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Patricia Sodomka, FACHE Senior Vice President, Patient- and Family-Centered Care, MCG Health, Inc.

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.

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Patricia Sodomka, FACHE Senior Vice President, Patient- and Family-Centered Care, MCG Health, Inc.

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  1. Design of Patient-Centered Care Health ITPatient 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 www.CPFCC.org

  2. Goals for this Presentation • Overview of ePHR Design Development and Outcomes Research Project • Impact of Patient and Patient Advisor Involvement in e-PHR Research Project • Findings to date “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.”

  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

  4. Remaking American Medicine Georgia AHA CEO Toolkit

  5. “Overall Project Goal” “Using an Electronic Personal Health Record to Empower Patients with Hypertension” Examine the feasibility, acceptability, and impact of an ePHR in a population of ambulatory patients with hypertension. www.CPFCC.org

  6. The Essential Role of the Patient Advisor Christine Abbott Lead Patient Advisor – ePHR Study

  7. Impact of Patients and Patient Advisors in Research Project on: • Research Methods • Design of PHR • Dialogue with Physicians

  8. Project Aims • Incorporate PFCC into the ePHR • Test the effectiveness of the ePHR in hypertensive patients • Measure the impact on system adoption of PFCC

  9. The Role That ePHR’s Can Play • Offer the opportunity for patient’s 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

  10. Modifications based on MS study Modifications based on WAVE 1 and National Advisory input Final modifications based on WAVE 2 WAVE 1 data collection National Advisory input WAVE 2 data collection Main Trial Aim 1Modifying our ePHR: My HealthLink

  11. Aim 2:The Trial

  12. Outcome Measures • 4 visits—every 3 months • Biological measures • BP, BMI, waist circumference • Fasting glucose, triglycerides, HDL, LCL • Patient empowerment measures • Patient activation (PAM) • Patient assessment of chronic illness care • Consumer assessment of healthcare providers and systems

  13. 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

  14. Initial FindingsWave 1 of Aim 1 • 15 patients, 9 interviewed • Themes developed through iterative process • User Themes • Themes about general ePHR issues • Technology Themes

  15. Technology Themes ePHR User Themes Improve Instructions #13 Cost #3 Navigation / Movement Medical Terminology System Themes #5 Understanding Improve Usability Saves money through fewer visits Jargon #9 Diary Functionability Ability to personalize Overwhelming #2 Disadvantages User-Friendly #7 Patient Familiarity & Training Internet Time Consuming #6 Contacts / Corrections / Suggestions Logistics A lot of information to learn Personalize user features #11 Medications Terminology #1 Advantages #10 Patient Expectations User Interface Specific Thorough #12 Access to ePHR Care Providers Increase efficiency of visit Tracking Data Access Interoperability Practice Patient Doctor #8 Additional Tracking Personalized Physical Measurements (ie. Diet, exercise, immunizations, etc.) Facilitates communication w/DR & Nurse Organizes medical records Activation Facilitate partnership to manage medical problems Initial Data Entry Upkeep #4 Linkages Within External ePHR Aim 1 – Wave 1 - Categorized Themes

  16. Initial FindingsWave 1 of Aim 1 • 7 technology themes identified • 40 specific suggestions • Rank ordered suggestions by importance and feasibility through collaborative process including patients

  17. Initial FindingsWave 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

  18. Implementation of Patient Suggestions

  19. National Sample QuotesHypertension Patient Panel “And he talks to me differently because he knows I can click on something and I know about it.” www.CPFCC.org

  20. National Sample QuotesHypertension 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.” www.CPFCC.org

  21. National Sample QuotesHypertension 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.” www.CPFCC.org

  22. 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, IT workers, or researchers think • Clarity increases

  23. APPENDIX

  24. My HealthLink

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