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7 Digital Health and Primary Care
Pages 225-258

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From page 225...
... For routine use in primary care, technology has not fundamentally expanded beyond electronic health records (EHRs) , registration systems, and patient portals created two decades ago.
From page 226...
... Conversely, overuse occurs when information is not transferred, as clinicians may repeat recent tests or procedures from elsewhere. Adding to this, people have limited access to their own health information through patient portals that present information in medical language.
From page 227...
... 2 in 1996, to promote and support health information exchange. However, HIPAA has largely been a barrier to information exchange and is badly in need of updating (NCVHS, 2019)
From page 228...
... It did not provide a way to incentivize or force EHR vendors to change and improve their systems, 3  A certified EHR product has received certification from the Office of the National Co ordinator for Health Information Technology that the system supports all of the required Meaningful Use functionalities (2020)
From page 229...
... Myriad health information resources are easily accessible to the consumer via the Internet, mobile applications, and patient-facing technologies (e.g., patient portals) that allow people to more easily interact directly with their clinicians.
From page 230...
... Population Health Population health, an essential component of effective primary care that is most enabled by digital health and currently neglected, encompasses strategies to make the delivery of evidence-based care easy. It shifts care from being reactive (e.g., someone has to schedule an appointment)
From page 231...
... . Other population health tools can include geographic information systems (GISs)
From page 232...
... 6 defines an interoperable HIT system as one that (a) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information tech nology without special effort on the part of the user; (b)
From page 233...
... For example, Draft 2 of the Trusted Exchange Framework and Common Agreement, released in April 2019, "outlines a common set of principles, terms, and conditions to facilitate interoperability and information exchange across disparate HIE platforms and help enable the nationwide exchange of electronic health information" (NASEM, 2019, p.
From page 234...
... While it may be feasible to train clinicians to use an EHR or other digital health tool, patient-facing systems need to be "plug and play": easy to access or download, intuitive to use, and understandable even for those with lower health literacies. Adding to this, some health information can be sensitive (e.g., self-reported substance use or sexual history)
From page 235...
... or when (e.g., automated access offered at age 13) to grant adolescents independent access to their own data and an ability to communicate with the care team, and EHRs largely are not designed to allow care teams to filter sensitive versus non-sensitive data to allow both parents and teens to have access to the EHR simultaneously, without jeopardizing either teen confidentiality and privacy or parental access to important, non-sensitive health information (Society for Adolescent Health Medicine et al., 2014)
From page 236...
... An overarching principle is that systems should aggregate information and make that information usable by clinicians, patients, families, and community members to carry out the core functions of primary care, including promoting access to care, coordinating care, ensuring care is integrated across settings, and allowing for high-quality population health (see Figure 7-1)
From page 237...
... These components include care access, coordination, integration, and safety and population health support. Digital health should be easy to use for all team members and care-seekers.
From page 238...
... This will promote trust and relationships between patients and their interprofessional care teams, increasing the likelihood of effectively co-created care plans, consistent engagement with the health care system, engagement with community resources, and improvement in health outcomes. Digital health may also have a unique benefit to adolescents.
From page 239...
... These include the decision support and artificial intelligence tools that are already being implemented to support interprofessional teams and community partners and sometimes also patient monitoring, engagement, and partnership tools that include activity app integration and virtual support communities. As discussed in Taking Action Against Clinician Burnout, HIT (i.e., digital health tools)
From page 240...
... A major goal of this new health information system should be to allow clinicians to focus on optimizing patient and population health, while adjuvant processes and technologies derive, to the extent possible, the essential business, administrative, and research data necessary to deliver high-value care efficiently and effectively.
From page 241...
... interpret content by applying health information to guidelines to say what it means, and (5) make information actionable to allow people to get care and make changes to improve health and well-being (Krist and Woolf, 2011)
From page 242...
... Only then can digital health tools be fully leveraged to improve communications, increase access to care, and reduce health care disparities. In terms of reducing health care disparities in clinical practice, access to care and culturally appropriate communication are essential starting points.
From page 243...
... applying health information to improve health in ways that promote person-centered care, support care teams, span settings of care, and generally make life easier (see Figure 7-2)
From page 244...
... . Once information is aggregated, automated systems are needed to analyze the information to make it usable by patients, families, and care teams.
From page 245...
... The same tools that collect health information should enable all involved parties to access health information through analytics and tools that promote the ability of patients, families, care teams, and communities to make sense of the available information and take action to improve health. This includes being able to make diagnoses, see what care is needed, deliver care, communicate among team members, coordinate care, and track progress.
From page 246...
... . Nontraditional health care team members will need access to and will generate health information.
From page 247...
... Technology disruption is needed to automate some elements of care delivery through artificial intelligence, chat bots and avatars, and ambient computing. • Coordinate care teams.
From page 248...
... The project then provided opportunities for community members to access health information and technology, in part through a bilingual online health care resource directory with low literacy and culturally appropriate content. With only limited resources, the program reached and trained more than 1,000 community members and providers.
From page 249...
... The linchpin to transforming the marketplace and promoting innovation will be true interoperability, not the checkbox interoperability that exists today. To achieve true interoperability, there must be a common health information database available to all health care clinicians to support data sharing while ensuring local control of the data to ensure security and
From page 250...
... . The report highlighted a distributed architecture, scalability, query distribution, data holder autonomy, and privacy protection as key attributes that would be needed to successfully implement a centralized distributed data network to support health information.
From page 251...
... While relationships, interprofessional care teams, comprehensive care, and health equity are critical elements of effective primary care, the direct evidence about how digital health can best support these functions is still evolving. This understanding will require work that goes beyond the current examination of clinician use of features or decision support tools, or individual logins to health portals or use of secure messages, and a rich, mixed methods, ethnographic research agenda that engages patients, families, interprofessional care teams, and community partners to understand optimal use over time.
From page 252...
... It could be used by any certified digital health vendor to create innovations, and patients could control who has access to their health information. There are several ways this could be achieved.
From page 253...
... 2009. Stimulating the adoption of health information technology.
From page 254...
... Madrid: Health Information Institute. Hughes, L
From page 255...
... 2018. Health information technology continues to show positive effect on medical outcomes: Systematic review.
From page 256...
... Washington, DC: Office of the National Coordinator for Health Information Technology. Phillips, R
From page 257...
... 2017. Increased health information technology adoption and use among small primary care physician practices over time: A national cohort study.
From page 258...
... 2018. A time-motion study of primary care physicians' work in the electronic health record era.


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