This is a joint presentation of Vera Rulon and Regina Holliday for AHIMA during Health IT week.

1. Improving
Health Information Quality Through
Patient Empowerment
Regina Holliday, Society for Participatory Medicine
Vera Rulon MS, RHIT, FAHIMA, FACMImimi, Pfizer Inc
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2. VERA’S PATIENT STORY
Completing the Masterpiece
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3. 3

4. 4

5. 5

6. Patient Empowerment: Key Points
• Communication
• Literacy
• Personal
• Practical
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7. Communication
The use of digital tools and
facilitating communication
between patients, caregivers
and healthcare providers can
improve data quality and
access to healthcare
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8. iConsumer: Digital Consumers Altering the Value Chain
McKinsey & Company*
Six Significant iConsumer Trends
Trend 2008 2012
1 Device shift
From PC to touch
PC
Mobile
Tablet
78%
22%
0%
57%
33%
11%
2 Communications shift
From voice to data
Voice
Email
Social
Other
39%
42%
15%
4%
27%
36%
26%
10%
3 Content shift
From bundled to fragmented
Mobile voice
Mobile data
61%
39%
22%
78%
4 Social shift
From growth to monetization
Social
Other internet
13%
87%
23%
77%
5 Video shift
From programmer to user controlled
Linear TV
DVR, VOD, OTT
78%
22%
65%
35%
6 Retail shift
From channel to experience
E-commerce/
All retail
3.6% 4.9%
*Authors Ewan Duncan, Eric Hazan, and Kevin Roche retrieved August 6 2013 from
http://www.mckinsey.com/insights/telecommunications/developing_a_fine-grained_look_at_how_digital_consumers_behave
Share of Usage
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9. Digital Revolution
• Manhattan Research
• Cybercitizen Health® 2012 study
Number of US adults
(ages 18+) using digital technology for health
information:
61 million 2011 75 million 2012
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10. The mHealth market will continue to grow
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11. Factors shaping the trend*:
• New technologies: smartphones, remote patient monitoring, social media
– cost and acceptance
*Guillemi, Andre; Benedict, Kevin mHealth Trends and Strategies 2013, May 2013 a special report by netcentric strategies
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12. • Population age:
– global population aging
– median population age increasing
– chronic diseases
– end of life 12

13. • Foundation in place: concept of “care everywhere” taking root
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14. • Move to personalized care
“mHealth is not a separate industry, but rather it’s the future of a healthcare
industry that’s evolving to care for patients differently, putting them first to
deliver services better, faster, and less expensively.”
David Levy MD, PwC (from Analysis & Trends in mHealth)
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15. Health Literacy
Empowered patients and their
caregivers can improve the quality of
health information through better
health literacy and input to their
medical record throughout the care
continuum
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16. Inviting Patients to Read Their Doctors’ Notes:
A Quasi-experimental Study and Look Ahead
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17. Key Findings: Post intervention survey
• 77% - 87% of patients reported that open notes helped them feel more in
control of their care
• Of those patients taking medications 60 % – 78% reported increased
medication adherence
• 26% - 36% expressed privacy concerns
Physicians
• Few reported longer visits (0%-5%)
• 3% - 36% reported changing documentation content or taking longer to write
notes (0%-21%)
At the end of the experimental period
• 99% of patients wanted open notes to continue
• No doctor elected to stop
Delbanco, Tom MD; Walker, Jan RN, MBA; et. al. Inviting Patients to Read Their Doctors’ Notes, Annals of Internal Medicine,
American College of Physicians retrieved 8/6/2013 from http://annals.org/article.aspx?articleid=1363511
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18. Wuerdeman, Volk et. al. “How Accurate is Information that Patients
Contribute to their Electronic Health Record?” AMIA 2005 Symposium
Proceedings p 834 - 838
Key Points
– The longitudinal medical record (LMR) is often incomplete
– Patient reported data is a promising source of general health information
– Patients can provide valuable information on: Presence or absence of tests
(supports preventative medicine); Surveys on quality of life
“Patients have important knowledge of their basic health maintenance, and can
and should assist physicians in recording information.
Patient access will increase the quality of this data to help ensure that the
physician has the most comprehensive file possible with which to work.
In addition to quality assurance, patient provided data and patient access to
LMR data will help increase communication between provider and patient.”
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DepressionScreening On LMR Problem list Not in LMR Total Participants
High Risk 4 (25%) 12 (75%) 16 (100%)
Moderate Risk 7 (27%) 19 (73%) 26 (100%)
Low Risk 20 (9%) 192 (91%) 212 (100%)
Total 31 223 254

19. Personal
Personal stories of how patients contributing to
their medical record improved the care they
received because of the improved quality of
their personal health information 19

20. Physicians need to adapt
• Dialogue
– “If you don’t mind, I am going to be typing
as you speak, I’m happy to show you what
I’m writing”
– “I’m going to look up your test results,
would you like to look at them together?”
• Caution
– Documenting socially stigmatizing
health conditions
– Sensitivity to patient perceptions
• Patient engagement
– Improving management of chronic disease, mental illness
– Patient-physician collaboration
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White, Amina MD; Danis, Marion MD Enhancing Patient-Centered Communication and Collaboration by Using the
Electronic Health Record in the Examination Room JAMA, June 12, 2013 – Vol 309, No. 22

21. Lets have a conversation
Ideas to facilitate governance and
oversight by healthcare providers and
health information management
professionals of patient/caregiver
input to the electronic medical record
(practical application)
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22. Themes
• Culture dominates
• “Listen first, listen fully”
• Patient engagement is a skill, not a trait
• Trust matters
• Prepared, engaged patients are a fundamental precursor to
high quality care, lower costs, and better health
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Institute of Medicine (IOM), Partnering with Patients to Drive Shared decisions, Better Value and Care Improvement,
meeting summary retrieved August 16, 2013 from
http://iom.edu/Reports/2013/~/media/Files/Report%20Files/2013/Partnering-with-Patients/PwP_meetingsummary.pdf

23. Questions?
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