SLIDE 1
Integrating Personalized Health Information from MedlinePlus in a Patient Portal
Damian Borbolla, MD, MS
CMIO Hospital Italiano de Buenos Aires (HIBA) Argentina damian.borbolla@hiba.org.ar
Damian&BORBOLLA,&Guilherme&DEL&FIOL,&Vanina TALIERCIO,&Carlos&OTERO,&Fernando&CAMPOS,&Marcela MARTINEZ,&Daniel&LUNA&,&Fernan&QUIROS
SLIDE 2 Introduction
PHR: “Healthcare-related online applications that allow consumers to interact with their health care information in one place”
- Patient Portals (tethered PHRs):
- Linked directly to the physician’s practice-based EHRs. Offers
advantages because it can include specific information imported directly from the patient’s medical record
- Stand-alone PHRs:
- Without integration to other systems
Infobuttons:
- Context-specific information embedded in EHR or PHR systems that provide
seamless access to relevant online health information resources
Implementation of Infobuttons in a Patient Portal
SLIDE 3
Introduction
MedlinePlus: Freely available consumer health information resource that offers information about diseases, conditions, and wellness issues in laymen terms. MedlinePlus information is offered in English and Spanish MedlinePlus Connect: Free service that allows health organizations and health IT providers to link patient portals and electronic health record (EHR) systems to MedlinePlus via Infobuttons
Implementation of Infobuttons in a Patient Portal
SLIDE 4 About Hospital Italiano de Buenos Aires (HIBA)
- Non-profit academic medical center
- Network of two hospitals with 750 beds
- 800 home care patients
- 24 clinics
- Insurance plan 155,000 people
- >2,200,000 outpatient visits (annually)
Implementation of Infobuttons in a Patient Portal
- 1998 - Italica Project – HIS
- EHR:
- Fully-implemented (paperless)
- Web-based
- Problem-oriented
- Patient-centered
- Terminology Server:
- Allows the mapping of local
vocabularies to SNOMED-CT
- PHR:
- Tethered Patient Portal
- Launched in Sep. 2007
SLIDE 5 About HIBA´s PHR
Implementation of Infobuttons in a Patient Portal
- HIBA insurance plan total
patients = 155,000
- 56% of these pts. enrolled in the
PHR
- PHR users from other health
insurance: 42,575
- Total Users enrolled: 129,768
!
New patients enrolled annually (blue) & cumulative enrollment (red):
SLIDE 6
!
!
Implementation of Infobuttons in a Patient Portal
SLIDE 7
!
!
Implementation of Infobuttons in a Patient Portal
SLIDE 8
Personalized health information at HIBA´s PHR
Implementation of Infobuttons in a Patient Portal
SLIDE 9 Personalized health information at HIBA´s PHR
Implementation of Infobuttons in a Patient Portal
- 2008: Personalized health information (Locally produced)
- Examples of locally developed information:
- Health promotion (e.g. exercising)
- Disease-specific information
- Prevention
- Food recipes
- Information about the Hospital
SLIDE 10 !
- Aug 2012 we added MedlinePlus information in Spanish
- 2 implementations:
- Web Service
- HL7 Context-Aware Knowledge Retrieval (Infobutton) Service-
Oriented Architecture (SOA) Implementation Guide
- Web Application
- HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge
Request URL-Based Implementation specification
"
SLIDE 11
Implementation of Infobuttons in a Patient Portal
SOA Implementation HIBA
Terminology+Server Check+pa4ent+Problem+List in+the+CDR SNOMED@CT+code NLM+receive request XML+genera4on+with informa4on+in+Spanish
Informa4on embeded+in PHR
NLM
Pa4ent+log+in
WS WS
SLIDE 12
Personalized health information patients clicks
Implementation of Infobuttons in a Patient Portal
SLIDE 13 Implementation of Infobuttons in a Patient Portal
SOA Implementation
- Search Engine:
- Top 5 terms retrieved:
- Diabetes
- Pregnancy
- Celiac disease
- Uterine polyp
- HIV
SLIDE 14
Implementation of Infobuttons in a Patient Portal
URL based Implementation HIBA
Terminology+Server Pa0ent+clicks+ona Infobu9on LOINC+code NLM+receive request Link+is+generated+with informa0on+in+Spanish
Open+new window+in PHR
NLM
Pa0ent+click+on results+tab
WS WS
SLIDE 15
Implementation of Infobuttons in a Patient Portal
URL based Implementation
SLIDE 16
% Lab sessions (red) and % clicks in lab. Infobuttons (blue) Implementation of Infobuttons in a Patient Portal
SLIDE 17
Infobuttons
Implementation of Infobuttons in a Patient Portal
! Total clicks % CBC!W!Auto!Differen6al!panel!–!Blood 11682 43 Urine!Culture 5236 19 Platelets 4683 17 Urinalysis 2362 9 Alanine!aminotransferase 2235 8 Others 1058 4 ! 27256 100
SLIDE 18 Discussion
- Strong use of both functionalities provided in the patient portal, especially by the
personalized information provided in the main screen linked to patients’ problem lists
- Similar experiences: “Recommender Systems” as a potential approach to suggest
items of interest to users.
- There is research experiences with recommender systems but in helping
clinicians’ decision making (not with patients)
- To our knowledge there are no publications describing similar experiences with
patients
- According to the NLM, there are approximately 13 healthcare institutions and
more than 30 EHR systems using MedlinePlus Connect
Implementation of Infobuttons in a Patient Portal
SLIDE 19 Future steps
- We know patients are reading information
- Now we need to understand the value patients find in the information
- Currently working on the translation and transcultural validation of AIM Q
- Information Assessment Method*
Implementation of Infobuttons in a Patient Portal
- Add other resources
- Add domains with information (medications)
- Further evaluation
* Pluye, P., Grad, R., Repchinsky, C., Jovaisas, B., Johnson-Lafleur, J., Carrier, M.-E., Granikov, V., Farrell, B., Rodriguez, C., Bartlett, G., Loiselle, C. and Légaré, F. (2013),
Four levels of outcomes of information-seeking: A mixed methods study in primary health care. J. Am. Soc. Inf. Sci., 64: 108–125. doi: 10.1002/asi.22793
SLIDE 20
Thanks! Damian Borbolla damian.borbolla@hiba.org.ar
Implementation of Infobuttons in a Patient Portal
