Welcome to patient centered care, supporting patient driven care coordination. This is lecture A, which will cover patient initiated information exchange. This unit will cover the following learning objectives. One, explain the importance of patient driven care coordination. Two, list ways a patient can use technology to drive care decisions and three, describe the concept of patient initiated information exchange. This unit will explore the use of technology to support and enable patient driven coordinated care. How can we help place the patient at the center of their care? Can Health I.T. tools support and enable patient driven care coordination? One of the ways that patients can manage their care coordination is through information exchange. The goal of information exchange is to allow patients to have all their health information in one location. In this model, health information will follow the patient as they move from provider to provider, enabling them to control sharing of their health information and providing the ability to share information when needed. The information exchange allows patients to easily track and monitor their own health. Also, an information exchange can help the patient to update and correct their health or billing information. Some of the primary technologies that are used for health information exchange include; the Blue button application, the iBlue button application, the Personal Health Record (PHR) and the patient portal. The blue button was developed by the U.S. Department of Veterans Affairs in coordination with CMS and the U.S. Department of Health and Human Services. The blue button enables patients to connect with their health plans, electronic medical record providers and other healthcare providers to locate, view and download personal health information. The blue button allows patients to find important information when they need it, gather information to make informed health decisions, share personal health information with others, review personal health records for accuracy and track scheduled health events. Information is available in a mobile format so that it can be accessed anywhere. Although the blue button provides a standard method to view and download patient information from multiple sources, the technology does not completely support patient driven care coordination. If health care has been provided by multiple organizations, the patient will need to make separate connections through the blue button to each organization in order to view information. In addition, not all organizations have joined the blue button initiative. The blue button allows the patient to review records for accuracy but changes and corrections to records cannot be done within the blue button application. The iBlue button was developed in response to an ONC challenge, to improve patient initiated information exchange. The iBlue button takes the blue button one step further by combining information from healthcare providers such as Medicare, the V.A, insurance plans and health records sent by care providers into one record. The application organizes all of these records into a summary view, accessed on a mobile device. Health information can be viewed and annotated. The iBlue button also includes links to information that allow the patient to learn more about health topics or to better understand terms. The iBlue button application allows records to be sent directly to a care providers i-Pad and the care provider can send information back to the patient's iBlue button application. The iBlue button provides two applications; one for patients, and one for care providers. Unlike the blue button, the patient can correct their health information right on the app. The iBlue button was designed to improve on blue button functionality. Although the iBlue button combines records from multiple providers into one easy view, not all providers are participating with the iBlue button process. The blue button is free. However, the iBlue button must be purchased by consumers and providers. At this time, the iBlue button app is in limited use. The Personal Health Record 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 the 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. The patient portal allows patients' access to portions of the electronic medical record through a secure login site. The patient portal is typically associated with only one health system and will contain records from health care provided only within that system. The patient portal contains a wealth of information for the patient to view and download. But until electronic health records are interoperable, a patient portable typically contain only the healthcare information generated within one healthcare system. Information available to the patient may differ from one patient portal to another and the patient may have to make a request for information not displayed in the portal. Although development and implementation of technology is designed to support patient initiated information sharing are proceeding at a fast pace. Most of these solutions do not yet provide a true seamless exchange of information. Technical, financial, cultural and legal barriers still remain. Technical barriers continue to present an obstruction to true patient initiated health information exchange. Some of these barriers include a lack of data standards. Data standards provide the ability of data from one system to match and integrate with data from another system. Without these standards, there is an inability to completely integrate information into one record. Another barrier is the need to change from medical language to a vocabulary that is patient friendly. Financial barriers to patient initiated health information include calls to the patient and provider for access and use of personal health information technology. Technology and equipment such as a smartphone, an internet connection or a computer are needed to take advantage of electronically sharing patient health information. The public is slow to realize the value of personal health records and is reluctant to pay for this technology. Several patient health record startups have failed in the past decade due to a lack of users. Because there is not widespread public acceptance and value of this technology, investors are hesitant to devote large sums of money into the ongoing development of technology that may not be profitable. Both patients and providers are moving towards an understanding and acceptance to patient initiated health information exchange. However, there are cultural barriers to overcome. Providers fear that they will have to deal with massive amounts of information that will impede their ability to care for their patients. Many providers are still transitioning from a physician directed model of care to a relationship based model of care. In a physician directed model of care, sharing of information is one sided; from the physician to the patient. This model of care does not support or value patient information sharing. Cultural shifts also need to occur within the patient culture, as the patient moves to greater understanding and use of a relationship based model of care, education and information will be needed to increase the patient's awareness and incorporation of bidirectional information sharing. Another barrier to information sharing is based on legal concerns; The ownership and use of patient data, especially when generated by health care providers, is still being debated. In a physician directed care model, patient information is controlled by the physician and the health care organization. Providers fear that opening up all medical record data to the patient can cause increased liability and legal action. As you can see from this diagram, summarizing the barriers that were previously discussed, there are several to overcome in order to facilitate patient initiated information exchange. These barriers are technical, financial, cultural and legal This concludes Lecture A, of supporting patient driven care coordination. To summarize, the goal of patient initiated information exchange, is to place the patient at the center of all of their data, so that information can seamlessly flow to the patient and then to anyone with whom they choose to share the information. The blue button, the iBlue button, the PHR and the patient portal, each help patients to share information. However, ongoing work needs to be done to achieve fully seamless sharing of data.
