Patient Centered

Information Technology

C.T. Lin MD, FACPChief Medical Information Officer, University of Colorado Health

Professor, University of Colorado School of Medicine

iHT2 Health IT SummitJuly, 2013

Denver, CO

I have nothing to disclose.

I have no relevant financial interest/arrangement or affiliation with

any organizations related to commercial products or services to be

discussed at this program.

Learning Goals

Be able to define and describe:

• Patient Centered Information Technology

• Risks / benefits of online communication

between patients and providers

• Risks / benefits of online release of results

• The impact of social media on patients

UCH 9th Avenue Campus

46 acres at 9th & Colorado

Vision 2020

Re-inventing health care for the next

century: from Bricks and Mortar to

Patient Centered Information Technology

One square mile; a health sciences city; 30, 000 employees when

complete, an opportunity to “re-invent healthcare” from the ground up.

Former Fitzsimons Army Base, now Anschutz Medical Campus

Outline

Patient Centered Information Technology

Paternalism?

Online communication

Access to health records

Social Media and Patients

Paternalism(doctor-centered)

Knowledge is power. Respect my studies.

I am too important for clerical tasks

Patients do best when they do what I say

There is nothing wrong with the way I work

Knowledge...power

I am too important

Pts…do what I say

Nothing wrong…

Collaboration is powerful

Communication improves safety

Connection fosters participation

Change requires a burning

platform

Doctor-centered

Patient-centered

Doctor-

centered

Patient-

centered

Doctor-

centered

Patient-

centered

!!

Diabetes-STARCORHIOSPPARO

Advance Check-InDirect SchedulingMy Doctor’s Office CEO-email

satisfaction

Electronic Medical

Records

• 82% of U.S. adults have Internet access • Harris Interactive poll, July, 2010

• 90% of online patients want to e-mail their doctor

• 56% of online patients say e-mail access would

influence their choice of doctor• Harris Interactive poll, April, 2002

Online communication

Online communication

(MD opinions)

“The floodgates will open”

“Patients will send chest pain

messages--at midnight!”

“Patients can reach me”

“Less telephone tag!”

So, what happened?

After 6 months…

Patient satisfaction improved

Sending a message to Docs: 24%

Prescription refills: 19%

Appointment requests: 24%

Overall care from the clinic 11%

Overall communication 32%

Most messages were sent after hours

0

2

4

6

8

10

12

14

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Time of Day

Only 27% of messages were

sent during clinic hours

50% from 5pm-MN

% of

messages

Patient perceptions

81% of MDO patients noted it saved them a

phone call to the clinic

33% noted it saved them a visit to the clinic

86% preferred the MDO to the telephone to

communicate non-urgent messages

There is NO FLOOD

1 message per day per 250 patients

OR, about 10 messages a day per doc

Online Communication

Summary

• MDO patients are more satisfied with communication and overall care

• Patients say it saves phone calls, visits

• Physicians are neutral to positive

• Messaging volume is modest

– 1 message for 250 patients online

• 2013: 42,000 patients enrolled

– 10,800 unique logins per month

Online communication

Comments or questions

Online release of test results

“Patients will be

confused.”

“The only reason I will

participate is that you

are doing a rigorous

study.”

“Patients will be better

participants in their

care.”

Intervention

Selected Laboratory Tests

Online release of doctor notes

“Patients will act on errors in transcripts.”

“Patients will be more anxious”

“This is a crazy idea; the phone will ring off the hook.”

“Patients can already

request their paper

chart. Why not?”

So, what happened?

After 12 months…

“I am quicker to notify my patients of their

results. Before, if I was busy, I might let a

result wait on my desk for a few days. Now,

because the patient might already have

seen it, I will make a phone call, or send an

online comment.”

Surprise!

Physician debrief

• “The problems were minor.”

• “I thought I would change my dictations

for this, but I did not”

• “Alerting patients to look at their

notes, both the physicians and staff can

do a better job. I think the patient has a

right to understand what is going on.”

Trust

Empowered

Felt understood

Adherence to treatment

Patient debrief

“I like going over the reports so that I have some

intelligent questions.”

“I probably don‟t remember half of what they said. So,

this gives me the chance to go back and pick up things I

had forgotten or missed.”

“I feel like I‟m having a more active role. My health is my

responsibility.”

“I lost my luggage while traveling. I went to a local doc

and said: „If you have Internet Explorer, I can show you

my chart. Could I have a few days of my meds?‟”

SPPARO Summary

NO: patient overuse or misunderstanding

NO CHANGE: health utilization (visits, calls)

physician documentation

MD, RN, patient satisfaction

IMPROVED: Patients felt more empowered

Patients felt more in control

Patients felt more trust in their doctors

Patients described many uses for their records

(travel, clarification, learning, error checking)

SPPARO update

Presenting this data to University audience• Administration saw a competitive advantage

• Nursing saw a patient education tool

• Physicians saw “no clinical benefit”

Study completed 2002, after 6 years of lobbying• My Medical Record launched in July 2008, house-wide

• Patient access to lab (exclude new HIV), rad, path

• No delay for labs, 1 wk for CT/MRI, 2wk for Path

After 4 years of patient utilization: • 42,000 patient accounts (minimal advertising)

• Over 1.3 million web pages of results viewed by patients

• 1 PET scan incident, 1 Dilantin level incident

Study Results: SPPARO

Comments or questions

• More transparency

• Social Media: Peer to Peer technology

• A global community of patient

experience and knowledge

• Attitude shift from privacy to sharing

• “My Doctor in my pocket”

What is the future of Patients Online?

Jum

p

Untethered Personal Health Record

Untethered Personal Health Record (discontinued)

Government sponsored, expert-driven

Non-profit, clearinghouse

For profit, expert mediated

For-profit, peer-to-peer

CT Lin MD

ct.lin@ucdenver.edu

Thank you!