Improving Health Information Quality Through

Patient Empowerment

Regina Holliday, Society for Participatory MedicineVera Rulon MS, RHIT, FAHIMA, FACMImimi, Pfizer Inc

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VERA’S PATIENT STORYCompleting the Masterpiece

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Patient Empowerment: Key Points

• Communication• Literacy• Personal• Practical

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Communication

The use of digital tools and facilitating communication between patients, caregivers and healthcare providers can improve data quality and access to healthcare

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iConsumer: Digital Consumers Altering the Value Chain McKinsey & Company*

Six Significant iConsumer Trends

Trend 2008 2012

1 Device shiftFrom PC to touch

PCMobileTablet

78%22%0%

57%33%11%

2 Communications shiftFrom voice to data

VoiceEmailSocialOther

39%42%15%4%

27%36%26%10%

3 Content shiftFrom bundled to fragmented

Mobile voiceMobile data

61%39%

22%78%

4 Social shiftFrom growth to monetization

SocialOther internet

13%87%

23%77%

5 Video shiftFrom programmer to user controlled

Linear TVDVR, VOD, OTT

78%22%

65%35%

6 Retail shiftFrom channel to experience

E-commerce/All retail

3.6% 4.9%

*Authors Ewan Duncan, Eric Hazan, and Kevin Roche retrieved August 6 2013 fromhttp://www.mckinsey.com/insights/telecommunications/developing_a_fine-grained_look_at_how_digital_consumers_behave

Share of Usage

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Digital Revolution

• Manhattan Research • Cybercitizen Health® 2012 study

Number of US adults (ages 18+) using digital technology for health

information:61 million 2011 75 million 2012

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The mHealth market will continue to grow

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Factors shaping the trend*:• New technologies: smartphones, remote patient monitoring, social media

– cost and acceptance

*Guillemi, Andre; Benedict, Kevin mHealth Trends and Strategies 2013, May 2013 a special report by netcentric strategies 11

• Population age: – global population aging– median population age increasing – chronic diseases– end of life 12

• Foundation in place: concept of “care everywhere” taking root

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• Move to personalized care“mHealth is not a separate industry, but rather it’s the future of a healthcare

industry that’s evolving to care for patients differently, putting them first to deliver services better, faster, and less expensively.”

David Levy MD, PwC (from Analysis & Trends in mHealth)

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Health Literacy

Empowered patients and their caregivers can improve the quality of health information through better health literacy and input to their medical record throughout the care continuum

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Inviting Patients to Read Their Doctors’ Notes: A Quasi-experimental Study and Look Ahead

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Key Findings: Post intervention survey • 77% - 87% of patients reported that open notes helped them feel more in control

of their care• Of those patients taking medications 60 % – 78% reported increased medication

adherence• 26% - 36% expressed privacy concerns

Physicians• Few reported longer visits (0%-5%)• 3% - 36% reported changing documentation content or taking longer to write

notes (0%-21%)

At the end of the experimental period• 99% of patients wanted open notes to continue• No doctor elected to stop

Delbanco, Tom MD; Walker, Jan RN, MBA; et. al. Inviting Patients to Read Their Doctors’ Notes, Annals of Internal Medicine, American College of Physicians retrieved 8/6/2013 from http://annals.org/article.aspx?articleid=1363511

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Wuerdeman, Volk et. al. “How Accurate is Information that Patients Contribute to their Electronic Health Record?” AMIA 2005 Symposium

Proceedings p 834 - 838Key Points

– The longitudinal medical record (LMR) is often incomplete– Patient reported data is a promising source of general health information– Patients can provide valuable information on: Presence or absence of tests

(supports preventative medicine); Surveys on quality of life“Patients have important knowledge of their basic health maintenance, and can

and should assist physicians in recording information. Patient access will increase the quality of this data to help ensure that the

physician has the most comprehensive file possible with which to work. In addition to quality assurance, patient provided data and patient access to

LMR data will help increase communication between provider and patient.”

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Depression Screening On LMR Problem list Not in LMR Total Participants

High Risk 4 (25%) 12 (75%) 16 (100%)

Moderate Risk 7 (27%) 19 (73%) 26 (100%)

Low Risk 20 (9%) 192 (91%) 212 (100%)

Total 31 223 254

Personal

Personal stories of how patients contributing to their medical record improved the care they received because of the improved quality of their personal health information

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Physicians need to adapt• Dialogue

– “If you don’t mind, I am going to be typing as you speak, I’m happy to show you what I’m writing”– “I’m going to look up your test results, would you like to look at them together?”

• Caution– Documenting socially stigmatizing health conditions– Sensitivity to patient perceptions

• Patient engagement– Improving management of chronic disease, mental illness– Patient-physician collaboration

20White, Amina MD; Danis, Marion MD Enhancing Patient-Centered Communication and Collaboration by Using the Electronic Health Record in the Examination Room JAMA, June 12, 2013 – Vol 309, No. 22

Lets have a conversation

Ideas to facilitate governance and oversight by healthcare providers and health information management professionals of patient/caregiver input to the electronic medical record (practical application)

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Themes

• Culture dominates• “Listen first, listen fully”• Patient engagement is a skill, not a trait• Trust matters• Prepared, engaged patients are a fundamental precursor to

high quality care, lower costs, and better health

22Institute of Medicine (IOM), Partnering with Patients to Drive Shared decisions, Better Value and Care Improvement, meeting summary retrieved August 16, 2013 from http://iom.edu/Reports/2013/~/media/Files/Report%20Files/2013/Partnering-with-Patients/PwP_meetingsummary.pdf

Questions?

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