Patient Portals: Building A Bridge For Patient Engagement

Transcription

1 Patient Portals: Building A Bridge For Patient Engagement Applying Information Technology to Support Patient-Centered Treatment Approaches June :30pm - 5:00 pm Bradley H Crotty MD MPH Instructor in Medicine, Harvard Medical School Investigator, Division of Clinical Informatics Beth Israel Deaconess Medical bcrotty@mail.harvard.edu 1 HSPH TECH Talk - June 15, 2015

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3 Dave Bushe via Flickr 3 HSPH TECH Talk - June 15, 2015

4 Patient Portals Patient Portal 4 HSPH TECH Talk - June 15, 2015

5 Have Multiple Components Personal Health Record Open Notes Transactions Secure Messaging 5 HSPH TECH Talk - June 15, 2015

6 PatientSite 6 HSPH TECH Talk - June 15, 2015

7 3 Key Lessons 1 There is no one size fits all 7 HSPH TECH Talk - June 15, 2015

8 Why Have Patient Portals? Patient Expectations Meaningful Use Stage I Stage II+ Data Patient Outcomes Efficiency of Care Delivery 8 HSPH TECH Talk - June 15, 2015

9 Why Have Patient Portals? Patient Expectations Meaningful Use Stage I Stage II+ >70 % Expect To Doc Moyer et al. Bridging the electronic divide. Am J MC(2002) vol. 8 (5) pp Data Patient Outcomes Efficiency of Care Delivery 9 HSPH TECH Talk - June 15, 2015

10 Why Have Patient Portals? Patient Expectations Meaningful Use Stage I Stage II+ Electronic Access To Medical Information Available Within 4 Business Days Data Patient Outcomes Efficiency of Care Delivery 10 HSPH TECH Talk - June 15, 2015

11 Why Have Patient Portals? Patient Expectations Meaningful Use Stage I Stage II+ Use Secure Messaging With Patients 5% of patients seen in a 90d window Data Patient Outcomes Efficiency of Care Delivery 11 HSPH TECH Talk - June 15, 2015

12 Why Have Patient Portals? Patient Expectations Meaningful Use Stage I Stage II+ Data Patient Outcomes Efficiency of Care Delivery Does it help improve the care of our patients? Is there a reasonable ROI? 12 HSPH TECH Talk - June 15, 2015

13 Portals & Patient Outcomes Limited data exist to document a benefit to patient portal use on health outcomes Unclear association with health care utilization Arthur Lien Goldzweig CL, Orshansky G, Paige NM, et al.ann Intern Med 2013;159(10): HSPH TECH Talk - June 15, 2015

14 Portals & Diabetes McMahon, G.T. et al., Diabetes Care, 28(7), pp P. 104 patients with diabetes mellitus and A1c 9% at VA I. All had an education class Intervention patients used a Web-Based Care Management Notebook computer Monitoring devices Care management website Messaging with care manager C. Usual Care O. A1C Utilization 14 HSPH TECH Talk - June 15, 2015

15 Portals & Diabetes Grant, R.W. et al., Archives of Internal Medicine, 168(16), pp P. 11 Primary Care Practices I. Web-Based Care Diabetes Journal C. Other Web-Based Modules (i.e. family history module) O. A1c diabetes mellitus med s 15 HSPH TECH Talk - June 15, 2015

16 Process of Care Quality Measures Wright, A. et al., Journal of General Internal Medicine, 27(1), pp P. 11 Primary Care Practices, (Cluster RCT) Flu Vaccination X 2 p=0.023 I. Health Maintenance Reminders C. Other Web-Based Modules (i.e. diabetes module, medication reconciliation) Mammography X 3 p=0.01 O. Intention to Treat Analysis Adherence to guideline-based care recommendations Pap Smears X 5 p= HSPH TECH Talk - June 15, 2015

17 Health Care Utilization Zhou, Y.Y. et al., The American Journal Of Managed Care, 13(7), pp Visits P. Kaiser Permanente (Northwest), Retrospective Case-Control I. Access to Portal + Messaging C. No Access To Portal % Difference p<0.003 O. Health Service Utilization Telephone Calls 13.7% Difference p< HSPH TECH Talk - June 15, 2015

18 Health Care Utilization Palen, T.E., JAMA pp.1 8. P. Kaiser Permanente (Colorado), Retrospective Case-Control I. Access to Portal + Messaging C. No Access To Portal (Propensity Matched Controls) O. Health Service Utilization 18 HSPH TECH Talk - June 15, 2015

19 OpenNotes: An Initiative That Invites Patients To Read Their Progress Notes Through A Patient Portal 19 HSPH TECH Talk - June 15, 2015

20 OpenNotes Invites Patients To Read Chart Focus Groups Survey OpenNotes Demonstration PCPs at BIDMC, Geisinger, Harborview (UW) Data Collection Survey Analysis Policy Development Implementation 84% of BIDMC patients opened at least one of their notes 82% GHS patients opened at least one note 47% of HMC patients opened at least one note 20-42% of patients reported sharing notes with others 20 HSPH TECH Talk - June 15, 2015

21 OpenNotes Delbanco, T. et al., Annals of internal medicine, 157(7), pp % reported better understanding of their health and medical conditions P. 114 Primary Care Doctors and Their 20,000 Patients 75% felt better prepared for visits I. Patient Direct Access To Notes Through Web Portal C. No Access To Notes O. Survey Measures 80% reported remembering the plan for their care better 84% felt more in control of their care 70% reported taking better care of themselves (incl. med adherence) 21 HSPH TECH Talk - June 15, 2015

22 { } Weeks after my visit, I thought, "Wasn't I supposed to look into something? I went online immediately. Good thing! It was a precancerous skin lesion my doctor wanted removed (I did). 22 HSPH TECH Talk - June 15, 2015

23 { } In his notes, the doctor called me "mildly obese." This prompted immediate enrollment in Weight Watchers and daily exercise. I didn't think I had gained that much weight. I m determined to reverse that comment by my next checkup. 23 HSPH TECH Talk - June 15, 2015

24 { } It really is much easier to show my family who are also my caregivers the information in the notes than to try and explain myself. I find the notes more accurate than my recollections, and they allow my family to understand what is actually going on with my health, not just what my memory decides to store. 24 HSPH TECH Talk - June 15, 2015

25 3 Key Lessons 1 Portals are not one size fits all 2 Portals, like most other forms of technology, are merely tools. Outcomes depend on how they are used. 25 HSPH TECH Talk - June 15, 2015

26 Challenges For Patient Portals 1. Ideal Governance Models 2. Policies For Patient Access 3. Reaching All Patients 4. Organizing Patient Generated Health Data 5. Aligning Patient Portals With Care & Business Processes CIO Patients Clinicians Business Operations Administrators Clinical Informatics Reti, S.R., Feldman, H.J. & Safran, C., Governance for personal health records. JAMIA, 16(1), pp Revenue & ROI 26 HSPH TECH Talk - June 15, 2015

27 Challenges For Patient Portals 1. Ideal Governance Models 2. Policies For Patient Access 3. Reaching All Patients 4. Organizing Patient Generated Health Data Info Embargo Withholding Notes Proxy Access My OpenNotes Toolkit available at: 5. Aligning Patient Portals With Care & Business Processes 6. Revenue & ROI 27 HSPH TECH Talk - June 15, 2015

28 Challenges For Patient Portals 1. Ideal Governance Models Minority Patients Are Less Likely To Adopt 2. Policies For Patient Access 3. Reaching All Patients 4. Organizing Patient Generated Health Data Yamin, C.K. et al., The digital divide in adoption and use of a personal health record. JAMA Int Med, 171(6), pp Aligning Patient Portals With Care & Business Processes 6. Revenue & ROI 28 HSPH TECH Talk - June 15, 2015

29 Challenges For Patient Portals 1. Ideal Governance Models 2. Policies For Patient Access 3. Reaching All Patients 4. Organizing Patient Generated Health Data 5. Aligning Patient Portals With Care & Business Processes 6. Revenue & ROI 29 HSPH TECH Talk - June 15, 2015

30 Challenges For Patient Portals 1. Ideal Governance Models 2. Policies For Patient Access 3. Reaching All Patients 4. Organizing Patient Generated Health Data 5. Aligning Patient Portals With Care & Business Processes 6. Revenue & ROI Scheduling Population Health Care Management Shared Care Plans 30 HSPH TECH Talk - June 15, 2015

31 Challenges For Patient Portals 1. Ideal Governance Models 2. Policies For Patient Access 3. Reaching All Patients 4. Organizing Patient Generated Health Data 5. Aligning Patient Portals With Care & Business Processes 6. Revenue & ROI Global Payments E-Visits Additional Fees Efficiency 31 HSPH TECH Talk - June 15, 2015

32 A Roadmap For Portals OpenNotes Shared Care Plans Patient Input & Labs 32 HSPH TECH Talk - June 15, 2015

33 3 Key Lessons 1 Portals are not one size fits all 2 Portals, 3 Leaders like most other forms of technology, are merely tools. Outcomes depend on how they are used. should create roadmaps for how patient portals should be used locally, tackle challenges head-on. 33 HSPH TECH Talk - June 15, 2015

34 For Further Reading OpenNotes Toolkit Available at Contact Information Bradley H Crotty MD MPH Division of Clinical Informatics Beth Israel Deaconess Medical bcrotty@mail.harvard.edu 34 HSPH TECH Talk - June 15, 2015

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36 Reports from Patients Post intervention 26-36% had privacy concerns Few patients said reading notes made them Worried (5-8%) Confused (2-8%) Offended (1-2%) 36 HSPH TECH Talk - June 15, 2015

37 PCPs Main Concerns OpenNotes impact on patients PCPs think patients who read their notes will: Find notes more confusing than helpful Worry more Feel offended Pre -intervention % BIDMC / GHS / HMC 48 / 54 / / 58 / / 8 / 29 Post-intervention % BIDMC / GHS / HMC 13 / 21 / / 42 / / 8 / 2 37 HSPH TECH Talk - June 15, 2015

38 PCPs Main Concerns OpenNotes impact on workflow Visits significantly longer More time addressing patient questions outside of visits More time writing/editing/ dictating notes Pre-intervention % BIDMC / GHS / HMC 23 / 32 / / 45 / / 36 / 34 Post-intervention % BIDMC / GHS / HMC 3 / 5 / 0 8 / 0 / 0 21 / 14 / 0 and the volume of electronic messages from patients did not change 38 HSPH TECH Talk - June 15, 2015