1. Patient Digital Design & Services:
The Next Generation of Quality
Susan Woods, MD, MPH
Oregon Health & Science University
Portland VA Medical Center
2. 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
3. What do people want?
Access
Great care
Avoid costs
3
11. KP.org reaches 65% -- 4 million +
http://thrive.kaiserpermanente.org/innovation
12.
13. 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
14. Usage Follows Value
• Test results
• Secure email
• Medication refills
• Notes & summaries
Functions
• Online authentication
• Proxy access
• Usability
• Technical support
Access
15. 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)
16. 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!
19. Patient-Facing Digital Services - Impact
Evidence Likely
More accurate information
Better experience
More knowledge of problems
Greater self-care
More prepared for visits
More efficient in-person visits
Greater trust in clinicians
Improved quality measures
Improved outcomes
More preventive services
Less no-shows
Need to mitigate digital divide
Patients
Improved adherence
Better caregiver knowledge/skills
Fewer tests
Better care coordination
Increased use of digital services
Healthcare Teams:
Shifting work
Need different communication
Care Delivery:
More visits for some
Less visits for some
20.
21. 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
24. 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.”
25. 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.”
26. 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.”
27. 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.”
28. “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
29. % Agree
Patients PCPs
Takes better care of self 70 28
Better understand conditions 84 41
Remembers care plan better 84 44
More prepared for visits 73 36
More in control of care 84 49
Take medications better 60 31
Views after one year
Inviting Patients to Read Their Doctors‟ Notes: A Quasi-experimental Study and a Look
Ahead
30. % Agree
Patients PCPs
Felt offended 2 8
More confusing than helpful 3 21
Worries more 7 42
Concerned about privacy 32 --
Views after one year
Inviting Patients to Read Their Doctors‟ Notes: A Quasi-experimental Study and a Look
Ahead
Example of care coordination: The provider learned more about the patient’s care through secure email. The provider was able to address multiple patient needs in a few minutes time. And they received a warm greeting from the patient!
Statements made from VA patients who accessed their electronic health record information –
That brings us to the 5th and LAST Top Reason for shared records: It’s time for us to re-design our work.
Demonstration of Blue Button – login to MHV website using VISN 20 Test Patient
Patients are cool. They know stuff you don’t. Photocredit: wearewhatwedo.org