Often considered a population “too old” for computer-based communication tools, a recent study found seniors who had undergone cardiac revascularization and used electronic Personal Health Records were more engaged, with improved clinical outcomes. When Fort Wayne, Ind. – based Parkview Physicians Group Cardiology provided a pre-populated PHR to approximately 200 cardiac patients (most over the age of 55), it found a significant improvement in hemoglobin A1c levels over a six-month period, as well as improved patient activation scores.
“Lifestyle modification and medication adherence are crucial to improving intermediate health outcomes that influence morbidity and mortality among cardiac patients,” said Michael Mirro, MD at Parkview Hospital. “This study shows that healthcare technology can increase patient engagement which then leads to more positive health outcomes.”
The study was part of an initiative funded by a Challenge Grant awarded by the Office of the National Coordinator for Health Information Technology (ONC) to Indiana Health Information Technology, Inc. (IHIT) and PHR vendor NoMoreClipboard (NMC) to make health informationexchange (HIE) data available to patients. Working with IHIT and NoMoreClipboard, data from the Parkview EHR was routed through the area HIE to populate patient PHRs.
Two-hundred patients who had undergone revascularization (stent and/or bypass) were recruited into the study. In addition to serial laboratory tests, surveys measuring patient engagement and technology acceptance were conducted at baseline and six months.
Personnel from the Parkview Research Center (PRC) worked with patients to set up their NoMoreClipboard PHR account and provided training. Parkview’s electronic health record system was configured to support PHR account creation and population. With the patient present, PRC staff was able to send a Continuity of Care Document (CCD) and the patient medical record number to the PHR from the patient chart in the EHR. The CCD was then routed through the Med-Web HIE, which serves Northeast Indiana, and NoMoreClipboard returned a PHR account activation code.
When a PHR account was created, the activation code was entered — establishing a match with the patient’s medical record number at Parkview and releasing discrete data from the CCD to populate the PHR. When new data is available in the Parkview EHR system, the practice can post that data to NMC with a single click.
“This is an example of true HIT integration,” said Jeff Donnell, president of NoMoreClipboard. “We also worked with Parkview to incorporate a daily health diary into the patient’s PHR so they can self-enter and transmit their blood pressure, heart rate, blood glucose, height, weight and BMI andsend it to their doctors. Patients could also sign up for daily reminders to complete and submit their diary information.”
“As we look ahead to Meaningful Use Stage Two, many in the provider community are concerned that the requirement to get five percent of patients to use electronic engagement tools is unrealistic,” added Mirro. “Our experience with a senior population indicates otherwise. More importantly, we are seeing that patients who participate in electronic exchange and use these tools are more engaged, more likely to adhere to prescribed therapies and treatment plans, and more likely to enjoy improved outcomes
and quality of life.”
Study Participant Demographics
Of the 184 patients who completed the six-month study, 70 percent were 56-74 years old. About 64 percent were covered by Medicare, and the majority were college educated. There was also a high prevalence of diabetes in the study population (33 percent).
Specific Study Results
- Active PHR users and super users experienced significant declines in HbA1c percentages. The mean hemoglobin A1c reduced from 6.25 percent to 6 percent.
- Patients with a history of diabetes showed a significant statistical improvement in glycemic control.
- Patients with access to a PHR had a greater understanding of their conditions and adopted healthier lifestyle behaviors.
- Over the duration of the study, data has been imported from Parkview’s EHR to patient PHR accounts more than 600 times, and patients have logged into the PHR more than 2,400 times. On average, patients logged in 8.7 times over a six-month period. Approximately 15 percent of the patients are using the health diary to self-report and share health measures.
“In addition to quantitative results, we also learned several big picture lessons from this study,” said Donnell. “Clinicians often tell us that tools like PHRs are a great idea for others, but certain patient populations won’t use these tools based on age, income or inability to use technology. Our experience in this study — and with other clients who serve patients on the wrong side of the digital divide — tell a different story.”