Doctors often face an uphill battle when managing patients with several health issues — and the biggest challenge is time.
Take a person with concurrent chronic conditions, for instance, who might be on more than a dozen medications. They frequently have a lot to discuss each time they step into a doctor’s office.
“It is difficult to get everything done in a single visit,” said Richard Grant, MD, a research scientist at Kaiser Permanente.
But what if the doctor could tap online communications tools to gather important patient data before an office visit so as to make the most of that face time?
Grant will be working with Eileen Kim, primary care diabetes clinical leader for Kaiser Permanente Northern California, to determine that answer.
A patient-centered approach
Kaiser Permanente researchers are using a grant of almost $3 million to study how mHealth can improve interactions between patients with type 2 diabetes and their physicians — and thereby improve clinical outcomes.
Kaiser’s Division of Research received the $2.9 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases, and plans to specifically focus on improving the quality time between primary care physicians and patients with multiple chronic conditions.
The hypothesis of the study is that an in-person visit with the primary care doctor is critical, but also difficult due to time constraints. The visit would be more productive if the doctor was made aware of a patient's priorities and top concerns before the meeting. That could be accomplished using an online program that meshes with the doctor's workflow.
Patients will be asked to fill out an online form and select their top two major concerns from a list of five. The topics are:
- Any important changes in your life since your last visit - changes at home, work, financial problems.
- Any new or important health issues such as pain, poor sleep, sexual issues.
- Any concerns about your medications — side effects, for example. Grant points out that not until the fourth question on the list is diabetes mentioned.
- Any concerns related to your diabetes (like lifestyle changes).
- Any mood and motivation issues.
All about workflow
The patient can only pick two topics to discuss before clicking on the submit button. But what arrives at the doctor’s desk is not another e-mail which the physician may or may not have a chance to read. Rather, it is designed to fit in with the workflow of the physician. It is sent to the physician’s computer where the doctor looks to prepare for the visit.
The system is part of the Epic EHR used by Kaiser Permanente called HealthConnect. In essence, the system is a health IT tool that emulates what most primary care physician probably dream about, becoming more like the old family doctor who can sit and chat with each patient for an hour or so in order to discover the underlying causes of a medical problem.
This is not to say the patient is calling the shots. The idea is to create a collaborative relationship to know where the patient is coming from.
When a patient registers for a visit the questionnaire is launched. Two-thirds of all Kaiser patients are registered online with KP.org. For one-third of patients that are not registered online, Grant said Kaiser is considering putting iPads in the waiting room.
As part of the study Kaiser will be audio taping, with the patient’s permission, a random selection of visits to see whether the patient or doctor followed the established agenda and if the tool helped improve the visit.
Adaptable for other health organizations
Grant believes that although Kaiser Permanente is unique in many ways, what they are doing is transferable to other healthcare institutions.
“This intervention focuses on patient and physician and any physician that uses Epic for their medical record and patient portal will not find it too challenging to adapt,” he said.
Perhaps the goal of the study is best summed up by eliminating what Grant calls the “hand on the doorknob” moment, when the visit is over and the patient is about to leave the examination room and says, “oh, by the way, I forgot to tell you …” and that last bit of information turns out to be the most important of all.
“If you boil it down,” Grant said, “it is simply giving the patient-doctor visit more structure.”
Kaiser plans to kickoff the five-year study in January 2015.
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