The meaningful use of patient-facing e-health applications has great potential to improve the quality and efficiency of health and health care. Particularly for people with chronic conditions, research demonstrates that patient activation, chronic care self-management, and shared decision making with their clinicians can have a substantial impact on effectively managing their health.
The California HealthCare Foundation released new consumer survey data this week which confirms and complements a variety of other research findings. Americans who have electronic access to personal health information know more about their health, ask more questions of their clinicians, and take better care of themselves.
That’s part of why the Health Information Technology Policy Committee (HITPC) that advises ONC recommended patient/family engagement as one of the five health outcome priorities for meaningful use (MU) of EHRs. And CMS included several relevant objectives in the proposed MU rule it released in January (comments from more than 2,000 organizations and individuals are currently being reviewed by CMS and ONC):
- Consumers’ timely copy of, and access to, electronic records
- After-care summary for each outpatient encounter
- Discharge summary for each hospital stay
- Patient reminders for preventive & follow-up care
The HITPC’s MU Workgroup will be holding a series of public hearings over the next several months to inform its recommendations for Stages 2 and 3 MU definitions. The first of these hearings focuses specifically on the patient/family engagement domain and will be held April 20.
In addition to the formal hearing, ONC and the MU Workgroup strongly encourage input from the public on this blog regarding the evolution of MU objectives to drive better patient and family engagement. In the coming days, some of the panelists who will testify on April 20 will post blog entries on this site as well.
We really want to know more about the meaningful use of HIT in the real lives of patients and families. We will explore how patient-generated data can be incorporated into the meaningful use of EHRs. We also need to address the policy challenges and infrastructure required to support patients’ and families’ meaningful use of HIT. This information will help us to develop a long-term framework for the evolution of HIT applications to facilitate patient and family engagement.
Your input on the same questions we’ve asked the panelists to answer would be most helpful to our efforts, although all comments are welcome. The full list of questions follows.
Panel 1: Meaningful Use of HIT in the Real Lives of Patients & Families
a. What are consumers’ health information needs in the context of their real lives?
b. How do results of ethnographic studies of individuals with chronic health conditions inform our understanding of how HIT can improve their use of health information and connectivity with their providers to improve their health?
c. What is the evidence base for patient benefit from their direct use of PHRs and other HIT that interacts with EHRs?
d. What is the role of mobile applications in improving health of individuals? Is there a specific role for underserved populations?
e. How can we use HIT to make information and knowledge actionable for patients?
f. How does HIT enhance collaboration between patients and their providers and change how the patient’s health is managed?
Panel 2: Incorporating Patient-Generated Data in Meaningful Use of HIT
a. What is the role of patient-generated data in improving health of individuals? What is the evidence?
b. How can patient-reported data be integrated into EHRs and the clinicians’ workflow to improve care management?
c. How can future conceptions of personal health information platforms and information tools facilitate patient-centered care, including transparency, coordinated care, patient activation, while protecting patient privacy?
d. What is the role of the patient in ensuring data in EHRs is accurate?
e. What are your recommendations for meaningful use criteria for 2013 and 2015 that are achievable by a broad spectrum of providers?
Panel 3: Policy Challenges & Infrastructure Requirements to Facilitate Patient/Consumers’ Meaningful Use of HIT
a. What is required for vendors to be able to export data from EHRs in such a way that consumers and patients can use the data in meaningfully?
b. What is the role of providers in making data available to patients in a meaningful way?
c. What are the meaningful uses of that data once exported? What evidence of measureable benefits exist?
d. What are the privacy and trust issues that might affect this from happening?
–Joshua Seidman PhD
Like most new systems, it takes alot of work to get everyone on board. In health care it’s all about training doctors, physicians as well as patients to know how to properly use technology to share medical records. Engaging patients to update their info online is becoming more popular. I can see technology changing to help patients get better treatment, hope this vision leads us toward cheaper healthcare.
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I would like to go one step further. Next to patients having insights into their own health information, it will be important for patients to work on their own health, via many possible natural options. One of them is EFT, Emotional Freedom Techniques, where simple tapping of the fingers on stress release points of the body will help those at home to deal with emotional and physical well being issues. By getting patients involved in their own health, their self esteem can grow rapidly, their health will increase drastically and the pressure on the health budget will be stongly relieved.
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I would have to agree with Peter that the personal and human interaction is critical in regards to dealing with patients at any level. To ensure the delivery of the information is understood, that the patient knows how to apply the information and the process involved and that they understand the contraindications.
It concerns me that there will always be those that will slip through the cracks when it comes to the implementation of an IT form of delivery.
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First, I would like to thank you for taking a closer look at the health care situation that many people find themselves having to deal with today and on a daily basis. Even though I do as much as I believe is possible in the form of exercise and and proper nutrition, as I get older, I can’t help but think of what might happen in my future that would cause me to have to depend on someone or something else. I can already see this happening with my parents and to be quite honest, it scares me a little to think about it. It’s reassuring to know that there are people and plans out there to help improve the quality and efficiency of the health care system.
Thanks again,
Jackie
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I think the after care summary is particularly critical. I know how challenging it can be to remember all that was discussed during a visit, especially when things may be difficult for the patient to completely understand immediately or when anxiety levels are high. Having a concise summary of next steps and other relevant information helps the patient feel more in control of their situation and better about their opportunity for success. Thanks for making it a priority!
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I think the most important point to consider when implementing new technology in the medical system is to determine the goal. Is the goal to save money, or to improve the service that can be offered to the patient.
Best of course would be a combination of the 2, as long as it doesn’t lead to too much staff lay-off that would be detrimental to the relationship with the patient over long-term because I think it is extremely important that a sick person feels taken care off properly, and not just brushed off as one in a million.
It’s all about finding a balance of cost-efficiency and patient care.
What do you think?
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I’m a senior citizen who is very concerned about the possibility of my doctors and other doctors in my area that say they will no longer treat Medicare patients or will not take any new Medicare patients on. What is being done to solve this problem for seniors.
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There is a transcendent issue regarding:
“Engaging Patients and Families Through the Meaningful Use of Health IT”
Having worked on the IT vendor side of HIT programs for clinicians in hospitals, an also patient information flows between health center doctors and hospitals, my view is that the biggest issue is not so much that patients would not know how to locate and interact with private data usefully, but far more that there is a lack of interfacing between
1. The numerous organizations that hold the data and
2 The data inside each organization being held in different non-interacting databases.
This means that even if the public was able to access their own data, it is often simply not there in ONE place.
For example if a patient suffers from an anxiety disorder of some sort such as GAD, or maybe has been attended to over a period of years by several different consultants about an alchohol anxiety state, in several different hospitals, different hospital departments, a local doctor, a pharmacy and so on, this means that the electronic records are scattered far and wide.
There have been many attempts to solve this issue, with the HL7 standard being a very fine code set for messages being sent between external systems, but at a database level and at a distributed level (the clinician’s workstation) the level of unification of data is a long a way off still.
And that is for just for the clinicians inside a hospital or hospital group. The systems in hospitals are generally supplied by various vendors, such as xray, lab results, patient admission, and so on, but all deliberately not able to talk to each other because of vendors protecting their niche.
To get around this, hospitals often choose one big vendor, but the problem there is that no single vendor can do best of class in all areas, let alone provide secure public access.
Watching this space very closely
Rob Clarkson.
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It seems to me that some of the impediments to patients’ ability to access healthcare IT stem from skills deficits or cognitive deficits, or mental health issues (e.g., depression, anxiety, paranoia). What this means, practically, is that we have to work to overcome these concerns by 1) making IT as accessible as possible (i.e., multi-sensory, user-friendly), 2) understanding and working to overcome the cognitive and skills deficits through training (i.e., equipping the patient to have greater self-determination), and 3) training providers to use IT and explain privacy in common, everyday language.
Patient-centric care must be focused on delivering the right services the right way at the right time. Part of the issue is helping to include family and caretakers through changing the way we approach medical privacy, moving beyond an individualistic approach to a more multisystemic approach. I think social workers are ahead of the field on this.
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My experience as a clinician has taught me that the only way to engage patients and families in their care is through education and open discussion. The issue at hand is the lack of technology to effectively support the education process in parallel to EHR usage. Digital content to support discussion is readily available but the infrastructure for delivery is quite the rare phenomenon today.
I would ask that technology developed specifically for patient engagement be recognized and brought into the current conversation.
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