|By the Innovations Exchange Team|
Cynthia Santos of Fairfax, Virginia, is one of many patients who are benefiting from a recent innovation in personal health records known as interactive preventive health records (IPHR). She uses an IPHR system called MyPreventiveCare to monitor her autoimmune disease, control her diet, and track her exercise.
The IPHR system compiles information from her electronic health record (EHR) and creates a summary page that uses lay language and an easy-to-read format. The summary page lists the dates of past preventive services and related test results, highlights missing information, and offers evidence-based recommendations for preventive care. Patients and their physicians can use the information to monitor progress and plan ongoing care, and patients can review the information for accuracy and notify their physicians’ offices if corrections are needed. To prepare for twice-yearly visits with her family physician, Ms. Santos updates her health risk assessment in the IPHR by responding to questions about preventive factors such as how often she exercises and how many servings of vegetables she includes in her diet. The IPHR automatically sends the updated summary to the EHR system of her physician, Alexander H. Krist, MD, MPH, of Fairfax Family Medicine Residency in Northern Virginia. Dr. Krist, who led the research and development of MyPreventiveCare, reviews the information and discusses the recommendations during office visits with Ms. Santos.
During her recent physical examination, Ms. Santos learned that her blood pressure was higher than normal. Afterward, she logged into MyPreventiveCare and saw that her blood pressure reading was flagged. She clicked on links to read about the measurements, learn more about hypertension, and consider steps she can take to lower her blood pressure. She also clicked on links to articles about hypertension from reputable sources such as the National Institutes of Health and the Mayo Clinic. ”I like that the focus of Dr. Krist’s care is on prevention rather than just medication,” she said.
Dr. Krist, an Associate Professor of Family Medicine at Virginia Commonwealth University (VCU) in Richmond, Virginia, and his VCU colleagues developed MyPreventiveCare to improve preventive services for patients, engage patients in health care decisions, and better prepare them for medical office visits. The IPHR customizes information from several sources including the patient’s EHR, articles on medical conditions from authoritative sources, and decisionmaking tools to better understand treatment options and preferences. The tool also sends reminders to patients to schedule appointments.
Dr. Krist and his colleagues at VCU conducted rigorous research on MyPreventiveCare in 2009 with grants from the Agency for Healthcare Research and Quality (AHRQ). The key results were:
- Among patients who used the IPHR, the delivery of recommended preventive services increased by 11.5 percent, compared with 2.2 percent for nonusers. Use of the IPHR was linked to greater increases in a variety of preventive services, including screenings for colorectal, breast, and cervical cancer and immunizations for tetanus and pneumococcal disease.
- The IPHR identified preventive services that patients needed, including screening tests, vaccinations, counseling on health behaviors, and consideration of a preventive medication. In addition, the IPHR showed that 35 percent of patients had inadequate control of a chronic condition.
- Clinicians were highly satisfied with the IPHR and reported improvements in patient engagement, documentation, and preventive care, along with reductions in their workload.
Dr. Krist recalled how the IPHR identified a female patient who was overdue for a Pap smear. Once her physician received the patient’s summary sheet with her previous Pap smear results, he noticed they were abnormal and that she never obtained the recommended colposcopy. His office scheduled her appointment for the same day to repeat her Pap smear and obtain a colposcopy.
Michael Rodriguez, MD, a primary care physician at Broadlands Family Practice in Ashburn, Virginia, participated in the research on MyPreventiveCare. Initially, he wasn’t convinced that it was in the patients’ best interests to have greater access to their health information. “I wasn’t sure how they would handle the information and whether seeing their test results, for example, would increase confusion or anxiety,” Dr. Rodriguez said. But, overall, the response by patients has been positive. As of October 2012, more than 34,000 patients in the 14 practices that participated in the AHRQ research had registered for and regularly used the IPHR. Approximately 400 patients register to use MyPreventiveCare each month.
The researchers also learned that patient enrollment in MyPreventiveCare increased dramatically when the entire clinical team promoted it. “We stopped relying solely on the doctors to encourage patients to sign up and involved other staff members who also interact with patients from intake to checkout,” Dr. Krist said.
Jeffrey Cohn, MD, a primary care physician at Broadlands Family Practice, said that testing and implementing the IPHR has focused attention on how clinicians document colonoscopy procedures. “We are moving towards greater standardization in our documentation and away from 12 physicians each documenting the procedure differently.”
Dr. Rodriguez mentioned that the IPHR has been helpful in meeting goals for care coordination and patient engagement that are required for Meaningful Use Stage 1. The primary care physicians expect that the IPHR will become increasingly important for practices seeking to meet Meaningful Use Stage 2 and 3 requirements and to obtain patient-centered medical home recognition. “Vendors will need to incorporate this type of functionality, especially to meet Stage 3 requirements,” Dr. Krist said.
To help practices understand and use IPHRs, Dr. Krist and his colleagues have written An Interactive Preventive Care Record: A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention. The resource is available from AHRQ at: http://healthit.ahrq.gov/KRIST-IPHR-Guide-0612.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software .).
Disclosure Statements: Dr. Alexander Krist received grant funding from AHRQ to conduct research using MyPreventiveCare and the National Cancer Institute to test the tool’s dissemination. He also received travel funds from the VCU to present the results at a medical conference. The IPHR is not a commercial product and neither VCU nor Dr. Krist benefit financially from its use.
Dr. Michael Rodriguez, Dr. Jeffrey Cohn, and Cynthia Santos reported having no financial interests or business/professional affiliations relevant to the work described in this article.