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The Emerging Role Of Online Communication Between Patients And Their Provider. Steven Katz M.D. M.P.H. Associate Professor Departments of Medicine and Health Management and Policy University of Michigan. Agenda. Motivation Current online landscape Challenges Early Experiences - PowerPoint PPT Presentation
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The Emerging Role Of Online The Emerging Role Of Online Communication Between Communication Between
Patients And Their ProviderPatients And Their Provider
Steven Katz M.D. M.P.H. Steven Katz M.D. M.P.H.
Associate ProfessorAssociate Professor
Departments of Medicine and Departments of Medicine and
Health Management and PolicyHealth Management and Policy
University of Michigan University of Michigan
AgendaAgenda
MotivationMotivation Current online landscapeCurrent online landscape ChallengesChallenges Early ExperiencesEarly Experiences PrognosisPrognosis
Motivation Motivation
PatientsPatients Frustrated with between-visit access Frustrated with between-visit access Are increasingly connected onlineAre increasingly connected online
Providers Providers Are frustrated with between-visit Are frustrated with between-visit
communicationcommunication Current modes are burdensome, fragmented Current modes are burdensome, fragmented
and inefficient and inefficient There is enormous mismatch between There is enormous mismatch between
communication mode and taskscommunication mode and tasks
Why web is rightWhy web is right
It is asynchronousIt is asynchronous It has enormous reachIt has enormous reach It is robustIt is robust
exchange and store informationexchange and store information provide servicesprovide services connect peopleconnect people
Communication can be tracked, managed, Communication can be tracked, managed, documented, and evaluateddocumented, and evaluated
It is secureIt is secure
Great ExpectationsGreat Expectations
The Internet will have a profound effect on The Internet will have a profound effect on the practice and business of medicine. the practice and business of medicine. Physicians, eager to provide high-quality care Physicians, eager to provide high-quality care and forced by competition to offer online and forced by competition to offer online services, will introduce e-mail and patient-services, will introduce e-mail and patient-friendly Web sites to improve administrative friendly Web sites to improve administrative services and manage common medical services and manage common medical conditions. Patients will identify more health conditions. Patients will identify more health information online and will take more information online and will take more responsibility for their care. The responsibility for their care. The doctor/patient relationship will be altered...doctor/patient relationship will be altered...
Jerome Kassirer. Health Affairs 2000
Trends in internet useTrends in internet use11
Type of use 2000 2002
E-mail/IM 55 62
Browsing 55 54
News 38 37
Information 36 33
Shopping 34 32
Any 66 71
1. UCLA internet report 2003 http://ccp.ucla.edu/pages/InternetStudy.asp
UCLA Center for Communication Policy, 2003
Digital Divide Digital Divide
Source: Pew Internet and American Life Surveys
Message Volume* Message Volume* University of Michigan Primary Care 2002University of Michigan Primary Care 2002
Time period
Physicians (N=120)
Email Phone
1 12 76
2 14 80
3 13 81
4 13 82
5 14 71
* weekly patient messages per 100 scheduled visits
ChallengesChallenges
PatientsPatients Lack experienceLack experience Digital divide Digital divide
ProvidersProviders WorkloadWorkload Uncertain value of online communicationUncertain value of online communication Little consensus about communication management Little consensus about communication management
Organization Organization Business model/ROIBusiness model/ROI Building and integrating online communication tools Building and integrating online communication tools No road mapNo road map
Dr. Katz:
I am a patient of yours through Yellow Care Network. Generally, I am seen by Dr. Rufus T. Firefly but I have not been able to contact him nor have I been able to get an appointment to see any doctor in the Internal Medicine clinic. When I called I was simply told there were no available appointment times. I am currently experiencing intense pain when I urinate as a result of a bladder infection and would very much like to get a antibiotic to start treating this. The symptoms are constant urge to urinate and painful urination followed by blood in my urine at the end of the urination. Can you please facilitate an appointment to see a doctor in your staff or prescribe an antibiotic. I am not taking any other medicines at this time.
various news:
1) referral to Diabetes Clinic DOES NOT SHOW UP on their records yet (as
of Friday 01/09)... was seeing Dr. Sugar
2) Am re-enrolled in Stop Smoking Program (she'll use your old referral)
but WILL NEED anti-depressant script soon
3) scripts for imdur (120mg & 30mg) WORKED at pharmacy...
4) referral to Eye Clinic OK... appointment set
5) referral to Cardiology Clinic OK... Dr. Heart said "...see you in a
year..." and "...are 95th percentile of her patients (for exercise
level, walking 3-5 miles /day)". Walked 11 miles last Monday=01/12
6) next apptmt with you(??) 04/02
Thank You
Components of a patient portalComponents of a patient portal
Service-related featuresService-related features Medication renewals, scheduling, forms, Medication renewals, scheduling, forms,
registration/billingregistration/billing A clinical communication toolA clinical communication tool
Secure messagingSecure messaging A patient health recordA patient health record
Populated from provider and patient data sourcesPopulated from provider and patient data sources Medical recordMedical record Patient: current meds, immunizations, health Patient: current meds, immunizations, health
status information (e.g. blood sugar or blood status information (e.g. blood sugar or blood pressure log)pressure log)
Yellow brick roadYellow brick road
Develop business modelDevelop business model Build or buy communication toolsBuild or buy communication tools Develop roll-out strategy Develop roll-out strategy
Map relationships and workflowMap relationships and workflow Develop rules of engagement and exchangeDevelop rules of engagement and exchange Develop education and promotion strategyDevelop education and promotion strategy Allocate provider effort during rolloutAllocate provider effort during rollout Evaluate processes and outcomesEvaluate processes and outcomes
Emerald CitiesEmerald Cities
Start-up ExperiencesStart-up Experiences
Patient uptake is slowPatient uptake is slow Patient online gapPatient online gap Resource offsets are uncertainResource offsets are uncertain Clinician and staff acceptance is highClinician and staff acceptance is high “ “Cultural Divide” between patients Cultural Divide” between patients
and their cliniciansand their clinicians
Disagree (%)
Email Web
Patients 47 33
Physicians 14 12
PatientPatient11 and physician attitudes towards role of and physician attitudes towards role of clinic staff in e-communicationclinic staff in e-communication
Patients: “ OK for clinic staff to handle my [e-mail/Web] messages for my physician”
Physicians: “OK for the clinic staff to handle patient [e-mail/Web] messages for me”
1. Patients who reported regular use of e-mail
0
10
20
30
40
50
60
70
80
90
% P
refe
rrin
g M
od
e
0
10
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40
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60
70
80
90
Visits
Phone
Online
Physicians
Patients
Cholester
oltest
Anxiety
orsadness
Rx side
effect
Back
pain
Abnorm
alPap/
PSA
Breast
ortesticul
ar
Sore
throat
Norm
al
PapPSA test
Prognosis: GoodPrognosis: Good
Patient facility and access is growingPatient facility and access is growing increase in broadband accessincrease in broadband access
Better online communication toolsBetter online communication tools Better clinical data systemsBetter clinical data systems Beginning of the “J curve” Beginning of the “J curve” Uncertain business modelUncertain business model