PHR

Project Provider ital Behavior Patient V Vital Behavior

Access PHR ttrack daily, and submit weekly to Access PHR, o review patients data and respond whe following: provider t ith any treatment plan adjustments within 24 hours of receipt Daily glucose readings Recovery behaviors: Meds taken oral, insulin) Designate time on s(chedule for PHR catch up work Food intake journal Weekly PHR Team check in meeting Exercise log Recovery behaviors: Family/provider phone or send PHR reminder to send in patient data Send feedback to patient weekly even if no action is needed to provide incentive and support Recovery behaviors: EHR alert for high glucose and when delay in response to paccess PHR Advice and Actions Once a week atient Provide read information and take quiz eport tools to monthly Diabetic panel status r Recovery behaviors: Family to provide weekly reminder Send patients a weekly tip to help keep focus Review lab schedule and make appointment. Go to clinic lab to have HGBA1c test drawn to provide an over time glucose assessment Recovery behaviors: Provider sends patient a weekly reminder to schedule lab appointment; phone call if appointment is missed.

Influence Strategies Influence Strategies

Personal Motivation: Have video of a patient Personal Motivation: Show provider shadow another provider a PHR to model. Personal successfully using using the enter glucose level, Ability: Provide a playground where provider food journal, and exercise log and send to the can practice. Social Motivation: S patient as provider. Personal Ability: Coach taff meeting agenda topic: Use of PHR data in treatment they practice e ntering health information into plans. Social end to provider. S experienced the PHR and sAbility: Pair more ocial user with less experienced user. Structural Motivation: Provider discusses with patient Motivation: Clinic rivacy and shows how the about concerns of pprovides PHR software and education. Structural Ability: Hold 30 ocial provider will manage the information. Sminutes on provider schedule each w create PHR work. Ability: Family helps patient eek for schedule Social Motivation: omfortable settings to where patient is in cProvide support group to learn from each other. Personal Ability: encourage daily tracking. Structural Provide at t Clinic provides software physician Motivation: he elbow support to the and and staff as they i tructural Ability: Provide training for free. Sncorporate PHR tasks into daily workflow. Structural M Help Desk Link for assistance. otivation: Send provider monthly report for all gives Personal Motivation: Provider diabetic patients that he can u or patient to a results of PHR and opportunity fse to compare ccess PHR Actions non-PHR patients. tool for practice. Personal Ability: At provider

Team Members: Nicole Wayne, Linda Vind, Kerry Heinecke Challenges Challenges
Personal: Personal: Finding ime / nd reason or reviewing the Finding ttime areason for fentering daily glucose patients d completion of educational values and ata; may have concerns about the accuracy of p assessments atient data Possess technical knowledge o review t Need to be computer savvy to tenter data he data and integrate nto c orget to enter electronically; imay flinical care the data, may Social: not understand Lack of shared eason for r with colleagues Finding time / rexperience eviewing PHR advice May n review information/take quiz. and to eed to learn a new, shared care delivery approach instead of current directed care model. Social: May need to develop a new way of communicating/relating to patients. May want to keep health condition private. Structural: May not have support of family to assist / Lack of technological tools ay require change n reinforce vital behaviors; mavailable in order tio review and r about t to healthcare d data; n belief system espond he the patients elivery eed to plan model potentially uncompensated time into schedule for PHR review and communication with patients. Need resources for maintaining Structural: the technology. Need to have technological tools available to enter their data Need resources for maintaining the technology i.e. battery backups, chargers for iPhone or laptop Develop new way of communicating with health provider, families/friends PHR Model Shift how patients manage Type II diabetes by using integrated PHR to cause a 10X increase in patient compliance as evidenced by reduced hospital admission, increased success in managing daily blood sugar, improved test results such asHgbA1C, decreased dependence on or eliminate need for meds Target Stakeholders: Patients with Type II Diabetes, Primary Care Physicians Key Metrics: % of diagnostic tests within range, Patient and Provider Satisfaction Vital Behaviors Metrics: % Diagnostic tests within range, Patient satisfaction, Provider satisfaction The Disruptors: Integration of PHR into clinical workflow, Meaningful Use. Social networking, PHR Use How Do We Know These Are Vital Behaviors? Project HealthDesign research shows that information gathered by patients was more important in determining treatment decisions than their official clinical medical record. It is thought that sharing information with providers helped both the provider and patient determine how medical treatments were working and make needed adjustments in treatment to maintain health. To uncover Real Vital Behaviors, we propose testing our assumptions by running a controlled pilot using our suggested vital behaviors, suggested recovery behaviors and monitoring outcomes. The goal of the pilot will be to find and validate best practice vital behaviors that can be used for successful patient and provider engagement to bring the desired outcomes. We believe costs would be minimal, as we will pilot internally with 2 providers and 20 patients. We would use existing staff to support the physician/practice workflows. We would ask the provider to invest 30 minutes per day to manage PHR work. We will monitor and study the outcomes and then will expand the pilot to a larger group while we continue to monitor and study the patient outcomes. Metrics we would use include: % of diagnostic tests within control ranges, patient satisfaction, and provider satisfaction, number of hospital/ED visits, number of clinic visits, and cost to payers / patients. We will also seek feedback from patients and provider.

appointment, have patient access the Advice tool and ask a question. Personal Motivation: Send patient a monthly diabetes summary that tracks completion status of patient tasks, glucose trend graph, and most recent HgbA1C. Personal Ability: Show patient how to schedule appointment and create appointment reminder in PHR.

Main Challenges Patient Engagement: Personal motivation - patient will need to commit and engage at level that will make a difference in health outcome Provider Engagement: Personal motivation - provider will need to add work that is potentially uncompensated time and will need to connect the improved patient outcome to added effort that will be required Project References:
1. 2. 3. 1. 2. 3. 4. 5. 6. Influencer The Power to Change Anything Kerry Patterson, Joseph Grenny, David Maxfield, Ron McMillan, Al Switzler, McGraw- Hill American Diabetes Association. (2010). American Diabetes Home Page. Retrieved from http://www.diabetes.org/ Robert Wood Johnson Foundation (RWJF). (2010). Project HealthDesign. Retrieved from http://www.projecthealthdesign.org/ Robert Wood Johnson Foundation (RWJF). (2008). Design teams unveil innovative PHR applications that help people take charge of their health. Retrieved from http://www.rwjf.org/pr/product.jsp?id=34528 Robert Wood Johnson Foundation (RWJF). (2010). Retrieved from http://rwjfblogs.typepad.com/pioneer/personal-health- records/ Robert Wood Johnson Foundation (RWJF). (2010). Tracking and sharing observations from daily life could transform chronic care management. Retrieved from http://www.rwjf.org/pioneer/product.jsp?id=56368 Geisz, M. (2010). Project HealthDesign: Rethinking the power and potential of personal health records. Retrieved from http://www.rwjf.org/pr/product.jsp?id=69288 \ Early Experiences with Personal Health Records, John Halamka, Kenneth Mandl, Paul Tang, Journal of Medical Informatics Association, Volume 15 No 1 Jan/Feb 2008 Integrated Personal Health Records: Transformative Tools for Consumer -Centric Care. Don Detmer, Meryl Bloomrosen, Brian Raymond, Paul Tang, BMC Medical Informatics and Decision Making October 2008

7. 8. 9. 10. 11. 12. 13. 14.

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