Patient Engagement and Health Transparency

G. Daniel Martich, MD, FACP | June 17, 2014

History – Untethered – Tethered

Current State – Scheduling – Billing – ePrescibing – Get Medical Advice – Results – Proxy – eVisits/Anywhere Care

Future – Open Notes – Chronic conditions – Social Network

Presentation Overview

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“Now is the perfect time to change” - Mark Bertolini HIMSS 2014

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Patients don’t stop being consumers – customers – when they put on a hospital gown Micah Solomon, Forbes Contributor

• Pros – Patient/consumer controlled – No HIPAA concerns – Most up-to-date

information

Untethered Personal Health Record

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• Cons – Consider the source – Tools vary – Synchronizing multiple

databases – Little/no security – No secure communication

with provider

“Consumer empowerment versus consumer populism in healthcare IT, “JAMIA, Simborg, 370-372 (April 2010)

• Pros – Open communication with

provider – Patients don’t need to re-

enter data – Secure and HIPAA compliant – Tied to MU – Optimize time utilization for

physician and patients

Tethered Personal Health Record

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• Cons – Office/physician MUST

USE EMR, not just have it in their practice

– Less flexible – Untethered PHR’s

“Consumer empowerment versus consumer populism in healthcare IT,” JAMIA, Simborg, 370-372 (April 2010)

• Implemented September 2004

• Aggressive implementation began September 2008

• 239,815 MyUPMC users • 23,000+ Mobile App users

MyUPMC – Current State

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373

83574

121831

225182

0

50000

100000

150000

200000

250000

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Num

ber o

f Pat

ient

s

MyUPMC Registered Users

Scheduling

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• eStatements • Payments • View insurance

summary • Chat with Customer

Service

Billing

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• Renew prescriptions • Requests refills • Helps meet secure

messaging measure for Meaningful Use Stage 2

Prescription Renewal

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Get Medical Advice

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Laboratory

Results

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PT/INR

Results

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Results

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Results Automatically Released to MyUPMC

Radiology

Pathology

Results

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Results Automatically Released to HealthTrak

Cardiology

Results

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Gastroenterology

Results

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Gastroenterology

Results

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Pulmonary

Results

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Neurology

Results

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• >4.5 million results released • Approximately 250K MyUPMC patients have received auto-

release results

Auto-Release – Overall Statistics

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Results Automatically Released to MyUPMC

Results

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The test results you are about to review may contain information that may be confusing or cause concern. If you have not already communicated with your provider we recommend you contact him/her to discuss and clarify the meaning of your results.

• Care Taker vs Care Partner • Patient portals

• Should the Care Partner

have access to this information?

Proxy

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“Care Partners and Online Patient Portals,” JAMA, Sarkar & Bates, E1-E2 (January 2014)

• Barriers – Access to share patient portal – HIPAA – No broadly adopted standards for Care Partner access

• Benefits to breaking down barriers

– Distance – Between-visit chronic disease self-management – Asynchronous modes of communication

• It’s solvable

– Provide separate credentials – Document Care Partner in EHR – Tie to MU

Proxy

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“Care Partners and Online Patient Portals,” JAMA, Sarkar & Bates, E1-E2 (January 2014)

eVisits/Anywhere Care

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DeJong, Santa, Dudley; JAMA April 2, 2014 Volume 311, Number 13, page 1287-1288

• Continuity Care – Available to patients that have

had an appointment in the last 3 years with a UPMC PCP practice that participates in the UPMC AnywhereCare program

– Patients expected response time will be within 1 business day

eVisits/Anywhere Care

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• Convenience Care – Available to any user physically

located in the state of Pennsylvania (at the time of submission)

– Available 7 days per week, 24 hours per day

– Patients expect a 30 minute response time

– Video option available for patients (9 am – 9 pm)

• Coverage provided by – UPMC Urgent Care Centers

Advanced Practice Providers and Physicians (6 am to 9 pm)

– Emergency Medicine Command Center Physicians (9 pm – 6 am)

UPMC AnywhereCare

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eVisits/Anywhere Care

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• Adults – Adult Patients (18 years of age or older) – A proxy of an Adult Patient (18 years of age or older)

• Pediatrics – Proxies of Pediatric Patients (3 - 17 years of age)*

– Limited to 3 medical conditions/diagnosis and video only – Cold, Cough and Pink Eye

*Pediatric UPMC AnywhereCare visits will be responded to by: 1. Children’s Community Pediatrics Physicians (Convenience

Care Model) 2. Participating Family Medicine Physicians (Continuity Care

Model)

• Benefits of eVisit ‒ Convenience and efficiency ‒ Lower costs - $38 ‒ Provided by Primary Care

Physician/ Advanced Practice Providers

• Potential drawbacks of eVisit ‒ Can a physician make an accurate

diagnosis? ‒ Are correct tests and follow up

ordered? ‒ Are drugs being overprescribed? ‒ Medical Malpractice issues ‒ Technical issues of video vs text

only ‒ Connected devices ‒ State licensure in order to be able

to prescribe across state lines

eVisits/Anywhere Care

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eVisits vs. Office visits

“A Comparison of Care at E-visits and Physician Office Visits for Sinusitis and Urinary Tract Infection,” JAMA INTERN MED, Mehrotra et al 173 (NO. 1), 72-74 (JAN 2013)

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Findings: eVisit vs. Office Visit Sinusitis and Urinary Tract Infection • UTI

– Less likely to order UTI-relevant test at eVisit

– Number of follow up visits were the same

– Less likely to order preventative care at eVisit

– More likely to prescribe antibiotic at eVisit

• Sinusitis – Follow up visits were the same – Less likely to order preventative

care at eVisit – More likely to prescribe antibiotic

at eVisit

eVisits/Anywhere Care

31 “A Comparison of Care at E-visits and Physician Office Visits for Sinusitis and Urinary Tract

Infection,” JAMA INTERN MED, Mehrotra et al 173 (NO. 1), 72-74 (JAN 2013)

eVisits/Anywhere Care

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Open Notes

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Kahn, Bell, Walker, Delbanco, JAMA April 2, 2014 Volume 311, Number 13

• Medical device integration (MDI) -process of taking the data from those devices and integrating it to an EHR.

• Examples include defibrillators, electrocardiographs, vital signs monitors, ventilators and infusion pumps – Diabetes Mellitus – glucometer – Obstructive Lung Disease – spirometer – CHF – scale

Chronic Conditions

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Invest In Wellness

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Heal Yourself

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Social Networking

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An Engaged Patient is a Healthy Patient

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“How Doctors Rate Patients,” Wall Street Journal, Landro, March 31, 2014

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• Just because we can – Clinical Messaging – Research interests – Surveys – Advertising

• Caution based on clinical decision support alerts

Communication with Patients

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Future

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- Pope John Paul II

“ The future starts today, not tomorrow.” - Pope John Paul II

QUESTIONS

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Questions?