Patient Centered Information Technology focuses on moving away from a paternalistic, doctor-centered approach to one that is more patient-centered through the use of online communication and access to health records. Studies showed that online communication via secure messaging improved patient satisfaction and reduced phone calls. Releasing test results and doctor's notes online did not increase confusion, anxiety or health utilization. Patients felt more empowered and in control of their care. The future of patient access online may include untethered personal health records on mobile devices and greater use of social media for peer-to-peer sharing of health experiences and information.

1. Patient Centered
Information Technology
C.T. Lin MD, FACP
Chief Medical Information Officer, University of Colorado Health
Professor, University of Colorado School of Medicine
iHT2 Health IT Summit
July, 2013
Denver, CO

2. I have nothing to disclose.
I have no relevant financial interest/arrangement or affiliation with
any organizations related to commercial products or services to be
discussed at this program.

3. Learning Goals
Be able to define and describe:
• Patient Centered Information Technology
• Risks / benefits of online communication
between patients and providers
• Risks / benefits of online release of results
• The impact of social media on patients

4. UCH 9th Avenue Campus
46 acres at 9th & Colorado

5. Vision 2020
Re-inventing health care for the next
century: from Bricks and Mortar to
Patient Centered Information Technology

6. One square mile; a health sciences city; 30, 000 employees when
complete, an opportunity to “re-invent healthcare” from the ground up.
Former Fitzsimons Army Base, now Anschutz Medical Campus

8. Outline
Patient Centered Information Technology
Paternalism?
Online communication
Access to health records
Social Media and Patients

9. Paternalism
(doctor-centered)

10. Knowledge is power. Respect my studies.
I am too important for clerical tasks
Patients do best when they do what I say
There is nothing wrong with the way I work

11. Knowledge...power
I am too important
Pts…do what I say
Nothing wrong…
Collaboration is powerful
Communication improves safety
Connection fosters participation
Change requires a burning
platform

12. Doctor-centered
Patient-centered

13. Doctor-
centered
Patient-
centered
Doctor-
centered
Patient-
centered
!!

15. Diabetes-STARCORHIOSPPARO
Advance Check-InDirect SchedulingMy Doctor’s Office CEO-email
satisfaction
Electronic Medical
Records

16. • 82% of U.S. adults have Internet access
• Harris Interactive poll, July, 2010
• 90% of online patients want to e-mail their doctor
• 56% of online patients say e-mail access would
influence their choice of doctor
• Harris Interactive poll, April, 2002
Online communication

17. Online communication
(MD opinions)
“The floodgates will open”
“Patients will send chest pain
messages--at midnight!”
“Patients can reach me”
“Less telephone tag!”

20. So, what happened?
After 6 months…

21. Patient satisfaction improved
Sending a message to Docs: 24%
Prescription refills: 19%
Appointment requests: 24%
Overall care from the clinic 11%
Overall communication 32%

22. Most messages were sent after hours
0
2
4
6
8
10
12
14
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Time of Day
Only 27% of
messages were
sent during clinic
hours
50% from 5pm-MN
% of
messages

23. Patient perceptions
81% of MDO patients noted it saved them a
phone call to the clinic
33% noted it saved them a visit to the clinic
86% preferred the MDO to the telephone to
communicate non-urgent messages

24. There is NO FLOOD
1 message per day per 250 patients
OR, about 10 messages a day per doc

25. Online Communication
Summary
• MDO patients are more satisfied with
communication and overall care
• Patients say it saves phone calls, visits
• Physicians are neutral to positive
• Messaging volume is modest
– 1 message for 250 patients online
• 2013: 42,000 patients enrolled
– 10,800 unique logins per month

27. Online communication
Comments or questions

28. Online release of test results
“Patients will be
confused.”
“The only reason I will
participate is that you
are doing a rigorous
study.”
“Patients will be better
participants in their
care.”

29. Intervention
Selected Laboratory Tests

30. Online release of doctor notes
“Patients will act on
errors in transcripts.”
“Patients will be more
anxious”
“This is a crazy idea; the
phone will ring off the
hook.”
“Patients can already
request their paper
chart. Why not?”

32. So, what happened?
After 12 months…

33. “I am quicker to notify my patients of their
results. Before, if I was busy, I might let a
result wait on my desk for a few days. Now,
because the patient might already have
seen it, I will make a phone call, or send an
online comment.”
Surprise!

34. Physician debrief
• “The problems were minor.”
• “I thought I would change my dictations
for this, but I did not”
• “Alerting patients to look at their
notes, both the physicians and staff can
do a better job. I think the patient has a
right to understand what is going on.”

35. Trust
Empowered
Felt understood
Adherence to treatment

36. Patient debrief
“I like going over the reports so that I have some
intelligent questions.”
“I probably don‟t remember half of what they said. So,
this gives me the chance to go back and pick up things I
had forgotten or missed.”
“I feel like I‟m having a more active role. My health is my
responsibility.”
“I lost my luggage while traveling. I went to a local doc
and said: „If you have Internet Explorer, I can show you
my chart. Could I have a few days of my meds?‟”

37. SPPARO Summary
NO: patient overuse or misunderstanding
NO CHANGE: health utilization (visits, calls)
physician documentation
MD, RN, patient satisfaction
IMPROVED: Patients felt more empowered
Patients felt more in control
Patients felt more trust in their doctors
Patients described many uses for their records
(travel, clarification, learning, error checking)

38. SPPARO update
Presenting this data to University audience
• Administration saw a competitive advantage
• Nursing saw a patient education tool
• Physicians saw “no clinical benefit”
Study completed 2002, after 6 years of lobbying
• My Medical Record launched in July 2008, house-wide
• Patient access to lab (exclude new HIV), rad, path
• No delay for labs, 1 wk for CT/MRI, 2wk for Path
After 4 years of patient utilization:
• 42,000 patient accounts (minimal advertising)
• Over 1.3 million web pages of results viewed by patients
• 1 PET scan incident, 1 Dilantin level incident

39. Study Results: SPPARO
Comments or questions

42. • More transparency
• Social Media: Peer to Peer technology
• A global community of patient
experience and knowledge
• Attitude shift from privacy to sharing
• “My Doctor in my pocket”
What is the future of Patients Online?
Jum
p

46. Untethered Personal Health Reco

47. Untethered Personal Health Record (discontinu

48. Government sponsored, expert-driv

49. Non-profit, clearinghouse

50. For profit, expert mediated

51. For-profit, peer-to-peer

52. CT Lin MD
ct.lin@ucdenver.edu
Thank you!