NORC Prashila Dullabh, MD July 18, 2013 Consumer Empowerment Workgroup : Evaluating Patients Role in Providing Feedback to Improve the Quality of Information.

NORC

Prashila Dullabh, MD

July 18, 2013

Consumer Empowerment Workgroup :

Evaluating Patients Role in Providing Feedback to Improve the Quality of Information in the Medical Record

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• Funded under ONC’s Consumer e-Health Program • Goals of the study

• Illustrate current approaches to patient feedback, comparing approaches in health care to other fields

• Assess responses to the need for patient engagement in efforts to improve data quality in EHRs, identifying any shortcomings in current practices and recommend responsive action

• Pilot test a patient feedback process

Important progress is being made….

ONC-Funded Study

Keeping EHRs Error-Free: the Value of Patient Engagement

Background

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Markle Foundation survey finds 87% of respondents would use a PHR to “check for errors or mistakes in their health records” (Markle Survey: The Public Expects Benefits from Health IT, December 2010)

Patients interested in accuracy of their records

Keeping EHRs Error-Free: the Value of Patient Engagement

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Survey of eight patient portals (2010)

• Beth Israel Deaconess Medical Center

• Children’s Hospital Boston

• Geisinger Health System

• Kaiser Permanente

• NorthShore University Health System

• Palo Alto Medical Foundation

• Partners HealthCare

• Veterans Health Administration

Encourage: Acknowledge potential for issues and recommend patient contact their provider

Facilitate: Build on encouragement to provide online mechanisms accept patient input:

Keeping EHRs Error-Free: the Value of Patient Engagement

Health Data Available Online

Encourage Feedback

Facilitate Feedback

Medication Lists 8 2 3

Allergies 7 1 4

Immunizations 6 1 3

Laboratory Results 7 1 1

Problem Lists and Diagnosis

6 1 1

Vital Signs 5 1 1

Clinical Summary & Discharge Instructions

6 1 0

Radiology Results 5 0 1

Medical History, incl. Procedures

5 1 0

Clinical Encounter Notes

0 0 0

Patient portals are being used to gather patient feedback

Geisinger Pilot Study

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and

Goals and Research Questions

Goals Research Questions Data Sources

Goal 1:•Determine if patients can be engaged to improve data quality of medical records

• Will patients be engaged to provide feedback?

• Will patients provide feedback?• What factors influence whether

patients provide feedback?

• Patient focus groups• Patient user observations• Interviews with pharmacists

and physicians

Goal 2:•Assess workflow for obtaining and processing patient feedback

• How should patient feedback be triaged?

• What workflows are needed to process patient feedback and update/amendment medical records?

• Interviews with pharmacists and physicians

Goal 3:Assess impact of the patient feedback

• How accurate is the feedback?• What is the impact of patient feedback on providers?• Does patient feedback contribute to more up-to-date/accurate records?

• Demographic data for sample

• Patient feedback data• Pharmacists’ medication

reconciliation logs• MyGeisinger usage rates

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• Started November 2011• Inclusion criteria:

• Patient has at least one chronic condition (e.g. asthma, hypertension, diabetes, COPD,CHF)

• Patient is a user of the MyGeisinger portal

• Patients with upcoming appointments invited to complete a medication feedback form prior to their office visit

• 2 clinics included in the original pilot• As of June 2012:

• Total of 1500 patients received the form,

Overview of Geisinger Pilot

Key Findings

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• Many patients liked the opportunity to provide feedback outside of office visits, and preferred the form to calling

• Many patients felt the form helped them to prepare for their visit and be more informed about their medications

• Providers report the form has improved patient engagement and information-sharing

“I take 30 or so meds. I probably wouldn’t be able to list all of them on my own. The form helps me remember to take all of my meds and request refills.”

- Participating patient

“It’s amazing to see the response we’ve received and the details patients have provided so far. They are very thorough. I had an elderly male patient who went through the survey completely. I assumed that a family member helped him complete the form, but then I talked to him and found out that he did it all by himself.”

- Participating pharmacist

Patient Engagement

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• Patient response ~30% exceeded expectations

Patients are Eager to Provide Feedback

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Patients are Eager to Provide Feedback

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Number of forms in which patients requested discontinuations or

changes in frequency or dosage

Number of medications entries requested to be

removed or changed

Patient requests

281 661

On average patient requested at least 2 changes per submitted form

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Patients Can Provide Accurate Feedback

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• Subsample Analysis of 116 patients

• In 56% (68/121) of cases pharmacists accepted patient requests for changes

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A Supportive Online Environment Important for patient feedback

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Usage Measures Description Annual Rates

Log-ins by all patients who logged in

Average number of log-ins to MyGeisinger

27

Logins by patients who submitted the medication feedback form

Average number of log-ins to MyGeisinger

63

MyGeisinger secure-messaging by all patients who logged in

Average number of secure messages

7.6

MyGeisinger secure-messaging by patients who submitted the medication feedback form

Average number of secure messages

10.2

MyGeisinger Usage Rates Annualized for 2012

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Proposed measure for Meaningful Use Stage 3: “SGRP 204D: Provide patients with the ability to request an amendment to

their record online (e.g., offer corrections, additions, or updates to the record) through VDT in an obvious manner.”

• Geisinger pilot results support• Provide outpatients the ability to request updates to their record online

(e.g., offer corrections, additions, or updates to the record) for medications through VDT using structured forms

• Measures: ~30% of patients responded to an offer to update. ~85% of those were processed within 4 business days

• Patient portal survey support• Medication allergies, Immunizations, and Demographics

• Other promising areas for patient sourced data • Smoking Status, Advance Directives, Family Health History

Policy Implications

Keeping EHRs Error-Free: the Value of Patient Engagement

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• Patients can be effectively engaged to provide accurate and reliable feedback

• There are effective strategies to gather and process patient feedback

• The pilot serves as a test case for collaborative processes that can be employed to improve data quality of EHRs

In Conclusion

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