Barriers & Drivers to Use of Health IT by the Elderly, Chronically, & Underserved

1. Barriers & Drivers to Use of Health IT by the Elderly, Chronically, & Underserved • Prepared by Oregon • Evidence Based Practice Center • Holly Jimison, Paul Gorman, Susan Woods, Peggy Nygren, Miranda Walker, Susan Norris, William Hersh

2. Background • Better outcomes w/ self management • Diabetes - DCCT trial; warfarin; asthma • Technologies facilitate process • home CBG, BP, INR, expanding array of health IT • Questions • Which Conditions? Which patients? • Which Technologies? especially HIT • What are barriers and drivers of use?

3. AHRQ Evidence Report • Create analytic framework • Define key questions • Define inclusion, exclusion criteria • Comprehensive literature search • Quality assessment of studies • Synthesis of results

4. Patient (age, gender, health status, literacy, etc.) Technology (email, PDA, cellphone, monitoring) Setting (access to care, internet, reimbursement) Analytic Framework Intermediate Outcomes (self-efficacy, physiologic measures) Patient Outcomes (QoL, Cost, Satisfaction) Use of Consumer HIT

5. Patient (age, gender, health status, literacy, etc.) Technology (email, PDA, cellphone, monitoring) Setting (access to care, internet, reimbursement) Intermediate Outcomes (self-efficacy, physiologic measures) Patient Outcomes (QoL, Cost, Satisfaction) Use of Consumer HIT Key Question 1 - 4 2 1 3,4 • Among elderly, chronically ill, and underserved populations, • What is the current level of use of health IT? • What types are most useful and usable? • What barriers hinder use of interactive health IT? • What drivers facilitate use of interactive health IT?

6. Patient (age, gender, health status, literacy, etc.) Technology (email, PDA, cellphone, monitoring) Setting (access to care, internet, reimbursement) Intermediate Outcomes (self-efficacy, physiologic measures) Patient Outcomes (QoL, Cost, Satisfaction) Use of Consumer HIT Key Question 5 5 5 • Among elderly, chronically ill, and underserved populations, • Is interactive consumer health IT effective? • How does effectiveness vary among these populations? • How does effectiveness differ from general population?

7. Inclusion: Populations

8. Inclusion:Technologies • Direct active use by patient • not just wearing a device • Computer does some processing • not just a conduit for information • Patient receives tailored information • advice, education, feedback • Excluded • telemonitoring, videoconferencing, general websites, FAQs

9. Spectrum of Information Interventions Information Provided to Client practice guideline self management systems state specific instruction risk calculator tailored advice tailored reminding systems disease forum patient specific advice interactive education disease specific recommendations disease FAQ risk calculator general advice population specific information general websites general knowledge remote monitoring none Information Gathered from Client none current state management plan habits and risks health conditions demographic

10. Literature Search • Published literature since 1990 • MEDLINE • PsychINFO • Cochrane Controlled Trials Register and Database of Systematic Reviews • ERIC • AARP Ageline • Grey literature: conferences, technical reports,.

11. Results: Literature Search 8522 abstracts/titles screened 563 papers reviewed 129 studies included

12. Major Findings: Use • Many studies of use of interactive HIT in populations of interest: rural, elders, underserved • but no comparison to general population • Use of interactive HIT higher if perceived health benefit and trusted advice • Access, ease of use, convenience key to wider use. • Most frequently used functions are online peer group support and disease self-management tools. • Anonymity, nonjudgmental nature of computer system an advantage with sensitive disorders

13. Major Findings: Impact • Effective HIT Provided Complete Loop: • Monitoring of current patient status • Transmission of patient data to clinic or system • Interpretation by clinician, comparison to goals • Adjustment of management plan • Communication back to patient • Repeat cycle at intervals appropriate to condition

14. Impact of Interactive HITExamples

15. Implications • For Patients and Clinicians • These systems can help achieve better outcomes in chronic conditions • For Developers and Researchers • Usability issues must be resolved prior to trials • Need clarity, consistency of methods, measures • For Policymakers • These systems help achieve better outcomes • Practice environment does not support use

16. Recommendations for Future Research • Questions about technology • Optimal frequency of use by patient • Optimal frequency of interaction with clinician • Whether success requires revision of managment plan or just reminding • Questions about populations • Direct comparison of elderly, underserved, chronically ill with general population

17. Questions? • gormanp at ohsu.edu

18. NASA Techology Readiness Levels

19. Systematic Review is a Satellite View Let’s you see the forest, obscures the trees

20. On The Ground You Need to Focus On the Trees