1. ETIM-1 CSE 5810 CSE5810: Intro to Biomedical Informatics Mobile Computing to Impact Patient Health and Data Exchange and Statistical Analysis Presenter: David N. Etim

2. ETIM-2 CSE 5810Outline  Introduction  Research Objectives  Mobile Work in Health Care  Electronic Medical Records  Studies on Patient Care  Research Design, Methods, Analysis  Comparison of Studies  Physician-Patient Relationship Effects  Summary

3. ETIM-3 CSE 5810Introduction  Health information sharing between patients and health care providers:  Diagnosis improvement  Increase patient’s understanding  Promotes independent care  Researchers want to educate and empower patients to learn more about health data sharing  Patient-Physician interaction is encouraged, leads to patient education of self-care

4. ETIM-4 CSE 5810 Research Objectives  Compare techniques and experiments in how mobile computing impacts clinical data exchange  How does it affect data analysis?  How is it helpful to patients to view medical records?  View strengths and weaknesses of patient interaction with online medical records  Compare and contrast between different views and information about how medical data is shared

5. ETIM-5 CSE 5810 Mobile Work in Health Care  What exactly is mobile work?  Usage of mobile technologies in varying degrees to accomplish tasks  Mobile work within hospitals is complex and sophisticated  Mobility of resources and individuals are at the center of patient diagnosis, treatment and care  Health care scenarios contain flexibility and work well with information exchange

6. ETIM-6 CSE 5810 Electronic Medical Records  Digital version of a paper chart containing all of patient’s medical history from one practice  Mostly used for diagnosis and treatment  Benefits:  Tracks data over time  Identifies patients due for preventive visits and screenings  Monitors how patients measure up to parameters  Vaccinations, blood pressure readings, etc.  Improves overall quality of care

7. ETIM-7 CSE 5810 Electronic Medical Records  What’s the difference between EMRs and EHRs?  Electronic Medical Records contain standard medical data collected in a provider’s office  Electronic Health Records (EHRs) consists of standard clinical data along with more comprehensive patient history  EHRs are designed to hold and share information from all providers involved  Data can be created, managed, and consulted by providers and staff  EMRs aren’t able to allow a patient’s health record to move with them to other health care providers, hospitals, and vendors

8. ETIM-8 CSE 5810 Studies on Patient Care  Studies done in the area of health data exchange involving mobile computing  Comparison of two studies: 1. Testing Web-based care management of glycemic control using a shared electronic medical record with patients who have type 2 diabetes 2. Assessment of patients using online medical records and impact on patient care and clinical operations

9. ETIM-9 CSE 5810 WEB-BASED CARE MANAGEMENT Study #1

10. ETIM-10 CSE 5810Introduction  Study aimed to improve glycemic control using a care manager  Wagner’s Chronic Care Model  Four Domains:  Self-management support  Delivery system design  Clinical information systems  Clinical decision support  Trial conducted at the University of Washington General Internal Medicine Clinic

11. ETIM-11 CSE 5810 Research Design and Methods  Participants enrolled in a 12-month open, randomized, controlled trial with parallel group design  7,000 patients used in trial  Patients with type 2 diabetes randomly assigned to group receiving online care management  EMR data used to identify potential participants between ages of 18 and 75  Patients excluded from study because of trial criteria  participated in pilot study, have major psychological illness, non-English speaking

12. ETIM-12 CSE 5810 Research Design and Methods  Participants introduced to Web-based program  Encouraged to review online records, send weekly blood glucose readings  Send e-mail updates if necessary  All providers used same electronic medical record  Patient specific reminders for measurement of (GHb)  Patient specific reminders for measurement of Gamma-Hydroxybutyric acid (GHb)

13. ETIM-13 CSE 5810Results  Analysis of outcome included all randomly allocated participants with available outcome data  Primary analysis used linear regression with change in GHb as dependent variable  Trial was designed to have 80% power to locate a difference of 0.5% in GHb concentration  Systolic and diastolic blood pressure, cholesterol levels, and usage of health care services didn’t create differences between groups

14. ETIM-14 CSE 5810 Statistical Analysis

15. ETIM-15 CSE 5810 Statistical Analysis

16. ETIM-16 CSE 5810 ELECTRONIC COMMUNICATION TO PATIENTS Study #2

17. ETIM-17 CSE 5810Introduction  Clinical trial conducted in specialty clinic at University of Colorado Hospital  Patients with Class II or Class III symptoms of heart failure  Project Objectives  Assess how a patient-accessible online medical record affects patient care and clinic operations  Providing patients with secure access to their medical records using the Internet

18. ETIM-18 CSE 5810Intervention  Participants in intervention group were given a username and password for System Providing Access to Records Online (SPARRO)  SPARRO provides a Web interface  Medical record  Educational guide  Messaging system  Patients in control group continues to receive standard care in practice

19. ETIM-19 CSE 5810 Data Collection  Throughout study period, dates were tracked for when patients used SPARRO  If a single participant used a component of SPARRO multiple times on a given day, counted as “patient hit day” for that component  Messages tracked and sent through SPARRO system to providers  Mobile phone messages tracked through review of medical records and logs

20. ETIM-20 CSE 5810Results  The intervention group was higher in adherence compared to being at a lower rate in self-efficacy  more emergency department visits

23. ETIM-23 CSE 5810 Comparison of Studies  Both studies and others previously have demonstrated improvements in adherence and satisfaction with physician-patient interaction  Patient-accessible medical records increased workload  Great efficiency in both techniques in systems  Patients learned that data is not up to date unless having clinical encounters or involved in lab studies  Electronic messaging does not substitute for phone communication

24. ETIM-24 CSE 5810 Effects of Physician-Patient Interaction  Physician-patient relationship may be an important influence on patients’ health outcomes  Patients either have positive or negative reaction to how physicians lead their treatment  Sense of comfort  Optimism/Pessimism about treatment  Functioning better from physiological and behavioral aspects  More information collection and conversation relate to better health statuses

25. ETIM-25 CSE 5810Summary  Technology is more capable than ever for providing patients with access to online records  Medical records are more convenient accessed through the Web, mobile devices, mostly helpful for patients  Patients review records multiple times and have assistance of others for comprehension and progress  Disruption is little to none for access granted to patients while continuing clinical operations