NYC PHR Development
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Example paper self-management tool, New York City
2008 will be an exciting year of increasing EHR use in NYC! Along with the EHR will come consumer access to the PHR that is tethered to the eClinicalWorks (eCW) software that more and more of our primary care providers will use.
eCW has a patient portal (http://www.eclinicalworks.com/webportal.php) that we will be testing and modifying to better support consumer self management. It provides essential functions, such as the ability to fill in demographics and health history, view medications, lab results, and bills, send and receive messages, and view educational materials. We will design special additional functions to build upon previous development of paper self management tools, such as the colorful one shown here.
Our special challenge is to design a PHR for the culturally and linguistically diverse Medicaid population in NYC. We are not sure how many have access to personal computers and the internet. We may experiment with kiosks in primary care waiting rooms to provide access and personal support for people to get started using the PHR. David Lobach is using kiosks after investigating internet use and PHR interest through a telephone survey of 31 Medicaid beneficiaries in North Carolina; only 52% had high-speed internet connections (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1839688). Another recent study compiled focus group reactions of medically underserved African Americans and Latinos in New Jersey to PHRs (http://www.mathematica-mpr.com/publications/pdfs/phrissuebr.pdf). Findings from these preliminary studies that I take to heart are: 1) most consumers want access to some basic personal health information, 2) many people think data should be entered by health personnel, but 3) people distrust the privacy and security of keeping their personal health information online and they want to be able to control access to the record and audit who views it and why. This tells me that our tethered eCW PHR may be the best place to start with our NYC Medicaid folks. Perhaps, if using the PHR actually improves control over serious health problems, more consumers will take the plunge and try it.
This year, we will have the opportunity to coordinate with other areas of the NYC Department of Health and Mental Hygiene (DOHMH) to decrease the rate of high blood pressure among city residents. Providers will be supplying Medicaid patients with BP monitoring equipment and our PHR may be one place where people can track and manage their own BP. It will add to the tools that consumers can find on helpful websites, such as information under “Healthy Heart” on: http://www.nyc.gov/html/doh/html/diabetes/diabetes-pub.shtml. Another DOHMH website with consumer BP resources is: http://www.nyc.gov/html/doh/html/cardio/cardio-pressure.shtml.
It is very exciting to coordinate public health and informatics programs to improve health with the large population we have in NYC!
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January 4th, 2008 at 4:24 pm
Melinda, it is very exciting to see that New York City is using this information to move forward in providing personal health records for residents!
The data you cite from Lobach tracks nicely with data just published last week by the Pew Internet & American Life Project (see this post), which demonstrates that Internet penetration is at a level that supports the value of this tool for communities of all backgrounds.
Thank you for keeping us updated - many will look forward to hearing more about your work.
January 4th, 2008 at 5:03 pm
Melinda,
It’s great to see the innovative plans you’ve developed for 2008 with respect to patient-centered HIT implementation!
I think you’re absolutely right that getting Medicaid beneficiaries to use the PHR for specific issues related to critical health issues will begin to create a sense of clarity for them around the potential value. Part of the question is: What are the possible “killer apps” that can draw them in?
You’re off to a good start with BP monitoring and Healthy Heart. A few other possible next steps to consider:
1) Spend some time shadowing these clinicians and patients in the exam room to understand clearly what are their critical information needs. For example, what happens during the visit–and particularly toward the end of the visit when next steps are being discussed–that suggests an obvious health information need?
2) Bring those insights back to a brainstorming session about the kinds of tools that could potentially meet those needs. Those can come from your existing NYC DOH resources; clearly, you already have some good ones that probably could be getting even more use if they were prescribed by the clinician or otherwise better integrated into the care delivery process.
3) It can also help you develop a list of new tools and content that you can search for and build into your future planning process.
Do you think these strategies might be useful?
–Josh
January 5th, 2008 at 2:35 am
[…] the eClinicalWorks (eCW) software that more and more of our primary care providers will use.” Article Melinda Jenkins, PCHIT, 4 January […]
January 7th, 2008 at 9:26 am
Josh,
We do have plans to implement some of the things you suggest. We plan to evaluate primary care providers’ use of the tools by survey and observation and we will get live input through provider participation in our new Clinical Advisory Commitees.
I am also looking for good ways to connect with community members for their input. Does anyone have related experiences to share?
Melinda