Welcome to Patient-Centered Care, Patient-Provider Communication. This is lecture c, the objectives for this unit, patient-provider communication, are one, explain the importance, elements, and processes of patient-physician communication. Two, discuss the concept of trust in the context of healthcare interactions. And three, describe various informatics tools and the practical considerations to support patient-provider communication. In this lecture, we will talk about informatics tools for patient-provider communication. This slide presents a graphic model of the digital practice infrastructure surrounding both providers and patients. This conceptual model acknowledges that the provider is no longer just a single physician or doctor group. But usually a multidisciplinary team, that is either physically or virtually integrated into an organized, structured delivery system, surrounding the provider and consumer-concentric rings. The slide lays out a spectrum of intertwined types of e-health communication tools that support patient-provider communication. Communication and information technology is changing rapidly worldwide. The digital revolution will have a profound impact on how physicians and healthcare delivery organizations interact with patients and populations. Over the coming decade, face-to-face patient-doctor contacts will become less common. And exchanges between consumers and providers will increasingly be mediated by electronic devices. The use of digital technology has revolutionized how we communicate. Providing access to health information, from virtually any location at any time. 2011 research shows that text messaging has been emerging as the preferred electronic communication venue. Both increasing availability of communication, but limiting the ability to provide the details of communication that are associated with a verbal conversation. In the recent IBM study, five out of ten students said they interact online with people they don't already know. In other words, they use social media to reconfigure and expand their social networks into totally new areas. In fact, even before finishing college, students are joining professional social networks such as LinkedIn to establish and benefit from professional relationships. People are communicating through digital and social media more than ever. Even government agencies use Facebook, Twitter, YouTube, Flickr, and other social media. Digital and social media are being used by consumers and healthcare providers but communication preferences are changing. According to the Manhattan research cyber citizen health 2012 study, the number of US adults age 18 years or older using digital technology for heath information has increased from 61 million in 2011 to 75 million in 2012. We are undergoing a digital revolution. The mobile health market will continue to grow due to the following factors, according to Guillemi and Benedict in 2013. There are new technologies such as smartphones, remote patient monitoring, and social media. There is a decreasing cost and increasing acceptance of mobile health. The population itself is also a factor because the global population is aging. The median population age is increasing and health is becoming more about chronic instead of acute diseases. Additionally, there is a foundation in place with a concept of care everywhere taking route. Healthcare is moving towards a precision-based model or personalized medicine. As a result of greater understanding of the human genome together with other personalized technologies. The industry will likely transform as had many other industries. To one that is predictive, personalized, participatory and preventive. mHealth will be a major factor in providing personal tool kits that will ultimate help those manage predictive vulnerabilities, chronic illnesses and episodic acute conditions, enabled by technology, connectivity and data. Mass customization is on the horizon, allowing mHealth solutions to flourish. Expectations are high that mobile technology will help to increase access to care in emerging markets and transform the developed world's costly healthcare behemoths into less expensive, prevention-based, and patient-focused systems. The surveys conducted for this research program found that although patients see relatively modest change so far, large numbers expect that mHealth will have a significant impact on how care is delivered in the next three years. The use of mobile health tracking devices, among both the young and healthy, and the old and sick, demonstrates high motivation to maintain or improve general well-being or prevent adverse health incidents. 35% of US adults say that one time or another they have gone online specifically to try to figure out what medical condition they or someone else might have. One in five Internet users have consulted online reviews and rankings of healthcare service providers and treatments. 13% of adults have gone online to find others who might have health concerns similar to theirs. People living with chronic and rare conditions are significantly more likely to do this. Some common examples of informatics tools to support patient-provider communication are patient portals, personal health records, and online communities. We will now talk about each and some other units in this component may also mention these tools. A patient portal is a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an Internet connection. Using a secure user name and password, patients can view health information depicted on this slide, such as recent doctor visits, lab results, and education materials. With patient portal implementation, a healthcare organization can enhance patient-provider communication. Empower patients, support care between visits, and most importantly, improve patient outcomes. The personal health record, PHR, is a patient-initiated electronic record that is separate from the EHR, and contains information selected and added by the patient. The PHR allows the patient the ability to update and change their health information at any time, and provides the patient the ability to share this information with anyone that they choose to share with. The PHR provides a patient the most control of their health information. There are some drawbacks to this technology, although some medical devices and wearable trackers can feed data into a PHR, very few electronic health record vendors currently interface into the PHR. Leaving the patient responsible for entry and updates to information. In addition, providers cannot send information directly into most PHR products. Leaving the patient to enter the updates. Online patient communities provide technology tools that support patient to patient communication and provide helpful information to guide patients in more effective communication with their providers. The website PatientsLikeMe, a site dedicated to providing a space for over 250,000 members to communicate with each other and share personal health experiences launched a 2014 campaign called Data for Good. This campaign is designed to encourage health data sharing to advance research and to change medicine. In a recent study focusing on sleep issues, PatientsLikeMe, was able to pull from its platform of more than 5 years worth of data to analyze over 184,000 symptom reports. The company was then able to run an additional member survey, to collect additional data, receiving more than 5,000 responses in less than 2 weeks. There are some practical considerations for supporting informatics and technology to facilitate patient-provider communication. Access to information, health literacy, privacy and security, and culture change are key factors and will be discussed in this lecture. Empowered patients and caregivers can share decision-making with their healthcare providers through better health literacy, and input to their medical record throughout the care continuum. Health literacy is defined by the U.S. Department of Health and Human Services as quote, the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions, and services needs to prevent or treat illness. This slide represents the range of tools supporting patient-provider communication along the continuum of patient care with the use of digital and mobile communications. Used after the active phase of patient care to monitor and promote adherence to therapy. There are resources on health literacy from a number of organizations such as AHRQ, AARP, and the Informed Medical Decisions Foundation. Now patients may have access to their records. A research study by Woods, Schwartz, Tuepker et al in 2013, identified four themes that characterized patient experiences with reading the full compliment of their health information. When seeing their records, patients felt that their communication with providers and healthcare systems was positively affected. Access also enhanced knowledge of their own health improves healthcare and allow for greater participation in the quality of their care such as follow up of abnormal test result or decision making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges they overwhelmingly felt that having more rather than less of their health record information provided benefits. Another study look at patient and provider related outcomes after the implementation of OpenNotes. What researchers found was that most patients felt more in control after reading their doctor's notes, also a majority reported increased medication adherence. Less than 5% of physicians reported longer visits and no more than a third of providers reported changing their documentation content or that it took longer to write notes. At the end of the experiment 99% of patients wanted OpenNotes to continue and no doctor elected to stop OpenNotes. Not only can it be helpful for patients to access their health record, but patient's information that they contribute could also be valuable. This is because the longitudinal medical record, or LMR, is often incomplete. So patient-reported data is a promising source of general health information. They can provide information about tests and quality of life, for example. Patients should have access to their information, assist with recording information and help with quality assurance of the information. By doing this, it will help increase communication between patients and providers. Privacy and security of health information are important, but also how patients perceive such information is protected, is also essential. According to a study done by Hughes, Patel, and Pritts done in 2014, individuals who strongly disagree that healthcare providers have reasonable protections in place for EHRs are over eight times more likely to have withheld information from their provider. Compared to those who strongly agree. Compared to the overall population individuals who strongly disagree that healthcare providers have reasonable protections in place for EHRs are almost five times more likely to have withheld information from their provider. So if a person does not believe that their health information is protected for privacy and security, they are less likely to share information. For information on insuring the privacy and security of information shared, please see component 22 unit 10. Introduction of electronic means of promoting patient-provider communication resulted in culture change, and a need for clinicians to adopt to the expectations of new generation of health consumers. For example a provider could say, quote, if you don't mind, I am going to be typing as you speak. I'm happy to show you what I'm writing, or quote, I'm going to look up your test results. Would you like to look at them together, end quote. It is important to consider how socially stigmatizing health conditions are documented and to be sensitive to patient perceptions. However, by engaging the patient to communicate with the provider it could improve management of chronic disease and mental illness and encourage patient-provider collaboration. This slide represents major themes to address, when electronic tools for patient-provider communication are being implemented. Partnering with patients represent a significant change in culture that must be addressed during each contact between provider and patient. Listening to the patient allows them the opportunity to participate in their care and can provide information and insights that may not be gained when talking. Both patients and providers need to learn the skills of engaging with each other, a significant part of changing the healthcare culture. Patient engagement is also base on trust between the two parties. And as a result patients will become more engaged and invested in improving their own health. This concludes lecture c of Patient-Provider Communication. To summarize, digital technology changed how patients and providers communicate. Mobile health and self tracking of general well being are examples and contributors of this manifestation. We talked about examples of informatics tools to support patient-provider communication, such as patient portals, personal health records and online patient communities. There are practical considerations for implementing such tools like data access, health literacy, privacy and security, and culture. However, providing patients access to their medical record and collaborating with them to contribute to their medical record could improve their care. This concludes unit 5, Patient-Provider Communication. The summary of this unit is providers with good communication skills. Identify patients' problems more accurately, and their patients adjust better psychologically, and are more satisfied with their care. Effective methods of communication skills are available, and the opportunity to practice them is essential. Listen carefully to patients, treat them respectfully, be honest and consistent, follow through on commitments and have an accepting attitude. Digital technology has changed how we communicate especially between patients and providers. An examples of informatics tools to support patient-provider communication are patient portals, personal health records and online patient communities.
