Busting the Myths of Personal Health Records

C.T. Lin MD, FACPChief Medical Information Officer, UCHealth

Professor, University of Colorado School of Medicine

I have nothing to disclose.

I have no relevant financial interest/arrangement or affiliation with any organizations related to commercial products or services to be discussed at this program.

evaluate these myths

• If patients talk to doctors online, then surely

THE FLOODGATES WILL OPEN

• Releasing test results online will create more

misunderstanding and re-work for doctors

• Showing doctor’s progress notes to patients

is “just asking for trouble”

• Social media can be used as a force for better

patient care

UCH 9th Avenue Campus46 acres at 9th & Colorado

Vision 2020

Re-inventing health care for the next century

One square mile; 30, 000 employees

Former Fitzsimons Army Base, now Anschutz Medical Campus

Paternalism(doctor-centered)

Knowledge is power. Respect my studies.

I am too important for clerical tasks

Patients do best when they do what I say

There is nothing wrong with the way I work

Knowledge...power

I am too important

Pts…do what I say

Nothing wrong…

Collaboration is powerful

Communication improves safety

Connection fosters participation

Change requires a burning platform

Traditional relationships…

PhysicianOther specialists

Medical record

Other patients

Patient

Insurers

Hospitals

Medical knowledge

Clinic staff

The Internet

Doctor-centered

Patient-centered

Doctor-centered

Patient-centered

Doctor-centered

Patient-centered

!!

Diabetes-STARCORHIOSPPARO

Advance Check-In

Direct SchedulingMy Doctor’s Office CEO-email satisfaction

Electronic Medical Records

myth #1

If patients talk to doctors online, then surely THE FLOODGATES WILL OPEN

• 87% of U.S. adults have Internet access • (Pew Internet Poll, Feb, 2014)

• 90% of online patients want to e-mail their doctor• 56% of online patients say e-mail access would

influence their choice of doctor• Harris Interactive poll, April, 2002

Online communication

Online communication (MD opinions)

“The floodgates will open”

“Patients will send chest pain messages--at midnight!”

“Patients can reach me”

“Less telephone tag!”

So, what happened?

After 6 months…

Patient satisfaction improved

Sending a message to Docs: 24%

Prescription refills: 19%

Appointment requests: 24%

Overall care from the clinic 11%

Overall communication 32%

Most messages were sent after hours

0

2

4

6

8

10

12

14

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Time of Day

Only 27% of messages were sent

during clinic hours

50% from 5pm-MN

% of messages

Patient perceptions

81% of MDO patients noted it saved them a phone call to the clinic

33% noted it saved them a visit to the clinic

86% preferred the MDO to the telephone to communicate non-urgent messages

There is NO FLOOD

1 message per day per 250 patients

OR, about 10 messages a day per doc

Online Communication Summary

• MDO patients are more satisfied with communication and overall care

• Patients say it saves phone calls, visits

• Physicians are neutral to positive

• Messaging volume is modest – 1 message for 250 patients online

• 2014: 75,000 patients enrolled

myth #1If patients talk to doctors

online, then surely THE FLOODGATES WILL OPEN

myth #2

Releasing test results online will create more misunderstanding and more work for doctors

myth #3

Showing doctor’s progress notes to patients is “just asking for trouble”

Online release of test results

“Patients will be confused.”

“The only reason I will participate is that you are doing a rigorous study.”

“Patients will be better participants in their care.”

InterventionSelected Laboratory Tests

Online release of doctor notes

Patients will act on errors in transcripts.

Patients will be more anxious.

This is a crazy idea; the phone will ring off the hook.

Patients can already request their paper chart. Why not?

So, what happened?

After 12 months…

I am quicker to notify my patients of their results. Before, if I was busy, I might let a result wait on my desk for a few days. Now, because the patient might already have seen it, I will make a phone call, or send an online comment.

-Physician participant

Surprise!

Physician debrief

• The problems were minor.• I thought I would change my dictations

for this, but I did not.

• Alerting patients to look at their notes, both the physicians and staff can do a better job. I think the patient has a right to understand what is going on.

TrustEmpoweredFelt understoodAdherence to treatment

Patient debriefI like going over the reports so that I have some intelligent questions.

I probably don’t remember half of what they said. So, this gives me the chance to go back and pick up things I had forgotten or missed.

I feel like I’m having a more active role. My health is my responsibility.

I lost my luggage while traveling. I went to a local doc and said: ‘If you have Internet Explorer, I can show you my chart. Could I have a few days of my meds?’

SPPARO SummaryNO: patient overuse or misunderstanding

NO CHANGE: health utilization (visits, calls) physician documentation

MD, RN, patient satisfaction

IMPROVED: Patients felt more empowered Patients felt more in control Patients felt more trust in their

doctors

Patients described many uses for their records (travel, clarification, learning, error checking)

SPPARO updatePresenting this data to University audience• Administration saw a competitive advantage• Nursing saw a patient education tool• Physicians saw “no clinical benefit”

Study completed 2002, after 6 years of lobbying• My Medical Record launched in July 2008, house-wide• Patient access to lab (exclude new HIV), rad, path• No delay for labs, 1 wk for CT/MRI, 2wk for Path

After 4 years of patient utilization: • 75,000 patient accounts (minimal advertising)• Over 1.5 million web pages of results viewed by patients• 1 PET scan incident, 1 Dilantin level incident

myth #2

Releasing test results online will create more

misunderstanding and more work for doctors

myth #3

Showing doctor’s progress notes to patients is “just asking for trouble”

myth #4

Social media can be used as a force for better patient care

Untethered Personal Health Record

Untethered Personal Health Record (discontinued)

Government sponsored, expert-driven

Non-profit, clearinghouse

For profit, expert mediated

For-profit, peer-to-peer

What’s next?

Mayoclinic.org from Medicare released data

http://www.propublica.org from Medicare released data

Is there a trusted source of doctor information?

So, how to find:

A good Surgeon who treats Aortic Aneurysms

near me?

Rating

Aortic Aneurysm Repair, Zip 80045

Rating Rating

Sal “your pal” Jones MD Frank “my way” Sinatra MD CT “Devo” Lin MD

Pt Satisfaction: 99%

Cost: $8,000

Pt Satisfaction: 89%

Cost: $10,000 Cost: $52,000

Pt Satisfaction: 60%

Outcomes Cases/year 100 Survival: 96% Re-admits: 2%

Outcomes Cases/year 500 Survival: 99% Re-admits: 1%

Outcomes Cases/year 12 Survival: 90% Re-admits: 10%

myth #4

Social media can be used as a force for better patient

care

myths?

• If patients talk to doctors online, then surely

THE FLOODGATES WILL OPEN

• Releasing test results online will create more

misunderstanding and re-work for doctors

• Showing doctor’s progress notes to patients

is “just asking for trouble”

• Social media can be used as a force for better

patient care

CT Lin MD ct.lin@ucdenver.edu

Thank you!