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Busting the Myths of Personal Health Records
C.T. Lin MD, FACPChief Medical Information Officer, UCHealth
Professor, University of Colorado School of Medicine
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.
evaluate these myths
• If patients talk to doctors online, then surely
THE FLOODGATES WILL OPEN
• Releasing test results online will create more
misunderstanding and re-work for doctors
• Showing doctor’s progress notes to patients
is “just asking for trouble”
• Social media can be used as a force for better
patient care
UCH 9th Avenue Campus46 acres at 9th & Colorado
Vision 2020
Re-inventing health care for the next century
One square mile; 30, 000 employees
Former Fitzsimons Army Base, now Anschutz Medical Campus
Paternalism(doctor-centered)
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
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
Traditional relationships…
PhysicianOther specialists
Medical record
Other patients
Patient
Insurers
Hospitals
Medical knowledge
Clinic staff
The Internet
Doctor-centered
Patient-centered
Doctor-centered
Patient-centered
Doctor-centered
Patient-centered
!!
Diabetes-STARCORHIOSPPARO
Advance Check-In
Direct SchedulingMy Doctor’s Office CEO-email satisfaction
Electronic Medical Records
myth #1
If patients talk to doctors online, then surely THE FLOODGATES WILL OPEN
• 87% of U.S. adults have Internet access • (Pew Internet Poll, Feb, 2014)
• 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
Online communication (MD opinions)
“The floodgates will open”
“Patients will send chest pain messages--at midnight!”
“Patients can reach me”
“Less telephone tag!”
So, what happened?
After 6 months…
Patient satisfaction improved
Sending a message to Docs: 24%
Prescription refills: 19%
Appointment requests: 24%
Overall care from the clinic 11%
Overall communication 32%
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
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
There is NO FLOOD
1 message per day per 250 patients
OR, about 10 messages a day per doc
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
• 2014: 75,000 patients enrolled
myth #1If patients talk to doctors
online, then surely THE FLOODGATES WILL OPEN
myth #2
Releasing test results online will create more misunderstanding and more work for doctors
myth #3
Showing doctor’s progress notes to patients is “just asking for trouble”
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.”
InterventionSelected Laboratory Tests
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?
So, what happened?
After 12 months…
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.
-Physician participant
Surprise!
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.
TrustEmpoweredFelt understoodAdherence to treatment
Patient debriefI 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?’
SPPARO SummaryNO: 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)
SPPARO updatePresenting 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: • 75,000 patient accounts (minimal advertising)• Over 1.5 million web pages of results viewed by patients• 1 PET scan incident, 1 Dilantin level incident
myth #2
Releasing test results online will create more
misunderstanding and more work for doctors
myth #3
Showing doctor’s progress notes to patients is “just asking for trouble”
myth #4
Social media can be used as a force for better patient care
Untethered Personal Health Record
Untethered Personal Health Record (discontinued)
Government sponsored, expert-driven
Non-profit, clearinghouse
For profit, expert mediated
For-profit, peer-to-peer
What’s next?
Mayoclinic.org from Medicare released data
http://www.propublica.org from Medicare released data
Is there a trusted source of doctor information?
So, how to find:
A good Surgeon who treats Aortic Aneurysms
near me?
Rating
Aortic Aneurysm Repair, Zip 80045
Rating Rating
Sal “your pal” Jones MD Frank “my way” Sinatra MD CT “Devo” Lin MD
Pt Satisfaction: 99%
Cost: $8,000
Pt Satisfaction: 89%
Cost: $10,000 Cost: $52,000
Pt Satisfaction: 60%
Outcomes Cases/year 100 Survival: 96% Re-admits: 2%
Outcomes Cases/year 500 Survival: 99% Re-admits: 1%
Outcomes Cases/year 12 Survival: 90% Re-admits: 10%
myth #4
Social media can be used as a force for better patient
care
myths?
• If patients talk to doctors online, then surely
THE FLOODGATES WILL OPEN
• Releasing test results online will create more
misunderstanding and re-work for doctors
• Showing doctor’s progress notes to patients
is “just asking for trouble”
• Social media can be used as a force for better
patient care