The Imperative to Anchor Care in Patient Needs & Perspectives
Va open notes and blue button va ehealth university dec 2012
1. VA Blue Button & Open
Notes
VA
Susan Woods, MD, MPH
December 14, 2012
2. Patient centered care empowers
patients to participate in their
health and healthcare. With more
complete access to their health
information, patients can become
active partners in their care.
2
3. Over 1.9 million registered users
0.9 million authenticated users
More than 76 million visits
33.5 million Prescription Refills
479,000 opted in for Secure Messaging
4. My HealtheVet & VA Blue Button Today
VA Medication History
VA Appointments*
VA Laboratory Results: Chemistry/Hematology*
VA Allergies and Adverse Reactions*
VA Wellness Reminders (MHV Clinical Reminders)*
VA Immunizations*
DoD Military Service Information*
7. Coming Soon : More VA Data
DEMOGRAPHICS PROBLEM PROGRESS VITALS MICRO-
List Notes & Readings Biology
PATHOLOGY EKG RADIOLOGY CONTINUITY of CARE
Surgical, List Reports DOCUMENT
Cytology, EM CDA File
8. PATIENTS & PROVIDERS
CARE-GIVERS
CAREGIVERSAPPS
Blue Button is patient centered,
and directly controlled by the patient.
...permissions & privacy
and data-sharing are easier!
10. Most patients and doctors agree that patients
should be able to download their own health
information
www.markle.org/sites/default/files/20101007_bluebutton_summary_1.pdf
11. Office of Civil Rights Memorandum
All patients have a
right to get their
health record.
Patients denied or
obstructed may file a
complaint with OCR.
12. Meaningful Use
Stage 1 Stage 2 Stage 3
2011-2012 2014 2016
Post-Visit Secure Automated
Summary Patient Blue Button
Messaging Transmit
+ +
View, Patient-
Download, Generated
Transmit Health Info
13.
14. Top 5 Reasons for VA OpenNotes
Technology changes patients’ lives and role in care.
Shared records: an idea whose time has come.
The evidence is in: benefits are high and risks low.
Veterans Voices: it’s what they want.
It’s time to re-design our work.
16. What Internet Users Do Online
% Adults who do Survey
10 Most Common Activities ▼
this▼ Year
Use search engine 91 2012
Use e-mail 91 2011
Get info on hobby or interest 84 2011
Search for map or directions 84 2011
Check the weather 81 2010
Look for health information 80 2010
Get info on something to buy 78 2010
Get news 76 2011
Go online for fun or to pass time 74 2011
Buy a product 71 2011
http://www.pewinternet.org/
21. • Enhance patient autonomy
• Improve patient-physician relationship
• Serve as educational tool
Shenkin B, Warner D. New England Journal Medicine 1973
23. Shared NHS Electronic Records
3 London practices gave record access -HealthSpace
Results:
86% accessed records
Age, ethnicity not associated with frequency
Poorer health - more frequent access
38% found errors (48% did not take action)
76% felt more involved in care
9% more worried about health
75% felt more confident in GP (3% less confident)
Bhavnani et al. Family Practice 2010; 28:188-19423
24.
25.
26. Patient Perceptions of Full Access to
Their Health Records through MHV Pilot
5 focus groups
Portland MHV Qualitative
(30+ pts/
Pilot users Analysis
caregivers)
27. Themes – Patient Views
Theme 1: Better communication with provider,
more prepared for visits
Theme 2: Enhanced knowledge and self-care
Theme 3: Patient participation in care and
quality
28. Communication…
“I can go in and ask more intelligent questions and we
don’t have to spend as much time with them
explaining everything to me. And then, with my stress
level up at the doctor’s office, I don’t hear half of it
and then we may have to do it again and again and
so, it helps us to have better communication”.
29. Knowledge and Self-Care
“Made me feel more responsible for myself too, like
there’s no excuses. You know, it’s right there, you
know. You can’t use ‘the doctor didn’t tell you’.”
“You could just pop over to Google or the library, a
dictionary in there, and check it out and see what it’s
saying instead of sitting there sweating it out trying to
figure out what it is.”
30. Participation in Care – Patient Decisions
“I don’t think I had to go as often [to the doctor]
because…yeah, because I could see my results. I
could see what was going on and I didn’t, I didn’t
get stressed out waiting to hear back from
somebody who might never call me.”
31. Patient Participation in Quality - as Reminder
“I had an ultrasound on my liver and I saw the results
online. It said, ‘Re-do in 6 months’. Well, 6 months came
and nothing happened. So I called the doctor and I say,
‘Well, it said here 6 months, re-do’. He says, ‘Oh yeah,
they did say that’. So, if I hadn’t reminded him, I
probably wouldn’t have got it.”
32.
33. Open Notes Study
• RWJF Pioneer Portfolio
• Beth Israel Deaconess, Harborview, Geisinger
• 100 providers and 20,000 patients
• Access provider notes through patient portal
• Email notification with new note upload
• 2010 to 2011 (access continues)
• Baseline and follow-up surveys
34. Patient and PCP Views of Open Notes after 1 Year
% Agree
Patients PCPs
Takes better care of self 70 28
Better understand health conditions 84 41
Remembers care plan better 84 44
More prepared for visits 73 36
More in control of care 84 49
Take medications better 60 31
Delbanco T et. al. Ann Intern Med, 2012
35. Patient and PCP Views of Open Notes after 1 Year
% Agree
Patients PCPs
Felt offended 2 8
More confusing than helpful 3 21
Worries more 7 42
Concerned about privacy 32 --
Delbanco T et. al. Ann Intern Med, 2012
39. 73 cents, Regina Holliday, Patient Advocate, Artist
http://reginaholliday.blogspot.com
http://www.slideshare.net/ReginaHolliday/vision-14132302#btnNext
40. Voice of the Veteran: What They Want…
Notify me.
Let me see all my health records.
Help me understand my information.
Let me add to the record.
Help me care for myself.
Help me manage my medications.
Help me manage my appointments.
Help my family caregivers help me.
Help me connect with other Veterans.
Make it easy for me to send you information.
Let me share my information outside the VA.
44. “As younger generations embrace
technology, one of the oldest tools in
medicine, the doctor’s note, is in its
infancy of reform.”
TW Feeley and KI Shine,
Annals of Internal Medicine, 2011
On this transformational journey, VA’s primaryfocus is patient engagement and empowerment. We’ve learned patients and families can and want to participate as active members in their health and their health care.One best way to empower patients as partners on our healthcare teams is to provide them with their own health information – easily and readily.