Integrating Personalized Health Information from MedlinePlus in a - PDF document

Integrating Personalized Health Information from MedlinePlus in a Patient Portal Damian&BORBOLLA,&Guilherme&DEL&FIOL,&Vanina TALIERCIO,&Carlos&OTERO,&Fernando&CAMPOS,&Marcela MARTINEZ,&Daniel&LUNA&,&Fernan&QUIROS Damian Borbolla, MD, MS CMIO Hospital Italiano de Buenos Aires (HIBA) Argentina damian.borbolla@hiba.org.ar

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

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

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 • 1998 - Italica Project – HIS • Insurance plan 155,000 people • >2,200,000 outpatient visits (annually) • 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 Implementation of Infobuttons in a Patient Portal

! About HIBA´s PHR New patients enrolled annually (blue) & cumulative enrollment (red): • 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 Implementation of Infobuttons in a Patient Portal

! ! Implementation of Infobuttons in a Patient Portal

! ! Implementation of Infobuttons in a Patient Portal

Personalized health information at HIBA´s PHR Implementation of Infobuttons in a Patient Portal

Personalized health information at HIBA´s PHR • 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 Implementation of Infobuttons in a Patient Portal

! • 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 "

SOA Implementation HIBA NLM Pa4ent+log+in Check+pa4ent+Problem+List in+the+CDR Terminology+Server SNOMED@CT+code NLM+receive WS request Informa4on XML+genera4on+with embeded+in WS informa4on+in+Spanish PHR Implementation of Infobuttons in a Patient Portal

Personalized health information patients clicks Implementation of Infobuttons in a Patient Portal

SOA Implementation • Search Engine : • Top 5 terms retrieved: • Diabetes • Pregnancy • Celiac disease • Uterine polyp • HIV Implementation of Infobuttons in a Patient Portal

URL based Implementation HIBA NLM Pa0ent+click+on results+tab Pa0ent+clicks+ona Infobu9on Terminology+Server LOINC+code NLM+receive WS request Open+new Link+is+generated+with window+in WS informa0on+in+Spanish PHR Implementation of Infobuttons in a Patient Portal

URL based Implementation Implementation of Infobuttons in a Patient Portal

% Lab sessions (red) and % clicks in lab. Infobuttons (blue) Implementation of Infobuttons in a Patient Portal

Infobuttons 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 Implementation of Infobuttons in a Patient Portal

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

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* • 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 Implementation of Infobuttons in a Patient Portal

Thanks! Damian Borbolla damian.borbolla@hiba.org.ar Implementation of Infobuttons in a Patient Portal