patient ehr: early patient and physician experiences · all employed physicians use the emr to view...
TRANSCRIPT
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Patient EHR: Early Patient and Physician Experiences
James M. Walker, MDChief Medical Information Officer
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Why Link?A former Fox News television producer
became seriously ill while working in Pakistan. After he got home, he was notified that the hepatitis A vaccine had been recalled because it was ineffective. Tests confirmed Hepatitis A and severe liver damage.
He remains unable to work.
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Outline
SettingDriversPatient experiencePhysician experienceBarriers
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Geisinger Health System
31 counties800 physicians (650 employed)42 clinic sites2 hospitalsPrimary to quaternary care70% fee for service
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Outpatient EHR Status
All employed physicians use the EMR toView all results, images, and recordsEnter all ordersDocument most patient encounters (and view all)
Ω
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Geisinger Drivers
Outpatient EHR designed for patient EHR
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Geisinger Drivers
Access to one’s own medical recordEasy communication with physicianAccess to information for self care
Crossing the Quality Chasm. Institute of Medicine, 2001.
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Geisinger Drivers - HIPAA
Access to Personal Health InformationClinical Communication
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Geisinger’s Goal:Transform Care
Delight patients.
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Geisinger’s Goal:Transform Care
Delight patients.Empower patients.
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Geisinger’s Goal:Transform Care
Delight patients.Empower patients.Improve practice efficiency.
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Geisinger’s Goal:Transform Care
Delight patients.Empower patients. Improve practice efficiency.Delight providers.
Ω
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Patient Drivers4.144.07
3.963.913.833.77
2.822.792.782.762.67
2.23
View Lab Results
Schedule/Cancel Appointments
Request Drug Renewal
Request Medical Advice
Find Disease-specific Information
Receive Personalized Health Info
Community Calendar
Non-GHS Doctor Access to My Chart
Clinic Travel Instructions
Chat Rooms
Community Bulletin Board
Purchase Medical Supplies
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Patient Drivers
Ask health questions 77%Manage appointments 71Prescriptions renewals 71Get the results of tests 70
Taylor, H. (2002). Patient/Physician Communication Online, Harris Interactive.
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Patient EHR Status
All practices, all specialties17,000 active usersPediatric accessProxy access
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1. View Your Records
Problem list
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1. View Your Records
Problem listAllergies and Medicines
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1. View Your Records
Problem listAllergies and MedicinesImmunizations
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1. View Your Records
Problem listAllergies and MedicinesImmunizationsHistories – surgical, medical, family, “social”
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1. View Your Records
Problem listAllergies and MedicinesImmunizationsHistoriesLab results (with interpretations)
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1. View Your Records
Problem listAllergies and MedicinesImmunizationsHistoriesLab resultsAppointment information
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2. Send and Receive Messages
Renew drugs
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2. Send and Receive Messages
Renew drugsRequest appointments
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2. Send and Receive Messages
Renew drugsRequest appointmentsRequest referrals
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2. Send and Receive Messages
Renew drugsRequest appointmentsRequest referralsAsk for medical advice
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Patient EHR Use (annualized)
280,000 lab test checks250,000 messages
15,000 requests for medical advice 7,000 drug renewals5,000 appointment requests
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MyGeisinger Activity 3rd QTR 2004
0
5,000
10,000
15,000
20,000
25,000
Allergi
es
Appoin
tmen
t Con
firm
Appoin
tmen
t Rev
iew
Contex
t Rela
vanc
yDem
ograp
hics
Encou
nter D
etails
Health
Main
tenan
ce
Health
Sna
psho
tIm
muniza
tions
Lab T
ests
Logo
utMed
icatio
nMes
sagin
gProb
lem Li
st
Proxy A
cces
s (View
)Prov
ider D
etails
Referra
l Req
uest
Terms a
nd C
ondit
ions
Jul-04Aug-04Sep-04
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MyGeisinger Messages Jul - Sept 2004
0
200
400
600
800
1,000
1,200
1,400
USERMESSAGE
MED ADVICE APPTREQUEST
APPTCANCEL
CUSTSERVICE
HMREQUEST
MEDSRENEWAL
DEMOGUPDATE
RFRLREQUEST
JulyAugSept
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Reference
Hassol, A., J. M. Walker, et al. (2004). "Patient Experiences and Attitudes about Access to a Patient Electronic Healthcare Record and Linked Web Messaging." J Am Med Inform Assoc 11: 505-13.
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Users vs. Non-users
2.583.48Clinic visits during the 9 months pre-implementation
42.7%41.4%Male57.3%58.6%Female
Sex25%18%65+30%49%46-6425%27%31-4520%7%18-30
Age*
Non-usersn= 281,517
Usersn = 4,245
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Patient Users
More office visitsMore chronic problemsChildren of eldersAge 46 to 64 Familiar with the Internet
Personal Health Working Group (2003). Connecting for Health: A Public-Private Collaborative.
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Criteria for Choosing Channels
Convenience FamiliarityAvailabilityComplexity of the messageCost
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Criteria for Choosing Channels
Fit with established care processesInteractivityFit with new, optimized processesSecurity and confidentiality
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Differential Preferences
47466262119249Tx
64
41
45
46
32
53
Pt.
Online (%)
38
68
6
18
24
44
MD
28
26
7
13
26
21
Pt.
Telephone
6
0
24
15
44
0
MD
97442Rx renewals
1230182Routine follow-up
4445183Lifestyle Choices
4733187Self-monitor
1836127Test results
3823153General Question
MDPt.MDPt.
In-Person (%)In Writing
%
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Patients and Physicians
47466262119249Tx
64
41
45
46
32
53
Pt.
Online (%)
38
68
6
18
24
44
MD
28
26
7
13
26
21
Pt.
Telephone
6
0
24
15
44
0
MD
97442Rx renewals
1230182Routine follow-up
4445183Lifestyle Choices
4733187Self-monitor
1836127Test results
3823153General Question
MDPt.MDPt.
In-Person (%)In Writing%
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Do Patients Like It?
“More, More, Faster, Faster.”Age secondary.Pediatric access critical.Adult children assist their parents.Usability critical.
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Patient Satisfaction
“Other things equal, I would prefer to go to a doctor who provides it.” 85“It provides the information I need.” 78“It is easy to find the information I need.” 85
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Lab Results
“At times, test results have worried me.” 21 (from 44)“I would like to have more of my lab results available online.” 92
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MD/Staff Feedback Groups(With 2% of patients active.)
No impact on office workloads.No excessive demand on doctors to answer e-mails.Concerns that both could be negatively affected remain.
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More Efficient Than Phones?
Kaiser Northwest found that e-mail is quicker and reduces the number of office visits. A similar Blue Cross/Blue Shield study found that e-mail took longer.
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Barriers
Lack of EHRs designed to support it
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Barriers
Lack of EHRs designed to support itLack of effectiveness evidence
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Barriers
Lack of EHRs designed to support itLack of effectiveness evidencePhysicians’ cost of change
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Barriers
Lack of EHRs designed to support itLack of effectiveness evidencePhysicians’ cost of changePatient acceptance
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Barriers
Much of the medical record is jargon (unusable as is)Legal complexity (pediatric access)
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Next Steps
Demonstrate provider benefits.ConveniencePay for performance
Demonstrate patient benefits.ConvenienceWell-being