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The Emerging Role Of Online The Emerging Role Of Online Communication Between Communication Between Patients And Their Provider Patients And Their Provider Steven Katz M.D. M.P.H. Steven Katz M.D. M.P.H. Associate Professor Associate Professor Departments of Medicine and Departments of Medicine and Health Management and Policy Health Management and Policy University of Michigan University of Michigan

The Emerging Role Of Online Communication Between Patients And Their Provider

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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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Page 1: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 2: The Emerging Role Of Online Communication Between  Patients And Their Provider

AgendaAgenda

MotivationMotivation Current online landscapeCurrent online landscape ChallengesChallenges Early ExperiencesEarly Experiences PrognosisPrognosis

Page 3: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 4: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 5: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 6: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 7: The Emerging Role Of Online Communication Between  Patients And Their Provider

UCLA Center for Communication Policy, 2003

Page 8: The Emerging Role Of Online Communication Between  Patients And Their Provider

Digital Divide Digital Divide

Source: Pew Internet and American Life Surveys

Page 9: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 10: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 11: The Emerging Role Of Online Communication Between  Patients And Their Provider

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.

Page 12: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 13: The Emerging Role Of Online Communication Between  Patients And Their Provider

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)

Page 14: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 15: The Emerging Role Of Online Communication Between  Patients And Their Provider

Emerald CitiesEmerald Cities

Page 16: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 17: The Emerging Role Of Online Communication Between  Patients And Their Provider

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

Page 18: The Emerging Role Of Online Communication Between  Patients And Their Provider

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Page 19: The Emerging Role Of Online Communication Between  Patients And Their Provider

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