Webinar: Advanced IT for the Medical Home: Engaging the Patient

Advanced IT for the Medical Home: Engaging the Patient    A special conference for senior executives & administrators from physician groups, emerging Accountable Care Organizations, health systems, Patient Centered Medical Homes, health plans, and government agencies.   To register for this interactive, 45 minute webinar, please click here. System Requirements PC-based attendees require: Windows® 7, Vista, XP or 2003 Server       Macintosh®-based attendees require:  Mac OS® X 10.5 or newer  Answers to Your Specific Questions If you have questions on our webinar and/or webinar formats, please contact us atmarketing@ptengage.com Webinar Date:  Monday, October 3rd Time:  12:00 pm Eastern Primary care is at the core of most every major initiative for health care reform - not the least of which is the Patient Centered Medical Home. The PCMH model will succeed or fail depending on how well primary care providers can engage their patients in a coordinated, continual, and directed pattern of care.  Information technology, when applied strategically and purposefully, can create engaged patients and be a key difference maker for PCMH efforts.     Benjamin Littenberg, MD FACP will share his experience as a practicing physician, academician, and information scientist about how primary care delivery is changing, and how engaging with patients is more important than ever to the financial and clinical success of the primary care practice.  Focused Discussion Attendees will learn: · How well the medical home model orients itself to patient engagement · How primary care physician-lead groups have implemented technology solutions that support PCMH criteria · What research and standard practices have established about how patient engagement improves the overall clinical experience and what that means for Medical Home providers · What are the anticipated impacts - risks and rewards - of PCMH on how providers and patients interact Seminar Speaker Benjamin Littenberg MD, FACP  Henry and Carleen Tufo Professor of Medicine, Professor of Nursing, Director of General Internal Medicine Division of General Internal Medicine, University of Vermont Chief Medical Officer, Patient Engagement Systems, Inc. Dr. Littenberg is the Henry and Carleen Tufo Professor of Medicine, Professor of Nursing and Director of General Internal Medicine at the University of Vermont. He received his medical degree from Case Western Reserve University and trained in internal medicine at Hartford Hospital in Connecticut. He was a Robert Wood Johnson Clinical Scholar at Stanford University before becoming Assistant Professor of Medicine at Dartmouth. Following an appointment as Associate Professor of Medicine at Washington University in St. Louis, he assumed his present position in 1999. Dr. Littenberg practices General Internal Medicine in Burlington, Vermont. His research interests center on technology assessment and quality improvement. Recent projects include new ways to measure quality of care in cancer, novel strategies for reporting test results to patients, better approaches to antibiotics in sinusitis, safety improvements in outpatient prescriptions, and strategies to address health literacy. In Vermont, Dr. Littenberg has been active on the Board of the Vermont Program for Quality in Health Care. He has developed statewide registry-based approaches to quality and safety improvement with the Vermont Breast Cancer Surveillance System and as Principal Investigator of the NIH-funded research grant for the Patient Engagement Systems Diabetes Information System which engendered Patient Engagement Systems.           Patient Engagement Systems 89 Beaumont Ave. Given Courtyard, 4 South Burlington, VT 05405 (802) 656-4576  About Patient Engagement Systems® Patient Engagement Systems® technology enhances patient engagement by fostering communication between patient and caregiver, and by delivering decision support to health-care providers. The PES system has been proven in a National Institute of Health clinical trial to improve health outcomes and reduce costs. The patent-pending PES technology uses automated reminders, alerts, flow sheets and population reports to help health care providers better care for their patients, and patients better manage their chronic conditions. PES has been used by thousands of patients with diabetes in Vermont, New York, California and Texas. Clients include municipalities, private hospital systems, physician organizations, and managed care organizations. For more information about Patient Engagement Systems (PES), visit http://www.patientengagementsystems.com.

Exchanging Health Information to improve medication adherence

Getting the right medicine into the right patient at the right time is a particularly challenging problem in outpatient care. Consider the required steps:

1. Prescriber selects the right medication
2. Prescriber prescribes the right medication
3. Patient carries the paper prescription to the pharmacy
4. Pharmacist interprets the written prescription correctly
5. Pharmacist selects, packages and labels the medication correctly
6. Patient returns to pharmacy
7. Patient receives the correct package
8. Patient takes the medication as prescribed
9. Patient requests refill at appropriate time
10. Return to Step 5

There are lots of variations on this scheme depending on insurance, expired prescriptions, need for clarifications, etc, etc., etc. A big one recently is that Step #3 is sometimes replaced by a network connection with quite high reliability.

There have been a number of studies on "secondary non-adherence" in which the pharmacy records identify patients who don't get refills (Step #9). There have even been some analyses of patients who drop off their paper prescription but fail to pick up the medicines (Step #6). However, until recently, the gap between prescribing and dispensing the first unit (Steps #3, "Primary Non-adherence") has been very difficult to study because of the lack of information exchange between the prescriber and the dispenser.

Marsha A. Raebel and the good folks at the Kaiser Permanente Institute for Health Research in Colorado just published an article in The Journal of General Internal Medicine about using health technology to identify those patients who need help in getting their first fill. They looked at over 12,000 new electronic prescriptions for  blood pressure, cholesterol or diabetes. Overall, about 7% failed to pick up their first medication, even though these patients had pretty good insurance coverage.

It is not clear yet why these folks don't show up to pick up their pills. Nor is it clear exactly what should be done about it. However, it is clear that this kind of health information exchange between prescribers and pharmacists should trigger an alert to someone inside the system: "This patient is not getting the intended care - call them and find out why!!"

Characteristics of Patients with Primary Non-adherence to Medications for Hypertension, Diabetes, and Lipid Disorders

Marsha A. Raebel, Jennifer L. Ellis, Nikki M. Carroll, Elizabeth A. Bayliss and Brandy McGinnis, et al.

Journal of General Internal Medicine Online First™, 30 August 2011

Empowering patients with data

I've been thinking more and more about the idea of engaging patients in their own care as the means to improve quality and reduce costs. Today I see that Farzad Mostashari, Director of the Office of the National Coordinator, is thinking along the same lines:

"The meta principle is putting patients at the center of information flows, literally. Achieving that means freeing the patient data, empowering patients by raising awareness that they can access their own data and teaching them to learn from it."

Perhaps the time has come....

Is it better to prescribe or negotiate?

Engaging patients in their own care means more than just giving them a handout or teaching them how to care for their feet. The tough part is motivating them to stay engaged for the long run. This is especially difficult when they have depression which itself induces dis-engagement from the world.

Exercise is an effective treatment for depression. It is also inexpensive and has positive benefits in other spheres of health such as weight control and heart disease prevention. However, it is notoriously difficult to get depressed patients to start exercising and to keep them engaged. One reason might be that the recommended duration and intensity of exertion can seem daunting. (30 minutes on the treadmill!!!)

A team of researchers from the University of Nottingham just published the intriguing results of a controlled trial in which they compared the effects of exercise of preferred intensity with exercise of prescribed intensity in thirty-eight women living with depression. The women who chose their own level completed more sessions and had better mental AND physical health at the end of the 12 week study.

The study is quite small (only 38 subjects) and may not be the last word on this issue, but the idea certainly warrants further investigation. It suggests that engaging patients in decisions about the dose of the treatment is effective at keeping them in the treatment. And, that's better than getting them on the "right" dose.

Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression. Patrick Callaghan, Elizabeth Khalil, Ioannis Morres, Tim Carter. BMC Public Health 2011; 11:465

Smartphones for Health? A survey

Last month, Consumer Health Information Corporation released the results of a survey of 395 smartphone consumers. It was a good first effort to dig into a very murky, but important question: how will folks use their smartphones to manage their own health? 


They reported a number of findings:

• 74% of smartphone apps are abandoned by the user before they use it 10 times.
• Most health apps do not comply with public health guidelines.
• In spite of these failings, most consumers were willing to pay a few dollars for the app.
• Respondents preferred text messages over other methods of getting health reminders.

This last finding is a bit problematic. Apparently the survey included only electronic methods of communication (phone calls, e-mails, app messages, etc.). However, none of these methods has ever been shown to improve health outcomes or lower costs. On the other hand, personalized first class mail is quite effective and has been proven in large scale clinical trials to change patient behavior for the better.

I guess that's what happens when you survey cell phone users on Facebook - they tell you they like using cell phones! But whether health apps will truly change our health awaits a more rigorous evaluation, including a large randomized clinical trial.

Patient Portals and Equity

Mita Goel, David Baker and the good folks at Northwestern University report in the Journal of General Internal Medicine about use of the patient portal in their large, academic practice in Chicago. Of 7,088 patients invited to open an account on the portal, 69% enrolled. However, older patients and minority patients were significantly less likely to use the technology.

Once they were enrolled, race and ehtnicity didn't seem to be associated with how the patients used the portal. However, younger patients were less likely to initiate a request for refill or advice, perhaps because they have fewer medical issues. Likewise, men used the system less than women, reflecting the general tendnecy for women to seek health care more often than men.

The good news for engaging patients and exchanging health information is that over 2/3 of patients in this large, complex population took the opportunity to enroll. Patients want to connect. The bad news is that it might not help resolve the racial and ethnic divides that continue to bedevil health care and American society - it might even make them worse.


Goel M, Brown T, Williams A, Hasnain-Wynia R, Thompson J, Baker D. Disparities in Enrollment and Use of an Electronic Patient Portal. Journal of General Internal Medicine 2011; Online first at http://dx.doi.org/10.1007/s11606-011-1728-3