Webinar: Patient empowerment can stem from leveraging health IT
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“It’s really changed the way I interact with my patients,” said Sinsky during a recent webinar sponsored by the Agency for Healthcare Research and Quality’s (AHRQ) National Resource Center for Health IT, which focused on the need for patient involvement with health IT for empowerment.
“If the patient doesn’t come up with the solution, it won’t work. The majority health determinants are outside of the [healthcare] provider’s control,” Sinsky said, mentioning diet, exercise and whether or not medications are being taken as some of those determinants. In addition, she said that engaged, activated patients, as well as their families, will achieve better outcomes.
At Sinsky’s facility, patients also are provided with thorough, updated medication lists upon discharge, which she believes helps patient compliance as they know the physician’s exact orders and expectations.
In terms of future direction for her facility, Sinsky would like to implement web portals, which she hopes will offer patients the ability to email their physician, as well as granting authority over the scheduling of their visits. In addition, she said that she looks forward to having the ability to post patient test results online, with links to further research and preventive measures. Moreover, Sinsky noted the creation of a hospital family portal, which would allow family members to access test result information via the web, in order for the family to become engaged in the care of a loved one, despite not being there in person.
Speaking about his facility’s experience in implementing an EHR system, including e-prescribing, laboratory and radiology interfaces, electronic billing, performance monitoring and a registry for population management, Alexander Krist, MD, from Virginia Commonwealth University School of Medicine, said, “our ideas came from a disconnect between the high perception of value of a personalized health record (PHR), but only 2.7 percent of adults have one.”
Krist noted that his trial, which implemented personalized portals for the promotion of patient-centered preventive and chronic disease care, sought to capitalize on the fact that 79 percent of Americans believe a PHR could provide major benefit in managing health and 47 percent of Americans have expressed interest in using an online PHR. Specific aims of the trial included increased shared decision-making for preventive services and improved clinician-patient communication about preventive needs, he said.
According to Krist, the randomized controlled trial consisted of eight practices using a common EMR and 5,500 patients, of whom 2,750 were mailed an invitation to visit the internet PHR and the remaining 2,750 control patients received the usual preventive care. They used EMR data, internet PHR data and postal surveys to measure increases in preventive care delivery.
Once a patient accepted the invitation and created an internet PHR, the program pulled the patient’s data, including demographics, vital signs, diagnoses, orders, results, management plans, medications and immunizations from the EMR. In addition to their health information, resources, including educational material, risk calculators, health tools, local resources and decision aids could be found on the online PHR.
While the researchers initially believed that younger patients would be those most likely to utilize the online PHR, Krist noted that a “fascinating finding” of the study was that many of the users (37 percent) were between the ages of 50-64. Following at 30 percent was 65-75 year-old patients, leaving patients between the ages of 18-34 and 35-49 trailing at 8 percent and 25 percent, respectably, he said.
In terms of the impact that the program had on patients and clinicians, Krist said that practices updated 59 percent of patient’s medical records and established contact with 84 percent of patients to schedule further wellness and chronic care visits, or to obtain a specific service for 19 percent of their patients.
“Future work will include looking at the impact on patient-clinician communication, as well as integrating [the program] into daily clinical activities and interfacing it with several new EMRs,” Krist explained.
Focusing on advanced illness and multimorbidity, nutrition and comparative effectiveness research, Christine Ritchie, MD, from the University of Alabama at Birmingham presented her care transition technology for those patients who leave the hospital and return home.
“Approximately 20 percent of recently discharged patients experience adverse events, often precipitated by ineffective communication and almost 12 percent report new or worsening symptoms within 3 to 5 days of leaving the hospital,” stated Ritchie. She said e-coaching is an interactive voice response-enhanced web-based care transition support for complex patients that supports the self-management of chronic conditions.
In a recent e-coaching pilot program, hospitalized patients with chronic obstructive pulmonary disease or congestive heart failure who had a prognosis greater than six months and were discharged home, had their symptoms monitored through a web-based dashboard. The researchers were met with very positive feedback, noted Ritchie, saying that a randomized controlled trial is underway as of February.
According to Ritchie, the goal of e-coaching is to share skills that are in line with patient concerns and goals and work with patients and caregivers to resolve any questions or concerns. “Patient engagement is a critical element of safe care transitions… Simple technology-supported monitoring approaches that integrate patient activation into care transition support may be a resource-efficient way to support patients,” she said.
Sinsky concluded that health IT is not completely “there” yet, as it has improved practices in important ways, yet created more work in other ways. “We have to avoid working for the computer instead of the computer working for you,” she said.