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Sands -‐ Engaging e-‐Pa-ents 2/8/13
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ì
Daniel Z. Sands, MD, MPH Society for Par-cipatory Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA
Consumer Health: A Wedge to Break the Healthcare Logjam?
© Copyright 2013 D. Z. Sands, All Rights Reserved
US Healthcare “System”
Variable Quality
Processes Outcomes Best prac-ces
Costly >US $2T
>17% GDP $8000/capita
Inefficient 30% waste Fragmenta-on
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Sands -‐ Engaging e-‐Pa-ents 2/8/13
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The Triple Aim
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ì Sir Francis Bacon English author, cour-er, & philosopher (1561 -‐ 1626)
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Knowledge is power.
Online Population Rising…
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…And Health Info Seeking Popular…
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Online Health Habits of US Adults
Sources: www.pewinternet.org; PwC HRI Social Media Consumer
Survey, 2012
ì 84% of online adults have looked for health info ì Rising over -me ì Each day, more people search for health informa-on than see a physician! ì More than half act on the informa-on
ì 34-‐42% of online users have read others’ health experiences
ì 27% of online adults have tracked their health informa-on online
ì 1/3 use social media for health
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e-‐Patients Want To Be Engaged…
Involvement in
Care
Communica-on
Convenience Informa-on
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But Are All Patients Ready for Engagement?
Source: Adapted from DiClemente and Prochaska, 1998 by hfp://www.adultmeduca-on.com/Facilita-ngBehaviorChange.html
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…But We Make it Difficult: Mismatch Between Desires and Service Offering
0% 10% 20% 30% 40% 50% 60% 70%
Online Appts
Online Billing/Pmts
Online Costs
E-‐mail
Viewing Record
Desired (Important/Very Impt) Available
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Source: Harris Interac-ve 9/10/12 at hfp://goo.gl/VzfmT
"Thinking now of new technologies your health care provider could implement, how important would each of the following be to you?” (of pa-ents who saw physician in past year)
Shifting Paradigm?
ì Informa-on asymmetry ì Physician as oracle ì Comfortable ì A burden?
ì Informa-on symmetry ì Physician as partner ì Threatening vs. libera-ng ì Physician as healer
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It’s About Engagement
Engaged Equipped Empowered Educated Enlightened Etc.
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Ter-ary
Secondary
Primary
Self-‐Care (off the Map)
Professional Care
Dis
cour
aged
E
ncou
rage
d $
¢
Industrial Age Medicine Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. © Copyright 2013 D. Z. Sands, All Rights Reserved
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Individual self-‐care
Friends and families
Self-‐health networks
Professionals as facilitators Professionals
as partners Professionals
as authori-es
Professional Care
Dis
cour
aged
E
ncou
rage
d ¢
$
Information Age Healthcare Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. © Copyright 2013 D. Z. Sands, All Rights Reserved
Patients and Physicians Each Have Expertise
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Patients Can (and Must) Help
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Benefits of e-‐Patient Engagement
Factor Impact
“Second set of eyes” viewing record Monitor test results; error-‐checking record
Improved communica-on: provider à pa-ent
Befer pa-ent understanding and reten-on; greater adherence
Improved communica-on: pa-ent à provider
More complete knowledge of pa-ent history and concern; fewer tests ordered; improved diagnos-c accuracy; reduced malprac-ce suits
Pa-ent research May find legi-mate informa-on that may have been missed (including informa-on from other pa-ents)
Pa-ent par-cipa-on in note crea-on More accurate notes
Shared care plan Greater adherence (pa-ents and providers); fewer errors/near-‐misses
© Copyright 2013 D. Z. Sands, All Rights Reserved
Benefits of e-‐Patient Engagement
Factor Impact
Increased knowledge of health Reduced burden of illness
Increased knowledge of disease from online info and from online peer support
Greater adherence, befer outcomes
Pa-ent-‐generated health data More data à befer understanding, befer outcomes
Demand for more care delivery op-ons and convenience transac-ons
Fewer missed follow-‐ups and missed prescrip-ons
Pa-ent blogging Therapeu-c journaling shown to improve health outcomes
Pa-ent-‐generated research Hypothesis-‐genera-on leading to new treatments
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© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD
© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD
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High Adoption and Usage of My Health Manager
ì 4M registered members
ì 104M visits to kp.org
ì 74M sign-‐ons to My Health Manager
ì 29.7M test results viewed
ì 12.2M email messages sent
ì 10M prescrip-on refilled
ì 2.7M appointments booked
© Copyright 2013 D. Z. Sands, All Rights Reserved
2011 Metrics
Source: KP.org screenshots and data courtesy of Kate Christensen, MD
54M Consultant with HTN and Hyperlipidemia
This is too cool. It's almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.
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61M Minister with DM and Chronic Pain
I have a lot of medical issues. This email system has left me feeling comfortable and in good hands! Otherwise, I would feel as cold, depleted, and alone, as the lifeless tree in my front yard in the deepest of winter!
© Copyright 2013 D. Z. Sands, All Rights Reserved
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Patient Network Plus:
SHARE
Pa-ents’ sharing detailed health data is what makes our communi-es special. This informa-on is the basis of the Pa-entsLikeMe network and validates each individual
LEARN The shared informa-on creates a new knowledge about the real
world treatment, symptoms, and reality of living with illness. Pa-ents
learn about their disease and themselves in context of the
community
FIND Pa-ents’ find other paIents like them. They discover what op-ons are available for treatment and if their experience with their disease is normal. They can reach out to others like them for advice and
insight.
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58M with Metastatic Renal Cell Carcinoma
My doctor prescribed ACOR and it saved my life.
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© Copyright 2013 D. Z. Sands, All Rights Reserved
Informatics and Patient Engagement
Pt info needs and seeking Pt vocabularies
Pt understanding and health literacy
Shared care plans
CDS for pa-ents Med informa-on reconcilia-on for
PHRs Non-‐visit-‐based care models
Content of peer support
Pervasive monitoring
Data-‐driven self-‐directed care
Collabora-ve health records
Collabora-ons plarorms
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ì Electronic health record use leads to fewer office visits (Health Affairs, Vol. 28, 2009)
ì Online behavior change program use leads to increased produc-vity at work (HealthMedia, 2008)
ì Pa-ents booking online appointments are more likely to keep them (KP study, 2008)
ì Access to forms and health plan insurance documents saves prin-ng and postage costs
© Copyright 2013 D. Z. Sands, All Rights Reserved
KP.org: Efficiencies
Improved quality scores associated with secure messaging, including 2 percent to 6.5 percent improvements in glycemic, cholesterol and blood pressure screening and control.
© Copyright 2013 D. Z. Sands, All Rights Reserved
KP.org: Health Outcomes
Health Affairs 29, NO. 7, 2010
Source: KP.org screenshots and data courtesy of Kate Christensen, MD
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ì Digital Coaching results in posi-ve health outcomes
ì Recent data show that over half of par-cipants: ì Lose weight ì Reduce stress ì Quit smoking ì Improve diet
© Copyright 2013 D. Z. Sands, All Rights Reserved
KP.org: Health Outcomes
Source: KP.org screenshots and data courtesy of Kate Christensen, MD
© Copyright 2013 D. Z. Sands, All Rights Reserved
www.myopennotes.org
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PaIents:
ì 47-‐92% viewed at least one note
ì 20-‐42% shared the note
ì 77-‐85% reported befer understanding of condi-ons
ì 77-‐87% felt more in control
ì 70-‐72% took befer care of themselves
ì 60-‐78% described befer medica-on adherence
ì 92-‐99% did not feel overwhelmed
Physicians:
ì 0-‐5% felt visits longer
ì 0-‐8% took more -me in visits
ì 0-‐21% took more -me wri-ng notes
ì No change e-‐mail volume
ì 3-‐36% changed their note content
ì Many described strengthened rela-onship with pa-ents
© Copyright 2013 D. Z. Sands, All Rights Reserved
OpenNotes: Results
www.myopennotes.org
Presentation of Information
High blood pressure
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Facilitating Patient Understanding
Reference Libraries
The pa-ent’s hypertension is poorly controlled...
Hypertension is another name for High blood pressure…
Context-‐sensi-ve hyperlinks and help
The pa-ent’s hypertension is poorly controlled...
The pa-ent’s high blood pressure is poorly controlled...
Automa-c Transla-on (appropriate to pa-ent literacy)
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Self-‐Monitoring Made Easy
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Patients in Care Plans: Alerts to Patients
Image from Epic MyChart Courtesy Kate Christensen, MD, Kaiser Permanente. © Copyright 2013 D. Z. Sands, All Rights Reserved
Do We Need Most F2F Visits?
Technology Synchronous? InformaIon Density
Telephone þ ««
E-‐messaging o «
Text messaging/IM o/ þ «
Remote monitoring þ «
Telemedicine þ (usually) «««
Advanced Telemedicine þ ««««
Office visit þ «««««
© Copyright 2013 D. Z. Sands, All Rights Reserved
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Electronic Bedside Communication Center (eBCC)
Courtesy of Patricia Dykes, RN, PhD, Partners HealthCare
© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KinergyHealth.com
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Meaningful Use and Patients
© Copyright 2013 D. Z. Sands, All Rights Reserved
© Copyright 2013 D. Z. Sands, All Rights Reserved hfp://www.na-onalehealth.org/pa-ent-‐engagement-‐framework
Sands -‐ Engaging e-‐Pa-ents 2/8/13
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A Glimpse of Health IT Serving Patients?
© Copyright 2013 D. Z. Sands, All Rights Reserved
hfp://www.healthit.gov/pa-ents-‐families/video/health-‐it-‐you-‐giving-‐you-‐access-‐your-‐medical-‐records
ì Slack WV. CyberMedicine: How Computing Empowers Doctors and Patients for better Health Care. Jossey-‐Bass 2001.
It can be argued that the largest yet most neglected health care resource, worldwide, is the pa-ent…
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© Copyright 2013 D. Z. Sands, All Rights Reserved
Conclusions
ì We must reimagine healthcare through pa-ent’s eyes
ì Tools to empower, engage, and collaborate with pa-ents need further development and evalua-on
ì These technologies lower barriers to pa-ent engagement
ì Pa-ents are essen-al to transforming our healthcare system to improve quality, decrease costs, and improve efficiency
ì Let pa-ents help
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© Copyright 2013 D. Z. Sands, All Rights Reserved
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Questions?
Questions and e-‐mail address
Danny@DrDannySands.com hQp://www.DrDannySands.com
@DrDannySands © Copyright 2013 D. Z. Sands, All Rights Reserved