In the PCHIT initiative, our primary point of contact for shadowing clinician-patient interaction has been the clinician and has taken place in clinics. However, we know that very few people–even those with chronic conditions unless they have serious acute events–spend more than 1% of their time in traditional clinical settings (think about how many hours out of hte 8,760 hours in a a year you spend in the doctor’s office or hospital).

For that reason, it’s equally important for us to spend time shadowing consumers accessing health information and health care from their homes, workplaces and elsewhere. While on our recent trip to practices in Boston, I had the opportunity to visit with two consumers, and learned about their recent experiences accessing new personal health records (PHRs).

These two people are older, well-educated adults, but both are fully “wired” seniors.  They recently were informed that they had access to their own personal health information (PHI) via a secure portal from their health plan. However, they weren’t given much guidance on what was available and how to make the most use of it. Moreover, they had access to very little PHI aside from medications (there does appear to be a function for renewing prescriptions). There was no access to lab values or other tests, and no link to content that would provide context on how the limited PHI that was available related to their health.

Interestingly, that health plan also seems to be involved in a PHR/health risk assessment (HRA) pilot project with the CDC using a separate platform. One of them received an email from his health plan a couple weeks ago asking if he wanted to participate, and he responded to a survey–basically an HRA. That ultimately led to the generation of an information prescription reminding him to get his flu shot. The reminder–and a second one to reinforce the message–made use of fancy graphics and mapping software to impart the flu shot recommendation. However, the glitzy mapping and graphics were, more or less, irrelevant to the message, and there was no content in the message that explained the health rationale behind why a senior with diabetes could benefit from an influenza vaccination (many people don’t think of the flu as being a serious illness despite the fact that it is responsible for 200,000 hospitalizations and 36,000 deaths every year in the US, and people with chronic conditions are at greatest risk for serious complications). Given the information he was prescribed, this person’s logical reaction to the email he got was: What’s the point of this map and why should I care about this message? 

This reinforces how important it is that we not assume that “If we build it, they will come.” Our PHR “Field of Dreams” requires that we are thoughtful in how we connect PHI to health content. PHI data points and informational messages need to include a health context so that the information has clear meaning to the individual and effectively communicates the health rationale for desired behaviors or informed decisions.

This entry was posted on Wednesday, November 14th, 2007 at 1:09 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.