Patient communication is heading to the web
Accessing health records could be key
One of the most promising and exciting aspects of web technology is the potential it has for transforming how pharmacists and other clinicians educate and communicate with patients, experts say.
Health care systems can use web sites and social networking to inform and educate patients. And they can use web technology to monitor and improve medication adherence, says Jerry Fahrni, PharmD, IT pharmacist at Kaweah Delta in Visalia, CA.
Through Twitter or a voice-over Internet phone system, providers can text or e-mail reminders to patients, he says.
"A patient who is taking warfarin, for example, could sign up for reminders that say, 'Mrs. Jones, it's time to take your warfarin,'" Fahrni explains.
The reminder could provide a phone number or link for the patient to contact with any questions.
"These are great ways to communicate," Fahrni says. "I just got a smart phone — Droid from Verizon — and I can do everything on it that I can do on my laptop computer."
Physicians could carry these smart phones around and have instant access to patient e-mails or messages from pharmacists or nurses about patients' surgeries or medications, he adds.
"Voice recognition is the next step, and we're heading toward that," Fahrni says.
Web technology might also lead to providing patients with access to their own electronic records, says John Poikonen, PharmD, clinical informatics director of the UMass Memorial Medical Center in Worcester, MA.
"The emergence of personal health records still is very new," Poikonen says. "It's clearly an emerging trend; we haven't yet fully used personal health records."
When patients have electronic access to their health records, interactiveness also will be a feature, he adds.
"A person will be able to access his records without filling out long forms and photocopying paper records," Poikonen explains.
"So while we're moving rapidly to complete the electronic patient record, the first step is reviewing that and seeing what is of value for the patient to view," he says. "We want to make available information that doesn't cause alarm and that enhances their health knowledge and experience, versus giving them something that can be misinterpreted."
For instance, patients might be able to view a secure portal that lists their lab values with a range provided for context.
"The second part of that is interacting with the health care provider, physician, pharmacist, etc.," Poikonen says. "That's really cutting edge, and it has huge potential."
The simplest interaction would relate to scheduling on-line, and this already is possible, he says.
"The second part of that is asking questions about what may be happening with them in an on-line dialogue with the physician or the pharmacist," Poikonen says. "There are services that you can subscribe to that would put the medical profile up and use it to help with compliance."
For example, a diabetic patient's blood sugar data could be posted on-line with a trending analysis that is sent to providers for interpretation, Poikonen says.
"The provider can get the information back to patients, and that's the really exciting stuff," he adds. "With the diabetic patient, someone who is interpreting the trending of the patient's blood sugar across time could make adjustments in the dosages or suggestions for lifestyle changes."
Doing this type of monitoring interactively through web-based information technology should be seen as a supplement to face-to-face provider-patient meetings, Poikonen notes.
Before such web-based provider-patient interactions can become the norm, there are some obstacles to overcome.
One is that practitioners have to become comfortable with these types of interactions and with having medical records available to patients, Poikonen says.
"Physicians traditionally have been very reluctant to have their record completely available to the patient," he says. "But there's more and more evidence that when people are engaged and want this information it doesn't hinder the care process."
From hospital pharmacists' perspective, there's the belief that when patients are given prescriptions they take them correctly and know how to watch for side effects, he notes.
"That's not true," Poikonen says. "A lot of folks need some hand-holding, and being able to interact with them through electronic methods means there's a lot of potential to increase compliance."
Patients increasingly are sophisticated with web technology, so this also is propelling forward the medical use of such technology.
"More and more people are using social networks on the patient side, so they're requesting more of this from health care providers," Poikonen says. "Part of what's hindering it is the comfort level on the provider side."
However the most significant obstacle involves reimbursement, he says.
"The financial incentive is there to have patients come into the office for a visit," he says. "In a classic study by Kaiser, we saw an almost 25% decrease in office visits when there's this interactive dialogue going on."
This is a good trend for payers, but not for providers under a fee-for-service system, Poikonen says.
"Why would hospital chief financial officers want to decrease their revenues by 20%?" he says. "The biggest problem is the reimbursement system in this country, and when this changes, this also will change dramatically."
The chief trend pushing health systems towards web-based technology and its efficiency benefits is the quality assurance movement that has providers reporting their outcomes for consumers to view, Poikonen says.
"As things get more electronic, plotting trends is becoming more prevalent," he notes. "Some states are plotting prescription use for antivirals, which is an indicator of where flu outbreaks might be occurring."
There are many public health implications to this information, he adds.
Pharmacists need to stay updated about web technology advances and determine how they can use it to improve their own careers and work, Poikonen suggests.
"I think there needs to be increased awareness of the web technology trends," he adds.
One of the most promising and exciting aspects of web technology is the potential it has for transforming how pharmacists and other clinicians educate and communicate with patients, experts say.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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