Chapter 10 - Consumer Informatics

the field devoted to informatics from multiple consumer or patient views - includes health literacy, consumer health applications, patient portals, personal health record (PHR), health information literature, and other consumer applications - can help patients become more knowledgeable about what questions to ask and what processes need to be done to help increase their chances of a positive health outcome (achieved through health info on conditions through the patient portal, regular reminders about immunizations and health screenings, nutrition plans to meet goals)

consumer informatics

"the languages, customs, beliefs, rules, arts, knowledge, and collective identities and memories developed by members of all social groups that make their social environments meaningful" - factors influence the way people communicate and how they understand and react to health information

culture

aspects of ____, derived from the patient's ethnicity, religion, and interpersonal values all influence how health information is received

culture, beliefs, and customs

challenges identified to the patient's adoption or continued use of the PHR

- age (older people typically use less technology - race/ethnicity (non-whites less likely to adopt/use PHR) - socioeconomic status (SES) (higher levels of SES had higher rates of adoption) - level of education - internet access - text/numeracy literacy - personal health history - health/chronic disease status (those who were healthy more likely to use the PHR) - disability (disabilities may affect ability to use PHR even with adaptive equipment) - usability or user-friendliness status of PHR - privacy and confidentiality concerns - lack of motivation to use PHR

factors contributing to an individual's health literacy

- communication skills of the patient and the healthcare professional providing the information - level of educational knowledge of healthcare - culture-based experiences with or knowledge of healthcare - demands on the healthcare organization Other health literacy factors include: - age grater than 65 - nonwhite ethnicity - recent immigrant - poverty level or below - English is second language

disadvantages of telehealth

- lack of funds to start telehealth program (cost includes hardware, planning, training, new technologies, staff to manage technologies) - decreased face-to-face interaction (actions taken to create a personalized, interactive environment in which the patient is engaged so the experience does not feel impersonal) - issues with patient technology (patents may not have adequate security measures or speed for best experience, leading to low-quality video) - reimbursement for e-visits (insurers are slow to cover telehealth despite trend) - pandemic put pressure on insurers to cover services

benefits of telehealth

- more convenient for patients - leads to better outcomes - reduced cost of care - higher patient satisfaction - patients who live in rural areas can reduce or eliminate trips to the city to see specialists - patients are able to be monitored while going about their day-to-day business - hospitalizations may be reduced as health issues may be identified early - amount of time out of work is less as travel time is reduced and monitoring is performed remotely - patients can submit blood sugar, blood pressure, and pulse results to the healthcare professional

factors contributing to the increased use of telehealth

- patients are more engaged in their healthcare - Affordable Care Act provided incentives to healthcare facilities to implement various telehealth models - some states are mandating that insurers pay for telehealth services - employers are offering telehealth to employees as part of their benefit program - the Veteran's Administration offers these services to veterans

items included in the PHR:

- personal identification, including name and birth date - people to contact in case of emergency - doctor's names and phone numbers - allergies, including drug allergies - medications, including dosages - list and dates of illnesses and surgeries - chronic health problems, such as high BP - living will or advance directives - family history - immunization history - home BP readings - exercise and dietary habits - health goals, such as stopping smoking or losing weight

reasons why health literacy is important:

1. ability to find the way through the healthcare delivery system (trouble completing forms, understanding a healthcare claim, knowing who to call, knowing what questions to ask) 2. knowing what information to share with the healthcare provider 3. ability to care for himself 4. ability to understand risk

to help people gain a better understanding of their health information and the healthcare delivery system, the Department of Health and Human Services (HHS) is working to solve this problem by developing a comprehensive action plan based on two overarching principles:

1. all people have the right to health information that helps them make informed decisions 2. health services should be delivered in ways that are easy to understand and that improve health, longevity, and quality of life

roles of HIM in PHRq

1. design and testing of PHRs 2. distribution of PHRs to consumers 3. training providers and consumers 4. protecting confidentiality

The National Action Plan to Improve Health Literacy has established 7 goals to improve health literacy:

1. develop and disseminate health and safety information that is accurate, accessible, and actionable 2. promote changes in the health care system that improve health information, communication, informed decision-making, and access to health services 3. incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level 4. support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community 5. build partnerships, develop guidance, and change policies 6. increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy 7. increase the dissemination and the use of evidence-based health literacy practices and interventions

for consumer informatics to have a positive impact on the patient's health, three factors are key:

1. individual tailoring of the interaction based on the characteristics of the patient 2. personalization (customizing the program specifically for the patient) 3. behavior feedback (provides messages to the patient about how well he is doing and where he is in the program)

three significant events in 2010's drastically influencing delivery of healthcare

1. the socio-political Black Lives Matter (BLM) movement starting 2013 2. the medical and health crisis of the corona virus (COVID-19) pandemic starting in late 2019 3. the hospital price transparency rule passed in 2019

challenges the PHR presents

1. who owns the data? 2. who can access that data 3. how does the PHR get populated? 4. is there adequate technology? 5. are there adequate laws and regulations? 6. how can information from an EHR populate the PHR?

upwards of ____ of people research a diagnosis, medication, or symptoms on the Internet and it is the top choice as to where to get medical info - 70,000 searches a minute on Google (more than a billion a day) -info could be outdated or erroneous

80%

in order to encourage patient engagement, the ___ ____ campaign was established by The Office of the National Coordinator for HIT (ONC) - a consumer-motivated method to improve healthcare by having the patient or caretaker actively involved in decisions and planning by having direct access to personal health information - the __ ___ logo signifies that consumers can electronically access their health information in a secure and easy manner - the more active patients are in their healthcare, the healthier they are likely to be

Blue Button

Identify the federal agency responsible for developing an action plan to improve health literacy. a. HHS b. AHIMA c. HRSA d. AMA

a. HHS

The health data collection process during the COVID-19 pandemic has been inconsistent when collected by state agencies. At a future point in time, hospitals, clinics, physician offices, and other healthcare providers will be submitting additional information aboutCOVID-19 cases they may have treated during this time. Identify the professionals would be best suited to conduct and manage this data collection process to ensure quality, accuracy, and completeness of the data. a. HIM b. nursing c. public health d. physician assistants

a. HIM

An excellent way to increase patient engagement is to have patients keep their own PHR. Not only will they have access to their lab results for themselves, but also to track exercise and dietary information. PHRs allow patients to: a. add other personal health-tracking information b. experience e-visits c. request prescription refill d. schedule appointments

a. add other personal health-tracking information

Connie has met with her new primary care physician and nurse practitioner (NP). The Np has explained in detail to her the patient portal for the practice. since Connie has some unusual conditions, the NP has shown her how to find more information on her conditions. The NP called it "consumer informatics". An example of consumer informatics includes a. health information literature b. EHR c. telehealth d. health record

a. health information literature

The XYZ Clinic is consulting with the hospital about social media. It is working with the CIO to strengthen its policies and procedures. The clinic's social media policies should address: a. improper usage of social media by the staff regarding clinic business and communications b. how patients can use social media c. how employees can use social media at home d. use of wearable technology

a. improper usage of social media by the staff regarding clinic business and communications

The ABC Clinic is a member of the Blue Button campaign. It wants to help improve the health of the community it serves by better educating its patients. The staff is trained as to how to increase the number of e-patients it has. An e-patient is one who: a. is engaged in her healthcare b. is using telehealth technologies c. has not signed up to use patient portal d. uses social media

a. is engaged in her healthcare

Dr. Tate told his patient James that he was going to "perform a CABG due to James's CAD before he had an AMI". Of course, James had no idea what Dr. Tate said or meant by that statement. The terms or phrases used for specialized terminology by a specific group is called a. jargon b. culture c. telehealth d. portal

a. jargon

ABC Hospital is working with the surrounding physician offices and health clubs to encourage more physical conditioning activities within the community. They have provided incentives to patient who join health clubs, lose weight, or decrease their cholesterol levels. This type of program is an example of: a. population health b. public health c. health disparities d. health literacy

a. population health

You are discussing material that can be posted to the hospital's website and its Facebook page by the Public Relations Department for ABC Hospital. Identify what they can post to their social media. a. support groups b. sharing clinical information with physician c. obtaining clinical information from physician d. wearable technology

a. support groups

New patients at ABC Clinic are given an orientation to the clinic's services. The health literacy orientation includes contact information and pictures of the providers as well as material on specific medical conditions. The material includes websites, articles, and diagrams to help patients and their caregiver/family better understand their conditions. Health literacy is important because patients need to be able to: a. understand risk b. use patient portal c. utilize telehealth technology d. use social media

a. understand risk

Kyle wants to ensure his physician knows about the dietary supplements he is taking for irritable bowel syndrome. Identify where Kyle should record this. a. health record b. PHR c. telehealth d. patient portal

b. PHR

The ABC clinic wants to make sure patients are more prepared for medical procedures by getting them involved patient education. One of the patient education sessions involves a tour of an operating room suite and they encourage the patients to be involved and ask questions. Benefits of this type of patient engagement include: a. focus on the individual b. improved patient satisfaction c. telehealth d. social media

b. improved patient satisfaction

A local university is now the site for COVID-19 testing. After meeting with the state health department and local hospital officials, they have devised a plan for the notification of positive test results. This plan includes notifying the patient, followed by contact with health professionals regarding treatment, tracing anyone the patient came in contact with, and follow-up care. This process is an example of: a. population health b. public health c. health disparities d. health literacy

b. public health

To better the rural community it serves, XYZ Hospital has instituted a remote patient monitoring system for patients with pacemakers. Patients use a smart phone app to download the information collected by the pacemaker that is then sent to their physicians on a more frequent basis than a regularly scheduled doctor's appointment, Because the data is collected more frequently, the doctor's can identify cardiac issues before they become a real problem requiring the patient to be admitted. Benefits to telehealth include: a. access to patient information b. reducing hospitalization c. providing information to healthcare providers d. population health

b. reducing hospitalization

"a diverse set of activities that can include interacting with healthcare providers, seeking health information, maintaining a PHR, and playing an active role in making decisions in regard to personal healthcare" - one of the benefits of consumer informatics is that these technologies encourage __ ___ Benefits - reduced costs - increased communication between physicians and patients through the use of technology - improved patient satisfaction - population health Key applications (provides additional info about health habits, care, and outcomes) - patient portals - PHR - social media

consumer engagement

Black women die at a higher rate from breast cancer than white women even though white women get breast cancer more frequently. Because the patient outcomes are unequal based on population statistics, this is an example of: a. population health b. public health c. health disparities d. health literacy

c. health disparities

Identify the accurate statement about health literacy. a. health literacy is all about the patient's reading level b. health literacy is not impacted by the patient's culture c. health literacy includes understanding discharge instructions d. health literacy applies to healthcare professionals only

c. health literacy includes understanding discharge instructions

Critique this statement: Consumer health applications are used solely by patients. a. this is a true statement b. this is a false statement as it is also used by insurers and healthcare providers c. this is false statement as it is also used by healthcare providers d. this is a false statement as it is only used by physicians

c. this is false statement as it is also used by healthcare providers

a ____ is a patient, client, resident, or other recipient of healthcare services

consumer

___ are healthcare-based applications designed for use by the patient or provider on smart phones, tablets, and other computers patients use ____ to: - access health informaiton - promote a healthy lifestyle - track calories and other information - manage their conditions - access the PHR the healthcare provider uses ____ to: - access patient information - communicate with patients and other healthcare professionals - monitor patients - provide telemedicine

consumer health applications

Deborah really likes the ability to go online and schedule her appoints with her internal medicine doctor. She just has to go the clinic's website and click into the patient scheduler and choose the day and time available that best meets her needs. She doesn't need to wait and talk to a staff member unless something unusually is going on. The information system that is controlled by the healthcare organization that allows patients to register is known as: a. PHR b. wearable device c. social media d. patient portal

d. patient portal

Sarah needs to schedule an appointment for her yearly physical exam. Her physician office has a very interactive EHR. Identify the aspect of the EHR she should use to request an appointment. a. health record b. PHR c. telehealth d. patient portal

d. patient portal

"refers to the growing gap between the underprivileged members of society; especially the poor, rural, elderly, and handicapped portion of the population who do not have access to computers or the internet; and the wealthy, middle-class, and young Americans living in urban and suburban areas who have access" - influenced by level of education of citizens, broadband of infrastructure in geographic area, people's computer literacy knowledge - in developing countries, is influenced by gender since the vast majority of women do not have cell phones or any type of computer, nor have access to the internet - during the pandemic, schools in higher socioeconomic zip codes had students more prepared to attend school online than those in poorer neighborhoods (40% of students in lowest socioeconomic areas accessed online learning once a week and more than 80% of affluent students were doing online learning every day for at least 2 hours a day, 1/3 of students did not have a device or had to share with a sibling, 10% of schools did not have online learning material)

digital divide

"individuals who are equipped, enabled, empowered, and engaged in their health and health care decisions" are called ____

e-patients

"a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. ___ ___ adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion." - an important obstacle in healthcare 1. African Americans have significantly higher health rates than whites, given their proportion within the population 2. Hispanic/Latinos suffer from significantly higher incidence rates of COVID-19, given their proportion in the population 3.

health disparities

the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions - patients must understand consent forms, discharge instructions, how and when to make appointments, be able to determine when they need to seek treatment or referrals, and where to go to get healthcare services - 90 million Americans have limited ___ ____ - not necessarily about a patient's reading ability or education level, but about understanding the terms and concepts related to their healthcare - anything that affects the patient's ability to make decisions related to his healthcare, including understanding insurance coverage and billing or his rights as a patient, is related to ___ ____

health literacy

___ is specialized terminology used by a specific group; in this case, healthcare professionals - the healthcare provider may believe that they are explaining the patient's condition in simple terms when, in fact, advanced medical terminology and ___ are being used Ex: - health information management (HIM) terms such as MS-DRGs, health information exchange, and notice of privacy practices are familiar the providers and HIM professionals, but patients do not necessarily understand them if they have heard them at all - difficulty understanding this makes it difficult for patients to make informed decisions about their healthcare or for them to understand the decisions that they make, potentially leading to negative outcomes - tools such as pictures (visual aids) or strategies like Teach Back (simple language to explain the patient's condition and asking the patient to repeat in their own words) and Ask Me 3 (three questions: what is my problem? what should I do? why do I need to do this?) are available to healthcare providers to help improve patients' understanding of their health

jargon

in Healthy People 2030, the definition of health literacy also includes ____ - "the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others"

organizational health literacy

a ____ is an information system established and maintained by the healthcare organization that allows patients to log in and obtain their health information, register for appointments, and perform other functions such as using secure email, downloading forms, updating demographics, scheduling appointments, and requesting a prescription refill - information contained in the ___ is a subset of the patients' electronic health record (EHR) - can be accessed by the patient at all times - information available varies, but can include lab results, summary of hospitalization, medications, radiographic reports - patients must log in, typically with a username and password to protect the patient's privacy - standalone systems (does not have all features of a system intregrated ___ and are typically used by smaller healthcare providers - integrated system (function of the EHR and are fully functioning) - portal itself is owned by HCO or another agent like a vendor, but information is owned by the patient trends include - personalization (physician can dispense medical info to patients for specific conditions) - mobile devices (used by patients to enter data like blood sugar levels for review by the physician) - wearable technology (ex: fitness trackers - uploaded and reviewed by physicians) - communication (two-way communication, request appointments, need for follow-up) Benefits - strengthening communication between the healthcare provider and the patient - providing patients with healthcare information - providing resources to the patient between patient visits - promoting patient engagement - reducing the amount of time that healthcare staff spending answering the phone, processing requests for information, and related activities Disadvantages - patients receive little if any training on how to use the ___ - many patients are unable to understand the info in them due to health literacy issues - unutilized by patients (60% review info, but only 20% use info to make decisions)

patient portal

the ____ is an electronic or paper health record maintained and updated by an individual for himself or herself; it is a tool individuals can use to collect, track, and share past and current info about their health or the health of someone in their care - contains info from both the physician and the patient, but it is controlled by the patient - the ____ may be managed by a healthcare provider, vendor, employer, etc. - are commonly being tied to patient portals of the healthcare provider's EHR - while 90% of insured patients have providers with patient portals and have established accounts, only 1/3 had actually used it in the previous year - is important because it links health information from all of the patient's care providers into one central location, which will help improve the overall quality of the care provided - has no uniform format and is independent of any specific provider's EHR or patient portal and therefore not constrained by those requirements - much info is the same as the patient portal - a PHR that is part of the EHR is called a patient portal - allows the patient to share information from other healthcare providers, exercise regimen, medications, dietary supplements, and other info the patient wants the healthcare provider to know - patient controls who has access to this info and what info it contains four common formats - paper (folder, three-ring binder - limited accessibility since there is only one source of info) - personal computer (uses patient's computer for storage that can be printed or transferred to a portable device to give to a provider) - Internet (provides access anytime and anywhere - patient can purchase service from a vendor who stores the data and provides basic services to the user; tethered or untethered) - portable devices (smart phones, tablets)

personal health record (PHR)

an important concept within consumer informatics is ____ - "an opportunity for health care systems, agencies, and organizations to work together in order to improve the health outcomes of the communities they serve - differs from public health - the reporting of ____ ____ metrics, such as immunizations and colon cancer screenings, is a key function of EHRs - consumers contribute through increased engagement in their healthcare

population health

"works to protect and improve the health of communities through policy recommendations, health education and outreach, and research for disease detection and injury prevention"

public health

a ___ is a popular and effective model for a PHR - the ____ is maintained by the patient and provider, health plan, or employer

shared data record

___ are online tools that allow people to communicate - healthcare organizations use ___ to advertise services, promote wellness, provide health education, provide support forums, and provide other communications to their patients and general public - does not utilize any patient-specific info and none of the postings are including in the legal health record benefits of using ___ in healthcare - building a sense of community for patients with chronic diseases - patients are better informed and can track their health - patients can search for clinical trials that they might qualify for - building awareness of conditions patient info cannot be exchanged on ___ due to privacy laws, but HCOs can use it to share emergency room wait times, list new services, gain information about patient satisfaction policies and procedures should address: - who can access ___ websites from within the HCO - improper usage of ___ - penalties for improper use of ___ - responsibility of employees to report improper use - ensuring that employees know that statements on their personal ___ accounts can impact the HCO patients can use ___ to text, blog, and post status updates to share info about their condition with their family and friends, access support groups for their particular disease, and raise money for medical research

social media

___ is defined as "the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration AHIMIA definition: "telecommunications systems that link healthcare organizations and patients from diverse geographic locations and transmit text, data, and images for (clinical) consultation and treatment includes remote patient monitoring (RPM) (collecting and reviewing health data that patients submit remotely), and mobile health (using cell phones, tablets, and other mobile devices to improve lifestyle, notify patients of disease outbreaks, and more) includes electronic visits (e-visits) that can take the form of real-time videos, or use of a portal where the patient logs in and asks the physician questions (patient and provider communicate synchronously - requires an appointment) (asynchronous methods [store-and-forward: includes videos that have been prerecorded, pictures, email, and more] - does not require an appointment) patients use ___ to take daily ownership of the healthcare by using wearable devices like fitness trackers and smart phones and watches to monitor a number of aspects of their health including exercise, blood sugar, and vital signs - the patient is notified if there is a problem technologies include - videoconferencing - Internet - store-and-forward imaging - streaming media - terrestrial and wireless communications Is used in - dentristry - counseling - both physical and occupational therapy - disease management - patient information - etc.

telehealth

____ PHRs are connected to the EHR and allow patients to access information contained within the EHR benefit - patients can identify any errors and therefore request a correction to the EHR

tethered

difference between a PHR and patient portal

the PHR is created and controlled by the patient whereas the patient portal is creased and controlled by the healthcare organization

____ PHRs are not connected to the EHR

untethered