In an effort to improve the quality of interactions between patients and their health care providers, United Hospital Fund (UHF) released a report today describing the development of a prototype for a new digital resource, How’s My Health Dashboard, which would help patients and providers work together to achieve the health goals important to patients.
Over the past 20 years, there have been great advances in care for chronic illnesses, yet challenges persist in the nature of the interactions between patients and clinicians, hindering effective co-management of health. These barriers have become all too apparent during the pandemic, as patients and clinicians adapt to changes in visits, some of which have moved on-line, and some patients’ conditions became even more complex due to pandemic-related delays in care and behavioral health problems.
A team from UHF’s Quality Institute facilitated a nine-month long co-design project with patients and clinicians from an New York City primary care practice that serves a diverse group of patients with high prevalence of diabetes. The practice had long endorsed patient-centered innovations, adopted health information technology (HIT) and promoted use of portals and various apps with their patients.
The team engaged ten patients and practice staff, conducting a series of active listening interviews to cultivate trust and set the stage for the co-design collaboration. These conversations explored the shared experience of both partners in co-managing diabetes, and revealed their common ground in seeking successful communications, discussing priorities and values, and setting an agenda and goals of care. Inclusion and trust also surfaced as important aspects of their interactions.
In the second phase, the team conceived of a digital tool that could help achieve what patients and clinicians seek from their interactions, and developed a blueprint for the tool, How’s My Health Dashboard, in partnership with two health information technologists/designers.
“The interviews shed light on the limitations of current HIT tools in facilitating effective communications between doctors and patients when co-managing chronic conditions like diabetes,” said Anne-Marie J. Audet, MD, UHF senior medical officer and author of the report. “Clinicians want to easily access patient-reported information that can make their interactions more effective, and patients wish they could more easily share this information with their doctor, especially about the issues that matter most to them. Existing HIT platforms create limitations for both.”
Clinicians access information about patients via their electronic medical records (EMR) system, and patients access theirs via a patient portal. Interviews confirmed that information generated by practitioners—such as physician notes and test results—can only be partially shared with patients on the portal, while patient-generated information—such as health status, self-reported symptoms, and goal achievements—is absent from the clinician’s EMR, or not easily accessible. Patients reported difficulties accessing their own information once it had been shared with physicians.
The How’s My Health Dashboard prototype begins to address the imbalance and the segregation of provider- and patient-generated information pertinent to the management of health.
Feedback on the dashboard prototype was collected from patients and clinicians, and both confirmed that it would foster trust, improve communication, and facilitate patients’ input into the setting of priorities. One patient said, “I can’t wait to use it” and offered to participate in a pilot program. All the clinicians interviewed valued the dashboard’s potential to set a shared agenda for a visit. “There will always be a gap between the provider and patient goals, but at least it’ll capture three priorities to better negotiate the time spent on things with the patient,” one said.
“When I bring a patient into my exam room, I want our time together to be golden. Everything we do at our practice is designed to make that 20-minute interaction the most meaningful for patients and clinicians alike,” said Dr. Stephanie Wang, Senior Medical Director of Care Transitions & Population Health at Mount Sinai Morningside and Medical Director, Mount Sinai Doctors Faculty Practice. “COVID-19 led Mount Sinai to rapidly adopt and implement telehealth services, changing the way we as health care providers interact with our patients.”
“This app builds on that transformative momentum and creates an innovative way for patients and clinicians to better negotiate the intricate dance of complex medical care. The best part is: we designed it together, so it meets everyone’s needs,” Dr. Wang said.
The report also lays out what would be required to create a working version, as well as factors that would aid adoption.
“Too often in health care, life-determining decisions are made without patients and their doctors sharing critical information,” said UHF president Anthony Shih, MD. “Chronic conditions need to be co-managed, and this digital tool could help clinicians realize that goal.”
The report, including the dashboard prototype and interview guides, was produced with support by New York State Health Foundation and can be downloaded from UHF’s website here.
United Hospital Fund
United Hospital Fund works to build an effective and equitable health care system for every New Yorker. An independent, nonprofit organization, we are a force for improvement, analyzing public policy to inform decision-makers, finding common ground among diverse stakeholders, and developing and supporting innovative programs that improve health and health care. We work to dismantle barriers in health policy and health care delivery that prevent equitable opportunities for health. For more on our initiatives and programs please visit our website at www.uhfnyc.org and follow us on Twitter.