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Patient Informatics

Patient Informatics. CH 6. Patient Informatics.

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Patient Informatics

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  1. Patient Informatics CH 6

  2. Patient Informatics • Patient Informatics (also known as consumer informatics) is a new aspect of Medical Informatics that largely reflects the empowered healthcare consumer. Patients are aware that many non-healthcare businesses are automating and modernizing their business processes to attract a larger market share. ATM machines, as an example, can provide cash in a few minutes regardless where you are located worldwide. This innovation required re-engineering and the acceptance of universal standards, not unlike many aspects of health information technology.

  3. The Internet for Patient Medical Education • Multiple surveys have confirmed that the Internet is the premier medical resource for both patients and medical professionals. This has occurred in the incredibly short time span of just 10-15 years. In another survey by Opinion Research Corporation it was noted that the top healthcare worries prompting Internet searches were: cost (41%), quality (25%), medical errors (16%) and all others (18%).

  4. Recent events confirm that patients are becoming more discriminating in their choices of all aspects of healthcare. No longer do they automatically accept the opinion of their physicians. In a Harris poll it was shown that 57% of patients discussed their Internet search with their physician and 52% searched the Internet after talking to their physician. Eighty nine percent felt their search was successful demonstrating confidence in the Internet as the new health library

  5. Multiple reasons have been suggested for the increased use of the Internet in the healthcare arena: • Healthcare is becoming more patient-centered in general. This has been promoted by the Institute of Medicine in all of their publications. • Quality patient education web sites abound • Most non-medical businesses are offering an online method to promote services, pay bills,etc • The increasing use of medical blogs, podcasts and wikis as part of the Web 2.0 movement • (the use of the Internet for free collaborative purposes) is very popular with patients

  6. • Patients are becoming impatient about finding the right answers, the best physicians, the best hospitals and the best medical care at the lowest cost • Our population is “graying” with an estimated 78 million Baby Boomers who are well educated and have more disposable income. This results in higher expectations. There is some evidence that patients expect their physicians to be tech savvy and would consider switching if they are not • Healthcare organizations are using information technology as a marketing tool to attract patients

  7. Computers are ubiquitous, as are broadband connections. Searching the Internet is now very fast and easy • Patients receive less face time with their physicians causing some patients to turn to the Internet for answers

  8. Examples of Online Patient Education Web Sites • WebMD • Revolution Health • MedlinePlus • Healthfinder • Florida State University Medical Library • Healthwise • UpToDate

  9. Figure 6.1 shows the results of a search for obesity, showing the high quality references and the convenient folders on the left

  10. Patient Web Portals • Web portals are web-based programs that patients can access for health related services. A web portal can be a standalone program or it can be integrated with an electronic health record. Patient portals began as a web based entrance to a healthcare system for the purpose of learning about a hospital, healthcare system or physician’s practice. Also, they were clearly a marketing ploy to attract patients who were Internet savvy. Currently, patient portals offer multiple patient services

  11. Most patient portals offer multiple services, whereas others like TeleVox offer a specific service like lab results notification. This secure web based program, known as LabCalls™ enables patients to access a web site and obtain lab results. The nurse or doctor leaves the results along with a canned explanatory message. Patients can also receive a text message on their cell phone that lab results are ready. This program integrates with the practice management system or the EHR.

  12. A minority of web portals actually integrate with an EHR, which means that most patient data has to be manually inputted. In the future when EHRs become more widespread, selected patient lab results will automatically upload to the patient portal, thus saving time and money. Patients will also be able to access parts of their electronic records.

  13. Examples of Patient Web Portals • MySaintAls • Epic MyChart • RelayHealth • MedFusion • ReachMyDoctor • My HealtheVet

  14. Personal Health Records (PHRs) • According to the American Health Information Management Association (AHIMA) the personal health record (PHR) is: “an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions”

  15. Ideal PHR Features • In spite of the fact that PHRs are new and are available in many formats, experts believe that PHRs should have the following features in order to be successfully adopted: • Portable, meaning that the information will follow you even when there is a job, insurer or clinician change. Another argument for portability is the fact that, on average, 41 million Americans move each year • Interoperable, meaning the PHR format can be shared among disparate partners. A standard such as the CCD would have to be adopted • Autopopulated, which would mean that clinical and test results would be inputted automatically

  16. Controlled by the patient • Longitudinal record and not just a snapshot • Private and secure • Must fit into clinician’s workflow and not be a separate process • May benefit from being certified

  17. PHR Formats • Tethered. The word tethered implies that the PHR is connected to one platform and not interoperable. The earliest and most common examples of this would be claims-based PHRs from insurers and healthcare organizations. Other examples would be PHRs tethered to an EHR or standalone patient portal. Payer-based PHRs have the advantages of being free to patients and easy to populate with claims data. They have the disadvantages of not being portable or interoperable and not controlled by patients. Moreover, claims data is always several weeks old and usually tells you that a test was ordered and does not provide the actual results.

  18. Untethered PHRs. Untethered PHRs imply they are not connected to one platform and there have more interoperability potential. PHR programs are available in multiple mobile and static platforms. There are more than fifty untethered personal health record products on the market, giving consumers many choices but obvious limitations.

  19. Secure Patient-Physician E-mail and E-visits • Secure patient-physician e-mail communication: The vast majority of Americans today use e-mail, however few physicians routinely use e-mail to communicate with their patients. • According to a 2005 survey by Harris Interactive,80% of patients who go online would like to communicate with their physicians.86 On the other hand, in another survey in 2005 by the Center for Studying Health System Change, 24% of physicians surveyed used e-mail to communicate with patients,

  20. Electronic visits • Electronic visits (e-visits or virtual visits) are an example of telehealth or telemedicine where medical care is delivered remotely. • There are multiple ways a patient can communicate remotely with a clinician. The web-based choices for patients might include:

  21. Secure messaging and templates to input a health concern and wait for a response by a clinician. • Telephonic communication (audio) to communicate with clinicians. • Audio and video to state a concern and show, example, a rash.

  22. Secure messaging • E-visits require secure messaging and not routine e-mail. This has the advantage of much better security and privacy and the ability to have a third party involved in the billing process. Patients and physicians must utilize a username and password to log onto a secure web site in order to conduct an e-visit. • A new free secure messaging service is available and known as HouseDoc. It would permit a virtual asynchronous visit, a request for medication refills, a request for appointments and test results. If the clinician charges the patient, the web service charges $2 and services are paid for by credit card.

  23. Telephonic visits • The concept of virtual visits has spawned innovation in the delivery of healthcare. As an example, TelaDoc is a telephone based consult service that is intended to supplement the care delivered by the primary care physician. This web based application guarantees a clinician will return a phone call in 3 hours and the average charge is $35. They claim to have 1 million members and offer services 24/7.

  24. Audio-Video Televisits • Patients can interact with clinicians using web-based videoconferencing, as well as secure chat and telephonic communication. They are promoting 24/7 access for patients from home and aim to coordinate care with the primary care clinician (PCM) and insurance company. The service locates an appropriate clinician (including specialists), initiates a live audio-video conversation with a clinician and forwards the results to the PCM.

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