Presented by Christopher Tashjian, MD, FAAFP, on September 27, 2013 at the fourth annual Center for Health Literacy Conference: Plain Talk in Complex Times.

1. How technology is changing rural medicine
to improve outcomes and communication
with patients: Fact, not theory.
Plain Talk in Complex Times 2013:
Communicating in a Time of Change
September 26-27, 2013 | Arlington, VA
Christopher H. Tashjian, MD, FAAFP
Health IT fellow using electronic health records and practice innovations to increase
participation
in the Million Hearts® initiative and improve performance on the Million Hearts goal
Chief Medical Advisor WHITEC

2. Health literacy is dependent on
individual and systemic factors:
 Communication skills of lay persons
and professionals
 Lay and professional knowledge of
health topics
 Culture
 Demands of the healthcare and public
health systems
 Demands of the situation/context

3. Health literacy affects people's ability
to:
 Navigate the healthcare system,
including filling out complex forms and
locating providers and services
 Share personal information, such as
health history, with providers
 Engage in self-care and chronic-
disease management
 Understand mathematical concepts
such as probability and risk

4. Who is at risk?
 older adults
 racial and ethnic minorities
 people with less than a high school
degree or GED certificate
 people with low income levels
 non-native speakers of English
 people with compromised health
status.7 Education, language, culture,
access to resources, and age are all
factors that affect a person's health
literacy skills.

5. EVERYONE!!!!

6. Modern Solutions
 Conversation
 PCMH
 EMR
◦ After Visit Summary
◦ Patient Education
◦ Patient Portal
 Smart Phone

7. Conversation

8. Patient Centered Medical
Home
 is a model of care that emphasizes
care coordination and communication
to transform primary care into “what
patients want it to be.”
 NCQA Patient-Centered Medical
Home (PCMH) Recognition is the
most widely-adopted model for
transforming primary care practices
into medical homes.

9. HIGH TECH
First need to acquire data and enter into
EMR

10. Create Database

11. Generate Patient Lists

12. Use of Filters

13. Patient Scorecards

14. Results as of 8/1/2013 for
Christopher Tashjian, MD
IVD
BP 99/104 95.2%
LDL 86/104 82.7
Aspirin 104/104 100%
Smoking 87/104 83.7
Hemoglobin A1C 82/104 78.8
Total (All 5) 57/104 55%

15. EMR – After Visit Summary
 information and instructions containing
the patient name, provider’s office
contact information, date
 and location of visit, an updated
medication list, updated vitals,
reason(s) for visit, procedures and
other

16. EMR AVS (continued)
 instructions based on clinical
discussions that took place during the
office visit
 any updates to a problem list,
immunizations or medications
administered during visit, summary of
topics covered/considered during visit,
time and location of next
appointment/testing if scheduled, or a

17. EMR AVS (continued)
 recommended appointment time if not
scheduled, list of other appointments
and tests that the patient
 needs to schedule with contact
information, recommended patient
decision aids, laboratory and other
 diagnostic test orders

18. EMR Patient Education
 Required for Meaningful Use
◦ Krames
◦ Exit Care

19.  Standard content written at or below
the 8th grade reading level
 Easy-to-Read content written at or
below the 4th grade reading level

20. Easy-to-Read documents
include:
 Need-to-Know and What-to-Do
information
 Simple words and sentences written in
plain language
 Ample white space
 Simple illustrations
 Uncluttered sections
 Active voice style writing
 Quality, clinician-reviewed medical
information
 Spanish translations

22. Patient Portal
 Patient portal helps you easily access
your health information and contact
your doctors and nurses. The patient
portal empowers you to become an
active participant in your care through
a broad range of activities and
services.

23. Key Benefits Patient Portal
Easy access to important health information
Secure communications with your doctor
Convenient appointment management
Tools to manage your care and improve
your health

24. Medical Record Access
View your medical record
Download a copy of your medical record
Share your record with health care
professionals

25. Secure Messaging
Exchange secure messages with your
doctor
Receive a convenient email notification
when you have a new message

26. Appointments
View appointment details
Reschedule or cancel an existing
appointment
Schedule a new appointment
Save appointments to your calendar

27. Online Forms
eVisits
Pre-visit interviews
Medical history surveys

28. Smartphones- now above
61%

30. Medical Apps for Docs
Epocrates
 The king of all medical apps,
Epocrates enables physicians to
review drug prescribing and safety
information, select health insurance
formularies for drug coverage
information, perform calculations like
BMI and GFR and access medical
news and research.

31. Medical Apps for Docs
Up to Date
Up to Date is a reference tool that
comes with evidence-based
recommendations, mobile-optimized
calculators and a CME tracker.

32. Medical Apps for Patients
 Pill Management
 Chronic Disease Management
◦ Diabetes
◦ Heart Disease
 Diet Management
 Exercise Management
 More every day!

33. Bottom Line

34. Million Hearts®
• National initiative co-led by CDC and CMS
• Partners across federal and state agencies and
private organizations
Goal: Prevent 1 million heart attacks
and strokes in 5 years

35. Key Components of Million Hearts™
COMMUNITY
PREVENTION
Changing the context
CLINICAL
PREVENTION
Optimizing care
Focus on
ABCS
Health
information
technology
Clinical
innovations
TRANS
FAT

37. For more information contact:
Chris Tashjian, MD, FAAFP
ctashjian@rfmc.org
Ellsworth Medical Clinic
715-273-5041