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The Emerging Role Of Online Communication Between Patients And Their Provider

The Emerging Role Of Online Communication Between Patients And Their Provider. Steven Katz M.D. M.P.H. Associate Professor Departments of Medicine and Health Management and Policy University of Michigan. Agenda. Motivation Current online landscape Challenges Early Experiences

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The Emerging Role Of Online Communication Between Patients And Their Provider

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  1. The Emerging Role Of Online Communication Between Patients And Their Provider Steven Katz M.D. M.P.H. Associate Professor Departments of Medicine and Health Management and Policy University of Michigan

  2. Agenda • Motivation • Current online landscape • Challenges • Early Experiences • Prognosis

  3. Motivation • Patients • Frustrated with between-visit access • Are increasingly connected online • Providers • Are frustrated with between-visit communication • Current modes are burdensome, fragmented and inefficient • There is enormous mismatch between communication mode and tasks

  4. Why web is right • It is asynchronous • It has enormous reach • It is robust • exchange and store information • provide services • connect people • Communication can be tracked, managed, documented, and evaluated • It is secure

  5. The Internet will have a profound effect on the practice and business of medicine. Physicians, eager to provide high-quality care and forced by competition to offer online services, will introduce e-mail and patient-friendly Web sites to improve administrative services and manage common medical conditions. Patients will identify more health information online and will take more responsibility for their care. The doctor/patient relationship will be altered... Great Expectations Jerome Kassirer. Health Affairs 2000

  6. Trends in internet use1 1. UCLA internet report 2003 http://ccp.ucla.edu/pages/InternetStudy.asp

  7. UCLA Center for Communication Policy, 2003

  8. Digital Divide Source: Pew Internet and American Life Surveys

  9. Message Volume* University of Michigan Primary Care 2002 * weekly patient messages per 100 scheduled visits

  10. Challenges • Patients • Lack experience • Digital divide • Providers • Workload • Uncertain value of online communication • Little consensus about communication management • Organization • Business model/ROI • Building and integrating online communication tools • No road map

  11. Dr. Katz: I am a patient of yours through Yellow Care Network. Generally, I am seen by Dr. Rufus T. Firefly but I have not been able to contact him nor have I been able to get an appointment to see any doctor in the Internal Medicine clinic. When I called I was simply told there were no available appointment times. I am currently experiencing intense pain when I urinate as a result of a bladder infection and would very much like to get a antibiotic to start treating this. The symptoms are constant urge to urinate and painful urination followed by blood in my urine at the end of the urination. Can you please facilitate an appointment to see a doctor in your staff or prescribe an antibiotic. I am not taking any other medicines at this time.

  12. various news: 1) referral to Diabetes Clinic DOES NOT SHOW UP on their records yet (as of Friday 01/09)... was seeing Dr. Sugar 2) Am re-enrolled in Stop Smoking Program (she'll use your old referral) but WILL NEED anti-depressant script soon 3) scripts for imdur (120mg & 30mg) WORKED at pharmacy... 4) referral to Eye Clinic OK... appointment set 5) referral to Cardiology Clinic OK... Dr. Heart said "...see you in a year..." and "...are 95th percentile of her patients (for exercise level, walking 3-5 miles /day)". Walked 11 miles last Monday=01/12 6) next apptmt with you(??) 04/02 Thank You

  13. Components of a patient portal • Service-related features • Medication renewals, scheduling, forms, registration/billing • A clinical communication tool • Secure messaging • A patient health record • Populated from provider and patient data sources • Medical record • Patient: current meds, immunizations, health status information (e.g. blood sugar or blood pressure log)

  14. Yellow brick road • Develop business model • Build or buy communication tools • Develop roll-out strategy • Map relationships and workflow • Develop rules of engagement and exchange • Develop education and promotion strategy • Allocate provider effort during rollout • Evaluate processes and outcomes

  15. Emerald Cities

  16. Start-up Experiences • Patient uptake is slow • Patient online gap • Resource offsets are uncertain • Clinician and staff acceptance is high • “Cultural Divide” between patients and their clinicians

  17. Patient1 and physician attitudes towards role of clinic staff in e-communication Patients: “ OK for clinic staff to handle my [e-mail/Web] messages for my physician” Physicians: “OK for the clinic staff to handle patient [e-mail/Web] messages for me” 1. Patients who reported regular use of e-mail

  18. Patients % Preferring Mode Physicians Sore throat Back pain Abnormal Pap/PSA Normal Pap PSA test Cholesterol test Anxiety or sadness Breast or testicular Rx side effect

  19. Prognosis: Good • Patient facility and access is growing • increase in broadband access • Better online communication tools • Better clinical data systems • Beginning of the “J curve” • Uncertain business model

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