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ALHEChapter12_Consumer_Health_Informatics.pptxChapter 12: Consumer Health Informatics
WILLIAM R. HERSH
M. CHRIS GIBBONS
YAHYA SHAIHK
ROBERT E. HOYT
Learning Objectives
After reviewing the presentation, viewers should be able to:
Identify the origins of consumer health informatics (CHI)
Discuss consumer health informatics tools
Enumerate the features and format of personal health records
Identify patient to physician electronic communication tools
Outline CHI barriers and challenges
Discuss future trends of CHI
Clearly, consumers (patients) are interested in technology as a means to improve access to medical care, improve communication with physicians and others and generally streamline the healthcare process
Consumer health informatics emerged with the confluence of widespread availability of the Internet and online information resources with the consumer movement that aimed to empower those who were ill (patients) and not yet ill (consumers) with information to maintain and improve their health as well as engage in the treatment of their disease
Introduction
Origins of CHI
Creation of the Internet in 1994 opened the door to consumers searching for medical information
Chronic diseases are on the rise and the population is aging; thereby increasing the need for more information and more tools
It has been known for over a decade that consumers want access to their health information online. A study by Deloitte in 2008 found that 60% of individuals surveyed wanted physicians to provide online access to their medical records and test results as well as online appointment scheduling
e-Health Era
Consumers want to interact directly with the healthcare system online
One important consumer health application is the personal health record (PHR)
The Markle Foundation provided an early definition of PHR in 2004, defining it as “an electronic application through which individuals can access, manage, and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment”
Tang 2006 categorized three types of PHRs:
The tethered PHR, which is an extension of the healthcare provider’s EHR
The standalone PHR, which is an isolated application. It may be on a mobile device or a website
The interconnected or integrated PHR. This is a separate application, but it has the ability to interact with one or possibly more provider EHRs.
Types of PHR
The tethered PHR
Patient Access to EHR
OpenNotes aims to provide patients with access to the entirety of their medical record, including clinical notes (Delbanco 2010). OpenNotes was initially implemented in three academic centers across the US
There is growing consensus that patients should be the owners and stewards of their personal health and healthcare data (Hersh 2017). Current systems do not facilitate this point of view, as data is for the most part stored in the siloed EHR and other systems of the places where they obtain care
In 2016, the ONC outlined patient engagement to include providing patients an electronic copy of their discharge instructions, providing patients an electronic copy of their health record within three business days, and identifying and providing patient-specific educational resources
But how much patient engagement is actually being done? The next slides show data from the ONC
Patient Engagement
Patient Engagement
Proportion of US hospitals that allow patients to view, download, and/or transmit data (ONC 2016)
Patient Engagement
Patient engagement functions available from US hospitals (ONC 2016)
Patients want to communicate electronically via email with their clinicians and the healthcare system
Seth et al. found three-quarters of patients in an urban family medicine clinical in Ontario would be interested in receiving test results and other communications by email, especially among those who were frequent users of email (Seth 2016)
However in the next slide there are some challenges with email communication
Patient – Clinician Electronic Communication
There are some instances when patients do not prefer email notification of test results, which is when they convey potentially bad news (Friedman 2016)
A study of physician concerns included the overload of messages, no ability to triage them (although most systems have that capability now), the insecurity of standard email, and the ability to be able to read and reply to messages in a timely manner (Anton 2016)
Patient – Clinician Electronic Communication Challenges
A Price Waterhouse study in 2010 estimated that 20% of outpatient visits could be eliminated by using e-visits. Virtual visits have the advantages of much better security and privacy and the ability to have a third party involved in the billing process
Telephonic and Audio-visual Communication
Remote patient communication continuum
An example of an e-visit service tethered to the enterpris EHR, is displayed in the Infobox below
Telephonic and Audio-visual Communication
| Virtual Visits at OHSU Oregon Health & Science University (OHSU) began offering virtual visits for urgent care in 2017. Patients can establish a live video chat using their computer, tablet or smartphone. This service is offered from 7 am to 10 pm seven days a week and that includes children over age 1. A list of the common disorders treated is on the service Web site. (https://www.ohsu.edu/xd/health/services/virtual-care/). Appointment availability is posted, and patients just need to confirm the time. Consent forms are also available to complete before the visit. The service is staffed by nurse practitioners and physician assistants. This service is only for residents of Oregon due to licensing laws. All or part of the virtual visit is covered by most insurance companies with a maximum charge of $49. All visits take place through the patient portal MyChart that is part of OHSU’s Epic EHR system. The patient can see a summary of their visit afterwards and the same summary is forwarded to their primary care provider. |
There have been many studies on electronic patient engagement beyond email
Davis-Giadina’s systematic review assessed patient access to medical records and clinical outcomes and found that the association was equivocal between access and improved outcomes (Davis-Giadina 2014)
There are, however, some concerns about PHRs. One systematic review found that PHRs require a wide range of health literacy demands on patients and healthcare providers (Hemsley 2017)
Efficacy of Consumer Health Informatics
The CHI field is evolving at an exceedingly fast pace. Providers and other stakeholders are using digital health tools
The use of technologies such as smart phones, social networks and apps are providing innovative ways to monitor health and well-being, providing greater access to information as well as leading to a convergence of people, information, technology and connectivity to improve health care and health outcomes (FDA Digital Health)
CHI AND HEALTHCARE REFORM
As average length of hospital stays decrease in the US, a growing body of literature is demonstrating the value and role of so called “Hospital at Home” models of care delivery. Perhaps as much as 15-25% of the total volume of care delivered in the future will be some variation of this hospital at home model of care
The next slide shows the future organization of healthcare delivery
CHI AND HEALTHCARE REFORM
CHI AND HEALTHCARE REFORM
The future organization of healthcare delivery
Conclusions
It is likely that patients and consumers will increasingly interact with the healthcare system in electronic ways
Questions remain about a number of issues, such as where data will reside, who will control it, and how it will be entered, accessed, and used
Continued research must inform the optimal ways in which data and information systems can be used to improve patient health and treatment of disease as well as the delivery of healthcare
