The Emerging Role Of Online Communication Between Patients And Their Provider

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The Emerging Role Of Online Communication Between
Patients And Their Provider

• Steven Katz M.D. M.P.H.
• Associate Professor
• Departments of Medicine and
• Health Management and Policy
• University of Michigan

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Agenda

• Motivation
• Current online landscape
• Challenges
• Early Experiences
• Prognosis

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Motivation

• Patients
• Frustrated with between-visit access
• Are increasingly connected online
• Providers
• Are frustrated with between-visit communication
• Current modes are burdensome, fragmented and
  inefficient
• There is enormous mismatch between communication
  mode and tasks

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Why web is right

• It is asynchronous
• It has enormous reach
• It is robust
• exchange and store information
• provide services
• connect people
• Communication can be tracked, managed,
  documented, and evaluated
• It is secure

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Great Expectations

• The Internet will have a profound effect on
  the practice and business of medicine.
  Physicians, eager to provide high-quality care
  and forced by competition to offer online
  services, will introduce e-mail and
  patient-friendly Web sites to improve
  administrative services and manage common medical
  conditions. Patients will identify more health
  information online and will take more
  responsibility for their care. The doctor/patient
  relationship will be altered...

Jerome Kassirer. Health Affairs 2000
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Trends in internet use1
1. UCLA internet report 2003 http//ccp.ucla.edu/
pages/InternetStudy.asp
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UCLA Center for Communication Policy, 2003
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Digital Divide
Source Pew Internet and American Life Surveys
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Message Volume University of Michigan Primary
Care 2002
weekly patient messages per 100 scheduled visits
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Challenges

• Patients
• Lack experience
• Digital divide
• Providers
• Workload
• Uncertain value of online communication
• Little consensus about communication management
• Organization
• Business model/ROI
• Building and integrating online communication
  tools
• No road map

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Dr. Katz I am a patient of yours through Yellow
Care Network. Generally, I am seen by Dr. Rufus
T. Firefly but I have not been able to contact
him nor have I been able to get an appointment
to see any doctor in the Internal Medicine
clinic. When I called I was simply told there
were no available appointment times. I am
currently experiencing intense pain when I
urinate as a result of a bladder infection and
would very much like to get a antibiotic to start
treating this. The symptoms are constant urge to
urinate and painful urination followed by blood
in my urine at the end of the urination. Can you
please facilitate an appointment to see a doctor
in your staff or prescribe an antibiotic. I am
not taking any other medicines at this time.
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various news 1) referral to Diabetes Clinic
DOES NOT SHOW UP on their records yet (as of
Friday 01/09)... was seeing Dr. Sugar 2) Am
re-enrolled in Stop Smoking Program (she'll use
your old referral) but WILL NEED anti-depressant
script soon 3) scripts for imdur (120mg 30mg)
WORKED at pharmacy... 4) referral to Eye Clinic
OK... appointment set 5) referral to Cardiology
Clinic OK... Dr. Heart said "...see you in
a year..." and "...are 95th percentile of her
patients (for exercise level, walking 3-5 miles
/day)". Walked 11 miles last Monday01/12 6) next
apptmt with you(??) 04/02 Thank You
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Components of a patient portal

• Service-related features
• Medication renewals, scheduling, forms,
  registration/billing
• A clinical communication tool
• Secure messaging
• A patient health record
• Populated from provider and patient data sources
• Medical record
• Patient current meds, immunizations, health
  status information (e.g. blood sugar or blood
  pressure log)

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Yellow brick road

• Develop business model
• Build or buy communication tools
• Develop roll-out strategy
• Map relationships and workflow
• Develop rules of engagement and exchange
• Develop education and promotion strategy
• Allocate provider effort during rollout
• Evaluate processes and outcomes

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Emerald Cities
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Start-up Experiences

• Patient uptake is slow
• Patient online gap
• Resource offsets are uncertain
• Clinician and staff acceptance is high
• Cultural Divide between patients
  and their clinicians

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Patient1 and physician attitudes towards role of
clinic staff in e-communication
Patients OK for clinic staff to handle my
e-mail/Web messages for my physician Physicia
ns OK for the clinic staff to handle patient
e-mail/Web messages for me
1. Patients who reported regular use of e-mail
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Patients
Preferring Mode
Physicians
Sore throat
Back pain
Abnormal Pap/PSA
Normal Pap PSA test
Cholesterol test
Anxiety or sadness
Breast or testicular
Rx side effect
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Prognosis Good

• Patient facility and access is growing
• increase in broadband access
• Better online communication tools
• Better clinical data systems
• Beginning of the J curve
• Uncertain business model