patricia sodomka, fache senior vice president, patient- and family-centered care, mcg health, inc
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Design of Patient-Centered Care Health IT
Patient Advisor involvement in ePHR Design and Outcomes Research
Patricia Sodomka, FACHESenior Vice President, Patient- and Family-Centered Care, MCG Health,
Inc.Director, Center for Patient- and Family-Centered Care, Medical College of
GeorgiaAHRQ’s 2008 Annual Conference
Promoting Quality – Partnering for ChangeSeptember 7 – 10, 2008
Bethesda, MD
www.CPFCC.org
www.CPFCC.org
Goals for this Presentation
Overview of ePHR Design Development and Outcomes Research Project
Impact of Patient and Patient Advisor Involvement in e-PHR Research Project
Findings to date
“This project was supported by grant number R18HS017234 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.”
www.CPFCC.org
Who We Are Health Sciences University for the 34 unit University System
of Georgia founded 1828 5 Schools (Medicine, Allied Health, Nursing, Dentistry,
Graduate Studies) Tertiary Academic Medical Center
• 632 bed facility includes Adult and Children’s hospitals, Ambulatory Care Center, Radiation Therapy Center
• 110 specialty clinics – Georgia and South Carolina• Network of 7 critical access and rural hospital affiliates
21,000 Admissions 508,000 Ambulatory Care Visits
www.CPFCC.org
Georgia
AHA CEO Toolkit
Remaking American Medicine
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“Using an Electronic Personal Health Record to Empower Patients with Hypertension”
Examine the feasibility, acceptability, and impact of an ePHR in a population of
ambulatory patients with hypertension.
“Overall Project Goal”
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The Essential Role of the Patient Advisor
Christine AbbottLead Patient Advisor –
ePHR Study
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Impact of Patients and Patient Advisors in Research Project on:
Research Methods
Design of PHR
Dialogue with Physicians
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Project Aims
Incorporate PFCC into the ePHR Test the effectiveness of the ePHR
in hypertensive patients Measure the impact on system
adoption of PFCC
www.CPFCC.org
The Role That ePHR’s Can Play
Offer the opportunity for patient’s to accumulate and manage their own information, track goals, track progress toward goals, manage meds, coordinate care
Transparency and access to information important features — link to the clinical information system strengthens benefits
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Aim 1Modifying our ePHR: My HealthLink
Modifications based on MS study
Modifications based on WAVE 1 and National Advisory input
Final modifications based on WAVE 2
WAVE 1 data collection
National Advisory input
WAVE 2 data collection
Main Trial
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Aim 2:The Trial
20 physicians
10 Internal Medicine 10 Family Medicine
5 ePHR 5 care as usual
180 Control patients (36 per physician)
180 Intervention patients
(36 per physician)
5 ePHR 5 care as usual
180 InterventionPatients
(36 per physician)
180 control patients(36 per physician)
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Outcome Measures
4 visits—every 3 months Biological measures
BP, BMI, waist circumference Fasting glucose, triglycerides, HDL, LCL
Patient empowerment measures Patient activation (PAM) Patient assessment of chronic illness care Consumer assessment of healthcare
providers and systems
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Outcome Measures
Patient/Physician Collaboration Measures Audiotapes of 100 intervention and 100
control visits at initial and 3-month visit• Content of communication• Taxonomy of requests from patients
Patient Utilization Measures Self-reported utilization Electronic abstraction
Adherence to Practice Guidelines Chart review
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Initial FindingsWave 1 of Aim 1
• 15 patients, 9 interviewed
• Themes developed through iterative process User Themes Themes about general ePHR issues Technology Themes
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ePHR Aim 1 – Wave 1 - Categorized Themes
ePHR User Themes
Technology Themes
System Themes#5
Understanding
#7Patient
Familiarity &Training
#10
Patient Expectations
Practice Patient Doctor
#1
Advantages
#2
Disadvantages
#3
Navigation /Movement
#4
Linkages External
Within
#6
Contacts / Corrections / Suggestions
#8
Additional Tracking
#9
Diary Functionability
#11
Medications
#12
Access to ePHR
Medical Terminology
Jargon
Internet
User-Friendly
A lot of information to learn
Activation
UpkeepInitial Data Entry
Facilitate partnership to manage medical
problems
Overwhelming
Time Consuming
TrackingData
Increase efficiency of visit
Thorough Specific
Facilitates communication w/DR & Nurse
Organizes medical records
Improve Instructions
Improve Usability
Ability to personalize
User Interface
Terminology
Personalize user features
Logistics
Access
Care Providers
Interoperability
Personalized Physical Measurements (ie. Diet, exercise, immunizations, etc.)
#13
Cost
Saves money
through fewer
visits
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Initial FindingsWave 1 of Aim 1
7 technology themes identified 40 specific suggestions Rank ordered suggestions by
importance and feasibility through collaborative process including patients
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Initial FindingsWave 1 of Aim 1
Technology themes included: Navigation issues Linkages within and external to PHR Content corrections Health tracking Diary functionality Expanded medication coverage Access to PHR data
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Implementation of Patient Suggestions
Wave 2 8
Main Trial 8
Future 1
Patient Training 4
Ranked Zero 11
Not technically feasible 7
Policy issue 1
National Sample QuotesHypertension Patient Panel
“And he talks to me differently because he knows I can click on something and I know about it.”
www.CPFCC.org
National Sample QuotesHypertension Patient Panel
“We don’t waste a lot of time on history, on how have you been, what have you done? It’s more we had goals and where are you at now with that? How’s this working out? I feel like my 15 minutes is fully packed. Whereas before 10 of it is spent trying to get where we needed to be.”
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National Sample QuotesHypertension Patient Panel
“In the past, if my labs were off, my primary would call and say I needed to make an appointment…we need to talk. But now, I can see if I need to make a goal before I see him. It makes for a better more productive visit.”
www.CPFCC.org
www.CPFCC.org
Using Patient Advisors in Research
• Not as subjects, as advisors
• Different language, different values
• Especially when designing patient systems
• Patient perspectives are different than what clinicians, IT workers, or researchers think
• Clarity increases
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APPENDIX
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My HealthLink
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