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Design of Patient-Centered Care Health IT: Patient Advisor Involvement in ePHR Design and Outcomes Research

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, Patricia Sodomka, FACHE, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (3.2 MB).

Slide 1

Design of Patient-Centered Care Health IT

Patient Advisor involvement in ePHR Design and Outcomes Research Patricia Sodomka, FACHE
Senior Vice President, Patient- and Family-Centered Care, MCG Health, Inc.
Director, Center for Patient- and Family-Centered Care, Medical College of Georgia

AHRQ's 2008 Annual Conference Promoting Quality—Partnering for Change
September 7-10, 2008
Bethesda, MD

Slide 2

Goals for this Presentation

Overview of ePHR [electronic personal health record] Design Development and Outcomes Research Project.
Impact of Patient and Patient Advisor Involvement in e-PHR Research Project.
Findings to date.

Note: "This project was supported by grant number R18HS017234 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality."

Slide 3

Who We Are

Health Sciences University for the 34 unit University System of Georgia founded 1828.
5 Schools (Medicine, Allied Health, Nursing, Dentistry, Graduate Studies).
Tertiary Academic Medical Center.
632 bed facility includes Adult and Children's hospitals, Ambulatory Care Center, Radiation Therapy Center.
110 specialty clinics—Georgia and South Carolina.
Network of 7 critical access and rural hospital affiliates.
21,000 Admissions.
508,000 Ambulatory Care Visits.

Slide 4

The slide shows an outline of the state of Georgia with an image of an "AHA CEO Toolkit," (shown in the picture as a videocassette and literature entitled, "Leadership") and a photograph from a PBS series entitled, "Remaking American Medicine."

Slide 5

The slide shows the cover of the September 1999 issue of BMJ entitled, "Embracing Patient Partnership."

Slide 6

Using an Electronic Personal Health Record to Empower Patients with Hypertension"

"Overall Project Goal."
- Examine the feasibility, acceptability, and impact of an ePHR in a population of ambulatory patients with hypertension.

Slide 7

Grant Investigative Team Structure

Project Leaders:
- Principal Investigator (PI): Pat Sodomka, FACHE, MCG PFCC Center.
- Co-I: Peggy Wagner, Ph.D., MCG Family Medicine.

Reporting to the Project Leaders:

Technology Leaders:
- Charlotte Weaver, Ph.D., RN, Cerner.
- Harold Scott, MC GHI Information Technology.
Research Leaders:
- Peggy Wagner, Ph.D., MCG Family Medicine.
- Study Coordinators (2) (TBD).
- Yoon-Ho Seol, Ph.D., MCG Health Informatics.
- Jim Dias, PhD, MCG Biostatistics.
- Data Manager (TBD)—MCG.
Ambulatory Operations:
- Sandy Hobbs, M.S.N., MCG Ambulatory Care Clinic.
- Shilpa Brown, M.D., MCG Internal Medicine.
- Bruce Leclair, M.D., MPH, MCG Family Medicine.
- Nurse Clinician (TBD).
- Guy Reed, M.D., MCG Chief of Cardiology.
- Joseph Hobbs, M.D., MCG Chair of Family Medicine.
PFCC Leaders:
- Beverley Johnson, Institute for Family Centered Care.
- Marie Abraham, Institute for Family Centered Care.
- Patient Advisors (local and national).

Slide 8

The Essential Role of the Patient Advisor

The slide shows a black and white photograph of a woman writing on a white board.

Christine Abbott.
Lead Patient Advisor—ePHR Study.

Slide 9

Impact of Patients and Patient Advisors in Research Project on:

Research Methods.
Design of PHR.
Dialogue with Physicians.

Slide 10

Project Aims

Incorporate Patient and Family Centered Care (PFCC) into the ePHR.
Test the effectiveness of the ePHR in hypertensive patients.
Measure the impact on system adoption of PFCC.

Slide 11

The Role That ePHRs Can Play

Offer the opportunity for patients to accumulate and manage their own information, track goals, track progress toward goals, manage meds, coordinate care.
Transparency and access to information important features—link to the clinical information system strengthens benefits.

Slide 12

Aim 1—Modifying our ePHR: My HealthLink

Modifications based on MS study.
WAVE 1 data collection.
National Advisory input.
Modifications based on WAVE 1 and National Advisory input.
WAVE 2 data collection.
Final modifications based on WAVE 2.
Main Trial.

Slide 13

Aim 2: The Trial

The slide shows an organization chart.

20 Physicians.
- 10 Internal Medicine.
  - 5 ePHR.
    - 180 Intervention Patients (36 per physician).
- 5 Care as Usual.
  - 180 Control Patients (36 per physician).
10 Family Medicine.
- 5 ePHR.
  - 180 Intervention Patients (36 per physician).
- 5 Care as Usual.
  - 180 Control Patients (36 per physician).

Slide 14

Outcome Measures

4 visits—every 3 months.
Biological measures.
- Blood pressure (BP), body mass index (BMI), waist circumference.
- Fasting glucose, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL).
Patient empowerment measures.
- Patient activation (PAM).
- Patient assessment of chronic illness care.
- Consumer assessment of healthcare providers and systems.

Slide 15

Outcome Measures

Patient/Physician Collaboration Measures.
- Audiotapes of 100 intervention and 100 control visits at initial and 3-month visit.
  - Content of communication.
  - Taxonomy of requests from patients.
Patient Utilization Measures.
- Self-reported utilization.
- Electronic abstraction.
Adherence to Practice Guidelines.
- Chart review.

Slide 16

Initial Findings: Wave 1 of Aim 1

15 patients, 9 interviewed.
Themes developed through iterative process.
- User Themes.
- Themes about general ePHR issues.
- Technology Themes.

Notes:

15 patients recruited, 9 interviewed. Themes developed by 3 research staff and classified into User Themes, ePHR themes, and Technology themes. Tech themes were discussed with project team as in subsequent slides.

Slide 17

ePHR Aim 1-Wave 1—Categorized Themes

The diagram shows how ePHR can present "User Themes," "System Themes," and "Technology Themes."

Notes:

Order of slides changed per Peggy. Let's do the larger context first and then focus in on the tech themes.

Slide 18

Initial Findings: Wave 1 of Aim 1

7 technology themes identified.
40 specific suggestions.
Rank ordered suggestions by importance and feasibility through collaborative process including patients.

Slide 19

Initial Findings: Wave 1 of Aim 1

Technology themes included:

Navigation issues.
Linkages within and external to PHR.
Content corrections.
Health tracking.
Diary functionality.
Expanded medication coverage.
Access to PHR data.

Notes:

I would give examples of each.
Navigation issues—make words have meaning, make it more intuitive.
Linkages—external such as health literacy. Internal such as directions to offices.
Content: expanded appointment scheduleing.
Health tracking:encourage frequent bp recording.
Diary: ability to personalize.
Medication: clarify data entry discussions.
PHR data: control access of which providers see what.

Slide 20

Implementation of Patient Suggestions

Wave 2: 8.
Main Trial: 8.
Future: 1.
Patient Training: 4.
Ranked Zero: 11.
Not technically feasible: 7.
Policy issue: 1.

Slide 21

National Sample Quotes Hypertension Patient Panel

"And he talks to me differently because he knows I can click on something and I know about it."

Slide 22

National Sample Quotes Hypertension Patient Panel

"We don't waste a lot of time on history, on how have you been, what have you done? It's more we had goals and where are you at now with that? How's this working out? I feel like my 15 minutes is fully packed. Whereas before 10 of it is spent trying to get where we needed to be."

Slide 23

National Sample Quotes Hypertension Patient Panel

"In the past, if my labs were off, my primary would call and say I needed to make an appointment. We need to talk. But now, I can see if I need to make a goal before I see him. It makes for a better more productive visit."

Slide 24

Using Patient Advisors in Research

Not as subjects, as advisors.
Different language, different values.
Especially when designing patient systems.
Patient perspectives are different than what clinicians, information technology (IT) workers, or researchers think.
Clarity increases.

Slide 25

Appendix

Slide 26

My HealthLink

Slide 27

The slide shows a screen shot of the homepage from "My HealthLink's" Web site with "Search For: Warfarin, in: Medications" highlighted in the two drop boxes.

Slide 28

The slide shows a screen shot of the "Hypertension Center" page.

Slide 29

The slide shows a screen shot of the homepage with "MCG Info" highlighted.

Slide 30

The slide shows a screen shot of the "Medication Information" page with "Topamax" highlighted.

Slide 31

The slide shows a screen shot of a page giving both an overview and links to various questions concerning the use of "Topiramate (oral)."

Slide 32

The slide shows a screen shot of the "Hypertension Center" page with a sub screen opened showing "My Plan," and "Medication Schedule."

Slide 33

The slide shows a screen shot of a "Graph" page. This one shows a patient's blood pressure being graphed over a week's time.

Slide 34

The slide shows a screen shot of the "Directory of Links" page.

Slide 35

The slide shows a screen shot of the "Glossary of Terms" page.

Slide 36

The slide shows a screen shot of the homepage from the "familydoctor.org's" Web site with "Dictionary" highlighted in the menu.

Slide 37

The slide shows a screen shot of the "Health Information" page from the "My HealthLink's" Web site.

Slide 38

The slide shows a screen shot of the "Maps and Directions" page.

Slide 39

The slide shows a screen shot of the "Online Appointment" page.

Current as of January 2009

Internet Citation:

Design of Patient-Centered Care Health IT: Patient Advisor Involvement in ePHR Design and Outcomes Research. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090908slides/Sodomka.htm