SUPPORTED BY A GRANT FROM THE NEW YORK STATE HEALTH FOUNDATION
Increasing demands on primary care have led to new challenges in patient-provider relationships. Primary care clinicians increasingly care for clinically and socially complex patients. They also work in a health care environment that is constantly shifting and unpredictable. A recent study showed that close to half of clinicians’ patients lived with two or more chronic conditions. The health needs of this population are significant and contribute to the difficulty in finding and scheduling appointments, long wait times, and the potential for visits that are too short, all of which affect the quality of the provider-patient relationship.
Why This Is Important
Over the past 20 years, there have been great advances in the care of people with chronic illnesses, yet challenges persist in the nature of the interactions between patients and clinicians, hindering effective co-management of health. These barriers became all too apparent during the pandemic, as patients and clinicians were forced to adapt to changes in how care is delivered, with many of the typical office visits replaced by telehealth visits. And patients’ conditions became even more complex due to pandemic-related delays in care and behavioral health problems. Innovations that facilitate and enhance interactions between patients and clinicians could make a significant impact on the resilience and levels of accomplishment perceived by the primary care workforce and on the health and well-being of their patients.
Our Work
A team from United Hospital Fund’s Quality Institute sought to better understand existing shortcomings in various aspects of the patient-provider partnership for chronic care—and ways of addressing them. The goal was to involve patients and primary care practitioners to explore together how a digital tool could address some of their challenges. A New York City primary care practice and its patients agreed to participate in this innovative co-design initiative.
The team engaged 10 patients and practice staff in the co-design work by conducting a series of active listening interviews to cultivate trust and set the stage for the co-design collaboration. These conversations explored their common ground—their shared experience in co-managing diabetes. The interviews revealed several concerns in common related to successful communication, the discussion of priorities and values, agenda- and goal-setting, visit efficiency, inclusion, and trust.
In the second phase of the project, the team conceived a shared digital tool that could help align priorities and goals, foster effective communication, improve visit efficiency, and contribute to the building of continuity and trust. A blueprint of the tool, How’s My Health Dashboard, was developed in partnership with two health information technologists/designers. Patient and clinician feedback on the prototype was collected, and issues of workflow and feasibility of use were explored. Project staff investigated the requirements to create a working digital version of the dashboard, as well as the factors that would facilitate or hinder its adoption.
The Bottom Line
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. 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 electronics 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 co-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.
This project substantiates that clinicians and patients are each invested in seeking to increase the quality of their interactions with one another. For clinicians, this means focusing on what is important to the patient and prioritizing their key concern during the visit. For patients, this means making sure they effectively share necessary information that enables clinicians to tailor recommendations to their unique life situation. This is the vision we should aspire to, and we should now focus on how we fully realize the dashboard concept.
Our Publications
Designing a Digital Platform to Monitor Health Status and Foster Trust Between Patients and Clinicians
(pdf)
Supporting resources (links go to pdfs of appendix files):
Dashboard Prototype
Interview Guides
Methods
Contact: Anne-Marie Audet