Web as Medium for Patient Access to Electronic Health Information James J. Cimino, MD, Vimla L....
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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
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Transcript of Web as Medium for Patient Access to Electronic Health Information James J. Cimino, MD, Vimla L....
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
Data Entry
Review
Advice
Education
Comments
Help
Logout
Vital Signs Blood Sugar
Data Entry
patcis.cgi
Web ServerWeb Browser
SessionRegistry
UsageLog
Internet
2
3
6
PatCIS Architecture
1
CGI
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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 log-on failures
22 wrong user name
51 wrong password
58 wrong Secure ID
33 log-ons without any activity
466 active sessions (261 logged out)
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630 log-ons
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18 User 1
User 2
User 3
User 4
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User 6
User 7
User 8
User 9
User 10
User 11
User 12
User 13
Log-Ons Failures by User
Active Log-Ons by User
0
5
10
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25
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50User 1
User 2
User 3
User 4
User 5
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User 7
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User 13
Average Monthly Log-Ons
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U1 U2 U3 U4 U5 U6 U7 U8 U9 U10 U11 U12 U13
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70User 1
User 2
User 3
User 4
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Average Session Time by User
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250User 1
User 2
User 3
User 4
User 5
User 6
User 7
User 8
User 9
User 10
User 11
User 12
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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 I
• Data review: 1831 total
I
• 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
