Lessons Learned from e-Patient Dave

I started the week with a blog about the Limitations of Administrative Data, so it's fitting to end the week with lessons learned and next steps.

e-Patient Dave, his doctor Danny Sands, Roni Zeiger from Google, and I spent many hours in online and phone conversation about the data elements in healthcare that are of greatest use to e-patients. Since the American Recovery and Reinvestment Act requires patients be given access to their electronic data, I have wanted to share all data with patients, both clinical and administrative. It's clear from our discussions that sharing billing data with patients is unreliable for clinical history, and it was a mistake to do that.

Administrative data is a coded summary of the clinical care that lacks perfect specificity and time references i.e. just because you had a diagnosis of low potassium 5 years ago does not imply it is a problem today.

Thus, we must be careful about what data we send to PHRs and how that data is presented to patients. Here's the action plan that Dave, Danny, Roni, and I developed to optimize the PHR experience for e-patients:

Problem List
This is useful clinical information as long as clinicians keep it current. Danny has done that with Dave's data, so it's Dave's best current source of relevant diagnoses and ongoing treatment.

Plan
1. Remove our ICD9 administrative data feed from Google so that the clinician's problem list is the only data which populates the Conditions area
2. Continue to improve our problem list functionality in webOMR so that it maps to SNOMED-CT, enabling Google and other PHR vendors to provide medical information and decision support based on a controlled vocabulary instead of just free text
3. Change the BIDMC Google Health Upload screen from "Diagnoses" to "Problem List"

Medication List
Name (with NDC coding), Dosage/Frequency, Prescription, Date provides good "data liquidity" of active medications. We will continue to investigate the utility of sending inactive medications.

Allergy List
Name, reaction, and level of certainty of the reaction has worked well. However, Google Health does not display the detailed reaction information. We will either insert this information into the Google Allergy notes or work with Google to add a new field.

Procedures
We do not currently send procedures to Google Health, nor do they appear in Patientsite. However, Dave feels they may be useful to e-patients. We will add Procedure name and date as a pilot

A great week of discussion with many lessons learned. We look forward to our ongoing work with e-patients, doctors, and Google.

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