Role of Patient-Facing Technologies in the Era of Health Reform

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Role of Patient-Facing Technologies in the Era of
Health Reform

• David K. Ahern, PhD
• Director, Health Information Technology Resource
  Center (HITRC) for Aligning Forces for Quality of
  RWJF
• Director, Program in Behavioral Informatics
  eHealth
• Department of Psychiatry, Brigham Womens
  Hospital/Harvard Medical School
• Senior Scientist, Abacus Management Technologies
• Meaningful Use Conference
• March 16, 2012

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Disclosure

• Co-founder and Principal of Abacus Management
  Technologies LLC
• The Good Health Gateway is a proprietary web
  portal platform of Abacus Management Technologies
  LLC

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Overview

• Patients are using HIT in a variety of ways
• Meaningful Use (MU) rule provides some initial
  guidance for patient-facing technologies
• Requires a greater understanding of patients
  wants and needs to determine how these
  technologies can be utilized effectively

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Patient-Facing Technology?
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Patient-Facing Technologies in Clinical Care
Theoretical Framework

• Patient Centered Care Model

Self-Management Support
Decision Support
Patient Navigator
Productive Interactions
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Am Journal of Prev Med 2011 40(5S2)S162-S172
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Current Patient Uses of HIT

• Seek health information for themselves, friends
  and family
• Access health services appointment scheduling,
  medication refills
• Communicate with provider via secure messaging
  regarding non-urgent health issues
• Use Computerized Tailored Interventions (CTIs)

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Current Patient Uses of HIT (cont.)

• Use a Personal Health Record (PHR) or patient web
  portal
• Use remote monitoring devices, wearable and
  passive sensors
• Seek social support and community engagement via
  social networks and social media

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Value of Web Portals
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Web Portals
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Value of PHRs
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What is Social Media?

• Tools which harness and capitalize on the robust
  aggregate of information and people online
• Shifts away from 3rd party media to user
  generated content
• Individually created and
• controlled flow of content
• (e.g., text, video, photos)
• to others

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Mobility andConstant Access as Drivers

• People who use Facebook on their mobile devices
  are almost 50 more active on Facebook than
  non-mobile users
• Worldwide mobile traffic from each region has
  increased at least 4x in the last two years, with
  6x increase in North America
• Having a smart phone increases sharing of all
  kinds.
• Susannah Fox (2010)

Facebook (2009) Admob.com (2010) Pew Internet
American Life (2010)
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Patient-FacingInformation and Services
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Patient-Facing Technologies for Meaningful Use
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Patient-facing TechnologyeBP Control Program
Principal Investigator Charles Eaton, MD,
MS Co-Principal Investigator David K. Ahern, PhD
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Problem of Uncontrolled BP

• 35 of Americans with hypertension optimally
  managed
• 25 are unaware of their diagnosis
• These risk identification and treatment gaps are
  greater for non-Hispanic blacks and
  Mexican-Americans

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Home BPM Lower than Office

• On average, home BPs are lower than office BPs by
  5 mm Hg
• SBP home - 135 office - 140
• DBP home - 85 office - 90

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Home BPM Treatment Goals

• BP goals for average risk
• SBP lt135 mm Hg or DBP lt85 mm Hg
• BP goal for high risk (Cardiovascular Disease,
  Chronic Kidney Disease, Diabetes Mellitus)
• SBP lt125 mm Hg or DBP lt75 mm Hg
• BP goal for Left Ventricular Dysfunction
• SBP lt115 mm Hg or DBP lt75 mm Hg

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Home BPM Device

• Omron BP monitor,
• HEM-790IT

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Patient Navigators
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Good Health Gateway Entry Screen
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Good Health Gateway Education
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Good Health Gateway My Monitoring Page
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Good Health Gateway Results
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Good Health Gateway Patient Navigator View
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Patient Navigator Summary View
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Centricity eBP Control Form
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Centricity eBP Follow-Up Form
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Overcoming Clinical InertiaRed Light

• HBP gt140/90 for AR
• HBP gt130/80 for HR
• HBP gt120/80 for LVD
• The PN will send a flag to team nurse and PCP,
  schedule an appointment as necessary
• PCP to escalate treatment - document in chart

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Overcoming Clinical InertiaAll Lights Flashing

• HBP gt180/120
• PN to contact team nurse or
• PCP for same day visit or ED visit
• PCP to evaluate for Hypertensive Urgency vs.
  Emergency, and make appropriate triage decision
• Document in chart

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Table 1. Demographics of Participants in eBP
Control Program (n28) Mean Age, yrs
(SD) 58.5 (12.0) Sex () Female 16
(57.1) Male 12 (42.9) Ethnicity
() Non-Hispanic White 25 (89.3) Non-Hispa
nic Black 2 (7.1) Non-Hispanic Am. Indian 1
(3.6) Education () Less than HS 2
(7.1) HS graduate 9 (32.1) More than
HS 17 (60.7) Marital Status
() Partnered 18 Not Partnered 9
eBP e-Health Blood Pressure
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Chronology of systolic BP from research visits
(RV), home monitoring (HM), and visits to primary
care physician (PCP) relative to home goal BP
(135/85) for an average risk patient. Enrollment
began on 9/15/2010 (1). Patient randomized to
gain access to patient navigator (PN), in
addition to web portal, on 1/6/2011 (2). Between
time point (1) and (2), patient had access to
only home monitoring. New medication was
prescribed on 2/14/2011 (3).
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Chronology of systolic BP from RV, HM, and visits
to PCP related to home goal BP (135/85) for an
average risk patient. Enrollment began on
9/13/2010 (1). Patient randomized to gain access
to only the web portal on 1/5/2011 (2). Between
time point (1) and (2), patient had access to
only home monitoring. Patient introduced to PN
on 4/4/2011 (3). New medications were prescribed
on 4/7/2011 (4). Participant met with hospital
social worker to assist with health insurance
4/25/2011 (5).
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Conclusions

• Success of health reform is predicated on
  improved health outcomes and reduced costs,
  achievable only with engaged and activated
  patients
• Patient-facing technologies are likely to play a
  critical role in supporting informed and
  activated patients
• Research is needed on comparative effectiveness,
  ways to increase adoption and minimize unintended
  consequences

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Thank You

• dahern_at_partners.org
• [phone]
• Twitter dahern1