An interactive preventive health record iphr to promote patient centered preventive care
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An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Preventive Care. Alex Krist MD MPH, Steven Woolf MD MPH, Daniel Longo ScD, Stephen Rothemich MD MS, Robert Johnson PhD, Eric Peele (RTI International), William Kerns MD, John Loomis, Gary Matzke PhD ahkrist@vcu.edu.

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An interactive preventive health record iphr to promote patient centered preventive care l.jpg

An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Preventive Care

Alex Krist MD MPH, Steven Woolf MD MPH,

Daniel Longo ScD, Stephen Rothemich MD MS, Robert Johnson PhD, Eric Peele (RTI International),

William Kerns MD, John Loomis, Gary Matzke PhD

ahkrist@vcu.edu


Personal health records phrs l.jpg
Personal Health Records (PHRs) Patient-Centered Preventive Care

  • High perception of value – 79% of Americans believe a PHR could provide major benefit in managing health

  • High interest – 47% of Americans expressed interest in using an online PHR

    …BUT only 2.7% of adults have an electronic PHR

2008 Markel Foundation


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Specific Aims Patient-Centered Preventive Care

  • To evaluate whether an invitation from a patient’s primary care clinician to use the IPHR (versus usual delivery of preventive care) will result in:

    • Increased delivery of age and gender USPSTF recommended clinical preventive services;

    • Use of the IPHR;

    • Increasedshared decision-making for preventive services; and

    • Improvedclinician-patient communication about preventive needs.


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Study Design Patient-Centered Preventive Care

  • AHRQ (R18), patient centered care HIT initiative

    (R18 HS17046- 01)

  • Randomized controlled trial

  • 8 practices using a common EMR (Touchworks)

  • 5500 patients

    • 2750 mailed an invitation to visit My Preventive Care

    • 2750 control patients receiving usual preventive care

  • EMR data and postal survey to measure increase in patients receiving recommended preventive care


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Preventive Services Addressed Patient-Centered Preventive Care

Diabetes screening

Osteoporosis screening

Tetanus vaccination

Influenza vaccination

Pneumococcal vaccination

Diet

Exercise

Smoking

  • Colon cancer

  • Prostate cancer

  • Breast cancer

  • Cervical cancer

  • Chlamydia screening

  • Hypertension screening

  • Hyperlipidemia screening

  • AAA screening

  • ASA chemoprophylaxis


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MPC Development Patient-Centered Preventive Care

  • Created website

    • Two rounds of usability testing

  • Streamlined data input

    • 11 or 12 health risk assessment questions

  • Linked to EMR

    • ODBC to trigger 8 stored procedures

    • 167 EMR data elements: demographics, vitals, orders results, management plans, medications, and immunizations

    • Ensured security and privacy


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MPC Development (cont) Patient-Centered Preventive Care

  • Created and programmed modifiable clinical decision support logic based on USPSTF recommendations

    • Supplemented with JNCVII, NCEP, ADA, 2005 Dietary, and ACIP guidelines

  • Wrote tailored messages

    • 391 individual messages

    • 244 trillion or 292 quadrillion unique combinations

  • Identified educational links and decision aids

  • Created patient email and clinician EMR reminders


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Doctor Summary / Reminder Message Patient-Centered Preventive Care


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My Preventive Care Patient-Centered Preventive CareUse

After 2 mailings, 356 (13%) patients have used the system


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Comparative PHR Use Patient-Centered Preventive Care

Health Aff. 2009: 28(2): 334-44


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User Characteristics Patient-Centered Preventive Care

  • 78% of patients had a wellness or chronic care visit in the past year

    • 32% Wellness visit / 46% Chronic care visit

  • Co-morbidities were common

    • 9% Diabetes - 46% Hyperlipidemia

    • 5% Cancer - 39% Hypertension

    • 12% Coronary artery disease


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Preventive Care Needs Patient-Centered Preventive Care

  • Users are up-to-date with 53% of preventive care

  • Only 2.2% of users are up-to-date on all services

  • Not up-to-date users need an average of 4.6 services


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Patients Up-to-Date With Care Patient-Centered Preventive Care


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Patients Up-to-Date With Care (cont) Patient-Centered Preventive Care


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Impact of MPC Patient-Centered Preventive Care

  • Clinician summary led practices to

    • Update 59% of patient’s medical records

    • Contact 84% of patients

      • Schedule a wellness visit for 27% of patients

      • Schedule a chronic care visit for 17% of patients

      • Get a specific service for 19% of patients

  • … we’ll see if My Preventive Care increases delivery of preventive care


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Concluding Thoughts Patient-Centered Preventive Care

  • Almost no one is up-to-date on everything

  • IT needs for prevention are unique and robust

    • Current HIT language is disease-based

    • Need longitudinal perspective (episodes of care)

  • An interactive PHR can enhance clinician-patient communication

  • PHRs and prevention could serve as the backbone for a national health information system

    • The patient is the constant throughout care

    • Everyone needs prevention


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Thank You For Your Time Patient-Centered Preventive Care… Any Questions?


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