For the last two years, the team at NoMoreClipboard has been working to get medical records to patients in real time and in a convenient format.
Their work with three distinct patient populations has been a great education in governance for health information exchanges, but the important take away was about patients.
“We always hear that patients are too old and they don’t use computers,” said Jeff Donnell, president of NoMoreClipboard. “More often than not, they will use a tool like this because they need it.”
Indiana has five health information exchanges and NoMoreClipboard worked with all of them to build a bridge between provider data and personal health records. Here are three examples that show that it is worth the time and effort to get data to patients.
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PHRs for everyone in Batesville
With this project, NoMoreClipboard worked with Margaret Mary Health, a critical access hospital that serves about 65,000 residents in the surrounding counties. Donnell estimated that there are about a dozen EHR systems in use in the community between the hospital’s two EHR systems and the systems used by independent providers that refer patients to the hospital.
The goal of the pilot project was to set up a community wide patient portal that uses data from all providers in the community and Health Bridge, an HIE that covers communities in Ohio, Kentucky and Indiana.
Here is how the process works.
- A person goes to a covered entity (Margaret Mary) to set up an account.
- An employee of Margaret Mary collects demographic data to start the identity verification process.
- The employee sends a query based on the demographic information to HealthBridge.
- HealthBridge runs the query against a master patient index to find a matching medical record number.
- HealthBridge returns a list of matches to Margaret Mary.
- Margaret Mary employee works with the person to identify the correct record.
- The person goes home to finish setting up the account that is prepopulated with EHR data.
- As new data is added to the EHR, it also updates the PHR.
Heart patients in Fort Wayne
The goal with this project was to determine if PHRs could help people with advanced heart disease take better care of themselves.
NMC worked with Parkview Physicians Group — Cardiology, a 24-physician cardiology practice in Northeast Indiana. PPCG provides care at three offices and a dozen clinics, and conducts 30,000 office visits and consultations as well as 40,000 hospital visits and consultations each year.
The team identified 200 people who recently had coronary artery bypass graft and/or stent insertion and offered them a NoMoreClipboard account. Most of the participants were between 65 and 74.
The accounts were populated with data from the patient EMRs. The team conducted a baseline survey to measure patient engagement and health, including weight, blood pressure, lipid and HbA1c levels.
The team ran another survey 6 months after the patients started using the records.
From a NMC report on the study:
Based on the number of times they logged into their ePHRs, users were classified into three groups: inactive (17%), active (55%) and super user (28%). There was a significant improvement in HbA1c among active users and super users, with the mean hemoglobin A1c reduced from 6.25 percent at baseline to 6.07 percent at six months. There was no significant improvement in blood pressure and LDL at six months.
Over six months, data has been imported from the PPCG EHR to patient PHR accounts more than 600 times. Patients have logged into the PHR more than 2,400 times. On average, a patient logged in 8.7 times over a six-month period.
People with diabetes in Paoli
Paoli is a town of 3,700 people and Jubilee Community Health is a safety net clinic there. The clinic has deployed a mobile version of NoMoreClipboard with their patients who have diabetes.
“We built out a modification so patients could interact with NMC and the clinic on a cell phone,” Donnell said. “We piloted with a small population but we have seen a dramatic improvement in compliance and A1C levels.”
A patient engagement coordinator trained patients to provide daily blood sugar measurements using the PHR and a smart phone. As patients submitted blood glucose results, they were presented with immediate feedback based on entered values. The coordinator texted people who forgot to enter their data. NMC reported these results from the pilot project:
Lab results were integrated into the PHR from the clinical messaging service offered by the HealthLINC HIE that serves the area. Lab results were provided after a 72 hour delay to allow clinic staff the opportunity to review results.
Over the course of the study, 37.5 percent of the patients remained actively engaged and regularly entered blood glucose readings via NoMoreClipboard. Of these patients, 28.6 percent had improved A1C levels and reported feeling better.
Linda Wells-Freiberger, the nurse practitioner who manages Jubilee Community Health, said one of her patients is a long-haul trucker who has struggled to control his diabetes for the past five years. His blood sugar level was 12.2 at the start of the study and 6.8 at the end.
[Chart from NoMoreClipboard]
