Patient-centered HIT: a pediatric case study Stephen C. Porter MD, MPH, MS Assistant Professor, Harvard Medical School Affiliate Faculty, Harvard-MIT Division of Health Sciences and Technology Faculty, Division of Emergency Medicine,Children’s Hospital Boston Email: [email protected]
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Patient-centered HIT: a pediatric case study Stephen C. Porter MD, MPH, MS Assistant Professor, Harvard Medical School Affiliate Faculty, Harvard-MIT Division.
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Patient-centered HIT: a pediatric case study
Stephen C. Porter MD, MPH, MSAssistant Professor, Harvard Medical School
Affiliate Faculty, Harvard-MIT Division of Health Sciences and TechnologyFaculty, Division of Emergency Medicine,Children’s Hospital Boston
• How can technology empower patients as the drivers of safe and effective care?
• How can patients’ knowledge and expertise be systematically– captured– analyzed– disseminated to all stakeholders in the health
care process?
Rules to bridge the quality chasm
• Care based on continuous relationships
• Customization based on patient needs
• Patient as source of control
• Shared knowledge and free flow of info
• Evidence-based decision-making
• Safety as system priority
• Cooperation among clinicians
The scope of patient report
• Symptoms– Illness specific– Guideline specific
• Current medications
• Previous reactions to medications
• Current disease management practice
• Unmet needs
Ideal flow of information
Data Capture
Data validation
Data integration
Correct actions based on evidence and knowledge
Information gaps in emergency medicine
• Critical data points– Medications– Allergies to medications– Immunization history
• Specific disease states– Asthma– Appendicitis
• Specific patient-provider barriers– Language– Literacy
ED Care for Asthma
• ED visit itself a marker of poor control• Significant percentage of patients discharged to
home report persistent morbidity one month later• ED-based barriers to improved care
– Under-recognition of chronic severity– Lack of awareness of patients’ medications– Communication barriers– System constraints– Insufficient discharge planning
Guidelines for Asthma
• Establish patient-clinician partnership• Prescribe anti-inflammatory medications to patients
with persistent asthma– inhaled steroids: recommended first line therapy
• Reduce exposures to precipitants of asthma symptoms
• Train all patients to monitor their asthma
Linking parents’ data to guidelines
• A child with persistent asthma who is not on a controller should be prescribed one– Identify persistent asthma symptoms– Identify current medications
• Establish whether a mismatch exists
• A child with asthma exposed to secondary smoke should have that exposure eliminated– Identify exposure to tobacco
• A child on inhaler(s) whose parent reports non-use of a spacer device should receive device/ teaching– Identify whether spacer device is used for sub-set of
patients who report inhaler medications
A Role for a Patient-driven Information Solution
• Parents can independently enter data using a multi-media interface to populate a knowledge engine and drive guideline-endorsed care– Porter et al JAMIA 2004;11:458-467
• Parents’ documentation of asthma-specific medication data superior to documentation of ED physicians and nurses– Porter et al JAMIA 2005; 12: 299-305
Idealized asthma care Parents told us what they know. Now let's act on their data and help!
Current symptoms and medications and recommended actions 1) Chronic severity for asthma: moderate persistent
2) Data that supports this severity: symptom 4 week frequency cough A few days wheezing Some days shortness of breath Some days night time awakening Some days
3) Current controller medications: flovent inhaler 44 mcg 2 puffs Not sure 4) Recommendations for Steve, age 13 y: · Prescribe new form of flovent inhaler medication completed Y/N ______
Current parent-child needs and recommended actions
1) In support of best medication practice Prescribe peak flow meter. Teach use. completed Y/N ______ How to give medication using inhaler completed Y/N ______
2) In support of environmental risk reduction Reduction of pet dander completed Y/N ______
3) In support of better access to care Help with getting prescription medicines completed Y/N ______ *