Transcript An Evaluation of Patient Access to their Electronic

Web as Medium for Patient
Access to Electronic Health
Information
James J. Cimino, MD, Vimla L. Patel, PhD, Andre W.
Kushniruk, PhD
Columbia University and McGill University
Consumer Health Information Issues
• Understanding on-line health information
• Access to personal health records
• Regulatory requirements are coming
• Commercial sites for giving patients access to their data
• What will happen to the patient?
• What will happen to the patient-provider relationship?
The Patient Clinical Information System
(PatCIS)
• New York Presbyterian Hospital clinical data repository
• Web-based Clinical Information System (WebCIS)
• National Information Infrastructure contract from NLM:
– give patients WebCIS
– see what happens
• Pilot study conducted
PatCIS Architecture
Web Server
Web Browser
patcis.cgi
Data Entry
Vital Signs
2
1
Blood Sugar
Logout
Session
Registry
Data Entry
Review
Advice
3
Education
Comments
Help
6
5
4
Internet
CGI
Usage
Log
PatCIS Recruitment
• Mail physician consent forms to physicians
• Wait for physicians to suggest subjects
• Mail URL for consent form to subjects
• On-line enrollment
• Patient prints, signs and mails consent form
• Physician provides function-specific consent
• Mail user name, password and SecurID card to patients
Log File Analysis
sandcar!Fri Oct 27 11:32:22 2000!cim.cpmc.columbia.edu!
|patcis^login
sandcar!Fri Oct 27 11:32:24 2000!cim.cpmc.columbia.edu!
|patcis^Data Review
sandcar!Fri Oct 27 11:32:28 2000!cim.cpmc.columbia.edu!
|patcis^Data Review^Laboratory Detail^lab_detail.cgi
sandcar!Fri Oct 27 11:32:30 2000!cim.cpmc.columbia.edu!
|patcis^Data Review^Laboratory Detail^labSum.cgi
sandcar!Fri Oct 27 11:32:35 2000!cim.cpmc.columbia.edu!
|patcis^logout
Results
•
•
•
•
•
Functions
Enrollment
System usage
Function usage
Adverse events
Functions
• Data entry: vital signs, diabetic flow sheet
• Data review: vital signs, diabetic flow sheet,
laboratory, radiology, pathology, cardiology,
discharge summaries, microbiology
• Education: geriatrics, diabetes, Home Medical
Guide, advanced directives
• Advice: cholesterol, mammograms
• Infobuttons: body-mass index, laboratory,
microbiology organisms, microbiology sensitivities,
Pap smear
Enrollment
• Mailing to >200 physicians
• 13 physicians returned signed consent forms
• 19 subjects suggested
• 13 enrolled
• 12 used the system over 19 months
• 1 non-CPMC subject enrolled
System Usage
131
33
466
----630
log-on failures
22
wrong user name
51
wrong password
58
wrong Secure ID
log-ons without any activity
active sessions (261 logged out)
log-ons
Log-Ons Failures by User
Active Log-Ons by User
Average Monthly Log-Ons
16
14
12
10
8
6
4
2
0
U1
U2
U3
U4
U5
U6
U7
U8
U9
U10 U11 U12 U13
Average Session Time by User
Minutes per Month
Function Usage I
• Data review: 1831 total
– 1518 laboratory
• 737 “Laboratory” button  1083 specific reports
• 186 “Laboratory Details” button
• 249 summaries
– 36 vital signs
– 35 diabetes flow sheets
– 212 reports (81 radiology, 35 pathology)
– 30 Microbiology
Function Usage II
• Data review: 1831 total
• Data entry: 73 total
– 34 vital signs
– 39 diabetes flow sheets
• Education: 53 total
• Advice: 6 total
– 5 cholesterol guideline
– 1 mammography guideline
• Other:
– 10 newsgroups
– 83 infobuttons
– 2 comments
– 10 e-mail to physician
– 17 disclaimers
– 13 help
Adverse Events
• None reported
Discussion
• Architecture supports integration, security and tracking
• Enrollment was disappointing
• Population was highly selected: by MD, by self, by Web
• Two patterns: monthly and daily
• Log-on difficulties overcome
• Laboratories are the most popular
Next Directions
• Diabetes mellitus patients
– Data entry
– Coordination with clinicians
– Targeted educational materials
• HIV patients
Conclusion
• Enthusiasm is not universal
• Technical issues were not a problem for our patients
• Privacy is achievable
• Patient understanding of their records was good
• Other features were of less interest
• Patient-physician impact was positive
The Three Questions
? How will your results affect diffusion of telemedicine?
• Increase the “comfort level”
• Identify areas for focused efforts
? What aspects would benefit from other study?
• Security model
• Evaluation methods
? If you were proposing this project today, how and why
would the approach differ?
• Build a patient’s view of the record
• Study doctor-patient-computer interactions directly