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HMGT512| Information Technology and Patient Engagement 1

Valley Hospital Stage 5: Support Me

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Choose your Role at Valley Hospital

The sessions you will be attending will help you achieve Stage 4 and 5 of the Patient Engagement Framework. Pay careful attention to your session. Take notes. You will need to share what you learned and any insights you gain with your co-workers.

Voiceover:

Six months have passed, and now the Patient Engagement Committee has decided to attend a conference on Patient Engagement in Northern California. The theme of the Conference is Partner & Support, Stages 4 & 5 of Patient Engagement. In addition to several interesting keynote speakers and the vendor trade show, there are several education sessions to choose from. The committee decides to divide and conquer, and since only five of the members can attend, each committee member will go to a single Track Session, and then all will share at dinner that evening what they learned. Choose your role from the drop down menu and be prepared to become an expert in the session you attend so you can share that knowledge with your co-workers.

The Chief Medical Officer

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Online Community Support Forums Track

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Evaluating patient experience in online health communities:

Implications for health care organizations

Voiceover:

Welcome to the Online Community Support Forums Track. In this presentation we will take a look at evaluating patient experiences in online health communities and the effects it is having on health care organizations.

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Screen 2:

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Online Communities

HCO’s creating online communities

• Kaiser Permanente • Johns Hopkins

Voiceover:

Online communities that focus on health-related matters have rapidly increased in number in the last several years or so. The increasing demand from health consumers for such forums have led several leading health care organizations (HCOs), including Kaiser Permanente and Johns Hopkins, to establish online communities/discussion forums as part of their patient-support services. Patients' interactions in such HCO-led online health communities potentially add another important dimension to the overall patient experience.

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• Limited research to focus on measuring or evaluating patients’ experience. • Evaluate patients’ online community experience (OCE). • Examine its impact on patients’ attitude toward the HCO and its services.

Voiceover:

However, there has been limited research focus on measuring or evaluating patients' experience in such online health communities. The objective of this study was to evaluate patients' online community experience (OCE) and examine its impact on patients' attitude toward the HCO and its services.

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• Data collected using an online questionnaire. • Sent to patients who participated in the online health communitites of three large

academic medical centers:

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1. Johns Hopkins University; 2. MD Anderson Cancer Center at the University of Texas; 3. Joslin Diabetes Center affiliated with Harvard Medical School.

Voiceover:

The data collection was conducted using an online questionnaire sent to consumers/patients who participated in the online health communities of three large academic medical centers: the Johns Hopkins Pathology discussion board, run by the pathology department at Johns Hopkins University; the MD Anderson Cancer survivor board, run by MD Anderson Cancer Center at the University of Texas; and the Joslin Discussion Board, run by Joslin Diabetes Center affiliated with Harvard Medical School.

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Four dimensions of patients’ OCE

Pragmatic Empathic Sociability Usability

The full version of this article is located in the course E-Reserves.

Voiceover:

Confirmatory factor analysis was done to validate the four dimensions of OCE. Linear regression technique was used to validate the impact of OCE on patient attitudes. The results provide support for four dimensions of patients' OCE: pragmatic, empathic, sociability, and usability. Furthermore, all these four dimensions of OCE had a positive impact on patient's attitudes toward the HCO and its services.

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Slide Two:

The Chief Nursing Officer

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Home Monitoring and Telemedicine Track

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A web-based system for home monitoring of patients with Parkinson’s disease using wearable sensors.

Voiceover:

I’m glad you chose the Home Monitoring and Telemedicine Track. Today we are going to explore monitoring Parkinson’s disease by combining wearable sensors and a simple web-based interface.

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MercuryLive, a platform to enable home monitoring of patients with Parkinson’s disease:

• Wearable sensors • Live streaming and storage of sensor data • A web-based graphical user interface • Video conferencing capability

Voiceover:

This introduces MercuryLive, a platform to enable home monitoring of patients with Parkinson's disease (PD) using wearable sensors. MercuryLive contains three tiers: a resource-aware data collection engine that relies upon wearable sensors, web services for live streaming and storage of sensor data, and a web-based graphical user interface client with video conferencing capability.

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Sensors can record:

• Severity of tremor • Bradykinesia • Dyskinesia

Voiceover:

Additionally, the platform has the capability of analyzing sensor (that is, accelerometer) data to reliably estimate clinical scores capturing the severity of tremor, bradykinesia, and dyskinesia.

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Test Result

• Average data latency 400ms • Video latency 200ms • Video frame rate 13 frames/s • With 800 kb/s bandwidth, 40% used for video compression.

Voiceover:

Testing results showed an average data latency of less than 400 milliseconds and video latency of about 200 milliseconds, with a video frame rate of about 13 frames per second when 800 kilobytes per second of bandwidth were available. We used a 40% video compression, and data feature upload requiring one minute of extra time following a 10-minute interactive session. These results indicate that the proposed platform is suitable to monitor patients with PD to facilitate the titration of medications in the late stages of the disease.

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Slide Three:

E-Visits Track

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Who are portal users vs. early e-visit adopters?

A preliminary analysis

Voiceover:

Welcome to the E-Visits Track. I’m going to talk with you today about our findings comparing portal users vs. early e-Visit adopters.

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A screencap of the Meriter portal.

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Patient portals and eVisits are gaining momentum due to increasing consumer demand for improved access to clinical information and services, availability of new technologies to deploy them and development of reimbursement initiatives by major payers.

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• Increasing interest in online health consultation • Adoption has been slow • Little known about the users of such services

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Despite increasing interest in online health consultation by consumers, adoption has been slow and little is known about the users of such services. In this study, we analyze the key features that distinguish early adopters of eVisits from portal consumers, in aggregate and in four distinct ambulatory practices, using data from a major healthcare

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provider in Western Pennsylvania. In this study, we analyze the key features that distinguish early adopters of eVisits from portal consumers, in aggregate and in four distinct ambulatory practices, using data from a major healthcare provider in Western Pennsylvania.

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Profile of E-Visit User

• Younger on average • Predominantly female • Not retired • In poorer health condition • Access the portal more frequently

Voiceover:

Preliminary results indicate that out of 10,532 portal users, the 336 patients who submitted 446 eVisits between April 1, 2009 and May 31, 2010 are younger on average, predominantly female, not retired, but in poorer health condition. They access the portal more frequently, indicating that they are potentially more involved in managing their health.

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Practice indicator is a significant predictor of eVisit usage:

• Varying strategies used to build awareness and encourage adoption

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Using fixed-effects logistic regression models to compare across practices, we note that practice indicator is a significant predictor of eVisit usage, perhaps due to the varying strategies used to build awareness and encourage adoption.

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Insurance coverage for eVisits significantly contributes in increased usage.

Approved Health Insurance

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Despite the small difference in out-of-pocket payment for eVisits covered by insurance vs. otherwise, insurance coverage for eVisits significantly contributes to increased usage.

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Image on Left of screen: A lady sitting down, and holding a tablet computer.

Image on right of screen: A doctor with a patient filling out a form.

Voiceover:

In ongoing work, additional characteristics of patients and practices that have access to the patient portal will be used to better delineate patients' choice of eVisit vs. the traditional office visit.

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Slide Four:

Comparing Care for Providers Track

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Consumers’ interpretation and use of comparative information on the quality of health care:

The effect of presentation approaches

Voiceover:

Thank you for choosing the Comparing Care for Providers Track. We are going to explore consumers’ interpretation and use of comparative information on the quality of health care and what ramifications it has for your health care practice.

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A man in a wheelchair exercising and a nurse helping him out.

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Public reports about health-care quality have not been effectively used by consumers thus far. A possible explanation is inadequate presentation of the information. To assess which presentation features contribute to consumers' correct interpretation and effective use of comparative health-care quality information and to examine the influence of consumer characteristics, fictitious Consumer Quality Index (CQI) data on home care quality were used to construct experimental presentation formats of comparative information. These formats were selected using conjoint analysis methodology.

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Screen 3:

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Different types of graphs

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We used multilevel regression analysis to investigate the effects of presenting bar charts and star ratings, ordering of the data, type of stars, number of stars and inclusion of a global rating. Data were collected during 2 weeks of online questioning of 438 members of an online access panel. Both presentation features and consumer characteristics (age and education) significantly affected consumers' responses. Formats using combinations of bar charts and stars, three stars, an alphabetical ordering of providers and no inclusion of a global rating supported consumers.

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Findings:

• More research is needed to further unravel the effects of presentation formats on consumer decision making in health care.

Voiceover:

Comparative information on the quality of home care is complex for consumers. Although our findings derive from an experimental situation, they provide several suggestions for optimizing the information on the Internet. More research is needed to further unravel the effects of presentation formats on consumer decision making in health care.

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Slide Five:

The Director of Education

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Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices:

A three-arm cluster randomized trial

Voiceover:

Welcome to the Reminders for Daily Care Track. I’d like to share with you our research findings on a smoking cessation program that combines computer-based and practitioner-delivered support and interventions.

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Used cigarettes with the word Quit in the middle.

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Brief advice for smoking patients has not been sufficiently integrated in routine care. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting.

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Three intervention programs consisting in the delivery of:

(1) Brief advice by the practitioner; (2) Individually tailored computer-generated letters; or (3) A combination of both interventions.

Voiceover:

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One hundred fifty-one practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions.

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Assessed three dimensions of population impact:

(1) Adoption (2) Reach (3) Effectiveness

Voiceover:

We assessed three dimensions of population impact: (1) adoption, that is, the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within seven months; and (3) effectiveness, measured as smoking abstinence at a 12-month follow-up.

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A young man crushing a few cigarettes in his hand.

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Among the practices, 70% adopted the program with no significant differences across study groups. Treatment was provided to 3,086 adult smokers. Negative binomial regression analysis revealed that the number of interventions provided was higher in practices allocated to the tailored letter and combination intervention groups by 215% ( p< .01) and 127% ( p= .02), respectively, compared to the brief advice intervention group.

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Screen 6:

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A doctor sitting down with a patient and talking at her desk.

Voiceover:

Among the patients who received the combination of both interventions, the odds of point abstinence from smoking was increased by 65% ( p= .02) and 32% ( p= .01), compared to the brief advice and tailored letters intervention respectively. Comparing the number of abstinent patients at follow-up revealed that the tailored letter and combination interventions were superior to the brief advice intervention.

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Computer-based intervention alone or in addition to conventional practitioner-delivered advice can foster the participation of general medical practices in tobacco control.

Voiceover:

Computer-based interventions alone or in addition to conventional practitioner-delivered advice can foster the participation of general medical practices in tobacco control.

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