Research Team and Partners

1. Improving Care Through AHRQ Health IT ToolsMyPreventiveCare – A Personalized Portal to Promote Patient-Centered Preventive Careahkrist@vcu.edu

2. Research Team and Partners • Steven Woolf • Stephen Rothemich • Daniel Longo • Anton Kuzel • Robert Johnson • Tina Cunningham • Eric Peele (RTI) • William Kerns • John Loomis • Paulette Kashiri • Steve Mitchell • Melissa Hayes • Kristin Schmidt

3. Personal Health Records (PHRs) • High perception of value – 79% of Americans believe a PHR could provide major benefit in managing health • High interest – 47% of Americans expressed interest in using an online PHR …BUT only 2.7% of adults have an electronic PHR 2008 Markel Foundation

4. Integrated PHRs Are Needed for Meaningful Use… this is Just Stage 1 • Send patients reminders • Provide patients with electronic copies of their health information • Provide patients timely electronic access to their health information • Provide clinical summaries for patients • Provide patient specific education resources • Implement and track clinical decision support

5. Problems with Integrated PHRs:Content is Not in Patient Language

6. Problems with Integrated PHRs:Information is Often Out of Date

7. Problems with Integrated PHRs:Lab Normal Ranges Are Wrong

8. Guidelines are Increasingly Complex

9. …Yet Every Practice Must Recreate Its Own PHR Clinical Recommendations

10. How MyPreventiveCare Works

11. MyPreventiveCare • Integrated PHR-EMR • Clinician and patient created for needs and workflow • Focused on preventive care and chronic disease • Clinical decision support logic integrated • USPSTF, JNCVII, NCEP, ADA, 2005 Dietary, and ACIP guidelines • Individually tailored patient messages and educational links • Partnered with ODPHP • Patient and clinician reminders system

12. Preventive Services Addressed Diabetes screening Osteoporosis screening Tetanus vaccination Influenza vaccination Pneumococcal vaccination Diet Exercise Smoking Weight loss • Colon cancer • Prostate cancer • Breast cancer • Cervical cancer • Chlamydia screening • Hypertension screening • Hyperlipidemia screening • AAA screening • ASA chemoprophylaxis

14. 2. Patient answers a brief health risk assessment Because MyPreventiveCare uses EMR data, the patient only needs to answer a few health risk questions • 11 questions for men and 12 for woman Questions are about data not stored well in EMRs • Race/ethnicity, health behaviors, family history, and some abnormal test results

16. 3. MyPreventiveCare receives patient-specific EMR data, patient reviews, and updates information. Thousands of EMR data elements are used that include: • Demographics, vital signs, diagnoses, orders, results, management plans, medications, and immunizations MyPreventiveCare is able to extract and understand this information from multiple EMRs

18. 4. MyPreventiveCare categorizes the patient’s status and gives a personal list of recommendations Logic is based on 8 sets of national guidelines with a focus on U.S. Preventive Services Task Force recommendations

19. 1. Patient is instructed to go to MyPreventiveCare May access directly on the web • www.MyPreventiveCare.com • www.MyPreventiveCare.net • www.MyPreventiveCare.org May access through an existing PHR • Link to MyPreventiveCare within a PHR that passes on patient information (single sign on) • MyPreventiveCare skin modified for seamless user experience MyPreventiveCare reconciles conflict between guidelines and deals with limited evidence by presenting information to patients and letting them and their doctor decide The list quickly and simply shows patients what they need, what they are doing well with, and what they need to think about

21. 5. A patient can learn more about any of their specific needs Patients can click on any topic in their summary list to see more detailed information Each message is individually tailored to the specific patient’s needs Each message includes specific patient data Messages were created with assistance from the Office of Disease Prevention and Health Promotion

23. 6. At the end of each detailed message are links to more resources Links are meant to be like the patient’s clinician showing the patient where to go on the web for more information Resources include educational material, risk calculators, health tools, local resources, and decision aids Links are individually tailored to each specific patient Resources are evidence-based from trusted, non-commercial, national organizations

25. 7. MyPreventiveCare sends a patient summary to the patient’s clinician Summaries come in the EMR similar to a lab result Summary includes • Any information that the patient updates • A list of the patient’s health behaviors • A list of the patient’s needs

26. Research Supporting MyPreventiveCare

28. MyPreventiveCare Dissemination Study • Assess best method of implementing the system • Mixed methods • Repeated measures analysis of use/delivery • Learning collaboratives • Workflow redesign • 9/10 – 8/12 • #290-07-100113 Effectiveness Study • Evaluate whether using the system increases prevention • 5500 patients randomized to a MyPreventiveCare-invitation vs. usual care • 9/07 – 8/10 • R18 HS17046-01

29. MyPreventiveCare Use

30. Preventive Care Needs • Users are up-to-date with 53% of preventive care • Only 2.2% of users are up-to-date on all services • Not up-to-date users need an average of 4.6 services

31. Process Impact of MyPreventiveCare Clinician summary led practices to • Update 59% of patient’s medical records • Contact 84% of patients • Schedule a wellness visit for 27% of patients • Schedule a chronic care visit for 17% of patients • Get a specific service for 19% of patients

32. Users More Up-to-Date than Non-users

33. More Needed To Redesign Work Flow

34. Its All About the Data • Quality of EMR data is highly variable • Dependent on EMR database structure • Dependent on practice data entry • Little adherence to standardized data exchange by EMR vendors (e.g. CCR/CCD) • Practices improvise and record information in strange ways • Standardized data exchanges are inadequate for prevention and chronic care • Lacks range of information (e.g. family history) • Lacks longitudinal historical perspective

35. National Needs – Technical and Cultural Challenges • Fixing these challenges requires difficult policy decisions • Mandate interoperability? Require data standardization? • Create support for integration and information exchange? • Resource practices differently to support new care models? • Redefine roles of public, private, academic, and clinical sectors? • Break down silos and share knowledge?

36. National Needs – Move Past Adoption

37. Patient Functionality – More Is Needed Patients want the system to be highly sophisticated and comprehensive. They want MyPreventiveCare to: • Centralize their health information from all sources in a secure but easy to use internet-based platform • Be highly personalized and directive • Prioritize and highlight critical information • Make recommendations • Involve their clinician (communicate and integrate) • PHR functionality needs major advances • Great potential to improve patient outcomes • Development cannot be left to IT vendors alone • Clinical entities need to create clinical content • Guideline developers need to operationalize their recommendations • Policy makers need to align content with priorities and resources • Researchers need to ensure systems improve outcomes

38. Thank you for your time and consideration