O VERVIEW Identify the origin of patient informatics and the role of the internet in patient education. Learn about the evolution and roles of secure email and virtual visits as a new form of patient- doctor communication.
I NTRODUCTION Patient Informatics is a new aspect of Medical Informatics. Aims to empower the patient. Patients expect many of the modernization that has occurred in other domains. ATM machines, for example, provide cash within minutes regardless of your location on the planet. This innovation required the re-engineering and the acceptance of universal standards.
D ESIRED I NFORMATICS F EATURES Email reminder of upcoming appointments 77% Schedule medical appointments online 75% Communicate with clinicians via email 74% Receive test results via email 67% Access to their electronic health record 64% Home monitoring that would transmit information to the doctor’s office 57% Source: Medical Informatics: Practical Guide for the healthcare Professional 2007
T HE I NTERNET FOR P ATIENT M EDICAL E DUCATION (1) The internet has become the main medical resource for both patients and medical professionals. In those who use the internet, all age groups admit to searching for health information. Women and students are among the most likely individuals to seek health information. Among the most frequently searched topics are: Specific disease Medical treatment Diet and Nutrition Exercise Medication issues including Alternative Medicine Depression
T HE I NTERNET FOR P ATIENT M EDICAL E DUCATION (2) Studies has shown that patients are no longer automatically willing to accept the opinions of their doctors. An American poll showed that 57% of patients discussed their internet searches / finding with their clinician and that 52% of patients searched the internet AFTER talking with their clinician. In that study, 89% reported that they were happy with the information that they found on the internet. Suggests confidence in the internet as the new health library. Excellent medical websites exist, however, many search can yield low quality, non-evidence based answers. Particularly when personal web sites offering patient experience are used.
R EASONS FOR I NCREASED I NTERNET U SE (1) Healthcare is becoming more patient-centered. Quality patient education sites are in abundance. In general, most companies (non-medical) are targeting the internet to promote their products and services. The increasing use of medical blogs, podcasts and wikis as part of the web 2.0 movement.
R EASONS FOR I NCREASED I NTERNET U SE (2) Patients are becoming more impatient about waiting for clear information. Baby boomers are well educated and expect high quality care for their conditions. Computers and broadband are becoming ubiquitous. Patients are receiving less face time with their doctors causing them to turn to the web.
O NLINE P ATIENT E DUCATION W EBSITES (1) WebMD > 30 million hits each month. Extensive health library New Treatment and drug information available. Provides a symptom checker. Daily email newsletter customized to patient concerns Negative – some commercial influence.
O NLINE P ATIENT E DUCATION W EBSITES (2) Revolution Health Personal Health Records Disease Information Forums Health Calculators Physician finder (USA) Symptom Calculator
O NLINE P ATIENT E DUCATION W EBSITES (3) Medline Plus Free Patient education site. Developed by National Library of Medicine and the National Institute of Health. Links with USA respected institutions such as the Mayo Clinic. Ranked Number 1 health information news website. 700+ health topics Search results include quality references. Drug information Health encyclopedia and dictionary 165 tutorials Video of surgical procedures Health News and Nationwide trial information.
Web Portals are web based programs that patients access for health related services. Can offer: Online registration Repeat prescriptions Test Results Electronic Visits Appointments Secure messaging Patient logs for vital signs and tracking other health data.
P ATIENT, D OCTOR I NTERACTION Mobile Device Patient PC based Record Paper based records Doctor Email E-visits EHREHR EHREHR Portal
P ATIENT F EEDBACK NHS Connecting for Health (Week 6) survey were asked: “I think that having my health information online would” 71% said “clarify doctor instructions 65% said “prevent medical mistakes 60% said “change the way I manage my own health 54% said “improve my quality of care Patient Web Portals are also expected to help with fewer ‘no shows’ resulting in saved costs and more throughput of patients.
S ECURE P ATIENT -P HYSICIAN E MAIL AND E- VISITS (1) In the UK and USA the vast majority of people now have access to email. Nevertheless, few primary care practices routinely use email to communicate with patients. 80% of patients who use the web would like to use this medium for commutating with their doctor (Harris 2005) In the USA, only 24% of doctors use email to communicate with patients. The figure is much lower in the UK.
S ECURE P ATIENT -P HYSICIAN E MAIL AND E- VISITS (2) Furthermore, 41% of surveyed patients found it frustrating to physically visit their GP when the outcome could have been communicated over the phone or via email. Simply put, the patients’ enthusiasm is not shared by clinicians. Reasons include: Liability Privacy issues Staff not being trained Feeling face-to-face meetings are better.
S ECURE P ATIENT -P HYSICIAN E MAIL AND E- VISITS (3) Email appears to hold several benefits. Communication is asynchronous – doctors can answer requests at their convenience. Overhead is less for email compared to phone messages and email are self documenting. Patient tend to lose less time from work. Disadvantages include: Inability to physically examine patients. Potential for communication / context errors. Possible slow response times Security issues The possibility of being overwhelmed by patient emails!
S ECURE P ATIENT -P HYSICIAN E MAIL AND E- VISITS (4) E-visits are ‘electronic’ patient – doctor interaction using secured messaging services rather than email. Advantage of much better security and privacy both parties present throughout the consultation Both must log on using secure passwords. Price Water House survey showed that 20% of outpatient visits could be eliminated by using e-visits. Disadvantage of prolonged consultation and doctors needing to provide answers on the spot.
S ECURE P ATIENT -P HYSICIAN E MAIL AND E- VISITS (5) Several funded reports have indicated that email and e- visits do not negatively impact of doctor’s time. Furthermore, patients are less likely to miss work and have reported that consultations online only take minutes (10-15mins). There is a consensus that minor complaints / ailments can be dealt with more efficiently on-line, therefore freeing up time for face-to-face consultations with more unwell patients. Also, if a patient and doctor conduct an online visit / consultation then even if a face-to-face follow up meeting is required the doctor will have the advantage of knowing why the patient is there thus saving time.
S UMMARY Many patients are shifting towards the desire for more user-friendly healthcare systems. They want rapid access to medical answers via the Internet and rapid access to their health record through web portals. Finally, they are keen to communicate with their doctors via secure email or e-visits. It will take time to see if patients and clinicians can align to make this a reality.