The Impact of Consumer Health Informatics Applications (Text Version)

Slide presentation from the AHRQ 2010 conference.

On September 28, 2010, Christopher Gibbons made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (1.2 MB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

Slide 1. The Impact of Consumer Health Informatics Applications

The Impact of Consumer Health Informatics Applications

The Johns Hopkins Evidence Based Practice Center

M. Christopher Gibbons, MD, MPH (PI)
Renee F. Wilson, MS, Lipika Samal, MD, Christoph U. Lehmann, MD, Kay Dickersin, MA, PhD, Harold P. Lehmann, MD, PhD, Hanan Aboumatar, MD, Joe Finkelstein, MD, PhD, Erica Shelton, MD, Ritu Sharma, BS, Eric B. Bass, MD, MPH

October, 2009

Slide 2

Slide 2. Note

Note

  • These slides are based on research conducted by the Johns Hopkins EPC under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the authors who are responsible for its contents; the findings and conclusions do not represent the views of AHRQ. Therefore, no statement in this document should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
  • Financial disclosure: None of the authors have a financial interest in any of the products discussed in these slides.
  • For more information about the Evidence-base Practice Centers Program and to view the final report from which these slides are based, please visit http://effectivehealthcare.ahrq.gov/.

Slide 3

Slide 3. Background

Background

  • HIT [Health Information Technology] may enable future transformations in health care delivery, quality, outcomes and costs.
  • There is growing interest in electronic tools that are owned and operated primarily by patients and healthcare consumers.

Slide 4

Slide 4. Background

Background

Consumer health informatics (CHI) applications are defined as any electronic tool, technology or electronic application that is designed to interact directly with consumers, with or without the presence of a healthcare professional, that provides or uses individualized (personal) information and provides the consumer with individualized assistance, to help the patient better manage their health or healthcare.

Slide 5

Slide 5. Background

Background

The objectives of this report were to review the literature on the evidence of the health impact of currently developed CHI applications, to identify the gaps in the CHI literature, and to make recommendations for future CHI research.

Slide 6

Slide 6. Key Questions

Key Questions

  1. What evidence exists that CHI applications impact:
    1. Health care process outcomes (e.g., receiving appropriate treatment) among users?
    2. Intermediate health outcomes (e.g. self management, health knowledge, and health behaviors) among users?
    3. Relationship-centered outcomes (e.g. shared decision making or clinician-patient communication) among users?
    4. Clinical outcomes (including quality of life) among users?
    5. Economic outcomes (e.g., cost and access to care) among users?

Slide 7

Slide 7. Key Questions

Key Questions

  1. What are the barriers that clinicians, developers, consumers and their families or caregivers encounter that limit utilization or implementation of CHI applications?
  2. What knowledge or evidence exists to support estimates of cost, benefit, and net value with regard to CHI applications?
  3. What critical information regarding the impact of CHI applications is needed to give consumers, their families, clinicians, and developers a clear understanding of the value proposition particular to them?

Slide 8

Slide 8. Methodology

Methodology

Conceptual Model

  1. What perspective?
    1. Outcomes/effectiveness
    2. Users
    3. Informatics tools
      1. Functional
      2. Architecture/Hardware
      3. Message Content
  2. Goals?

Slide 9

Slide 9. Methodology

Methodology

An image of a flowchart on the processes and outcomes.

Note beneath diagram: Key question 3 (knowledge or evidence deficits) and 4 (critical information regarding CHI applications) are not included in this conceptual framework.

Slide 10

Slide 10. Methodology

Methodology

  • Search strategy:
    • RCT's Only (Key Question #1)
    • All study designs (Key Questions #2, #3, #4)
  • Databases
    • MEDLINE®, EMBASE®, The Cochrane Library, Scopus, and CINAHL
    • Published reviews, Grey literature
    • Query of technical experts, advisors, and project investigators
  • Exclusion Criteria
    • No health informatics application, Application does not apply to the consumer, General health information application (general Web site) and is not tailored to individual consumers, "Point of care" device (defined as requiring a clinician to use or obtain and is part of the regular provision of care), or No original data provided.

Slide 11

Slide 11. Methodology

Methodology

  • Quality assessment:
    • Jadad Criteria
    • GRADE Working Group Criteria
  • Double data review and quality assessment.
  • Iterative feedback and review by technical expert panel (TEP) & External Advisors.

Slide 12

Slide 12. CHI Impact on Process outcomes (KQ 1a)

CHI Impact on Process outcomes (KQ 1a)

Results

  • Significant (+) impact of CHI in at least one outcome:
    • 4 of 5 asthma studies

Slide 13

Slide 14. Relationship centered outcomes (KQ1c)

Results for Intermediate outcomes (KQ 1b)

  • Significant (+) impact of CHI in at least one outcome:
    • 100% of 3 breast cancer studies.
    • 89% of 32 diet/exercise/physical activity studies.
    • 100% of 7 alcohol abuse studies.
    • 58% of 19 smoking cessation studies.
    • 64% of 11 obesity studies.
    • 86% of 7 Diabetes studies.
    • 88% of 8 mental health studies.
    • 75% of 4 asthma/COPD studies.
    • 14 single studies on other conditions.

Slide 14

Slide 14. Relationship centered outcomes (KQ1c)

Relationship centered outcomes (KQ1c)

Results

  • Significant (+) impact of CHI in at least one outcome:
    • 5 of 8 studies

Slide 15

Slide 15. Clinical outcomes (KQ1d)

Clinical outcomes (KQ1d)

Results

  • Significant (+) impact of CHI in at least one outcome:
    • Clinical outcomes:
      • 1 of 3 breast cancer studies.
      • 2 of 5 diet/exercise/physical activity studies.
      • 7 of 7 mental health studies.
      • 1 of 3 Diabetes studies.
      • 11 miscellaneous single studies.
  • No evidence of consumer harm attributable to CHI.

Slide 16

Slide 16. Economic Outcomes (KQ1e)

Economic Outcomes (KQ1e)

Results

  • Insufficient evidence to determine economic impact of CHI.

Slide 17

Slide 17. CHI utilization Barriers (KQ2)

 

CHI utilization Barriers (KQ2)

Results

  • 31 studies addressed the barriers to CHI applications:
    • Cancer, HIV/AIDS (and sexually transmitted disease), mental health, physical activity/diet/obesity, smoking cessation, prostate cancer, and hypertension.
  • Systems level barriers:
    • Internet access at home or in the community, Computer hardware requirements, Computer device shape/design/configuration, incompatibility with current healthcare as a barrier.

Slide 18

Slide 18. CHI utilization Barriers (KQ2)

CHI utilization Barriers (KQ2)

Results

  • Individual level barriers:
    • Clinic staff who feared increased workloads, lack of built-in social support, forgotten passwords, automated data entry, inability to allow for back entry of old data, lack of adequate user customization, substantial financial investment.
    • Application usability (19 0f 19 studies), Patient knowledge, literacy, and skills (11 of 12 studies), Application too time-consuming (5 of 6 studies), too many participant E-mails (1 of 1 study), Utilization fees (1 of 1 study), Privacy concerns, doubt regarding patient control of information or lack of healthcare system trust (4 of 5 studies), cultural barriers (1 of 2 studies), Consumers expectations of application acceptability, usefulness, credibility (8 of 8 studies), Cost (1 of 1 study), Physical or cognitive impairment (1 of 1 study), Anxiety over the use of computers, complaints about lack of personal contact with clinicians and the belief that IT would not be an improvement to current care (2 of 2 studies).

Slide 19

Slide 19. The cost benefit of CHI (KQ3)

The cost benefit of CHI (KQ3)

Results

  • Insufficient evidence to determine the cost benefit of CHI.

Slide 20

Slide 20. Knowledge/evidence Deficits regarding CHI Value (KQ4)

Knowledge/evidence Deficits regarding CHI Value (KQ4)

Results

  • Patient factors:
    • The impact of patient preferences, knowledge, attitudes, beliefs, on CHI utilization and outcomes.
    • The efficacy of Using Web 2.0/Web 3.0, ubiquitous computing and social networking environments for CHI applications.
    • Effect of sociocultural and community factors on access, usability, desirability and benefit of CHI applications.
    • Trust, security, confidentiality of CHI data.
    • CHI and at risk populations (children, seniors, disabled, minorities).

Slide 21

Slide 21. Knowledge/evidence Deficits regarding CHI Value (KQ4)

Knowledge/evidence Deficits regarding CHI Value (KQ4)

Results

  • CHI application utilization factors:
    • The effect of differential access to broadband internet access, health literacy, or technology literacy�on CHI mediated health outcomes.
  • Technology-related issues:
    • The relative importance of hardware vs. software design on CHI efficacy.
    • The impact of Culturally Informed (hardware) Design on outcomes.
  • Health-related questions:
    • The role of CHI applications in addressing acute health problems.
    • The role of CHI applications in primary, secondary and tertiary prevention.
    • The impact of CHI applications on social factors including social isolation and social support and broader social determinants of health.

Slide 22

Slide 22. Discussion

Discussion

  • Current literature is broad (studies on many topic areas) but at times thin (limited number of studies in each topic area).
  • Emerging themes:
    • CHI applications can significantly impact health outcomes.
    • CHI applications may also be effective adjuvants to traditional healthcare.
    • Effective CHI applications include 1) individual tailoring, 2) personalization and 3) behavioral feedback.

Slide 23

Slide 23. Knowledge Gaps Regarding CHI Applications

Knowledge Gaps Regarding CHI Applications

  • The role of CHI applications targeting children, adolescents, the elderly and caregivers.
  • Consumer knowledge, attitudes, beliefs, perceptions and practices regarding technology utilization, particularly among priority populations.
  • The effect of CHI applications on health outcomes among racial and ethnic minority populations, low literacy populations and the potential effect of these applications on healthcare disparities.
  • The impact of CHI content design (software) vs. platform design (hardware) on consumer utilization and outcomes.
  • The role of Web 2.0, social networking and use of other platforms (e.g."On Demand", television and gaming platforms) in CHI applications.

Slide 24

Slide 24. CHI Research Needs and Opportunities

CHI Research Needs and Opportunities

  • Standardized interdisciplinary CHI nomenclature.
  • A CHI Design & evaluation registry.

Slide 25

Slide 25. Project Summary

Project Summary

  • Consumer Health Informatics offer the promise of enhancing patient centeredness, improving access to healthcare interventions and therapies, lowering healthcare costs, improving health outcomes and reducing health disparities.
  • The impact of CHI applications has not been previously reviewed.
  • Despite study heterogeneity and some data paucity, this review found evidence that CHI applications can improve certain adult clinical and intermediate health outcomes (mental health and smoking cessation).
  • Effective interventions often employ tailored content, personalized messages and appropriate, ongoing behavioral feedback.
  • The role of CHI applications among children, priority populations, on healthcare processes or economics has not been adequately evaluated.
  • Many personal and systems level utilization barriers exist.
  • Knowledge gaps include the health impact of social networking technologies, CHI impact on Disparities, the role of CHI in acute disease management and primary, secondary or tertiary disease prevention.
  • Next steps should include the development of a standardized nomenclature and CHI registry to facilitate research and reporting.
Current as of December 2010
Internet Citation: The Impact of Consumer Health Informatics Applications (Text Version). December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/gibbons/index.html