Presentation Transcript

1. The Problem of Patient Engagement: Advancing PHR Adoption and Exchange by Resolving Privacy and Security Concerns

   Ian Worden, MBA, MHI, PMP LifeNexus CIO 2013 Arizona Health & Medical Technology Expo; Privacy and Security Technologies 4/24/2013
2. What are the driving forces behind improving patient engagement and are they working? What is patient engagement and why does it matter? How do health information exchange privacy and security concerns prevent engagement and how do we address them?
3. Patient Engagement Patient engagement is a key objective of private and secure health information exchange
4. Driving Forces: Policy “The single biggest lever to individual empowerment is access to data.” The ONC Federal Health IT Strategic Plan: 2011-2015
5. Driving Forces: Incentives
6. Driving Forces: Reimbursement and Delivery Models There is a shift away from fee-for-service to performance based reimbursement
7. Driving Forces: Outcomes People actively engaged in their health and health care tend to have better outcomes—and, some evidence suggests, lower costs. -21%
8. Status: The Rise of Patient Disengagement In spite of driving forces behind consumer engagement, the percentage of disengaged consumers is increasing rapidly. 34% 2012 23% 2008
9. Defining Patient Engagement Patient uses educational material and online resources 64% Patient uses tools and resources to manage his or her medical record and other health data 59% Patient feels comfortable challenging doctor when something doesn’t seem right or when explanations are not clear 41% Patient feels comfortable discussing health issues and questions with doctor or nurse face-to-face 38% Patient communicates with doctor about changes in health status in a timely way 38%
10. Defining Patient Engagement Center for Advancing Health – “Actions individuals must take to obtain the greatest benefit from the health care services available to them.” Health Affairs Health Policy Brief – “Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior, such as obtaining preventive care or exercising regularly.” Health Affairs: Analysis & Commentary Article – “Although there is no widely accepted definition, engagement generally captures the notion that patients are involved in the process of their care—actively processing information, deciding how best to fit care into their lives, and acting on their decisions.”
11. Defining Patient Engagement EHR Incentive Program Measures: Patients view, download or transmit their electronic health records Patients send a secure message Patients provided with an electronic copy of their health information Patients provided patient-specific education resources Patients provided with an electronic copy of their discharge instructions
12. The Elements of Patient Engagement Participate Patient engagement is a person’s sustained participation in managing their health in a way that creates the necessary self-efficacy to achieve physical, mental and social well-being. Well-Being Sustain Self-Efficacy Manage WWW.BetterPatientEngagement.com
13. The Consequences of Misalignment You said if I build it they will come
14. Health Information Exchange & Patient Engagement Personal Health Records (PHR) Electronic Individually owned Private and secure Individually managed Not the legal record of provider
15. A Potentially Powerful Engagement Tool The Touted Benefits of a PHR Empowers consumers Improves provider and consumer communications Informs diagnosis and treatment decisions Promotes coordinated care Promotes shared decision-making Promotes behavior change
16. Perspective of Patients Perceived benefits of PHR use: PHR use would improve their sense of control over their own health 68% 66% 61% PHR use would improve their communication  with their doctors Control Communication Safety PHR use would improve the safety of their care
17. Perspective of Providers 81%of doctors surveyed said they wanted their patients to keep the records up to date Demographic Info 95% Family History 88% Medications 86% 85% Allergies 81% Medical Info 1 Harris Poll Survey http://tinyurl.com/chsaqz8
18. PHR Adoption Only an estimated 1 in 10 (or less) have used an electronic personal health record Only an estimated 6% use a patient portal
19. Privacy and Security are Barriers to PHR Adoption 75%concerned about privacy 9.1%concerned about security
20. Justified Concerns Since 2009, 538 breaches of protected health information 21,408,505patient health records affected Personal health information is valuable Credit card information can be worth 50 cents to $1 per record PHI can be worth between $2 and $50 per record 87%of the US population can be uniquely identified with 5 digit zip code, birthdate and sex.
21. Beyond Privacy and Security Compliance Address Privacy and Security Appearance “Look and feel” of a website is often the strongest factor behind users’ trust decisions Placing privacy and security indicators near the user’s locus of attention will likely increase efficacy. 1
22. Beyond Privacy and Security Compliance Address Control of Privacy Settings Higher perceived control of personal information is associated with lower privacy concerns People experience a greater feeling of control when they are able to determine the release of information Enable more consumer control over the access and release of information 2
23. Beyond Privacy and Security Compliance Address Readability of Privacy and Security Policies Users should be able to easily find, review, and understand the privacy and security policies. Privacy and security policies should be written at a Flesch-Kincaid Grade level score of 12 or lower. 3
24. Conclusion It will not be enough to simply be compliant with privacy and security standards. Private and secure personal health information exchange should be addressed in a manner that recognizes, facilitates and aligns to the elements of patient engagement. Only in this way will the benefits of personal health information exchange be fully realized.
25. Questions
26. References Slide 4: http://www.healthit.gov/policy-researchers-implementers/health-it-strategic-planning Slide 5: http://www.healthit.gov/sites/default/files/oncdatabrief9final.pdf Slide 5: http://www.healthit.gov/sites/default/files/onc-data-brief-7-december-2012.pdf Slide 5: http://www.healthcareitnews.com/news/ehr-incentive-payments-top-12-billion Slide 5: http://www.klasresearch.com/News/PressRoom/2013/PatientPortals Slide 6: http://www.ama-assn.org/ama1/pub/upload/mm/399/hsr-payment-reform-models.pdf Slide 7: http://tinyurl.com/cdbcnc4 Slide 8: 2012 http://tinyurl.com/ax56yj2 Slide 9: http://www.nationalehealth.org/ckfinder/userfiles/files/2012%20NeHC%20Stakeholder%20Survey%20Results%20FINAL.pdf Slide 10: http://www.cfah.org/pdfs/CFAH_Engagement_Behavior_Framework_current.pdf Slide 10: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86 Slide 10: http://content.healthaffairs.org/content/32/2/242.abstract Slide 11: https://www.cms.gov/Regulations-and-guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf Slide 12: http://www.betterpatientengagement.com/2013/03/03/the-path-to-increased-patient-engagement-lies-in-the-definition/ Slide 14: http://www.ahima.org/advocacy/personalhealthinformation.aspx Slide 15: http://tinyurl.com/bzo95mk Slide 16: http://tinyurl.com/chsaqz8 Slide 17: http://tinyurl.com/chsaqz8 Slide 18: http://www.markle.org/publications/1440-phr-adoption-rise Slide 18: http://www.chilmarkresearch.com/2011/03/18/much-ado-about-patient-portals/ Slide 19: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/C/PDF%20ConsumersHealthInfoTechnologyNationalSurvey.pdf Slide 19: http://www.informationweek.com/healthcare/electronic-medical-records/consumers-slow-to-adopt-electronic-perso/229401249 Slide 20: http://www.redspin.com/docs/Redspin_Breach_Report_2012.pdf Slide 20: http://hamptonroads.com/2013/03/lapses-security-put-personal-health-records-risk Slide 20: http://dataprivacylab.org/projects/identifiability/paper1.pdf Slide 21: http://www.guanotronic.com/~serge/papers/chi09a.pdf Slide 22: http://www.heinz.cmu.edu/~acquisti/papers/acquisti-SPPS.pdf Slide 23: http://tinyurl.com/bneop2c Slide 23: http://www.humanfactors.com/downloads/jun02.asp