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Idea Collaborative editing and improved tooling for patient portals

By Norman Sondheimer | 08 Dec, 2014

Idea submitted by: Norman Sondheimer

Online tools and processes that patients can employ to improve the accuracy of their electronic health records. Patient portals are enabling easy access to one’s record. At the same time, patients are discovering errors of various types in these records. These errors include simple demographic data, out of date medication lists, incomplete medication allergies, inaccurate medical histories, missing laboratory tests and more. Without attention, the quality of data is certain to lead to patient disengagement as trust deteriorates.

Current portals, at best, allow patients to edit their basic demographic data and provide secure emails to their physician. Our idea is for the development of online tools and processes based on structured online forms like those used to edit demographic data and similar to those used by ecommerce companies for consumers to report problems. These forms can be less intimidating to patients and employed more conveniently than email. They will need to be matched by tools on the physician’s side to efficiently process the input.

Tools like these will be introduced in the developed world and moved throughout the world as patient access to health records expands. Success can be measured not just in the quality of data in patients’ medical records but by their engagement in their own healthcare.

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A/Prof. Terry HANNAN Advisor Replied at 6:12 PM, 8 Dec 2014

Norman, I like the ideas you have posted here. Using a non-institutional 'record model' based on my years of using "Summary record Formats" all my patients;
1.Have a copy of their record. This can be in "e" or manual
2. They have direct email access to me about the record contents and their management
3. ALL email communications are stored IN the record under date and time
4. I am able to access the records wherever I have internet access and this allows me to respond almost in real time to a patient's request when I am mobile e.g. recently in Turkey, the Croatian coast and Venice
5. There is NO over abuse of this privilege by patients.
6. I am able to prevent re-admissions, repeat prescriptions, etc using the email communications
7. The record design is based on "Clinical information management" experiences over time
8. All patient are encouraged to "take a copy with them" wherever they go-hard copy or "e".
9. Finally and most importantly they have to confirm the accuracy of the entered information with me.

Norman Sondheimer Replied at 11:02 PM, 8 Dec 2014

That’s just great, Terry. I am certain you have done more than prevent re-admissions and repeat prescriptions, as well as, confirm the accuracy of the entered information. You have given your patients a sense that you and they are mutually responsible for the care plan. That’s what we want out of patient engagement. We need your process to spread.

In our surveys, we have found the most uptake of the collaborative idea if we stay close to getting agreement on medication lists. Perhaps that is because the patient is regularly asked about them during office visits. It appears to be similarly important to insert the collaboration at sensitive points in the care process.

We just published the analysis of a tool that gives Geisinger Health System patients their medication list to edit just before they have a scheduled appointment http://repository.academyhealth.org/egems/vol2/iss3/10/. The experiment went so well that the online medication feedback mechanism is now used in 22 Geisinger Ambulatory Clinics for all appointments with Primary Care Physicians. It has been expanded to include other information such as medication allergies. Geisinger find that 51% of patients complete the form. 38% of these forms give updates. They are going to continue to expand the process to all of our Ambulatory Clinics over the next fiscal year. Particularly encouraging is that Geisinger serves many rural, older and poorer communities.

Another positive result was published this year that showed patient successfully doing their own medication reconciliation via a patient portal following hospital discharge http://www.ncbi.nlm.nih.gov/pubmed/24036155.

One reasonable strategy is to spread the word on the effectiveness of having patient doing their own medication reconciliation online, while building up a body of evidence that the collaborative model works well in data element after data element. If we can get the EHR vendors to include collaborative editing in patient portals, then we have a chance to make the process a part of the standard of care worldwide.

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Jordan Harmon Advisor Replied at 6:46 PM, 9 Dec 2014

Thanks for submitting this Idea Norman. I agree- there is a lot of room to grow in ensuring that both patients take responsibility for updating information in portals prior to visits and make current portal functionality better. There are some EMR companies working on making these portals more interactive for patients so that they only click a button to confirm or enter new information. Also, this information is then transferred to the patient's chart for the physician to review and confirm. No data is entered into the chart unless confirmed by a physician. However, even with this current functionality, it remains limited in use by patients and we could definitely use more interactive portals.

Your thought around patients doing their own medication reconciliation is interesting but will patients be able to ensure accuracy prior to visiting the physician? If they enter mis-information, this only adds to the confusion in the office.

Ethan Katsh Replied at 8:16 PM, 9 Dec 2014

Norm, thanks for submitting this. It is a wonderful idea and an opportunity for patients to contribute something valuable. Errors in EHRs are dangerous and patients are in an excellent position to identify them and alert their providers.

Norman Sondheimer Replied at 10:07 PM, 9 Dec 2014

Thanks, Jordan. Good to hear the Portal vendors are moving forward. Very important.

I want to make sure to clarify our experience on two points. Physicians and other health professionals have to take responsibility for reviewing much of the material submitted by patients. Take control substances, providers can not accept the word of a patient that he or she has received a prescription for a narcotic from someone outside their system. We believe a triage approach where some changes, such as removing a duplicate prescription entry or the completion of the medications in a prescription, can be accepted automatically. Some changes, such as a new over the counter medications or new regular prescription from another provider, might be accepted by the same level of staff that does medication reconciliation when rooming a patient during an office visit. Finally, there has to be a level where contact with the patient has to be made, such as when a patient reports he is no longer taking an important medication. No matter what, the changes have to be marked for provenance.

The other important point is about confusion. Jim Walker, who is now at Siemens Healthcare, once suggested that it is best to look at parts of the medical records as the current state of the provider and patient's mutual understanding of the truth. That's easy to understand with symptoms and problems. But Jim felt, it was also true with procedures, inoculations, family histories, allergies, and, even, medications. How many times have you personally forgot to mention an over the counter medication when asked by your doctor in the tension environment of an office visit? What we believe our experiments have shown is that by opening the online channel, we can get generally high quality information.

Thanks for the encouragement.

Jordan Harmon Advisor Replied at 5:11 PM, 18 Dec 2014

Norman- I agree that we can't merely accept the word of mouth for prescriptions. We need direct buy in and data from other providers/systems in order to really see the full picture for one patient. Is there a way that you could incentivize organizations/providers to take part in this data exchange? Also, how do we obtain a more accurate "current understanding of the truth" with multiple systems and providers? I think these are really valuable points and interested in hearing your view.

This Community is Archived.

While this community is no longer active, we invite you to review and recommend past posts and resources. Membership for this community is closed, but we hope you'll join us in one of the many other communities on GHDonline.

Moderators of Technology for Patient Engagement and GHDonline staff