Agenda
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
„
„
Motivation
Current online landscape
Challenges
Early Experiences
Prognosis
Motivation
„ Patients
„
„ Frustrated
with betweenbetween-visit access
„ Are increasingly connected online
„ Providers
Why web is right
„
„
and their organizations
frustrated with betweenbetween-visit
communication
„ Current modes are burdensome, fragmented
and inefficient
„ There is enormous mismatch between
communication mode and tasks
exchange and store information
provide services
„ connect people
„
„
„ Are
Great Expectations
The Internet will have a profound effect on the
practice and business of medicine. Physicians,
eager to provide highhigh-quality care and forced by
competition to offer online services, will introduce
e-mail and patientpatient-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...
It is asynchronous
It has enormous reach
It is robust. You can:
„
„
Communication can be tracked, managed,
documented, and evaluated
It is secure
Trends in internet use1
Type of use
2000 2002
E-mail/IM
55
62
Browsing
55
54
News
38
37
Information
36
33
Shopping
34
32
Any
66
71
1. UCLA internet report 2003 http://ccp.ucla.edu/pages/InternetStudy.asp
Jerome Kassirer. Health Affairs 2000
1
Digital Divide
UCLA Center for Communication Policy, 2003
Source: Pew Internet and American Life Surveys
Message Volume*
University of Michigan Primary Care 2002
Challenges
„
Time
period
Patients
Physicians (N=120)
„
Email
„
Phone
1
12
76
2
14
80
3
13
81
„
Providers
„
4
13
82
5
14
71
„
„
„
Lack experience
Digital divide
Workload
Uncertain value of online communication
Little consensus about communication management
Organization
„
„
„
Business model/ROI
Building and integrating online communication tools
No road map
* weekly patient messages per 100 scheduled visits
Components of a patient portal
Dr. Katz:
I am a patient of yours through Yellow Care Network. Generally, I
am seen by Dr. Rufous 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.
„
„
„
ServiceService-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)
2
Yellow brick road
Emerald Cities
„ Develop
business model
or buy communication tools
„ Develop rollroll-out strategy
„ Build
„ Map
relationships and workflow
rules of engagement and exchange
„ Develop education and promotion strategy
„ Allocate provider effort during rollout
„ Evaluate processes and outcomes
„ Develop
Patient1 and physician attitudes towards role of
clinic staff in ee-communication
StartStart-up Experiences
„
„
„
„
Patient uptake is slow
Online gap or patient selection
Resource offsets are uncertain
Clinician and staff acceptance is high
“Cultural Divide” between patients
and their clinicians
Patients: “ OK for clinic staff to handle my [e-mail/Web] messages
for my physician”
Physicians: “OK for the clinic staff to handle patient [e-mail/Web]
messages for me”
Disagree (%)
Email
Web
Patients
47
33
Physicians
14
12
1. Patients who reported regular use of e-mail
90
80
Prognosis: Good
70
60
50
40
Patients
30
% Preferring Mode
„
„
Patient facility and access is growing
20
„
10
0
90
Visits
80
Phone
Online
70
60
50
40
30
Physicians
20
10
0
increase in broadband access
„ Better
s
ole
Chest
t
or
ty s
xie es
Anadn
s
or
st ar
ea ul
Brestic
t
al
rm A
no PS
Ab ap/
P
in
pa
ck
Ba
e
si d t
Rx fec
ef
at
ro
th
re
So
p
Pa
al t
rm tes
No SA
P
l
ro
te
online communication tools
„ Better clinical data systems
„ Beginning of the “J curve”
„ Uncertain business model
3