{"id":9312,"date":"2011-05-22T10:00:06","date_gmt":"2011-05-22T15:00:06","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=9312"},"modified":"2021-05-19T11:59:39","modified_gmt":"2021-05-19T15:59:39","slug":"safety-net-populations-do-benefit-from-online-phrs-poster-at-icsiihi-colloquium","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2011\/05\/safety-net-populations-do-benefit-from-online-phrs-poster-at-icsiihi-colloquium.html","title":{"rendered":"Safety net populations do benefit from online PHRs: poster at ICSI\/IHI Colloquium"},"content":{"rendered":"<p>The Society for Participatory Medicine was well represented last week at the 14th \u00a0ICSI\/IHI Colloquium. (<a href=\"http:\/\/icsi.org\" target=\"_blank\" rel=\"noopener noreferrer\">ICSI<\/a> is the Institute for Clinical Systems Improvement, a small midwestern think tank that&#8217;s way too poorly known.) SPM members who presented:<\/p>\n<ul>\n<li>Jane Sarasohn-Kahn of Health Populi gave the keynote for Day 2<\/li>\n<li>Jessie Gruman, four time cancer patient and founding co-editor of <a href=\"http:\/\/jopm.org\" target=\"_blank\" rel=\"noopener noreferrer\">our journal<\/a>, gave an important breakout session, about which I&#8217;ll be writing soon. (Jessie is founder and president of the excellent <a href=\"http:\/\/cfah.org\" target=\"_blank\" rel=\"noopener noreferrer\">Center For Advancing Health<\/a>.)<\/li>\n<li>Brian Ahier presented on the status of health IT, as Meaningful Use rolls out. (&#8220;You can&#8217;t measure the improvements that you gotta measure, unless you have computers keeping track of it.&#8221;)<\/li>\n<li>I gave a half-day pre-conference workshop titled &#8220;Participatory Health: Reshaping Patient Care.&#8221; I&#8217;m told the workshop had 40-50% higher registration than usual: interest in participatory medicine is strong.<\/li>\n<\/ul>\n<p>An unexpected bonus was that right outside the workshop door, a poster presentation addressed some questions people often ask about patient participation and online health records:<\/p>\n<p><!--more--><\/p>\n<ul>\n<li>Will patients with problems actually use a PHR (personal health record)? (Many observers say PHRs are a non-starter, a pointless exercise.)<\/li>\n<li>Especially, will poor people use one?\n<ul>\n<li>Obviously, most don&#8217;t even <em>have<\/em> a computer.<\/li>\n<li>Plus, computer literacy is necessary, and education levels among the poor are statistically lower. Frankly, are such people smart enough? (Many observers won&#8217;t come out and say it, but in my experience that&#8217;s what it boils down to.)<\/li>\n<li>Note: People in lower socio-economic tiers are often referred to as &#8220;safety net&#8221; populations &#8211; they can&#8217;t afford insurance, so the only care they get is whatever &#8220;safety net&#8221; their state or region provides.<\/li>\n<\/ul>\n<\/li>\n<li>What about people with mental diagnoses &#8211; substance abuse, depression (low motivation?), etc.?<\/li>\n<\/ul>\n<p>Those are the questions examined by this project, produced by an Emory University team headed by\u00a0Benjamin\u00a0Druss, MD, MPH\u00a0and funded by a grant from AHRQ (Agency for Healthcare Research and Quality). They studied a population of\u00a0safety net patients\u00a0with at least one mental illness diagnosis\u00a0<em>and <\/em>one or more additional conditions (co-morbidities).<\/p>\n<p>Final results (including health outcomes) won&#8217;t be available until this fall, but clear evidence has emerged about PHR use (and benefits). Here&#8217;s the poster. Click to view PDF, 420k:<\/p>\n<p><a href=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2011\/05\/Emory-ICSI-2011-poster-on-shared-care-plan.pdf\" target=\"new\" rel=\"noopener noreferrer\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-9314 alignnone\" title=\"Emory poster May 2011\" src=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2011\/05\/Emory-poster-May-2011-1024x657.png\" alt=\"Emory poster (click to open the poster PDF)\" width=\"600\" height=\"385\" srcset=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2011\/05\/Emory-poster-May-2011-1024x657.png 1024w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2011\/05\/Emory-poster-May-2011-300x192.png 300w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2011\/05\/Emory-poster-May-2011-800x514.png 800w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2011\/05\/Emory-poster-May-2011-600x385.png 600w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2011\/05\/Emory-poster-May-2011.png 1157w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/a><\/p>\n<p>The early impressions (bottom right) caught my attention: <em>(emphasis added)<\/em><\/p>\n<div id=\"_mcePaste\">\n<ul>\n<li>Access to computers <strong>less of a barrier<\/strong> than anticipated<\/li>\n<li>Low digital literacy: Significant portion of participants; but <strong>can be successfully addressed <\/strong>with basic computer training.<\/li>\n<li>Usefulness for coordination of medical care [is]\u00a0<strong><em>less<\/em> <\/strong>than anticipated<\/li>\n<li>Interactions with clinicians: PHR <strong>print-outs help consumer take charge<\/strong><\/li>\n<li>Overcoming initial reluctance by clinicians: <strong>improved interactions with \u201cactivated\u201d consumers<\/strong> and access to hard-to-obtain health information.<\/li>\n<li>\u201cActivated\u201d consumers <strong>take over<\/strong> directing their own health care.\n<ul>\n<li>&#8220;Activation&#8221; was assessed using the well known PAM (<a href=\"http:\/\/www.insigniahealth.com\/solutions\/patient-activation-measure\" target=\"_blank\" rel=\"noopener noreferrer\">Patient Activation Measure<\/a>) test, developed at the University of Oregon and currently marketed by Insignia Health. (See <a href=\"http:\/\/www.insigniahealth.com\/solutions\/patient-activation-measure\/what-a-pam-score-reveals\" target=\"_blank\" rel=\"noopener noreferrer\">the behaviors<\/a> that are said to be predicted by PAM.)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>I seized the opportunity to speak with Emory&#8217;s Silke von Esenwein PhD, who was there; she was lead author on the poster. I pulled out my Flipcam and did a very rough, quick hallway interview. (The ringing sound at the start is the hallway chimes, as we were called back into session.)<\/p>\n<p><span class=\"embed-youtube\" style=\"text-align:center; display: block;\"><iframe loading=\"lazy\" class=\"youtube-player\" width=\"1080\" height=\"608\" src=\"https:\/\/www.youtube.com\/embed\/xsgnlpFpHr0?version=3&#038;rel=1&#038;showsearch=0&#038;showinfo=1&#038;iv_load_policy=1&#038;fs=1&#038;hl=en-US&#038;autohide=2&#038;wmode=transparent\" allowfullscreen=\"true\" style=\"border:0;\" sandbox=\"allow-scripts allow-same-origin allow-popups allow-presentation allow-popups-to-escape-sandbox\"><\/iframe><\/span><\/p>\n<p>I&#8217;m fascinated with the evidence that computer access is less of a barrier than anticipated. But it&#8217;s not a shock:<\/p>\n<ul>\n<li>Last month SPM member Ted Eytan MD showed me a snapshot of &#8220;safety net&#8221; people in his neighborhood, occupying every single computer the local library has.<\/li>\n<li>Last November John Moore at Chilmark Research posted\u00a0<a href=\"http:\/\/chilmarkresearch.com\/2010\/11\/12\/smashing-myths-assumptions-phr-for-urban-diabetes-care\/\" target=\"_blank\" rel=\"noopener noreferrer\">Smashing Myths &amp; Assumptions: PHR for Urban Diabetes Care<\/a>, which documented that for the urban poor, their <em>handheld<\/em> is sometimes their &#8220;medical home.&#8221; (And they use it!)<\/li>\n<\/ul>\n<p>Silke agreed with the off-the-cuff remark at the end of the video:<\/p>\n<blockquote><p>Many people believe it&#8217;s just not imaginable that people who don&#8217;t have a\u00a0good\u00a0life could be good at this.<\/p><\/blockquote>\n<p>It&#8217;s too early to draw firm conclusions from this study, and any study should be replicated (though <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2011\/01\/the-decline-effect.html\/comment-page-1#comment-71577\" target=\"_blank\" rel=\"noopener noreferrer\">much medical research never is<\/a>). But however well-meaning those concerns may be, it appears they&#8217;re superstitions, not\u00a0science. So let&#8217;s get over that and get on with <em>empowering, equipping <\/em>and <em>enabling <\/em>our citizens, so they can be <em>engaged <\/em>in their care.\u00a0<em>[Update: see <a href=\"https:\/\/participatorymedicine.org\/epatients\/archives\/2014\/02\/emory-study-phr-resulted-in-significantly-improved-quality-of-medical-care.html\" target=\"_blank\" rel=\"noopener noreferrer\">our 2014 post<\/a> for the final paper]<\/em><\/p>\n<p><em>All<\/em> our citizens. With nobody left out.<br \/>\n_______<\/p>\n<p>p.s. The PHR used in the study was &#8220;My Health Record,&#8221; which was adapted by Emory for this purpose from <a href=\"https:\/\/www.sharedcareplan.org\/\" target=\"_blank\" rel=\"noopener noreferrer\">Shared Care Plan<\/a>, a free <a href=\"http:\/\/www.whatcomcounts.org\/whatcom\/index.php?module=pnLocalResources&amp;func=viewDetail&amp;id=1159\" target=\"_blank\" rel=\"noopener noreferrer\">county-wide PHR<\/a> in Whatcom County, Washington. What would be possible if everyone you know had access to such a tool? (Here&#8217;s the punch line: free PHRs do exist.)<\/p>\n<p><i>Are you a member of the Society, supporting our work and participating in our member-only listserv? It&#8217;s only $30. Is your company a member, providing greater support? <a href=\"http:\/\/participatorymedicine.org\/join-us\">Join here.<\/a><\/i><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Society for Participatory Medicine was well represented last week at the 14th \u00a0ICSI\/IHI Colloquium. (ICSI is the Institute for Clinical Systems Improvement, a small midwestern think tank that&#8217;s way [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":9314,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[21,367,5,59,3586,2],"tags":[7458,165,158,4974,119,92,218,3592],"coauthors":[8070],"class_list":["post-9312","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-e-ptsresources","category-medical-records","category-ptdoc-co-care","category-policy-issues","category-research-issues","category-trendsprinciples","tag-emory-university","tag-health-care","tag-medical","tag-mental-illness","tag-phr","tag-poor","tag-safety-net","tag-spm"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Safety net populations do benefit from online PHRs: poster at ICSI\/IHI Colloquium - SPM Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/participatorymedicine.org\/epatients\/2011\/05\/safety-net-populations-do-benefit-from-online-phrs-poster-at-icsiihi-colloquium.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Safety net populations do benefit from online PHRs: poster at ICSI\/IHI Colloquium - SPM Blog\" \/>\n<meta property=\"og:description\" content=\"The Society for Participatory Medicine was well represented last week at the 14th \u00a0ICSI\/IHI Colloquium. 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