Patient-centered medical home and secure messaging

As technology and technology access continues to advance, I believe that the patient-centered medical may take advantage of new health and behavioral informatics innovations.

Consider the following principles that are sometimes linked to the patient-centered medical home, and examples of how behavioral informatics could help...


Patient-driven
Lots of opportunities here. Behavioral informatics applications have been created to provide patient reported outcomes (see NIH PROMIS) and some on patient reports of care provided. Systems could be further developed to provide decision support based on provider and patient input to facilitate shared decision-making.

Team-based
The patient should be considered a part of the medical team and not the object of action. In this context, applications that increase engagement of patients and families in the system are applicable. Secure messaging systems that allow patients to communicate with the team are an excellent example. A well-researched system in the Comprehensive Health Enhancement Support System (Gustafson, Brennan et al).

Efficient
Many Behavioral Informatics interventions allow asynchronous communication (reducing telephone tag), or provide computer-tailored education. Computer-tailored systems in general have considerable sunk costs, but the marginal costs (per user/patient) are low. Thus, where these systems can effectively offset human resources, efficiency is created.


Comprehensive
Patient-facing technologies can provide adherence and health promotion reminders using patient registries, thus increasing the comprehensiveness of care.

Continuous
Again, web and mobile technology interventions are key to overcoming episodic care.

Coordinated
Patient-centered goals can be communicated to all providers through personal health records, so the all on the team are aprised.


Enhanced communication
All of the above apply here.

Patient facing technology and Meaningful use

The proposed interim rule for meaningful use of health information technology is out. It can be viewed at

http://www.federalregister.gov/OFRUpload/OFRData/2009-31217_PI.pdf

The good news is that the rule includes language related to patient-centered technology (beginning on page 59 of the pdf)

Patient-centered technology

From the Meaningful Use
HIT policy committee priority #2: to engage patients and families in their healthcare (excerpted from the actual rule in quotes below)

"
1. Provide patients and families with timely access to data, knowledge, and tools to make informed decisions and to manage their health
(a disclosure made to a family member or a patient's guardian consistent with Federal and State law may substitute for a disclosure to the patient)


2. Send reminders to patients per patient preference for preventive/follow-up care. Patient preference refers to the patient's choice of delivery method between internet based delivery or delivery not requiring internet access

3. Provide patients with an electronic copy of their health information (including diagnostics test results, problem list, medication lists, allergies) upon request (through personal health records, patient portals, CD, USB)

4. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 96 hours of the information being available to the EP.
"

The inclusion of the personal health record/patient portal is very exciting and should be viewed as encouraging to those who conduct research in patient-facing technology.

What is not so encouraging is the exclusion of:

“Provide access to patient-specific education resources upon request.”

The rationale is that "there is currently a paucity of knowledge resources that are integrated within EHRs." The authors of the rule clearly acknowledg the importance of the patient-specific ecucation resources goal. Those involved in the behavioral informatics community should consider commenting on the rule in the next 50 days. Creative solutions to this problem are needed.

Also, no information on doctor-patient secure messaging (electronic communication) is included on my review. I think that this is a critical channel of communication that certainly represents a meaningful use of technology.

Comments are welcome.