Just Read: In a health system where patient-physician email is actually used, how it impacts care

In an American health system, where, for the most part, patients *still* do not have access to their online medical records or access to their physicians (see: Patel V, Barker W, Siminerio E. Individuals’ access and use of their online medical record nationwide. Office of National Coordinator for Health Information Technology and Majority of Americans don’t use digital technology to access doctors | CAPP), this is a study conducted by the research team at Kaiser Permanente (@KPDOR) where patients mostly *do* have this access.

Of interest, they looked at how patients who had higher co-pays thought of using email as their first contact with providers, and how it may have shifted their use of services. This article on the @KPShare web site summarizes things nicely so I won’t repeat here: Patient-Initiated E-mails to Providers: Associations With Out-of-Pocket Visit Costs, and Impact on Care-Seeking and Health

I do want to clarify that the study is not asking about cost-sharing for email interactions. It asked what people would do if they didn’t have email at all. Totally different question. And no less interesting at this stage of adoption.

Speaking of adoption, the national numbers are 30% of people are offered their online medical record, and 46% viewed it at least once. That’s super low.

At Kaiser Permanente, 100% of people are offered their online medical record, 69% of the eligible population (as of 2Q2015) have signed up to use it, and 68% have viewed it at least once in the last quarter. 40% accessed it 5 or more times in the last quarter. By definition this is patient directed activity because there aren’t any organizational barriers to this access. These numbers are much better 🙂 .

Read the study to find out more what they do with it once they have it, which is a much more interesting question than, “when are they going to get it.”

#nhssm : the RCGP’s Patient Online: The Road Map

#nhssm : the RCGP’s Patient Online: The Road Map
Recently the Royal College of GPs (RCGP) launched their Patient Online: The Road Map document which sets out how patients and GPs will be able to interact online over the next few years. I wondered how many patients actually knew that Patient Online existed.

Currently only 1% actually have access to any of the facilities, why? The answer is simple; the functionality has not been enabled by the practice. In fact only 37% of GP practices have actually enabled the functionality. As a patient I find that staggering. 42 million people have taken the time to register to say they wish to use the facility yet the “on” button hasn’t yet been pressed.

Presentation: Meaningful mobile technology use … to achieve Total Health

Attaching slides from webinar today hosted by FierceHealthIT (@fiercehealthIT) : mHealth’s Impact on the Future of Meaningful Use – FierceHealthcare , on which I appeared with Joe Kvedar, MD (@jkvedar), talking about Kaiser Permanente’s mobile health journey.

Health information technology is in service to Total Health in my world, or as I sometimes say, prevention is the new HIT.

Note, Kaiser Permanente’s Mobile Center of Excellence is hiring! See 2nd to last slide. I’m attaching version with notes as well as an embedded slideshare, if you want to just see the images. Comments welcome, as usual.


Now Reading: Access to a PHR constitutes highly meaningful use – published data on member retention from Kaiser Permanente

Most investigations report on adoption and the characteristics and preferences of users of online access websites or patient portals integrated with electronic health records (EHRs). Far fewer reports document the impact on outcomes of patient portals.

In 2009 I wrote a post the day after I met Regina Holliday – Is it meaningful if patients can’t use it? | Ted Eytan, MD. How nice in 2012 to find out that the data supports the right answer to this question, which is the title of this post. And in actuality, this data was being generated three years before I wrote that post in 2009, so the “meaning” has been happening for a really long time.

This paper was authored collaboratively by colleagues at Kaiser Permanente Northwest and Kaiser Permanente Health Information Technology Transformation and Analytics and looks at a specific outcome related to the use of a personal health record – health plan member retention. In the Kaiser Permanente system, it’s important to note that this is co-mingled (in a happy way) with retention and support of the patient-physician relationship. You can imagine that deciding to terminate this relationship (the term used in the health plan world) is a decision that can result in undesired costs in time, money, data, and health (and not in that order), most significantly for the patient, so it is an outcome worth analyzing.

The results – using the Personal Health Record is associated with a choice to stay a member/patient

The actual likelihood is 2.578 times more.

Interestingly, the other factors that are associated include increased age, longer tenure of membership, high illness burden, presence of hypertension.

These results highlight what can be discovered in an integrated system – there is an ability to aggregate clinical and usage data (in a privacy protected way) to provide insights for all of health care.

Even more interestingly, the effect exists across all levels of tenure (from less than 1 year to greater than 10 years) but was greatest for members who were with Kaiser Permanente for less than a year. Check out the figure on page e251 to see this comparison – it’s striking and it implies that a Personal Health Record may have important impacts in the joining of a practice or health system. Some would say (myself included) that this is a critical time to establish communication and build solid relationship with a physician and with good health.

Before you say, “Ted, this data just shows that people who like their health system or are healthy tend to use its personal health record,” the investigators worked to address this:

To control for self-selection bias, we performed a matched case-control analysis with propensity scoring and exact matching; propensity score matching methods control for confounding factors to some degree but do not address causality.

What this means is – it is true that we cannot say that the PHR caused people to stay with their Kaiser Permanente health care. At the same time, we can say that patients in similar situations (age, illness, time in the system) had the same associations with retention. One more thing, the investigators looked at voluntary retention only – involuntary termination, which happens when an employer changes your health plan choices, was not included for obvious reasons.

Not saying, “I told you so.”

Well before Meaningful Use rules came out, I remember having a dialogue with someone about their potential, and was told, “Ted, patient access is just a distraction when it comes to meaningful use regulations.” I knew at the time that patient access was the right thing for the people we serve. Now everyone can know that this is the right thing for the people who serve them, too.

Performing well for patients includes loving what you do to support people in achieving their life goals through optimal health, and loving it when they get there. So it’s not that anyone lost the argument I had back in 2009, it’s that we all won :).

Here’s what a strengthened relationship looks like, as embedded in the press release about the study:

HealthIT (.gov) – for everyone, including YOU – video animation

My friend and community colleague (name which community, there are many where we are collegial) Lygiea Ricciardi ( @Lygeia ) sent me a message about the new Health IT video “Health IT for You – Giving you Access to Your Medical Records” that said “if you were to point to it on your blog or twitter, we sure wouldn’t object.” ;

Never mind about that, I insist:

This is the fun part of writing a blog (which is always fun) – celebrating the accomplishments of people you respect. I know Lygeia didn’t produce this work by herself (unless she has secret computerized animation talent I am unaware of…). However it is a testament to her leadership in the Office of the National Coordinator that we are able to write the story of health information technology as a country that includes patients and their families. It wasn’t that long ago that I would hear people saying, “Ted, EHRs are for doctors, PHRs are for patients.” Now, luckily, that talk is all gone and replaced with “Health Information Technology is for everyone (you included)”. I am so glad that Lygeia has been a developer and carrier of that message to the American public – she does it with creativity, resolve, and the ability to laugh as we move ahead.

Now on to the video :). It does a great job describing the need for a change in American health care and the benefits that patients and families should expect from health information technology. The last sentence is very important: “ask your health care provider how they use Health IT.” I mentioned in an interview recently that any person seeing a doctor in this country will be in a practice that has either recently converted or will be converting to an electronic health record. Now is the time to ask them about this and let them know you want to be involved. Let them know that you want to participate in their use of an electronic health record not just because you want to achieve your life goals through optimal health, also because you want them to be a great doctor for you. And who doesn’t want to be a great doctor for you? Everyone does.

I can’t help but juxtapose this video with the “Connected” advertisement from Kaiser Permanente in 2009. I’m doing it to show that this world exists already for 9,000,000 members (and 4,000,000 are now actively using it as of this month- See: A Personal Health Record now serving 4,000,000 registered users – Kaiser Permanente My Health Manager | Ted Eytan, MD), and it’s as great as it seems from both videos. Come join us.

A Personal Health Record now serving 4,000,000 registered users – Kaiser Permanente My Health Manager

In this presentation that I gave: “What does social media mean, in an integrated care system? A conversation at @KPGarfield | Ted Eytan, MD“, I rounded up from 3.93 million members using kp.org’s My Health Manager on Slide 7.

The 2Q-2012 data has since come out, and now it’s official.

4,020,271 Kaiser Permanente members are signed up to use their Personal Health Record, which is 63 % of the eligible membership. A picture is worth 4,000,000 words, so here’s the new image. Note that I changed the Y axis to accommodate future growth :).

Adoption of My Health Manager, the personal health record available on kp.org

When I joined Kaiser Permanente in 2008, there were 2.5 million members registered to use My Health Manager, no mobile access, and the slope of the growth was still increasing.

In a world where people have said that consumers aren’t interested in personal health records, I offer just two words to describe the image of adoption here: hockey stick.

You can read more at the national press release put out yesterday: Four Million People Choose Connectivity and Convenience with Kaiser Permanente’s Personal Health Record :

Through My Health Manager, members can view their medical record, email their providers, check lab test results, order prescription refills, and manage appointments from their computers or handheld devices. In 2011 members signed on to My Health Manager more than 74 million times and took advantage of the website features in record numbers:

  • 29.7 million lab results viewed online
  • 12.2 million emails sent to providers
  • 10 million prescriptions refilled
  • 2.7 million appointments scheduled