The U.S. Agency for Healthcare Research & Quality (AHRQ) has just released a thorough literature review of the “Impact of Consumer Health Informatics Applications.” The report, prepared by the Johns Hopkins Evidence-based Practice Center and led by Chris Gibbons, is part of AHRQ’s evidence report/technology assessment series.

Gibbons et al concluded that “available literature suggests that select CHI applications may effectively engage consumers, enhance traditional clinical interventions, and improve both intermediate and clinical health outcomes.”

The abstract is below and can be accessed here and has a link to the full 500+-page report.

Objective: The objective of the report is to review the evidence on the impact of consumer health informatics (CHI) applications on health outcomes, to identify the knowledge gaps and to make recommendations for future research.

Data Sources: We searched MEDLINE®, EMBASE®, The Cochrane Library, Scopus™, and CINAHL® databases, references in eligible articles and the table of contents of selected journals; and query of experts.

Methods: Paired reviewers reviewed citations to identify randomized controlled trials (RCTs) of the impact of CHI applications, and all studies that addressed barriers to use of CHI applications. All studies were independently assessed for quality. All data was abstracted, graded, and reviewed by 2 different reviewers.

Results: One hundred forty-six eligible articles were identified including 121 RCTs. Studies were very heterogeous and of variable quality.

Four of five asthma care studies found significant positive impact of a CHI application on at least one healthcare process measure.

In terms of the impact of CHI on intermediate health outcomes, significant positive impact was demonstrated in at least one intermediate health outcome of; all three identified breast cancer studies, 89 percent of 32 diet, exercise, physical activity, not obesity studies, all 7 alcohol abuse studies, 58 percent of 19 smoking cessation studies, 40 percent of 12 obesity studies, all 7 diabetes studies, 88 percent of 8 mental health studies, 25 percent of 4 asthma/COPD studies, and one of two menopause/HRT utilization studies. Thirteen additional single studies were identified and each found evidence of significant impact of a CHI application on one or more intermediate outcomes.

Eight studies evaluated the effect of CHI on the doctor patient relationship. Five of these studies demonstrated significant positive impact of CHI on at least one aspect of the doctor patient relationship.

In terms of the impact of CHI on clinical outcomes, significant positive impact was demonstrated in at least one clinical outcome of; one of three breast cancer studies, four of five diet, exercise, or physical activity studies, all seven mental health studies, all three identified diabetes studies. No studies included in this review found any evidence of consumer harm attributable to a CHI application.

Evidence was insufficient to determine the economic impact of CHI applications.

Conclusions: Despite study heterogeneity, quality variability, and some data paucity, available literature suggests that select CHI applications may effectively engage consumers, enhance traditional clinical interventions, and improve both intermediate and clinical health outcomes.

Nancy Shute has a nice piece in yesterday’s Charlotte Observer that summarizes “6 ways electronic medical records might make diagnosis easier and more convenient, and care safer.” An excellent writer, Nancy has done a good job of boiling down all the grandiose discussions on EHR functionality into tangible, “what have you done for me lately?” functions. This consumer orientation to EHR functionality is badly needed as we define “meaningful use.”

With every one of them, however, by attaching information therapy (Ix) to the technological function, we could substantially expand the utility of that application. So, I’d like to propose amendments to Nancy’s six high-impact apps.

1. “Skip trips to the doctor.” Yes, secure e-mail with your clinicians is a huge convenience factor, and attaching an information prescription about what to do next (or when it really would be time to come into the office) would provide additional value to the patient.
2. “Track Mom’s medical chart even if you’re in Albuquerque or Altoona.” As long as you can actually interpret what’s in the online record, that’s fine. But what if the medical jargon raises more questions than it answers. If the chart via the portal contains links to content that contextualizes the data points, you’ll feel a lot more comfortable staying in Albuquerque or Altoona.
3. “Get lab test results without having to play phone tag with the doctor’s office.” By hyper-linking the lab test results to brief explanations of what each acronym means, what the “normal” ranges are, and what it means if your values are “abnormal,” the lab values will have much more meaning.
4. “Never again drag X-rays to a specialist.” Very few lay people can interpret radiology images, so attaching the radiology report (translated into plain language) to the digital files will empower consumers.
5. “Find out if your prescriptions could have dangerous interactions, before you start taking them.” But then what? Provide some guidance to the consumer about alternatives or what questions to ask your doctor, pharmacist or other health care professional.
6. “Use your cell phone to tap into your health records.” Put everything together from above, and the more ubiquitous cell phone really will ring!

As we move forward in defining what we want out of “meaningfully used” EHRs, let’s take a page from Nancy’s book and boil these functions down into what they actually mean for the day-to-day lives of consumers. But let’s also go the extra step of making the most of the electronic opportunities that present themselves by connecting data points to content that helps all consumers use these tools most effectively.

According to new data from Manhattan Research (as reported here by iHealthBeat), 36% of US physicians reported that they communicated online with patients in the first quarter of 2008. That’s up from 31% in 2007 and 25% in 2006.

That 11 percentage-point increase is a 44% jump in adoption over two years–a steady rise. It may signal that we’re nearing a tipping point for adoption of a technology that is a foundation of so many effective Ix applications. Secure messaging and other forms of electronic and asynchronous communication make possible so many enhancements to the traditional clinician-patient relationship.

As online communication takes hold, it will be important that delivery systems, technology companies and other organizations develop creative solutions that facilitate the integration of clinicians’ personalized notes/comments/opinions/recommendations with high-quality health content and navigation to additional resources.

The combination of clinician personalization and accurate, comprehensive, understandable and tailored content will allow for mass personalization of Ix. Paul Wallace (IxCenter Board Chair) and I wrote about strategies for doing this in an IxCenter white paper from a few years back that you can download from our Web site.