quality

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Patient HIT, Value & Quality

  1. 1. Patient Digital Design & Services: The Next Generation of Quality Susan Woods, MD, MPH Oregon Health & Science University Portland VA Medical Center
  2. 2. Points • Consumer rise of digital tools • PHRs = consumer meaningful use • Portal use driven by value, access • Patient & healthcare team benefit • Participatory care is PHR 2.0
  3. 3. What do people want?  Access  Great care  Avoid costs 3
  4. 4. Information & Services Transforming
  5. 5. Looking online for health information Pew Research Center’s Internet & American Life Project, 2012 Survey. N = 3,014
  6. 6. 73% 91% 58% 30% 37% 47% 61% 41% 42% 43% 2% 5% 19% 26% 4% 10% 29% 34% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Cell Phone Desktop Laptop Game console Tablet eBook Reader Adult Gadget Ownership Trends – Pew Surveys http://www.pewinternet.org/Trend-Data-%28Adults%29/Device-Ownership.aspx
  7. 7. 73% 75% 78% 85% 84% 82% 85% 83% 88% 88% 85% 85% 87% 91% 35% 45% 46% 45% 47% 45% 56% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Cell Phone and Smartphone Ownership, Over Time % of American adults who own a cell phone or smartphone http://www.pewinternet.org/Trend-Data-%28Adults%29/Device-Ownership.aspx
  8. 8. 71% Got information or care from a health professional for their last problem
  9. 9. MyGroupHealth Users and PHR Usage
  10. 10. KP.org reaches 65% -- 4 million + http://thrive.kaiserpermanente.org/innovation
  11. 11. Patient Meaningful Use Transactions Expert Care Shared Data Self-Care Community Ahern DK, Woods SS, Lightowler et al. Promise of and potential for patient-facing technologies to enable meaningful use. Am J Prev Med. 2011
  12. 12. Usage Follows Value • Test results • Secure email • Medication refills • Notes & summaries Functions • Online authentication • Proxy access • Usability • Technical support Access
  13. 13. Observations on Secure Email • Drives team-based care • Great for patients • Great for front-line staff • Know more between visits • Better in-person visits • Respectful of time • Rare inappropriate use (they call)
  14. 14. I started radiation treatment at the University Hospital, 5 times a week. The cream you prescribed for my rash is helping, I don‟t have refills. Thanks and have a happy holiday!
  15. 15. http://www.hsrd.research.va.gov/publications/esp/myhealthevet.cfm#.Ui_0Hj9-rQM
  16. 16. Patient-Facing Digital Services - Impact Evidence Likely More accurate information Better experience More knowledge of problems Greater self-care More prepared for visits More efficient in-person visits Greater trust in clinicians Improved quality measures Improved outcomes More preventive services Less no-shows Need to mitigate digital divide Patients Improved adherence Better caregiver knowledge/skills Fewer tests Better care coordination Increased use of digital services Healthcare Teams: Shifting work Need different communication Care Delivery: More visits for some Less visits for some
  17. 17. Shenkin B, Warner D. New England Journal Medicine 1973 A 40-year old idea…. • Enhance patient autonomy • Improve patient-physician relationship • Serve as educational tool
  18. 18. 23 J Med Internet Res 2013;15(3):e65
  19. 19. 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.” “I could see my results. I could see what was going on and didn‟t get stressed out waiting to hear back from somebody who might never call.”
  20. 20. Knowledge Doctors aren‟t real gabby and never tell you everything. Even if you ask questions, they‟ll sort of slide around them. They don‟t have time. I found stuff out that I was just truly amazed at about myself. “You could pop over to Google….and see what it‟s saying instead of sitting there sweating it out.”
  21. 21. Self-Care “Made me feel more responsible for myself, 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 pop over to Google or the library, and see what it‟s saying instead of sitting there sweating it out trying to figure out what it is.”
  22. 22. Patient Participation in Care Quality “I had an ultrasound on my liver and saw the results. It said, „Re-do in 6 months‟. Six months came and nothing happened. So I called the doctor. He says, „Yeah, they did say that‟. So, if I hadn‟t reminded him, I wouldn‟t have got it.”
  23. 23. “I‟d like to know, what you think and what you know, and what you‟re predicting. Rather than just write it in there, tell me and then write it.” Patient Participation in Care Quality
  24. 24. % Agree Patients PCPs Takes better care of self 70 28 Better understand 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 Views after one year Inviting Patients to Read Their Doctors‟ Notes: A Quasi-experimental Study and a Look Ahead
  25. 25. % Agree Patients PCPs Felt offended 2 8 More confusing than helpful 3 21 Worries more 7 42 Concerned about privacy 32 -- Views after one year Inviting Patients to Read Their Doctors‟ Notes: A Quasi-experimental Study and a Look Ahead
  26. 26. It‟s a good time to re-design our work.
  27. 27. 32
  28. 28. Talk to Patients. They Know Cool Stuff You Don’t.
  29. 29. Thank you! @SueWoods susan.woods@va.gov http://www.sharedhealthdata.com

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