Web as Medium for Patient Access to Electronic Health Information

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Web as Medium for Patient Access to Electronic
Health Information

• James J. Cimino, MD, Vimla L. Patel, PhD, Andre
  W. Kushniruk, PhD
• Columbia University and McGill University

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Consumer Health Information Issues

• Understanding on-line health information
• Access to personal health records
• Regulatory requirements are coming
• Commercial sites for giving patients access to
  their data
• What will happen to the patient?
• What will happen to the patient-provider
  relationship?

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The Patient Clinical Information System (PatCIS)

• New York Presbyterian Hospital clinical data
  repository
• Web-based Clinical Information System (WebCIS)
• National Information Infrastructure contract from
  NLM
• give patients WebCIS
• see what happens
• Pilot study conducted

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PatCIS Architecture
Web Server
Web Browser
patcis.cgi
Data Entry
Session Registry
Vital Signs
Blood Sugar
Logout
Data Entry
Review
Advice
Education
Usage Log
Comments
Help
Internet
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PatCIS Recruitment

• Mail physician consent forms to physicians
• Wait for physicians to suggest subjects
• Mail URL for consent form to subjects
• On-line enrollment
• Patient prints, signs and mails consent form
• Physician provides function-specific consent
• Mail user name, password and SecurID card to
  patients

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Log File Analysis

• sandcar!Fri Oct 27 113222 2000!cim.cpmc.columbia
  .edu! patcislogin
• sandcar!Fri Oct 27 113224 2000!cim.cpmc.columbia
  .edu! patcisData Review
• sandcar!Fri Oct 27 113228 2000!cim.cpmc.columbia
  .edu! patcisData ReviewLaboratory
  Detaillab_detail.cgi
• sandcar!Fri Oct 27 113230 2000!cim.cpmc.columbia
  .edu! patcisData ReviewLaboratory
  DetaillabSum.cgi
• sandcar!Fri Oct 27 113235 2000!cim.cpmc.columbia
  .edu! patcislogout

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Results

• Functions
• Enrollment
• System usage
• Function usage
• Adverse events

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Functions

• Data entry vital signs, diabetic flow sheet
• Data review vital signs, diabetic flow sheet,
  laboratory, radiology, pathology, cardiology,
  discharge summaries, microbiology
• Education geriatrics, diabetes, Home Medical
  Guide, advanced directives
• Advice cholesterol, mammograms
• Infobuttons body-mass index, laboratory,
  microbiology organisms, microbiology
  sensitivities, Pap smear

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Enrollment

• Mailing to gt200 physicians
• 13 physicians returned signed consent forms
• 19 subjects suggested
• 13 enrolled
• 12 used the system over 19 months
• 1 non-CPMC subject enrolled

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System Usage

• 131 log-on failures
• 22 wrong user name
• 51 wrong password
• 58 wrong Secure ID
• 33 log-ons without any activity
• 466 active sessions (261 logged out)
• -----
• 630 log-ons

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Log-Ons Failures by User
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Active Log-Ons by User
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Average Monthly Log-Ons
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Average Session Time by User
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Minutes per Month
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Function Usage I

• Data review 1831 total
• 1518 laboratory
• 737 Laboratory button ? 1083 specific reports
• 186 Laboratory Details button
• 249 summaries
• 36 vital signs
• 35 diabetes flow sheets
• 212 reports (81 radiology, 35 pathology)
• 30 Microbiology

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Function Usage I
I

• Data review 1831 total

• Data entry 73 total
• 34 vital signs
• 39 diabetes flow sheets
• Education 53 total
• Advice 6 total
• 5 cholesterol guideline
• 1 mammography guideline
• Other
• 10 newsgroups
• 83 infobuttons
• 2 comments
• 10 e-mail to physician
• 17 disclaimers
• 13 help

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Adverse Events

• None reported

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Discussion

• Architecture supports integration, security and
  tracking
• Enrollment was disappointing
• Population was highly selected by MD, by self,
  by Web
• Two patterns monthly and daily
• Log-on difficulties overcome
• Laboratories are the most popular

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Next Directions

• Diabetes mellitus patients
• Data entry
• Coordination with clinicians
• Targeted educational materials
• HIV patients

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Conclusion

• Enthusiasm is not universal
• Technical issues were not a problem for our
  patients
• Privacy is achievable
• Patient understanding of their records was good
• Other features were of less interest
• Patient-physician impact was positive

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The Three Questions

• How will your results affect diffusion of
  telemedicine?
• Increase the comfort level
• Identify areas for focused efforts
• What aspects would benefit from other study?
• Security model
• Evaluation methods
• If you were proposing this project today, how and
  why would the approach differ?
• Build a patients view of the record
• Study doctor-patient-computer interactions
  directly