Patient Engagement Key To Better Health: AHRQ ReportPatient Engagement Key To Better Health: AHRQ Report

1 7 Portals Powering Patient Engagement

7 Portals Powering Patient Engagement(click image for larger view and for slideshow)

A new report from the Agency for Healthcare Research and Quality (AHRQ) summarizes the experiences and results of researchers who developed and evaluated new ways to use health IT in patient-centered care.

The report finds that many of the 16 AHRQ-funded projects had positive effects on processes of care, intermediate patient outcomes, or both. It also highlighted a number of areas -- including some that figure in stage 2 of Meaningful Use -- where commercial vendors have not yet made much of an impact.

Paul Tang, MD, the lead researcher for one of the AHRQ projects and also vice chair of the Health IT Policy Committee, which advises the federal government on its EHR incentive program, told information Healthcare that a lack of standardization has held back progress in the development of patient-centered health IT applications that involve home monitoring devices.

"The availability of widely adopted standards is very scant," he said. "So you're pretty much connecting from one [electronic] record system to one supplier of devices or even one model." He believes, however, that the patient engagement criteria in Meaningful Use stage 2 will prompt more commercial R&D in this area.

The AHRQ grant program, known as the Enabling Patient-Centered Care Through Health IT (PCC) initiative, was launched in 2007. It focused on the use of health IT to create or enhance patient-centered models of care in ambulatory settings.

The PCC's four areas of focus included patient self-management, which was addressed in all 16 projects; providing access to information (10 of the projects), patient-clinician communication (seven), and shared decision-making (two). The AHRQ also funded projects in three preference areas: medication management (eight), vulnerable populations (seven), and practice-based research networks (five).

Several of the research projects involved personal health records (PHRs). For example, one team developed a Web-based PHR that allows patients to enter, view and print current and past medicines, and monitor allergies, conditions and health events over time.

Although most of the researchers created their own applications, they were all based on existing technologies, such as interactive voice response systems or electronic health records, and some were quite basic. For example, one team developed an automated telephone system to support shared decision-making. The system used medication claims data to provide tailored queries and prompts based on each patient’s medication history, with patients responding via touch-tone commands.

In contrast, the team led by Tang, who is VP and chief innovation and technology officer at the Palo Alto Medical Foundation, used state-of-the-art technology in its project. It developed an online diabetes management system that featured wireless uploading of home glucometer read¬ings to the EHR, with graphical feedback correlated to parameters such as laboratory results, medications and clinical findings. This sophisticated system included a summary status report, tailored care plans, education and advice via text and video. Patients communicated online regularly with nurse case managers and a dietician. In a randomized controlled trial, Tang and his colleagues showed that the intervention group had significantly better diabetes control than the control group, as measured by A1c values, after six months. The difference disappeared after 12 months, but more patients in the experimental group lowered their A1c during the study period.

Some other PCC projects also showed improved outcomes. For instance, a PHR that gave patients direct access to information in their physician's EHR displayed tai-lored recommendations and reminders for 18 preventive services based on information in the EHR and a risk assessment completed by the patient. It resulted in the portion of recommended preventive services that were up-to-date rising from 68% to 74%.

Although the AHRQ projects did not create any "killer apps" that significantly improved patient outcomes, Tang noted that the PCC began at a time when few physicians had comprehensive EHRs and patient portals also were rare. Both of those technologies need to be in place, he said, to have a marked impact on patient engagement.

Since the passage of the HITECH Act in 2009, he said, there has been "a huge uptick" in adoption of EHRs. He estimated that around 25% of physicians now have a portal attached to their systems.

Patient engagement, a strong focus of Meaningful Use stage 2 and of the policy committee's stage 3 proposal, is an area where more research needs to be done, Tang said.

"Patients are now able to conveniently view their data on a patient portal," he pointed out. "Now we need to give them more information and more knowledge about their data so they know how to interpret it. Then we have to give them tools to manage their health when they have the feedback from their data. And we need a professional culture that supports shared decision making."

In addition, he said, more research needs to be done in the area of getting patients engaged. Studies by Judy Hibbard and others have shown a correlation between low activation and poorer outcomes. But it's still not clear what motivates patients to take control of their health, he noted, and how health IT can play a role in that.

As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital Big Data Analytics issue of information Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.)