Patient-Centered Informatics System to Enhance Health Care in Rural Communities

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DESCRIPTION (provided by applicant): We propose a research demonstration project to evaluate whether integrating the functions of an electronic medical record, personal health record, and communication system leads to more patient-centered care in rural communities in the Intermountain West. This system, which we call the Unified Health Resource (UHR), combines the patient controlled personal health record with the ability to read and, if necessary, improve the accuracy of the information in the electronic medical record. The clinician, who controls information in the electronic medical record, can view and comment on the personal health record, when granted access by the patient. Structured e-visits support several types of electronic communications between clinicians, clinic staff, and patients. Clinics send a variety of automated reminders to patients, including structured electronic forms to solicit electronic reporting of possible symptoms of adverse drug events and to promote better organization of concerns prior to in-person visits. Patients request medication refills and report results of home monitoring tests, such as blood pressure readings and blood glucose values online. The system facilitates the reconciliation of clinician and patient medication lists. The proposal builds on our prior work to implement and evaluate health information technology in rural settings. Clinics that participated in our previous studies will be recruited to this new project. We will apply formative evaluation methods to assess and improve usability, usefulness, and adoption. To estimate impact on patient-centered care, patients will be recruited to a multi-community observational cohort study. Measures of patient activation, involvement in decision-making, self-management behaviors, medication management, and preventive practices will be obtained at baseline and serially during follow-up. During Year Three, we will launch a community-wide education campaign to enhance adoption of the UHR by increasing awareness of personal health records and the utility of asynchronous communication with clinicians. In summary, the UHR combines the functions of multiple electronic tools to bring patients enhanced control of their own health data, increased options for solving personal health issues, and improved access and continuity of clinical care, freed from constraints of time and location. This health information technology will support a new model of interaction between clinicians and patients, aiming to increase the patient-centeredness of care. Our implementation of an education campaign within a rural public health framework will help extend the benefits to underserved populations and to guide nationwide dissemination efforts.