1. Patient-centered HIT: a pediatric case study Stephen C. Porter MD, MPH, MS Assistant Professor, Harvard Medical School Affiliate Faculty, Harvard-MIT Division of Health Sciences and Technology Faculty, Division of Emergency Medicine,Children’s Hospital Boston Email: stephen.porter@childrens.harvard.edu

2. The challenge How can technology empower patients as the drivers of safe and effective care? How can patients’ knowledge and expertise be systematically –captured –analyzed –disseminated to all stakeholders in the health care process?

3. Rules to bridge the quality chasm Care based on continuous relationships Customization based on patient needs Patient as source of control Shared knowledge and free flow of info Evidence-based decision-making Safety as system priority Cooperation among clinicians

4. The scope of patient report Symptoms –Illness specific –Guideline specific Current medications Previous reactions to medications Current disease management practice Unmet needs

5. Ideal flow of information Data Capture Data validation Data integration Correct actions based on evidence and knowledge

6. Information gaps in emergency medicine Critical data points –Medications –Allergies to medications –Immunization history Specific disease states –Asthma –Appendicitis Specific patient-provider barriers –Language –Literacy

7. ED Care for Asthma ED visit itself a marker of poor control Significant percentage of patients discharged to home report persistent morbidity one month later ED-based barriers to improved care –Under-recognition of chronic severity –Lack of awareness of patients’ medications –Communication barriers –System constraints –Insufficient discharge planning

8. Guidelines for Asthma Establish patient-clinician partnership Prescribe anti-inflammatory medications to patients with persistent asthma –inhaled steroids: recommended first line therapy Reduce exposures to precipitants of asthma symptoms Train all patients to monitor their asthma

9. Linking parents’ data to guidelines A child with persistent asthma who is not on a controller should be prescribed one –Identify persistent asthma symptoms –Identify current medications Establish whether a mismatch exists A child with asthma exposed to secondary smoke should have that exposure eliminated –Identify exposure to tobacco A child on inhaler(s) whose parent reports non-use of a spacer device should receive device/ teaching –Identify whether spacer device is used for sub-set of patients who report inhaler medications

10. A Role for a Patient-driven Information Solution Parents can independently enter data using a multi-media interface to populate a knowledge engine and drive guideline- endorsed care –Porter et al JAMIA 2004;11:458-467 Parents’ documentation of asthma-specific medication data superior to documentation of ED physicians and nurses –Porter et al JAMIA 2005; 12: 299-305

13. © 2003 Children’s Hospital Boston