crotty engaging patients in new ways from open notes to social media

Engaging Patients in New Ways: From OpenNotes to Social Media

Bradley H Crotty, MD, MPH, FACP

Division of Clinical InformaticsBeth Israel Deaconess Medical Center

AMDIS Fall Symposium9/30/2013

Current Challenges

• Information Asymmetry• Integration• Reinforcement

Two Possibilities

• OpenNotes – Sharing Clinicians’ Notes With Patients• Social Media – Connecting with Patients

• Does OpenNotes help patients become more engaged in their care?

• Is OpenNotes the straw that breaks the doctor’s back?

• After 1 year, will patients and doctors want to continue?

OpenNotes Timeline

2010 2011 2012 2013

OpenNotes Demonstration

PCPs at BIDMC, Geisinger, Harborview (UW)

Implementation

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Data Collection Pol

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Among Patients with Notes (visits)

• 84% of BIDMC patients opened at least one of their notes

• 82% GHS patients opened at least one note

• 47% of HMC patients opened at least one note

• 20-42% of patients reported sharing notes with others

Reports from Patients Post Intervention

• 70-72% of patients across the 3 sites reported taking better care of themselves

• 77-85% reported better understanding of their health and medical conditions

• 76-84% reported remembering the plan for their care better

• 69-80% felt better prepared for visits

• 77-87% felt more in control of their care

Reports from Patients Post Intervention

• AND…

among those taking medications, 60-78% reported “doing better with taking my medications as prescribed.”

Reports from Patients Post intervention

• 26-36% had privacy concerns

• Few patients said reading notes made them• Worried (5-8%)• Confused (2-8%)• Offended (1-2%)

PCPs’ Main ConcernsOpenNotes impact on patients

Pre -intervention %BIDMC / GHS / HMC

Post-intervention %BIDMC / GHS / HMC

PCPs think patients who read their notes will:

Find notes more confusing than helpfulWorry more

Feel offended

48 / 54 / 43

50 / 58 / 45

33 / 8 / 29

13 / 21 / 12

15 / 42 / 12

18 / 8 / 2

PCPs’ Main Concerns OpenNotes impact on workflow

Pre-intervention %

BIDMC / GHS / HMC

Post-intervention %

BIDMC / GHS / HMC

Visits significantly longer

More time addressing patient questions outside of visitsMore time writing/editing/ dictating notes

…and the volume of electronic messages from patients did not change

23 / 32 / 21

49 / 45 / 34

46 / 36 / 34

3 / 5 / 0

8 / 0 / 0

21 / 14 / 0

Weeks after my visit, I thought, "Wasn't I supposed to look into something?“ I went online immediately. Good thing! It was a precancerous skin lesion my doctor wanted removed (I did).

In his notes, the doctor called me "mildly obese." This prompted immediate enrollment in Weight Watchers and daily exercise. I didn't think I had gained that much weight. I’m determined to reverse that comment by my next check-up.

If this had been available years ago I would have had my breast cancer diagnosed earlier. A previous doctor wrote in my chart and marked the exact area but never informed me. This potentially could save lives.

It really is much easier to show my family who are also my caregivers the information in the notes than to try and explain myself. I find the notes more accurate than my recollections, and they allow my family to understand what is actually going on with my health, not just what my memory decides to store.

Patients’ Comments

Implementation & Policies

• For Consideration

• Types of Notes• Exclusion of Patients, Specific Notes• Inclusion of Additional Specialties, Clinics• Pediatric Patients• Feedback

Bruce Eric Kaplan. They New Yorker. 6/8/2009. Licensed through Condé Nast.

Social Support and Integration Have Previously Been Linked to Better Health

• Instrumental• Information• Appraisal• Emotional• (Negative)

Patients Use Social Media to Find Health Information

•80% of internet users look online for health information

Fox, Samantha. The Social Life of Health Information. Pew Research Center, 2011.

Patients Use Social Media to Find Health Information

•80% of internet users look online for health information•34% have read individual commentary or experience about health or medical issues on a website or blog

Fox, Samantha. The Social Life of Health Information. Pew Research Center, 2011.

Patients Use Social Media to Find Health Information

•80% of internet users look online for health information•34% have read individual commentary or experience about health or medical issues on a website or blog

•24% have consulted online reviews of drugs or medical treatment

Fox, Samantha. The Social Life of Health Information. Pew Research Center, 2011.

Lo, B. & Parham, L., 2010. The Journal of Law, Medicine & Ethics

Patients Use Social Media to Find Health Information

•80% of internet users look online for health information•34% have read individual commentary or experience about health or medical issues on a website or blog

•24% have consulted online reviews of drugs or medical treatment

•23% follow friends’ health experiences online

Fox, Samantha. The Social Life of Health Information. Pew Research Center, 2011.

Patients Use Social Media to Find Health Information

•80% of internet users look online for health information•34% have read individual commentary or experience about health or medical issues on a website or blog

•24% have consulted online reviews of drugs or medical treatment

•23% follow friends’ health experiences online•18% have gone online to find others with similar health concerns

Fox, Samantha. The Social Life of Health Information. Pew Research Center, 2011.

Social Networking Communities Can Provide Support to Patients

PatientsLikeMe•Social network for healthcare•Tracks treatments, patient outcomes•Research Community

http://www.patientslikeme.com

Idriss, S., Kvedar, J. & Watson, A., 2009. Archives of Dermatology.

I have made friends through theonline group that I nowcommunicate with outside of thesupport group, and with whom I feelcomfortable discussing personalsituations and health. This hasallowed me to gain and give moreone-on-one support.

Patients Use Social Media to Find Health Information

•80% of internet users look online for health information•34% have read individual commentary or experience about health or medical issues on a website or blog

•24% have consulted online reviews of drugs or medical treatment

•23% follow friends’ health experiences online•18% have gone online to find others with similar health concerns

•9% have started or joined a health-related group

Fox, Samantha. The Social Life of Health Information. Pew Research Center, 2011.

Behavior Change With Social Media

http://www.stickk.comBryan, G., Karlan, D. & Nelson, S., 2010. Annual Review of Economics

Behavior Change With Social Media

http://www.fitbit.com

Health Teams Are Engaging With Patients

•Share and/or spread reliable information

Medical Practices & Institutions Adopt Twitter for Patient Education

http://www.twitter.com

Medical Practices & Institutions Adopt Social Platforms to Curate Information

https://www.facebook.com/KidsPlusPediatrics

Medical Practices & Institutions Adopt Social Platforms to Curate Information

•Share and/or spread reliable information•Advertising

Health Teams Are Engaging With Patients

We Also Can ‘Advertise’…

•Share and/or spread reliable information•Advertising•Learning from patients

Health Teams Are Engaging With Patients

Weitzman, E.R. et al., 2011. PLoS ONE

Learning With Our Patients: TuDiabetes.org

•Share and/or spread reliable information•Advertising•Learning from patients•Connecting with patients

Health Teams Are Engaging With Patients

Hawn, C., 2009. Health Affairs.

Wang CJ. 2012. JAMA

Summary

“The patient is the most underused member of the care team” Warner Slack

• We can leverage new technologies to extend our reach.

• OpenNotes is an example of technology to reduce information asymmetry and engage patients, relatively passive.

• Social Media may have applications for population management, public health promotion.

• Concepts raised by social media may have broader implications in health IT and health system / practice management.

Bradley Crotty MD MPH

330 Brookline AvenueBoston, MA 02215

617-278-8170; bcrotty@bidmc.harvard.edu

Bradley Crotty MD MPH

330 Brookline AvenueBoston, MA 02215

617-278-8170; bcrotty@bidmc.harvard.edu