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Health Information Sharing & Decision Making




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Health Information, Patient Education & Medical Decision Making

MODEL I
MODEL II
MODEL III
MODEL IV
g&u krumme (2011)


  1. The Big Picture (Model 1):

    1. Evolving Medical Technologies

        Dr. David B. Agus: Technology and the Future of Medicine (YouTube)

    2. The Evolving Role of Information Technology in the Health Care System

      At the national as well personal levels, we are increasingly concerned about spiraling health care costs. Information access, processes and technologies (IT) have become central to most propositions as to how health care costs can be brought under control. Information processes and behaviors involving consumers (patients) are part of this package. As in other areas of American society, volunteer work is essential in the transmission of health related information and patient education.

      • CROSSING THE QUALITY CHASM: A New Health System for the 21st Century
        [Committee on Quality of Health Care in America; INSTITUTE OF MEDICINE.
        NATIONAL ACADEMY PRESS, Washington, D.C.
        • Ch.7: Using Information Technology [pp.164-180] "... health care should be supported by systems that are carefully and consciously designed to produce care that is safe, effective, patient-centered, timely, efficient, and equitable. This chapter examines the critical role of information technology (IT) in the design of those systems.

      • Health Technology Assessment Program (HTA) [Washington State Health Care Authority] Project Health Design
        Project HealthDesign is forging a new vision of personal health records (PHRs) by exploring practical ways to capture and integrate patient-recorded observations of daily living (ODLs) into clinical care. American Health Information Community (AHIC) The American Health Information Community (AHIC) is a federal advisory body, chartered in 2005 to make recommendations to the Secretary of the U.S. Department of Health and Human Services on how to accelerate the development and adoption of health information technology. AHIC was formed by the Secretary to help advance efforts to achieve President Bush’s goal for most Americans to have access to secure electronic health records by 2014. American Health Information Management Association (AHIMA) "AHIMA (American Health Information Management Association) is a health information management (HIM) professional association over 63,000 members strong. Since its founding in 1928, AHIMA has remained committed to quality healthcare through quality information." American’s Health Insurance Plans: Innovations in Health Information Technology
        www.ahipresearch.org/innovation_series.html Certification Commission for Healthcare Information Technology (CCHIT)
        Founded in 2004, and certifying electronic health records (EHRs) since 2006, the Commission established the first comprehensive, practical definition of what capabilities were needed in these systems. The certification criteria were developed through a voluntary, consensus-based process engaging diverse stakeholders, and the Certification Commission was officially recognized by the federal government as a certifying body. Commission on Systemic Interoperability
        The Commission was charged with developing a strategy to make healthcare information instantly accessible at all times, by consumers and their healthcare providers. On October 25, 2005, the Commission released its report, Ending the Document Game: Connecting and Transforming Your Healthcare Through Information Technology, to the United States Congress, the Administration, and the American public. HIMSS Analytics HIMSS Analytics supports improved decision making for healthcare organizations, healthcare IT companies and consulting firms by delivering high quality data and analytical expertise. Healthcare Information and Management Systems Society (HIMSS) HIMSS News and Research: "HIMSS is the source for healthcare IT information. HIMSS’ industry intelligence empowers you to ask the right questions and implement the right solutions." HL7 United States
        Health Level Seven International (HL7) is the global authority on standards for interoperability of health information technology with members in over 55 countries. SNOMED International The International Health Terminology Standards Development Organisation is an international not-for-profit organization based in Denmark. IHTSDO acquires, owns and administers the rights to SNOMED CT and other health terminologies and related standards. IHTSDO develops and promotes use of SNOMED CT to support safe and effective health information exchange. SNOMED CT is a clinical terminology and is considered to be the most comprehensive, multilingual healthcare terminology in the world.

      • Kaiser Permanente: Care Connectivity Consortium: Better Data - Diagnosis - Counsel - Treatment - outcome [Information for better health care -- YouTube Video]

      • The Public and Doctors Overwhelmingly Agree on Health IT Priorities to Improve Patient Care [January 31, 2011 | Markle Health in a Networked Life] "The Markle survey found that majorities of the US public and doctors share many of the same hopes for advancing health through information technology (IT). Responding to parallel surveys at a time when significant health care policy changes were being debated and implemented, the public and doctors overwhelmingly agree on key requirements for information technology to increase the quality, safety, and cost-efficiency of care, as well as core privacy protections."

      • "Microsoft in Health" Health Solutions:
        1. Health Plan Sales: Streamline marketing and sales processes and move them online to help achieve more efficient operations at lower costs.
        2. Enterprise Resource Planning: Deliver services within your budget with better financial tracking and tighter business operations.
        3. Health Portals: "Facilitate better communication by creating secure access to data, applications, and services." "Delivering patient care, coordinating with specialists, managing administrative tasks, interacting with payers, and staying up to date on evidence and protocols - they all depend on accessing and sharing information in a secure manner."

      • Electronic Medical Records Videos on YouTube

    3. Organizational and Institutional Contexts and Changes (& their Impacts on Health Communication)



  2. Shared Medical Records & Online Doctor - Patient Communication

    :

    • How Patient-Centric Care Differs from Patient-Centered Care [Digital HealthCorner, March 2012] "The NIH defines patient-centered care as follows: “health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs and preferences and solicit patients’ input on the education and support they need to make decisions and participate in their own care...”
      ... "Patient-centric healthcare differs in that the information and interactions emanate from the patient. Wireless technologies are built around the premise that personalized data and interactions prompted by the patient and managed by both the patient and provider..."
      One important component of these information processes involving the consumer is generally labeled "Record Sharing". Washington State, the University of Washington and Group Health Cooperative have become leaders in this field. Thus, it is anticipated that more and more Port Ludlow residents will be confronted with "Record Sharing" types of communication schemes in the near future .... as Group Health members in Kitsap County already are.

    • HEALTH INFORMATION SHARING

      • OVERVIEW:

        1. EHR Interoperability A Hot Topic At HIMSS [Health Information Management and Systems Society] Interoperability between disparate electronic health record (EHR) systems was a major focus of the conversation and the announcements at the recently concluded annual conference of the Health Information Management and Systems Society (HIMSS) in New Orleans.... (Epic) had not been invited to join CommonWell, and [...] the alliance was a "competitive weapon" to be used against Epic....

        2. Within Healthcare Providing Organizations

        3. Between Organizations: "Health Information Exchange" [HIE]

          • Wikipedia HIE is "the mobilization of healthcare information electronically across organizations within a region, community or hospital system."
            --- "provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer and more timely, efficient, effective, and equitable patient-centered care. HIE is also useful to public health authorities to assist in analyses of the health of the population... [cont.]..."

          • Electronic Health Records (EHR) & "Epic" [plhealth.org/personalhealthrecords.html]

          • Northwest ImageShare " is a collaboration between Harrison Medical Center, Advanced Medical Imaging, The Doctors Clinic, and Olympic Radiology to overcome the technical challenges of accessing patient images and information among competing entities and, as a result, to improve patient care." [June 2013]
          • Economies of Scale Between Competitors: Northwest ImageShare
          • General Electric Health Information Exchange System [used by Harrision MC, click!] ... To tie it all together, Harrison will deploy the Centricity Health Information Exchange (HIE) Services offering to connect patient data that will reside in the EMR at employed and community physician practices with medical records stored in the hospital’s existing clinical information system. By enabling document-based information sharing via a secure, standards-based HIE infrastructure, this connectivity will create community-based patient charts with shared problems, medications, allergies and lab data. ...

          • Care Connectivity Consortium - Technology & Interoperability [Kaiser - YouTube Video] Geisinger Healthsystem Chief Health Information Officer Jim Walker, MD discusses what standards the CCC is using to exchange health information between participating organizations. | Teresa Younkin, Community Engagement Manager for the Keystone Beacon Community, shares her story of how interoperability improved the care and day-to-day life of her family during a time of serious illness.

          • CCC (Consortium on Interoperability) Care Connectivity Consortium Takes Care Coordination to New Levels for Patients and Providers Health information exchange across organizations makes for better care decisions — Health care is better with the health information exchange among members of the Care Connectivity Consortium, according to providers and patients.

        4. Between Providers and Patients: Patient Portals etc.

    • Electronic Health Records [HIMSS] "The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting."

    • Harrison Medical Center

      • Press Release Archive: Harrison has a $30.5 million HERO - 10/23/2008 [Electronic medical record promises a higher standard of care]
      • Harrison Medical Center deploys HIE from GE Healthcare April 22, 2011 | Healthcare IT News BREMERTON, WA – Harrison Medical Center has announced that its healthcare community is now operational with GE Healthcare’s eHealth Information Exchange. “Working with GE to implement a Health Information Exchange (HIE) supports our ‘Vision 2015’ strategic priorities around physician and provider alignment, operations redesign, and cultural transformation," says Adar Palis, executive vice president and chief administrative officer of Harrison Medical Center. "GE’s HIE platform is helping us to improve the quality and efficiency of the care our clinician community provides our patients.”
      • Harrison Medical Center Deploys GE Healthcare's Health Information Exchange To Help Healthcare Community April 26, 2011 (Healthcare Technology Magazine)
      • CIO earns healthcare leader distinction Adar Palis, Harrison Medical Center’s vice president of administration and chief information officer, recently was named to the Becker’s Hospital Review list of “Rising Stars: 25 Healthcare Leaders Under Age 40.”
        Palis, 32, joined Harrison Medical Center in 2002 as a network engineer and was later named CIO of the hospital in 2005, becoming the organization’s youngest executive at age 27. He quickly initiated significant changes at the hospital, such as establishing a more customer-focused IT department, constructing a state-of-the-art data center, installing a new network infrastructure to include remote campuses digitizing X-rays, and introducing free wireless across all Harrison campuses.

    • Microsoft Health Vault (Provider) Put consumers in control of their health information, store it in a central location, and make it easy to share and update. How? With Microsoft HealthVault, a security-enhanced, flexible health solutions platform.

    • Washington State - First in the Nation for Consumer Managed Health Record Banks Health Record Banks provide patients an opportunity to securely store personal health information in one location using Web-based tools available from both Microsoft HealthVault and Google Health [no longer]. These online portals link patients to their Health Record Bank account where they can create, view, verify and share a copy of their health information. These pilots will be one of the first Health Record Banks in the United States that allow patient control.

    • Blue Ribbon Commission Projects, (E2SSB 5930)

    • Washington Healthcare Forum: Reforming the Care DeliverySystem [2010?] The Forum believes that the most challenging problems facing health care are the intertwined issues of cost, quality and access....

    • Group Health: "My Group Health for Members" 'Members have access to to one of the most robust web sites...' '"My Group Health," the patient Web portal that allows enrollees to send secure e-mail messages to their providers, view their medical record online, and access health promotion information relevant to their specific medical conditions. Patients must register and verify their identification to qualify for these enhanced Web services.'

    • Everett Clinic Manage your health when it's convenient for you.
      • Visit your doctor online
      • Check lab results
      • Request appointments
      • Renew prescriptions
      • Leave a message for your doctor
      • Medical Records & Privacy Information Medical Records Release Form (pdf): Authorization for Release of Medical Information Use this form to request a copy of your medical records or to request that another healthcare facility send your medical records to The Everett Clinic.
        • Understanding Your Health Record / Information (pdf)
        • (a) Access your Medical Information online
          (b) Convenient Online Doctor Visits

          Communicate with your primary care doctor without coming into the office. New, convenient online eVisits allow you to visit with your doctor regarding the following conditions: Cough, Diarrhea, Red Eye, Sinus Problems, Urinary Problems , Vaginal Discharge/Irritation, Back Pain (not work related).
          Doctors reply to eVisit requests within one business day. The cost is $35 and some insurance plans do pay for eVisits. Go to: everettclinic.com and log into your MyChart account for eVisit access....
      • Group Health Affiliation We chose to affiliate with Group Health because it shares our vision about the need to provide better care at a lower cost... (We) both believe health care costs can be lowered dramatically by focusing on coordination and prevention, reducing unnecessary trips to hospitals and emergency rooms and reducing the number of expensive tests and procedures.

    • Personal Health Records (PHR) [plhealth.org/phr.html]




  3. The Third Model: The Informed & Educated Patient

    Structural changes in a developing economy, in general, and in health care, in particular tend to lead to more than proportional increases in the cost of personal, face-to-face, one-on-one services, such as our visits with our physician. Adjustments are made to these increases in personal service costs in the form of
    1. increasing charges to the consumer (or to the insurance companies, Medicare etc.),
    2. decreasing the relative salary levels for many medical professionals;
    3. shifting tasks to professionals with less qualifications and lower salaries;
    4. shifting tasks to the patient or the patient's family, and/or
    5. increasing the health professional's productivity, e.g., by substituting personal "patient-information time" by digital information processes.

    The resulting communication complexity and need for patient education are now increasingly tackled by computerization, i.e. increasingly, patient information is entered into the computer only once and the information for the patient is transmitted by print-outs, the provider's secure Website or by Email. Group Health members are now also encouraged to contact their doctors by Email which may not only be more convenient for patients but may also save time for the physician (whose income may not depend on frequent patient visits). It is likely, however, that the most time is saved by an increasing shift of patient education from the doctor's office to the computer. Patients are not only encouraged but increasingly required to inform themselves on the Internet.

    Physicians, whether they are family practitioners or specialists, have hundreds of diseases, conditions and treatments to keep up with, and each of these relate differently to specific patient situations. Even the most dedicated doctors cannot follow all promising developments in ongoing medical and pharmaceutical research. Patients have the advantage that they can concentrate their "research" on one, their own, condition. Yet patients are also vulnerable to succumbing to technological euphoria in the face of ever more powerful hard- and softwares and the attractions of the Internet. “We must not confuse the thrill of acquiring or distributing information quickly with the more daunting task of converting it into knowledge and wisdom.” [www.technorealism.org/]

    In a nutshell, there are ways in which consumers can better inform and educate themselves to compensate for the ever shorter times in the doctor's office and thereby, at the same time, make sure that they fully understand what the doctor has told them, ask better questions, make more informed suggestions, get second opinions and put the specific diagnosis and treatment regime into broader contexts. (gk)

      • Informed Healthcare Choices:

        • Health Literacy: Accurate, Accessible and Actionable Health Information for AllHealth Literacy Introduction Learn about Health Literacy, Health Literacy Resources , Understanding Health Literacy, Understanding Literacy, Get Training.

        • Health Literacy: A Prescription to End Confusion Report of the Committee on Health Literacy, Board on Neuroscience and Behavioral Health, Washtington, DC:Institute of Medicine of the National Academies. April 2004

        • Older Adults: Why Is Health Literacy Important? "....differences in access to formal education and literacy training, the complexity and technical nature of health information, and the natural processes of aging may compromise older adults' capacity to use health information and make sense of messages...."

        • Ideally, patient education begins before the patient sees the provider or enters the hospital. These are among the steps in the continuing patient education process: Assessment of the patient's health literacy, providing information about the relevant disease process and treatment options, the involvement of different providers in these treatment options and the resulting transitions and needed transition planning, especially with respect to discharge instructions for the patient and the transmission of discharge information to post-discharge providers who, in turn, might be responsible for the transition to a homecare environment. [Excellent article: Transitions of Care: A Path to Quality Outcomes. Nurse.com, November 2013.]

        • Developing Materials to Match the Health Literacy Skills of Older Adults "Do you want to communicate health messages to an older adult audience? Whether you're developing print or online information, broadcast media or delivering a health presentation, this web site is for you. This section will provide tools and resources to help you improve your communication with older adults and address health literacy barriers."
        • Consumer Health Informatics and Patient Decisionmaking [Summary, Agency for Healthcare Research & Quality (U.S.DHHS)] "Although patient health informatics tools can potentially empower patients to make more informed choices, there is limited empirical evidence of the outcomes of their use and of their overall value. Few controlled and comparative studies exist on the effectiveness of tools intended to inform patients about their medical choices, treatment alternatives, and the risks and benefits of alternatives according to a study by Research Triangle Institute for the Agency for Health Care Policy and Research (AHCPR).... "
          • Effective Healthcare Program ["Helping You Make Better Treatment Choices"]
          • Guides for Patients and Consumers:
            1. Research reviews: These comprehensive reports draw on completed scientific studies to make head-to-head comparisons of different health care interventions. They also show where more research is needed.
            2. Original research reports: These reports are based on clinical research and studies that use health care databases and other scientific resources and approaches to explore practical questions about the effectiveness — or benefits and harms — of treatments.
            3. Summary guides: These short, plain-language guides — tailored to clinicians, consumers, or policymakers — summarize research reviews’ findings on the benefits and harms of different treatment options. Consumer guides provide useful background on health conditions.
          • Registries for Evaluating Patient Outcomes: A User’s Guide: 2nd Edition [Research Report - Final – Sept. 27, 2 2010]

        • Informatics Center: Knowledge Management (Vanderbilt Univ. Medical Center) "Knowledge Management (KM) provides high-level data and knowledge organization skills to optimize the enterprise clinical, research and educational initiatives. Collaborating with clinicians and researchers, highly trained information specialists embed best practices in the organizing, structuring and reuse of the institution's knowledge...."
          • Evidence-Based Services - Patient Informatics Consult Service "The Patient Informatics Consult Service (PICS) is a free information service provided by Knowledge Management information specialists to all current Vanderbilt patients and the people who care about them..." "This service combines the library's Patient Education Collection with the expertise of the PICS information specialists to retrieve accurate, relevant, and appropriate information for Vanderbilt patients in easily-understandable information packets tailored to the individual's needs about their specific medical condition or disease...."

        • Foundation for Informed Medical Decision Making (Boston, MA) [2011] At The Foundation for Informed Medical Decision Making, we believe that optimal medical decisions require fully informed patients who participate fully in a shared decision-making process, rather than delegating decisions to their doctors. We believe that one medical answer can never be right for all people. The decision that will best serve a particular patient often depends on the patient's own preferences and values. And the treatment that is best for one patient may not be best for another in exactly the same situation. At the Foundation, we consider the opportunity to engage in the process of shared decision making to be a basic right of every patient.
          • Foundation for Informed Medical Decision Making [older, 2006 Website] The Foundation for Informed Medical Decision Making is ... dedicated to assuring that people understand their choices and have the information they need to make sound decisions affecting their health and well being...
            The Foundation believes that it is the convergence of the two concepts: medical evidence and patient perspectives that create a truly informed decision in medical care.
          • What is an "Informed Medical Decision"?
          • informedmedicaldecisions.org/ Patient Decision Aids "Decision aids should include evidence-based information about all viable treatment options, a balanced value-neutral presentation of the advantages and disadvantages of each option, and information related to the patient perspective to help patients clarify their preferences and values about treatment."
            "Decision aids can be paper-based or electronic; electronic decision aids can be delivered through a variety of technology, including Internet, office-based kiosk, or recorded media."

          • What is a Decision Aid? "Patient decision aids are tools that help people become involved in decision making by giving them information about their options and the possible outcomes of those options and by encouraging patients to think about and express their personal values. They are designed to complement, rather than replace, counseling from a health professional."

      • Patient Education / Health Literacy

      • External Personal Health Record (PHR) services: [for safe-keeping & sharing]
        • Google Health The product will continue service through January 1, 2012. After this date, you will no longer be able to view, enter or edit data stored in Google Health. You will be able to download the data you stored in Google Health, in a number of useful formats, through January 1, 2013.
        • Microsoft Health Vault [see also Model I]



  4. The 4th Model: Informed Patients Make their own Health Choices and share in Medical Decision Making.

    In 2007, a new section (.033)was added by the legislature to Chapter 41.05 RCW(Revised Code of Washington) with the intent “to increase the extent to which patients make genuinely informed, preference-based treatment decisions…… by recognition of shared decision making and patient decision aids in the state’s laws on informed consent” (the forms you are given to sign prior to any procedure/ treatment option scheduled by your provider!) Our Education Resource Center has begun compiling reference materials for Patient Decision Aids for high priority health/wellness conditions, e.g., heart, stroke and diabetes, which nicely exemplify this legislation. As used in the RCW 7.70.060 section “Shared Decision Making,” patient decision aid “means a written, audio-visual, or online tool that provides a balanced presentation of the condition and treatment options, benefits, and harms…” (uk)


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Patient Responsibilities: How to...

  1. How to find a healthcare provider?

  2. How to Make the Most of Your Doctor's Visit [By Dr. Ranit Mishori, PARADE Magazine]

  3. How to prepare for a visit to your doctor... and what kinds of questions to ask

  4. How to prepare for a hospital stay...

  5. How to Protect Yourself and Your Family from Medical Errors (SCCA) "Studies have shown that by taking an active role in your health care, you can reduce the opportunity for errors to occur. We want you to know that it is okay to ask questions about medications and treatments, and to become involved in decisions about the care you receive. SCCA appreciates you partnering with us to make sure you have the positive experience that patients have come to expect from SCCA. The following tips were taken from the Agency for Health Care Research and Quality “20 Tips to Help Prevent Medical Errors......" " Click & scroll down!

  6. How to organize your "Health Portfolio".... (in a three-hole folder or online)
    • Create a Personal Health Record [University of Minnesota] "A personal health record (PHR) is a collection of information about your health. It is different from an Electronic Medical Record (EMR) or Electronic Health Record (EHR), which are owned and stored by your healthcare provider. ..."

    • Personal Health Records [familyhealthportfolio.com/blog/personal-health-records/] "... Health care providers and health insurance carriers all have bits and pieces of your family’s information. As the number of choices for specialists, clinics, and pharmacies increases, it’s up to you to collect, organize, and manage this information for your family...."

    • Create a Personal Medical History: Your doctors keep records, you need to as well [AARP July 2010]

    • Harrison Medical Center: Medical Records | Frequently Asked Questions "We are happy to provide you with a copy of your medical record—or to send it to a designated physician or facility. Please print and complete the form (see to the right), and return it to us by fax or mail. Please be aware that there is a fee for copying the record. The amount will be determined once we have received your request."

    • Other PHR Resources

  7. What to do if you suspect that your doctor does not know or that the diagnosis is wrong?

  8. How to prepare for an unexpected ambulance ride?

  9. 5 Tips for Taking an Elderly Patient to the Emergency Room [Hospital.com]

  10. How to remember what your doctor said?

  11. What to ask for after a doctor's visit?

  12. Medical Tests: Questions to Ask the Doctor (Source: WebMD)

  13. What to ask for after any kind of surgery or invasive procedure? (even if the doctor says "everything is fine")

  14. How to exercise (your feet and legs) on extended airplane rides?

  15. How to prevent falls?

Source: Decatur - Fidalgo: TRANSFORMING HEALTHCARE AUGUST 30, 2010 [Linked from this page: Health Record Bank]


GENERAL HEALTH INFORMATION RESOURCES:


Disclaimer:
The WebGuys behind this assembly of Web resources are not responsible for the content of the Web Sites to which they have provided links.
Nothing on this site shall constitute medical advice.

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(2010) Last updated: Dec 2014 (gk) -- plhealth.org(at)gmail.com