A strong argument can be made that the health care field is one of the most information-intensive sectors in the U.S. economy and avoidance of the rapid advances in information technology is no longer an option. Consequently, the study of health care information technology and systems has become central to health care delivery effectiveness. This course covers the modern application of information technology that is critical to supporting the vision and operational knowledge of the health care leaders in managing the health care organization. Heath care decision-makers have to meet head-on the dynamic challenges of health care delivery quality, cost, access, and regulatory control. Additionally, this course integrates the Healthcare Information System as integral to the Quality Assurance Tracking Programs including measurement of systems inputs, processes, and outputs with special emphasis on systems outcomes research and organizational accountability to its various stakeholders, not the least of which are government regulators.
Module 2: Patient Self-Service with Health IT
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From the course by Icahn School of Medicine at Mount Sinai
Health Care IT: Challenges and Opportunities
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Meet the Instructors
Bruce J Darrow, MD, PhDVICE PRESIDENT MSHS | President's Office ASSOCIATE PROFESSOR | Medicine, Cardiology ASSOCIATE PROFESSOR | Population Health Science and Policy
Cardiology
Nicholas G Genes, MD, PhDASSOCIATE PROFESSOR | Emergency Medicine ASSOCIATE PROFESSOR | Genetics and Genomic Sciences
Emergency Medicine
[MUSIC]
Hello, I'm Nicholas Genes.
This lecture we're going to be focusing on the many capabilities of today's patient
portals, and what patients can do for themselves through health IT today.
Maybe you have a science fiction kind of view of what doctors are capable of.
Here's an image of a Star Trek's Dr. McCoy interfacing with the hive mind.
He was gaining the wisdom of the ancients to be able to perform a complex surgery.
But I like to think of this as a really plugged-in and connected doctor, who is
able to respond to patient requests, even if the patient wasn't at the bedside.
And today's patient portals kind of facilitate this access in a more
limited fashion.
If you have an account with your clinic or
your doctor, or your healthcare institution and you can login and
view your data, you'll see a lot of longitudinal data.
Some data that doesn't change from visit to visit.
You'll see your past medical history, the diagnosis that you carry, your allergies,
you'll see a record of all the visits you've had with that institution.
A lot of patients ask me about allergies and blood type.
They think that that information should be front and center.
And indeed a lot of these portals do show allergies pretty clearly and
the blood type, however, is something that you might feel it's nice to know,
but it turns out that no responsible blood bank would
ever transfuse someone without confirming their blood type.
So even if you say that you're type A positive your blood is
going to be drawn and checked against that before any blood is administered to you.
The risk is simply too great and
we don't want patients to assume that risk themselves.
So, blood type, well, it's nice to know it's never going to be a crucial bit
of information that you need to communicate to your doctor.
Medication lists on the other hand are hugely important.
And I rely on them heavily in the emergency department.
And this is a key features I think of patience portals.
You can quickly log in and view all your medications,
view the time you supposed to take them and the dose.
There's still room for
improvement I think in a lot of patience portals how they display this information.
Because, really, I think this is a great opportunity for education.
As I talk to patients I talked to them on my own family members.
I see sometimes that they'e taking medications that they're not exactly sure
why and they're not exactly sure of which one is which.
They just know they are suppose to take the purple pill at 3 o'clock or
the red pill in the morning.
This is I think an opportunity for improvement.
And if you think about it, it's also an opportunity to track adherence and
let your doctor know which medications are disagreeing with you,
which one is your less likely to take.
There are some cool apps and
software tools that are coming online that are facilitating this.
For instance, WebMD has an app where you can upload all your medications and
if you have a watch, a smartwatch your
medication will show up at the point and time that you are supposed to take it.
And they can really clear for you to know what drug you are supposed to take when,
how many of those drugs you are supposed to take, and
you can even mark it as taken or skipped.
And your doctor can then review that data to see
what drugs you're struggling to adhere to and maybe you're regimen can be adjusted.
Also, this is a great opportunity for
education and you can learn more about why your taking the drugs that you are taking.
So, I think patient portals can facilitate some of this,
but they can do a better job than what they're doing today.
Beyond longitudinal data, like medicationalists and past diagnoses, we
see a lot of episodic data, lab results, radiology reports, and doctor's notes.
And this can lead to a lot of fear and confusion.
And we try to answer questions and facilitate understanding.
That's why I think some doctors are often reluctant to release this information
directly to patients.
They like to preview it first, because, for instance, some radiology reports,
radiologists are custom to reporting a lot of incidental findings or
making remarks like, cannot rule out malignancy or something like that.
A statement like that or
a statement about a mass that is seen might be really alarming to a patient.
And understandably, a doctor would like to review that information
before releasing it to a patient so
that a conversation can happen and the results can be put in context.
As for doctors notes this is actually is about controversial.
I think everyone agrees that patients should be able to see their own data but
some doctors are reluctant to release their notes to the patient.
There is a famous Seinfeld episode where Elaine was identified as a problem
patient.
And doctor after doctor that she saw read the same entry in her chart and
wouldn't share it with her and she became very anxious about to what this paragraph
about her said and high genes and sued, because there's a sitcom.
But it's actually, it's a relic of past a era and I think people understand
now that patients do have access or should have access to all their data.
But, I do feel that most characters would like to know before a patient is accessing
that data, so that they can anticipate questions.
And there's another downside in that,
sometimes this information is not can be correctly.
For instance, here's a snapshot from my patient portal.
As you can see, I have some eye issues and I was born with a thalassemia, but
as a kid I had recurrent sinus infections, so I had an adenoidectomy.
I had some lymph tissue removed from my sinuses and
when I told my new primary care doctor this,
he wrote in the chart adenoidectomy and it actually got mangled.
And when I log in to the chart it got written up as history of nose job.
I feel like this was the patient portal trying to simplify a diagnoses to make it
easierfor me to understand, but
in fact, it can give the wrong information entirely.
So it's not always perfect.
Sometimes the doctor enters the data wrong or
sometimes the system misinterprets the data.
But in addition to reviewing old data, today's portals allow for
a lot of patience-centric activities and functions that the patience want to do.
So just scheduling new visits, requesting prescription refills and
even sometimes getting questions answered, depending on your doctors practice.
So here's a screen shot of a popular electronic health record patience portal.
You can see this patient when they log in and authenticate with the system,
they can view a lot of test results, they can review old appointments.
They can see some health reminders such as it's time to get your flu shot,
or it's time to get your colonoscopy.
They have in this case 400 messages with their provider,
more than 400, but they also have the option to schedule an appointment.
And in a web browser this looks like this,
you can actually if you sometimes a calendar
of your doctor's upcoming availability and schedule something that works for you.
And then you can even enter data about why you want to have this visit,
is it just a routine check-up, you need a form filled out, or
is there something specific that's bothering you?
And this is great, because it helps the doctor prepare for
the visit and makes the visit more efficient for everyone.
There's also the capability now in Select Settings to schedule a telehealth visit.
So if you're feeling like you don't want to get out of bed, but
you got a question that you want to relay to your doctor, your doctor can actually
communicate with you via PC, tablet or smartphone in some cases,
which is really great and really efficient, but not always appropriate.
If you're having chest pain, if you're having a neurologic deficit,
that might be a stroke, you really shouldn't wait around for
a telehealth visit, there's better things you should be doing.
And finally I want to talk a little bit about messaging with doctors and
messaging with practices.
Obviously messaging can be very important when you don't need to pick up
the phone and wait on hold while you ask a very simple question.
So you can sometimes message the practice saying,
can I please reschedule this appointment or something like that.
But messaging doctors, I think, is something that I catch on.
You see this sometimes in concierge practices where in addition to your
regular health insurance and paying for various services that your doctor orders,
you can pay this additional premium and
your doctor is more available to you either by phone or by text message.
And this is a system that has its appeal because sometimes
scheduling a video visit is not necessary, sometimes text messaging
can do it all by itself and that can be facilitated through a patient portal.
Other things that patient portals can do.
If you're accessing it through a mobile app sometimes you can see the nearest
specialty clinic or nearest urgent care clinic or nearest emergency department.
You have an option for bill pay.
And sometimes you can even see the charges and you have some charge transparency.
And then finally we'll talk about the blue button and it's option to download data.
So, bill pay is a function that a lot of websites and
now some apps support, and that's one thing.
But, wouldn't it be great to actually see how much things cost before
the procedures is performed on you, or before the imaging test is performed.
This has been enormously difficult in the US.
A lot of companies, I've been working on a lot of states recognized that they want to
promote a form of decision making and they want patients to have some understanding
of the extreme price variability and charge variability that's out there.
And why are these prices so variable?
It has to do with very convoluted
insurance arrangements with various healthcare institutions.
But if your doctor orders an MRI for
you, it might be a lot cheaper to get it done somewhere else.
And increasingly states want patients to be aware of this and
to choose something that has the smallest copay or
to keep it in that work and keep it as inexpensive as possible.
Patient portals can begin to facilitate this.
Although so far,
it's been a standalone apps that have been accommodating this function.
The blue button is another initiative, we'll see this in some page and portals.
The ability to just click this button and get a compressed zipped file
that has all your patient data in it and it's in a format that can be uploaded to
other healthcare systems or shared with other doctors.
And really this is a fundamental feature that patient portals should have but
many don't.
The blue button has been advocated by both, federal government and
patient advocates.
Most notably, e-Patients Dave deBronkart is a cancer survivor and
wrote about his experience and the difficulties he had getting his patient
data out of one system and into another where he could transfer his care.
And he has written very movingly about other patients that won't just lucky as
him fight their cancer.
For instance, there is one patient who received radiation therapy for
dermoid malignancy many decades ago.
And then as a result of that radiation therapy developed another malignancy
much more recently.
When this patient went to an oncologist to say look I have a new malignancy,
the oncologist said we have to find the records from your first radiation therapy
to see what dose was applied because that might really impact the treatment here.
And those records no longer existed, they were discarded by old healthcare
institution and they were setting some kind of merger or something like that.
So, really not involving patients in their own healthcare,
not letting them access their data and then discarding old records,
you think that this kind of thing will be impossible but it is surprisingly common.
So, having patients being able to download their data is an important function.
And yet, it's something that a lot of hospitals are reluctant to do.
Technologically, it's a little difficult.
It kind of overwhelms patients with a lot of information.
And I think some hospitals are also reluctant to let patients
switch providers and switch care so easily.
So there have been some institutional roadblocks,
but I do feel the blue button movement is gaining steam and
it is getting easier to download your data and share it with who you want to.
Thank you.
[MUSIC]
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