Engaging patients with health IT

Transferring the locus of control from practitioners to patients can improve the way care is delivered, and ultimately patient outcomes, according to speakers at the fourth annual Consumer Health IT Summit on Sept. 15 in Washington, D.C.

A questionnaire on medications delivered through the patient portal helped Geisinger Health System more efficiently and meaningfully deliver care, said Michael Evans, director of ambulatory clinical pharmacy programs.

“We make sure medication reconciliation is up to date before the office visit,” he said. Even the elderly, which take on average 25 to 30 medications, can accurately enter their medications into the portal. “Most importantly, now patients understand why they are taking medications, and they are not adding medications when it really was adherence that was the issue.”

It’s important to ensure that patients have the skills and technologies so data and advice can flow back and forth, said Janet Wright, executive director of Million Hearts, a five-year initiative aimed at preventing one million heart attacks.

Measuring blood pressure only during clinical visits is insufficient; data should be continually measured from patient-controlled devices and triggers should go off when parameters are exceeded and when an algorithm shows that the high readings represent a pattern. “This is about improving the quality of decisionmaking,” she said. “It helps build trust because patients are monitoring it.”

An app for patients of home-bound NICU babies proved helpful for Nwando Eze, MD, MPH, who is a pediatrician and neonatology fellow at Children’s Hospital of Orange County in California.  

Providers, who often see 30 to 40 patients per day, struggle to manage families of NICU babies in an outpatient setting. When her daughter was born prematurely, Eze agreed to participate in a pilot in which she downloaded an app that allowed her to track her baby's weight, number of diapers and moods, and also communicate with her provider and set up appointments.

“Even as a doctor, it can be quite complex,” she said of the number of appointments following her daughter’s discharge. However, the app was especially helpful for appointment setting, and for monitoring weight—the most important measure for a underweight baby. However, she said the data on moods may not be as helpful for a pediatrician.

Use of apps or health IT should ultimately strengthen relationships with providers. “I would hate to see, as a byproduct, the loss of a doctor-patient relationship. It should accentuate this relationship,” she said. Also, she cautioned again sharing data too quickly in sensitive situations, like HIV diagnoses, as it's in the interest of patients that trained professionals are on hand to guide patients with resources and information following such a disclosure.

“It should be a team effort. All stakeholders need to be involved,” she said.