crotty engaging patients in new ways from open notes to social media
DESCRIPTION
TRANSCRIPT
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
Sur
vey
Sur
vey
Focu
s G
roup
s
Ana
lysi
s
Data Collection Pol
icy
Dev
elop
men
t
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; [email protected]
Bradley Crotty MD MPH
330 Brookline AvenueBoston, MA 02215
617-278-8170; [email protected]