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ileana balcu

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March 28, 2013 9:02 am

The portals that the patients are given their data through are of very low quality, non user-friendly and usually unattended – I have seen more then one practice that didn’t answer the secure messages. The ones I had access to were implemented to check the boxes required to pass the meaningful use requirement rather than help clinicians and patients. The clinicians and patients are at the bottom of the ladder in this with so little say in the game.

Maybe one solution would be to survey clinicians and patients on how the tools they are given are working. Have the EP/EH pay a few patients to give feedback on the system. Have all clinicians give feedback on the tools and suggestion on priorities.

Have a mandated quality improvement effort for the HIT tools.

Don’t… more »

…ask for more, ask for quality, usability, and end user (clinician and patient) satisfaction.

It is very difficult for patients to complain to their doctors – we see how stressed out they are and how the systems do not help. A direct line between (certain, super-user) patients and the IT Department would be very useful. « less

March 28, 2013 9:16 am

The tools that the patients have are low quality. Hospitals can force physicians and nurses to use them, but they can’t force patients. The key is to improve the tools.

Maybe ONC can help by getting direct patient feedback on the tools used and forcing vendors/ HIT departments to resolve the issues: usability and quality of data.

On the Pledge program for example, allow patients to feedback how the promised Blue Button works for them. In amazon.com style: rating plus comments.

Maybe this feedback should be an integral part of the Blue Button download? Once you tried to download you are asked how that worked for you.

March 29, 2013 9:10 am

For some hospitals/providers, I think this might be better indeed, but for a lot of others, just getting them to be aware of the things that IT should do: patient registries, giving patients their data, secure messaging, etc. needed to be done. Probably some hospitals/providers can do better without the handholding, while others need some nudging.

A non-punitive, consultancy as needed on a case by case basis would be nice. If you’re doing well and have good plans to move forward, we just learn from you and go to someone else!

March 28, 2013 12:55 pm

Welcome to Planning Room, ileana balcu. Thank you for your comment. ONC is concerned about the different ways in which the government can act to both improve HealthIT tools and to shift both patient and provider attitudes towards HealthIT. You can read more about these issues and share any other ideas you have, here.

March 28, 2013 10:13 am

In many ways I think ONC could help by getting out of the way. Many features we were intending to implement, based on patient feedback, had to be delayed in order to implement functionality in lign with the MU program.

March 29, 2013 12:58 pm

Hello Ileana balcu and thanks for your comment. It seems that you are saying that certain providers will need to be educated about various ehealth tools before they will feel comfortable using these tools. Do you think that the non-punitive consultancy will help enhance these providers’ ability to give their patients better access to their records?

March 28, 2013 6:32 am

SUGGESTION – shift the focus away from data and information towards using health IT to strengthen the RELATIONSHIP AND OUTCOMES between everyone on the care team – including patients and their care givers. The “r” in EMR should be “relationship” not “record”

Example: I both worked at and received my care at Group Health Cooperative (owned by its 620,000 patient/members)and we have had an EHR since 2005 and over 60% of all members use it to not only download data like labs but to stay connected to our care team via a patient portal, mobile apps, email etc combined with new roles on the health care team like 24/7 consulting nurses, and workflows that include the patient at the design stage vs after the fact (engagement)

The goal isn’t… more »

…data but tool that allows connection anytime anywhere to the health care team.

PRO’S CON’S
Many people discredit the group health mayo models because they are integrated systems (docs on salary and investments from health IT are kept in house vs going out the door to the insurance co’s) but this works in the “private” sector as well

PERSONAL EXAMPLE -After I left GHC I got my care via the University of Washington (uses the same EHR as Group Health) I once started to get sick a few hours before I had to fly out of town on a business trip. I called the after hours consulting nurse and she pulled up my records, authorized an RX that was sent to a national chain in Boston, when I arrived I picked it up, the next morning my doctor’s office nurse called me up to check on me. The entire event happened on the phone and online and took my needs and workflow into account and the tech enabled it.

DATA OR REFERENCES – Group Health Cooperative started their EHR implementation by giving patients access first to their clincial records and online services and is now one of the top 10 ranked health plans in the US and the top ranked in the region – http://www.ghc.org/news/news.jhtml?reposid=/common/news/news/20120920-quality.html

Critical to their success was using healthIT to identify other areas that needed to change and they also shifted to the medical home model in the last few years. https://www1.ghc.org/html/public/features/20101001-medical-home.html “For every dollar Group Health invested, mostly to boost staffing, it recouped $1.50.”

CONCLUSION HealthIT wasn’t the sole solution but it was a critical foundational component to this change and the benefits are clear both in terms of quality, patient satisfaction and provider retention. It goes way beyond merely sharing information and data and is instead a core backbone of a health care system that meets the six pillars and 3 aims of a learning health care system of the future – foundational to that is patient centered design and care (vs after the fact consumer engagement) « less

March 28, 2013 8:07 pm

We need to have a wider sense of what data is “health information”. For example, current plans seem to exclude dental health, chiropractic, non-medical psychological services, health care modalities for people from non-Western cultures, and personal practices such as exercise, diet, work habits, sleep, or family life. Restricting data to a limited or profession-parochial view limits its utility for patients and may prevent care providers from knowing key facts.