sands - engaging e-patients - for acmi€¦ · title: sands - engaging e-patients - for acmi.pptx...

Sands -‐ Engaging e-‐Pa-ents 2/8/13

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ì

Daniel Z. Sands, MD, MPH Society for Par-cipatory Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA

Consumer Health: A Wedge to Break the Healthcare Logjam?

© Copyright 2013 D. Z. Sands, All Rights Reserved

US Healthcare “System”

Variable Quality

Processes Outcomes Best prac-ces

Costly >US $2T

>17% GDP $8000/capita

Inefficient 30% waste Fragmenta-on



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The Triple Aim




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ì Sir Francis Bacon English author, cour-er, & philosopher (1561 -‐ 1626)


Knowledge is power.

Online Population Rising…



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…And Health Info Seeking Popular…


Online Health Habits of US Adults

Sources: www.pewinternet.org; PwC HRI Social Media Consumer

Survey, 2012

ì  84% of online adults have looked for health info ì  Rising over -me ì  Each day, more people search for health informa-on than see a physician! ì  More than half act on the informa-on

ì  34-‐42% of online users have read others’ health experiences

ì  27% of online adults have tracked their health informa-on online

ì  1/3 use social media for health



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e-‐Patients Want To Be Engaged…

Involvement in

Care

Communica-on

Convenience Informa-on



But Are All Patients Ready for Engagement?

Source: Adapted from DiClemente and Prochaska, 1998 by hfp://www.adultmeduca-on.com/Facilita-ngBehaviorChange.html


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…But We Make it Difficult: Mismatch Between Desires and Service Offering

0% 10% 20% 30% 40% 50% 60% 70%

Online Appts

Online Billing/Pmts

Online Costs

E-‐mail

Viewing Record

Desired (Important/Very Impt) Available


Source: Harris Interac-ve 9/10/12 at hfp://goo.gl/VzfmT

"Thinking now of new technologies your health care provider could implement, how important would each of the following be to you?” (of pa-ents who saw physician in past year)

Shifting Paradigm?

ì  Informa-on asymmetry ì Physician as oracle ì Comfortable ì A burden?

ì  Informa-on symmetry ì Physician as partner ì Threatening vs. libera-ng ì Physician as healer



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It’s About Engagement

Engaged Equipped Empowered Educated Enlightened Etc.


Ter-ary

Secondary

Primary

Self-‐Care (off the Map)

Professional Care

Dis

cour

aged

E

ncou

rage

d $

¢

Industrial Age Medicine Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. © Copyright 2013 D. Z. Sands, All Rights Reserved


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Individual self-‐care

Friends and families

Self-‐health networks

Professionals as facilitators Professionals

as partners Professionals

as authori-es

Professional Care

Dis

cour

aged

E

ncou

rage

d ¢

$

Information Age Healthcare Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. © Copyright 2013 D. Z. Sands, All Rights Reserved

Patients and Physicians Each Have Expertise



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Patients Can (and Must) Help




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Benefits of e-‐Patient Engagement

Factor Impact

“Second set of eyes” viewing record Monitor test results; error-‐checking record

Improved communica-on: provider à pa-ent

Befer pa-ent understanding and reten-on; greater adherence

Improved communica-on: pa-ent à provider

More complete knowledge of pa-ent history and concern; fewer tests ordered; improved diagnos-c accuracy; reduced malprac-ce suits

Pa-ent research May find legi-mate informa-on that may have been missed (including informa-on from other pa-ents)

Pa-ent par-cipa-on in note crea-on More accurate notes

Shared care plan Greater adherence (pa-ents and providers); fewer errors/near-‐misses


Benefits of e-‐Patient Engagement

Factor Impact

Increased knowledge of health Reduced burden of illness

Increased knowledge of disease from online info and from online peer support

Greater adherence, befer outcomes

Pa-ent-‐generated health data More data à befer understanding, befer outcomes

Demand for more care delivery op-ons and convenience transac-ons

Fewer missed follow-‐ups and missed prescrip-ons

Pa-ent blogging Therapeu-c journaling shown to improve health outcomes

Pa-ent-‐generated research Hypothesis-‐genera-on leading to new treatments



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© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD

© Copyright 2013 D. Z. Sands, All Rights Reserved Source: KP.org screenshots and data courtesy of Kate Christensen, MD


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High Adoption and Usage of My Health Manager

ì  4M registered members

ì  104M visits to kp.org

ì  74M sign-‐ons to My Health Manager

ì  29.7M test results viewed

ì  12.2M email messages sent

ì  10M prescrip-on refilled

ì  2.7M appointments booked


2011 Metrics

Source: KP.org screenshots and data courtesy of Kate Christensen, MD

54M Consultant with HTN and Hyperlipidemia

This is too cool. It's almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.



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61M Minister with DM and Chronic Pain

I have a lot of medical issues. This email system has left me feeling comfortable and in good hands! Otherwise, I would feel as cold, depleted, and alone, as the lifeless tree in my front yard in the deepest of winter!




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Patient Network Plus:

SHARE

Pa-ents’ sharing detailed health data is what makes our communi-es special. This informa-on is the basis of the Pa-entsLikeMe network and validates each individual

LEARN The shared informa-on creates a new knowledge about the real

world treatment, symptoms, and reality of living with illness. Pa-ents

learn about their disease and themselves in context of the

community

FIND Pa-ents’ find other paIents like them. They discover what op-ons are available for treatment and if their experience with their disease is normal. They can reach out to others like them for advice and

insight.


58M with Metastatic Renal Cell Carcinoma

My doctor prescribed ACOR and it saved my life.



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Informatics and Patient Engagement

Pt info needs and seeking Pt vocabularies

Pt understanding and health literacy

Shared care plans

CDS for pa-ents Med informa-on reconcilia-on for

PHRs Non-‐visit-‐based care models

Content of peer support

Pervasive monitoring

Data-‐driven self-‐directed care

Collabora-ve health records

Collabora-ons plarorms



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ì  Electronic health record use leads to fewer office visits (Health Affairs, Vol. 28, 2009)

ì  Online behavior change program use leads to increased produc-vity at work (HealthMedia, 2008)

ì  Pa-ents booking online appointments are more likely to keep them (KP study, 2008)

ì  Access to forms and health plan insurance documents saves prin-ng and postage costs


KP.org: Efficiencies

Improved quality scores associated with secure messaging, including 2 percent to 6.5 percent improvements in glycemic, cholesterol and blood pressure screening and control.


KP.org: Health Outcomes

Health Affairs 29, NO. 7, 2010



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ì  Digital Coaching results in posi-ve health outcomes

ì  Recent data show that over half of par-cipants: ì  Lose weight ì  Reduce stress ì  Quit smoking ì  Improve diet


KP.org: Health Outcomes



www.myopennotes.org


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PaIents:

ì  47-‐92% viewed at least one note

ì  20-‐42% shared the note

ì  77-‐85% reported befer understanding of condi-ons

ì  77-‐87% felt more in control

ì  70-‐72% took befer care of themselves

ì  60-‐78% described befer medica-on adherence

ì  92-‐99% did not feel overwhelmed

Physicians:

ì  0-‐5% felt visits longer

ì  0-‐8% took more -me in visits

ì  0-‐21% took more -me wri-ng notes

ì  No change e-‐mail volume

ì  3-‐36% changed their note content

ì  Many described strengthened rela-onship with pa-ents


OpenNotes: Results

www.myopennotes.org

Presentation of Information

High blood pressure



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Facilitating Patient Understanding

Reference Libraries

The pa-ent’s hypertension is poorly controlled...

Hypertension is another name for High blood pressure…

Context-‐sensi-ve hyperlinks and help

The pa-ent’s hypertension is poorly controlled...

The pa-ent’s high blood pressure is poorly controlled...

Automa-c Transla-on (appropriate to pa-ent literacy)


Self-‐Monitoring Made Easy



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Patients in Care Plans: Alerts to Patients

Image from Epic MyChart Courtesy Kate Christensen, MD, Kaiser Permanente. © Copyright 2013 D. Z. Sands, All Rights Reserved

Do We Need Most F2F Visits?

Technology Synchronous? InformaIon Density

Telephone þ ««

E-‐messaging o «

Text messaging/IM o/ þ «

Remote monitoring þ «

Telemedicine þ (usually) «««

Advanced Telemedicine þ ««««

Office visit þ «««««



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A Glimpse of Health IT Serving Patients?


hfp://www.healthit.gov/pa-ents-‐families/video/health-‐it-‐you-‐giving-‐you-‐access-‐your-‐medical-‐records

ì Slack WV. CyberMedicine: How Computing Empowers Doctors and Patients for better Health Care. Jossey-‐Bass 2001.

It can be argued that the largest yet most neglected health care resource, worldwide, is the pa-ent…



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Conclusions

ì  We must reimagine healthcare through pa-ent’s eyes

ì  Tools to empower, engage, and collaborate with pa-ents need further development and evalua-on

ì  These technologies lower barriers to pa-ent engagement

ì  Pa-ents are essen-al to transforming our healthcare system to improve quality, decrease costs, and improve efficiency

ì  Let pa-ents help



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sands - engaging e-patients - for acmi€¦ · title: sands - engaging e-patients - for acmi.pptx...

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