3/30/2016 OBJECTIVES PATIENT ENGAGEMENT IS

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1 ENGAGING THE PERSONAL HEALTH RECORD (PHR) TO CREATE A UNIFIED MEDICAL RECORD Sarah Hatchett, PMP HatchIT, LLC OBJECTIVES Introduce the model and importance of Electronic Health Record (EHR)/Personal Health Record (PHR) data ownership for hospitals and patients Understand options for leveraging EHR data and EHR portals to build an effective PHR Explore how the use of PHR tools increase patient engagement and overall health literacy PATIENT ENGAGEMENT IS an organization s strategy to get patients involved in actively and knowledgeably managing their own health and wellness and that of family members This includes reviewing and managing care records, learning about conditions, adopting healthy behaviors, making informed healthcare purchases, and interacting with care providers as a partner. - HIMSS Analytics,

2 HEALTHCARE DATA LANDSCAPE Patients these days Self-service Mobile Plugged-in Family-oriented Highly value security & privacy Health data these days Complex structure Siloed Non-discrete Proprietary Highly regulated HEALTH CARE DATA LANDSCAPE YOUR HEALTH CARE DATA IN ACRONYMS PHR EMR EMR EMR EHR 2

3 PHR AND EMR INTEGRATION PHRs tethered to EMRs or portals offer integration: Messaging between patients and doctors Appointments Health maintenance reminders E-Visits Refill Requests PHR EMR EMR EMR EHR INTEROPERABLE PHRS Share information to providers via upload PHR EMR EMR EMR EHR EXAMPLE 3

4 EXAMPLE EXAMPLE 4

5 THE GOOD PHRS Popular with patients* (Delbanco et al., 2012; Goel et al., 2011) Effective in improving outcomes for chronic conditions such as asthma, diabetes, fertility, glaucoma, HIV, hyperlipidemia, and hypertension (Price et al., 2015) If 80% of the population used PHRs, the US could save $21 billion annually** (Barlow et al., 2004) Can facilitate Meaningful Use Stage 2 objectives** Increases patient engagement and adherence to medical intervention, satisfaction, and empowerment* (RWJF, 2015 ; Archer et al, 2011) Improve health behaviors such as less use of tobacco, regular exercise, dietary changes, and improved medication compliance* (Archer et al, 2011) *=Tethered only **=Interoperable only THE BAD Despite millions of dollars spent on PHRs Published evidence and research on PHRs is relatively limited and dated Compared to the promises, adoption rates continue to be lower than hoped, especially among adults age 45 and over (CHCF, 2010) Population health and risk screening is largely untapped Providers fail to effectively communicate with patients about the availability of portals (TechnologyAdvice, 2014) Push to meet Meaningful Use requirements caused many to implement basic solutions that don t facilitate engagement or interoperability (HIMSS Analytics, 2015; Studeny, et al 2014 ) THE UGLY Not all conditions are sensitive to PHR as an intervention PHRs are still not fully portable or instant-access in the case of emergencies Healthy patients are less motivated Slow to move into the inpatient space These technologies can exacerbate health disparities (Goel et al., 2011; Yamin et al. 2011) 5

6 BARRIERS TO ADOPTION Patient Lack of physician or employer endorsement Poor usability, lack of functionality Privacy & Security concerns Daily routine Culture Digital divide, e-health literacy Provider Interoperability challenges Lack of education & training Lack of reimbursement for time spent communicating Liability concerns PATIENT FACILITATORS OF ADOPTION Satisfaction with their provider Perceived value Perceived empowerment Communication High levels of e-health literacy - (Agarwal et al, 2013; Noblin, et al, 2012) E-HEALTH LITERACY: PORTAL ACCESS IS NOT ENOUGH Patients need tools to aid them in interpreting contents of the PHR to improve understanding to increase competency in improving their own health outcomes (Tang, et al 2005; Nielsen-Bohlman, et al 2004) Application features Large icons and pictorial depictions No jargon or acronyms Access to outside sources of information Non application support Hands-on training Communications & materials 6

7 ENGAGE THE PATIENT, ENGAGE THE PHR A patient portal based on a single EHR is not a patient engagement strategy! Food for thought: Who owns patient engagement at my organization and does the portal align with our goals? Is my current patient portal facilitating patientprovider partnership? Is the vendor exploring next-generation technology solutions? Are we investing enough time and resources in patient communication about portals? Have our patient/family council members assessed for usability and understandability? How can we incentivize patients and providers? QUESTIONS? APPENDIX 7

8 APPENDIX: POPULAR PHRS HealthVault PatientsLikeMe Onpatient Careplan OpenNotes Dossia APPENDIX: RECENT STUDIES Project HealthDesign: Rethinking the Power and Potential of Personal Health Records gram_results_reports/2015/rwjf66523 High Hopes, Unfulfilled Promise: Healthcare Organizations Looking Beyond Portals for True Patient Engagement, HIMSS Analytics Survey Finds 8