Health Literacy, eHealth, and Communication Putting the Consumer First: Workshop Summary (2009) / Chapter Skim
Currently Skimming:
4 Outcomes and Challenges of eHealth Approaches: Panel 2
4 Outcomes and Challenges of eHealth Approaches: Panel 2
Pages 47-72
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 47... ...
originally designed to engage a very vulnerable population -- migrant and seasonal farm workers -- in their own health care through the use of a personal health record. It was later expanded to include other vulnerable populations such as the homeless, those with special needs, women, and children.
|
From page 48... ...
Additionally, it serves as an affordable electronic health record for small clinics. When the MiVIA pilot project started in 2003, it had a goal of enrolling 50 migrant workers.
|
From page 49... ...
FIGURE 4-1 Patient dashboard. SOURCE: Solomon, 2008.
|
From page 50... ...
MiVIA is currently working with two electronic medical record companies to test this feature. MiVIA also has a complete audit-and-edit trail with date and time stamping.
|
From page 51... ...
The clinician portal features an alphabetical list of individual clinicians or clinics, and patient lists by organization. Access to patient records is with the owner's permission only.
|
From page 52... ...
In the Finger Lakes region of New York MiVIA is working with five clinics, three voucher sites, and an integrated network and is involved in telemedicine. Hospitals that join MiVIA use it as a method for health information exchange between local physicians' offices, their patients, and the hospital.
|
From page 53... ...
Solomon concluded with a vision for the future of MiVIA and other personal health records. In that vision, these tools make it possible for both physician and patient information to be sent directly to the PHR from any electronic health record; there are condition-specific modules for self management; access to critical information is available 24 hours a day, 7 days a week; and the tools have the ability to bridge language barriers between patients and providers.
|
From page 54... ...
Whatcom County had been very much interested in designing a patient-centered health care system. Development of a user-centered electronic health record, the Shared Care Plan, fit well with the activities of the County.
|
From page 55... ...
The idea behind the goal is that if patients could be encouraged to use the Shared Care Plan, even if they did not understand everything they encountered, not only would their health literacy increase but, if their Shared Care Plan was up to date, they would be in a good position to deal with any issues that might arise in their health care. There are currently more than 1,400 Shared Care plans in Whatcom County.
|
From page 56... ...
In terms of scope, for example, even though survey after survey has shown that the thing patients most want to be able to do is refill their medications online, and even though project designers knew it was a high priority for patients, the decision was made to not include that in the personal health record. That decision was made because the task was too large to accomplish for every single health organization in the community, and the Shared Health Plan is a community-wide resource.
|
From page 57... ...
When this was done, it was found that patients' tools are very different from the tools one might build for clinicians and health care professionals. Finally, the design work focused on how to support the tasks that were identified, rather than making up the tasks that one thinks patients should be doing.
|
From page 58... ...
As in the case of MiVIA discussed earlier, the wallet-sized card provided with the Shared Care Plan is valued by both patients and their health care professionals. The card provides a concise summary of some of the most pertinent information in the personal health record and can be easily printed.
|
From page 59... ...
This is a way to group all the community clinicians together whom the patient has not explicitly listed on the care team. By granting community clinicians access to the records, the patient is saying that anyone who needs to access the Shared Care Plan in an emergency may have access.
|
From page 60... ...
60 HEALTH LITERACY, eHEALTH, AND COMMUNICATION FIGURE 4-3 Care team members. SOURCE: Gauthier, 2008.
|
From page 61... ...
The Shared Care Plan was developed specifically for a chronic-disease population. Once it was turned into a more general personal health record the target audience expanded and the need for meeting patients at their own knowledge level increased.
|
From page 62... ...
Patients also expected to be able to log in to the system and immediately have all of their health care records electronically available for them to download into their personal health record. But as Marchibroda mentioned, only a small percentage of physicians use electronic health records.
|
From page 63... ...
Hundreds of people all over the world have downloaded the code base and the documentation guide. One question PeaceHealth staff is currently pondering is how its patient portal should interact with the Shared Care Plan and other PHRs.
|
From page 64... ...
. More people now go online for health information every day than visit a doctor, which is what Susannah Fox of the Pew Internet and American Life Project referred to as the "Dr.
|
From page 65... ...
The Center for Information Therapy took part in a project that observed how clinicians and patients use HIT to advance patient education and to make better use of HIT tools. Time was spent in a wide variety of settings -- small practices with one or two physicians, for example, multi-specialty groups, and in integrated delivery systems. About half of the time was spent in federally qualified community health centers.
|
From page 66... ...
The problem is that facilities frequently do not plan in advance to buy smartcard readers when they buy their computers. Similarly, many facilities are implementing electronic health records without thinking about the portal access.
|
From page 67... ...
The challenge will be to involve patients. Gauthier responded that in the PeaceHealth project participating clinics were often the first ones to introduce the concept of the Shared Care Plan and its personal health record to patients.
|
From page 68... ...
This does not mean that the various facilities do not have their own charts, but all the information relevant to the member is stored in the MiVIA personal health record. The same participant asked what the repercussions are regarding reimbursement and revenue streams for using these electronic tools, especially for the providers who are providing clinical care.
|
From page 69... ...
Gauthier added that there are definitely opportunities for standardizing personal health records, but there will always be a need for segmentation. For example, a patient could take an activation quiz to find out where he or she is on the health literacy scale and then be prescribed a certain type of PHR based on how health-literate that patient is.
|
From page 70... ...
The idea of using promotores or community health workers as educators is a good one which seems to work well. There are other resources that can be deployed as well, such as librarians and other ancillary health professionals.
|
From page 71... ...
Patient navigators or student health ambassadors are an important tool. Seidman said that working with promotores and community health workers to train people in the use of the Internet also creates other social and employment opportunities.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.