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Older adults and accessible EHRs. Juan Pablo Hourcade University of Iowa Accessible EHR Workshop. The Need. Increasing population 14% of US population and rising Heavy use of healthcare system 30% of prescription drugs Many see multiple providers Chances for miscommunication

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Older adults and accessible ehrs

Older adults and accessible EHRs

Juan Pablo Hourcade

University of Iowa

Accessible EHR Workshop


The need
The Need

  • Increasing population

    • 14% of US population and rising

  • Heavy use of healthcare system

    • 30% of prescription drugs

  • Many see multiple providers

    • Chances for miscommunication

  • 14-23% prescribed medications incorrectly

  • Up to 40% don’t take medications as prescribed


Promise of ehrs
Promise of EHRs

  • Reduce mistakes by providers

    • Enable multiple providers to communicate

    • Access full medical records

  • Older adults can take greater control of their health

    • Track health information

    • Get warnings


The challenges
The Challenges

  • Lack of computer literacy

    • Lack of confidence

    • Little understanding of networks, the Internet

    • Moving target

      • Older adults of today are different from those 10 years ago

  • Cognitive decline

    • Fluid intelligence

    • Working memory

    • Learning

    • Ability to filter irrelevant information


The challenges1
The Challenges

  • Perceptual decline

    • Vision problems

    • Hearing problems

  • Motor decline

    • Difficulty using pointing devices


Our experience
Our experience

  • Designing online Personal Health Record software for older adults

    • Older adults enter their health information

  • Usability testing of existing PHR software with older adults

    • Older adults faced great difficulty

  • Participatory design sessions with older adults in retirement community

    • 12 sessions over 3 weeks

  • Additional focus groups with other older adults

  • Field testing with hundreds of older adults to begin later this year


Lessons learned
Lessons learned

  • Older adults want to keep track of a lot of information but want to enter very little

    • Wanted to keep track of >20 items for each medication

    • Only willing to enter about 5

    • Issue with displaying large amounts of information

    • We ask them to enter only most important information


Lessons learned1
Lessons learned

  • Available warnings on medications not written for older adults

    • How to best tell older adults they should not be taking something they are taking

      • They think it’s safe because they’ve been taking it for a long time

      • They wonder why their doctor hasn’t warned them

    • We use a three-level warning system


Lessons learned2
Lessons learned

  • Perceived privacy and security are crucial for adoption

    • Lack of understanding of computer networks

    • Suspicious of how data will be used, who will see it

    • Where does advice come from?

    • Association with a trusted institution helps





Acknowledgements
Acknowledgements

  • This project was supported in part by 1 R18 HS017034-03.  Additional funding was provided by cooperative agreement number 5 U18 HSO16094 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.