Patient HIT, Value & Quality

Patient Digital Design & Services: The Next Generation of Quality

Susan Woods, MD, MPHOregon Health & Science University

Portland VA Medical Center

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

What do people want?

Access Great care Avoid costs

3

Information & Services

Transforming

Looking online for health information

Pew Research Center’s Internet & American Life Project, 2012 Survey. N = 3,014

Apr-06

Dec-07

Apr-08

Apr-09

Sep-09

May-10

Sep-10

May-11

Aug-11

Jan-12

Feb-12

Apr-12

Aug-12

Sep-12

Nov-12

Dec-12

Jan-13

May-13

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

73%

91%

58%

30%

37%

47%

61%

0.410.42

0.43

0.020.0500000000000001

0.190.26

0.0400000000000001

0.1

0.29 0.34

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

April-0

6

Decem

ber-0

7

April-0

8

April-0

9

Septe

mber

-09

May

-10

Septe

mber

-10

May

-11

Febru

ary-

12

April-1

2

Septe

mber

-12

Novem

ber-1

2

Decem

ber-1

2

May

-13

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

73% 75%78%

85% 84% 82%85% 83%

88% 88%85% 85% 87%

91%

0.35

0.45 0.46 0.45 0.47 0.45

0.56

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

71%Got information or care from a health

professional for their last problem

MyGroupHealth Users and PHR Usage

KP.org reaches 65% -- 4 million +

http://thrive.kaiserpermanente.org/innovation

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

Usage Follows Value

Functions

•Test results•Secure email•Medication refills•Notes & summaries

Access

•Online authentication•Proxy access•Usability•Technical support

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)

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!

http://www.hsrd.research.va.gov/publications/esp/myhealthevet.cfm#.Ui_0Hj9-rQM

Patient-Facing Digital Services - Impact

Evidence LikelyMore accurate informationBetter experienceMore knowledge of problemsGreater self-careMore prepared for visitsMore efficient in-person visitsGreater trust in cliniciansImproved quality measuresImproved outcomesMore preventive servicesLess no-shows

Need to mitigate digital divide

PatientsImproved adherenceBetter caregiver knowledge/skillsFewer testsBetter care coordinationIncreased use of digital services

Healthcare Teams:Shifting workNeed different communication

Care Delivery:More visits for someLess visits for some

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

23

J Med Internet Res 2013;15(3):e65

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.”

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.”

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.”

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.”

“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

% AgreePatients PCPs

Takes better care of self 70 28Better understand conditions 84 41Remembers care plan better 84 44More prepared for visits 73 36More in control of care 84 49Take medications better 60 31

Views after one year

Inviting Patients to Read Their Doctors’ Notes: A Quasi-experimental Study and a Look Ahead

Ann Intern Med, October 2, 2012 157(7):461-470

% AgreePatients PCPs

Felt offended 2 8More confusing than helpful 3 21Worries more 7 42Concerned about privacy 32 --

Views after one year

Inviting Patients to Read Their Doctors’ Notes: A Quasi-experimental Study and a Look Ahead

Ann Intern Med, October 2, 2012 157(7):461-470

It’s a good time to re-design our work.

32

Talk to Patients. They Know Cool Stuff You Don’t.

Thank you!

@SueWoodssusan.woods@va.govhttp://www.sharedhealthdata.com