Patient with Provider Portal: A New Brunswick Experience

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• Patient with Provider Portal A New Brunswick
  Experience
• Atlantic Health Information Systems Conference
• White Point Beach, Nova Scotia
• September 23 25, 2009
• Janice Campbell
  Liz Nemeth
• Primary Health Care Consultant
  Manager,
  Clinical Practice
• New Brunswick Department of Health
  Healthtech
  Consultants

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• Agenda
• Setting the Context
• Evaluation Methodology
• Findings and Analysis
• Conclusions and Recommendations

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• Setting the Context (Data from 2005 2006)
  Prevalence of Diabetes
• 1.9 million Canadians diagnosed with diabetes
• 1 / 17 Canadians
• 5.5 of all women
• 6.2 of all men
• Prevalence higher in New Brunswick, Newfoundland
  and Labrador and Nova Scotia
• (Public Health Agency of Canada.
  http//www.phac-aspc.gc.ca/cd-mc/diabetes-diabete/
  face-eng.php )

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• Setting the Context (Data from 2005 2006)
  Prevalence of Diabetes
• 22 of older Canadians (aged 75 79) diagnosed
• Adults 20 and gt - death rates for those with
  diabetes 2 3 times greater than general
  population
• Among 20 39 year old persons with diabetes, the
  death rate is 6 times that of general population
• (Public Health Agency of Canada.
  http//www.phac-aspc.gc.ca/cd-mc/diabetes-diabete/
  face-eng.php )

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• Setting the Context Prevalence of Diabetes
• 53,258 of New Brunswickers currently living with
• diabetes
• Also known that a large number of persons with
• diabetes have not been diagnosed / unaware
  that
• they have the disease

(Personal Communication via email, B. Greene,
Department of Health, New Brunswick, June 12,
2009)
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• Setting the Context Chronic Diseases
• Growing concern over the number of
• persons living with chronic diseases in
  Canada
• In 2007, it was reported that more than 9
  million
• Canadians suffer from chronic illnesses
  
• approximately 77 of New Brunswickers
  have
• been diagnosed with one or more chronic
  illnesses
• (CCHS Cycle 3.1, 2005)

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Patient with Provider Self-management Portal A
New Idea

• Provincial Health Plan 2008-2012 world- class,
  technologically empowered health care system
• Innovation leaders in tele-health services
• Balance between promotion and provision of care
• Self-sufficiency agenda

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Patient with Provider Self-management Portal A
New Idea

• Chronic disease management strategy
• Self-management tools
• -Tele-Care
• -My Choices, My Health
• -Portal could be another approach
• Huron-Perth Diabetes Education Centre

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Patient with Provider Self-management Portal A
New Idea

• Decided to start with diabetes
• Diabetes education class attendance
• Waiting lists diabetes and pre-diabetes
• Accessibility for rural patients

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Guiding Principles

• Voluntary participation
• Patient decides how/what to use
• Empowering for patient
• Patient with Provider

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• Pilot Time Frame
• Go-Live Launch of Pilot Mid-January 2009
• Data Collected Mid-May 2009

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• Pilot Sites
• Saint John Area
• Fredericton
• Sussex
• St. Stephen
• St. George
• Blacks Harbour
• Grand Manan

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• Evaluation of Self-Management Web-based Project
  Patient With Provider Portal
• Goals of Evaluation Project
• To better understand
• Characteristics of the adopters of portal
  technology
• Portal features most valued / discourage users
• To identify
• Beginnings of user patterns
• Any changes in health status (over short time)
• Impact on health care providers and traditional
  health care service delivery (over short time)

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• Context of Inquiry
• Explore Portal Technology Potential Benefits
  for Patients
• Explore the potential for patients, through web
  technology, to
• Access evidence-based information and a health
  care team
• Track their wellness status including
• - Self-care behaviours (such as diet and
  exercise)
• - Self-monitoring indicators (such as weights,
  blood sugars,
• diagnostic tests)
• Share personal status indicators with health care
  providers
• Learn about useful resources (such as local
  presentations and support networks)

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• Evaluation Methodology
• Qualitative Quantitative Approaches

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Theoretical Framework

• Canada Health Infoways
• Benefits Evaluation Framework

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Theoretic Framework Guiding Evaluation
(Canada Health Infoway Benefits
Evaluation Framework, Lau, Hagens Muttitt, 2007)
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Theoretic Framework Guiding Evaluation
Dimensions of Focus
(Canada Health Infoway
Benefits Evaluation Framework, Lau, Hagens
Muttitt, 2007)
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Portal User Demographics

• Females 35
• Males 36
• Youngest 18 yrs
• Eldest 86 yrs
• Mean Age 52.5 yrs
• Mean Age Women 47.2 yrs
• Mean Age Men 57.6 yrs
• Median Age 54 yrs

• Newly Diagnosed (lt 1 yr) 31
• Known Diagnosis 40
• Type I DM 2
• Type II DM 69
• Pediatric Transition 1
• Insulin Pump Patients 3

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Portal User Demographics
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Portal User Demographics
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Portal User Demographics
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Portal Accounts Created Each Month
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Portal Accounts Created Each Month
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Portal Accounts Created Each Month
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Portal Accounts Created Each Month
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• Sampling and Sample Size
• Two Groups Engaged
• Patients
• Providers

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• Sampling and Sample Size
• Patients 30 sources
• Providers 14 sources ( possible limitation)
• (71 patients used the portal during the pilot)

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• Data Collection Methods
• Interviews
• Focus Groups
• Surveys

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Patient Participation in Evaluation

• Patient Survey
• 22 patients requested a survey 19 completed
• Interviews
• 8 patients interviewed 1 accompanied by spouse
• Focus Groups
• 2 patients

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Provider Participation in Evaluation

• Provider Survey
• 5 completed survey
• Interviews
• 6 providers were interviewed
• Focus Groups
• 3 providers participated

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• Findings and Analysis
• Patient Perspective

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Frequency of Portal Tabs Accessed

• Change Your Secret Question and Email Setting
  15
• Log in Success 1009
• Log Out 326
• My Activity 113
• My Front Page 280
• My Goals 90

• My Library 149
• My Logbook 526
• My Nutrition 90
• My Questions 124
• My Reports 222
• Self Learning 93

Total 3039
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Frequency of Access by Month
PDP Previously Diagnosed Patient NDP Newly
Diagnosed Patient
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Frequency of Access by Month
PDP Previously Diagnosed Patient NDP Newly
Diagnosed Patient
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Frequency of Access by Month
PDP Previously Diagnosed Patient NDP Newly
Diagnosed Patient
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Frequency of Access by Month
PDP Previously Diagnosed Patient NDP Newly
Diagnosed Patient
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Monthly Access by Patient
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Monthly Access by Patient
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Monthly Access by Patient
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• Ive been able to navigate theres a gamma of
  information related to diabetes so many tools
  it was very helpful going through various
  things, for example, long term effects of
  diabetes on you, just been looking through.. I
  havent had an opportunity to really look at
  all.
• Easy to navigate with more use, it will be
  even easier. Its been great as I work shift
  work.

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• denial is the biggest factor for this disease
  dont want to admit to have it. Have
  information to look over that you may be
  experiencing etc.the last year Ive been tired
  and with elevated sugars it was worse...you feel
  down for a bit but then realize that you need to
  have control.the portal has helped

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• I was negligent in keeping records and the
  portal has disciplined me to keep regular records
  along with the diabetes education.

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• I dont mention it diagnosis of diabetes
  unless I need to ...some people see it as a
  weakness, getting older, especially my male
  friends are probably worse off than me and dont
  even know it...I dont say too much and maybe it
  is vanity I dont know

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• Summary of Findings Patient Perspective
• Patients perceived benefits of portal with
  self-management of diabetes
• Easy to access and navigate
• Offered suggestions for tweaking
• Information for healthy lifestyle welcomed
• Portal could help them achieve positive healthy
  outcomes
• Perceived benefits related to information all in
  one place, or one stop shopping
• Use of portal could help in communication with
  providers
• Concept of portal could be applied to other
  chronic diseases

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• Findings and Analysis
• Provider Perspective

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• Limitation with the portal is that it has the
  potential to provide a lot of information for
  motivated patientsproblem is that the vast
  majority of patients are not motivated

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• Summary of Findings Provider Perspective
• Saw potential for benefits of portal for patient
  with self-management
• Offered suggestions for tweaking
• Recommended more development work on motivation
  and assessment for readiness for change
• Not convinced of benefits to workflow /
  integration into practice
• Inconclusive findings about benefits related to
  communication amongst clinicians
• Portal concept could be applied to other chronic
  diseases

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• One of the issues we had was that patients
  cant be seen quickly enough. Not getting into
  basic education this is a tool that will help
  bring services to the patient in a more efficient
  fashionwe still provide teaching and glucose
  monitoring

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• Limitations of Study
• Very short period of time for data collection
• Majority of data collection from one site
• Inability to trend usage of individual patients
  for the duration of the pilot
• Decreased involvement of physicians

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• Practice Implications
• Useful tool to promote collaborative practice
  between nurse practitioners and physicians /
  specialists for patient self-management
• Useful tool to promote interdisciplinary approach
  to chronic disease management
• Possible applicability to other chronic diseases
  especially for patient self-management

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Conclusions and Recommendations
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• Portal Expansion and Patient Attitudes to
• Accessing Information
• Expand to other Regional Health Authorities
• Staged Implementation
• Careful Consideration Regarding Initiation
  required resources, pre- and post-measurements

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• Patient Centered Care and Engagement
• Capitalize on work to date engage patients in
  refining the portal, i.e., staging of
  information
• Expand use of portal to other chronic diseases
  engage patients through advisory groups
• Establish links to model of care
• Capitalize on work to date related to motivation
  to change unhealthy behaviours

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• Use of Technology and Process Improvements
• Capitalize on work to date establish user
  groups patients and providers
• Conduct thorough workflow analysis of clinical
  settings

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• Coordination of Care and Use of Patient Portal
• Develop a set of principles to guide the further
  development and staged implementation of the
  portal
• Optimize the role of a Primary Care Provider

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• Transformation of Health Care Patient Portals
• Use foundational work to date to build and
  introduce change management strategies
• Modules can be expanded / interchanged for other
  chronic disease management

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Final Thoughts.

• Relationship is key to engage and involve
• Patient
• Family
• Provider
• Reciprocity required in relationship
• Portal technology is only a tool to enhance this
  reciprocal relationship

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Questions???
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• Acknowledgements
• Thank you to all of the patients, families and
  health care providers that participated in this
  pilot project!
• Thanks to the Huron-Perth Diabetes Education
  Centre for sharing ideas!
• Thank you to AnyWare Group for the portal
  technology!

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• Contact Information
• Janice Campbell Janice.Campbell_at_gnb.ca
• Liz Nemeth lnemeth_at_healthtech.ca
• Linda Yetman lyetman_at_healthtech.ca
• George Hubley ghubley_at_anywaregroup.com