Tag Archives: adoption

Prescription for PHR digital divide: CPR (Consumer Public Relations)

Just published this week in the Archives of Internal Medicine is a must-read paper about the digital divide in PHR adoption. The digital divide in adoption and use of a personal health record, by CK Yamin and colleagues at Brigham and Women’s Hospital in Boston, looks at PHR use among Partners Healthcare patients.

The researchers compared users and non-users of the Patient Gateway PHR. Those who registered for the PHR with a mailed password and created an account, were compared to patients who never registered. These 2 groups were compared across demographics including gender, age, insurance status, race and ethnicity. They also looked at geocodes, based on an address, and used this to estimate an individual’s socio-economic status. Finally, they looked at the presence of 5 chronic conditions (the most common plus heart failure, the most expensive), as well as the frequency of PHR login.

Many findings are what would be expected. Patients using the PHR were somewhat more likely to be women, 30 to 65 years old, have commercial insurance, and be at a higher socioeconomic level. In addition, non-white and Hispanic were significantly less likely to have registered for the PHR. While the minority populations were small at under 10%, the differences were concerning. For example, African American were only half as likely to adopt a PHR as whites.

An interesting result was that patients having 1 or more chronic condition were more likely to have registerd for the PHR. Another welcome finding was that once people were registered, the usage of the PHR showed little differences among the demographic and clinical groups.

In other words – there’s disparity in the people coming to the playground. Once inside the playground gate, however, people look pretty similar.

I did a very similar, albeit smaller, study years ago in Maine. Using Claims Data to Examine Patients Using Practice-Based Internet Communication: Is There a Clinical Digital Divide?, published in Jounal of Medical Internet Research, which compared users and non-users of an early PHR prototype. The results were almost a perfect match, including the finding that patients with a chronic condition were more likely to be users. Bingo.

By the way, once I found out (in 2004) that PHR users weren’t just the “worried well”, and the promise to improve patient health was real….I began the journey into consumer informatics! Side note: Dr. Richard Rockefeller, early champion of using technology to empower patients, funded that study. A former family practice doc in Maine, Richard has been U.S. Chair for Doctors without Borders for some time.

So, just how do we get people to come to the playground? How do we raise awareness and understanding about PHRs? How do people get a sense of what’s in it for them? I’ve posted before about shining a light on the black box of PHRs. The feds can wire up the country and get everyone connected, but that’s not going to solve this issue. We need new ways to think about this, new designs and new types of marketing, communication, and bringing the technolgy to the people. Otherwise we’re headed for greater disparities.

What’s your prescription?

Parallel Grids Should Plug In: Consumer Health and Energy Usage Management

I like to read Fast Company, a business design magazine. It would be great if they show someone over 35 on the cover, but hey, it’s great because it is cutting edge. So when I saw an article about sharing sharing energy usage data with consumers in order to change their behavior, I had an exciting aha! moment. And some jealousy.

The story, The Home Energy Management Market Heats Up, talks about software bringing consumers real-time information about their energy use – to gain energy efficiency and reduce costs. It seems nirvana is having people plugged into the smart-grid, getting actual data usage information (and incentives?), not only for a healthier wallet but also for a consumption-hungry world to use less energy.

I’m particularly intrigued by a creative, consumer-oriented company called OPower, who want to achieve energy efficiency, as they say:

…at an unprecedented scale by driving a new level of customer involvement and satisfaction, proactively engaging consumers and helping them make smarter choices.

Sound familiar?

Take a look at their behavioral science embedded into online feedback and engagement work. They even allow consumer-entered information and sharing stories, along side the system-sourced data feedback.

In Healthcare, we dream about consumers having access to well-designed displays of their individually tailored data and being connected to the “grid” so it can nudge and empower and change outcomes. As we drive for more participatory medicine and online patient engagement, we could use more ideas and out-of-the-box alignment.

I think Healthcare needs to team up (yes! plug in!) with the energy management space, right away. What do you think?

To Find Meaningful Use, Understand the Context of Patient (Our) Lives

It’s been many weeks since my last post, but I got to Paris & Italy for the 1st time. It’s impressive how everyone drove small cars. Will Americans switch to small, more fuel efficient cars? And if so, why? Just another example of adoption that should happen, and how users will have to be the drivers (sorry, no pun intended), not the car developers…

While away, Meaningful Use rules surfaced. Although most are provider-oriented, I continue to dwell on consumer adoption and value. Of course we have to start with providers, since sharing computerized records with patients can’t happen unless there are computerized records. But it’s never too early to map out anticipated value…in the eyes of the patients.

Let’s think like a patient (that’s us). We don’t wake up in the morning and say “I need a list of my allergies and medications.” Meaningful Use comes from a provider perspective, saying, “Don’t duplicate tests. Don’t make me track down medication lists and medical problems (even though records often ave errors).

We have to be careful about assuming what is patient Meaningful Use.

What DO patients care about? Here’s a few:

Do I need to worry about something?
How can I feel better?
What are my choices?
What happens if I don’t do anything?
What will this cost (in time and dollars)?
Are you any good as a doctor?
How do I get answers to things that come up?
How do I get hold of you?

We also need to reconcile that what patients want and what they need are not always the same thing. Patients want convenience and efficiency. They want less costs. These are not consistently compatible with better health. Sometimes less is more, and sometimes less is less.

Here’s my take on the TOP THREE ways to address these needs:
1. Secure Messaging
2. Plain Old Telephone
3. Seeing (and adding to) medical chart notes

Notice only #3 is explicitly about electronic medical records. Plus, it means patient access to all chart notes, with the ability to enter data into the record. Meaningful to patients? Many say yes. To providers? It’s debatable.

Let me know what you think will provide the greatest value – meaning – for us patient types.