2022/09/08

Digital Health from a Healthcare Perspective (Part 7)

The second part: “MyChart” One App for All Personal Health Records

Medical communication, Telemedicine

Eight Principles of Patient-Centered Care Fulfilled by the Technological Evolution of Electronic Health Records

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Eight Principles of Patient-Centered Care
Most important in healthcare is accessibility from the patient’s perspective, which requires a patient-centered approach in which patients are recognized as individuals, their values and wishes are respected, and they are proactively involved.

In the late 1980s, a study that reviewed various groups of patients, family members, physicians, and non-physician hospital staff immediately following hospital discharge, the relevant literature, and subsequent additional studies defined eight critical factors for patient-centered care. These are known as “the Picker Principles of Patient-Centered Care,” after the name of the institution involved in the study(1)(2).

Specifically, the eight items are as follows
 1) Respect for the patient's values, preferences, and expressed needs 
 2) Information and education
 3) Access to care
 4) Emotional support to relieve fear and anxiety
 5) Involvement of family and friends
 6) Continuity and secure transition between health care settings
 7) Physical comfort
 8) Coordination of care

For patient-centered medical care, it is necessary to have a single source of detailed patient information so that various medical staff can share up-to-date information. One tool to meet this need is an EHR. As mentioned in the previous part, EHRs enable immediate registration and retrieval of patient information and smooth communication among staff members. In other words, the EHR has made it possible to provide better medical care that respects the patient’s wishes. Initially, the user of EHRs was limited to hospitals and clinics, but this has further evolved into a form that patients themselves can use. The mobile personal health system “MyChart” is a typical example introduced here.

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“MyChart” and its eight principles
The “MyChart” was reviewed with the eight items mentioned above and covered most of them as follows.

1) Respect for patient values, preferences, and expressed needs
The menu of the app includes the medical records and the goals of treatment with the utmost respect for the patient's wishes. The attending physician lists plans, such as what should be done for the next visit, forming the basis for effective treatment by a trusted medical provider.
2) Information and education, 3) Access to care, and 4) Emotional support to relieve fear and anxiety
Another feature is the ability to exchange messages with medical institutions. When sending a message, the user can divide the message into categories such as “non-urgent medical consultation,” “questions about prescription details,” “questions about test results,” “questions about re-visits,” and “requests for letters of referral,” to discuss the need for medical attention and the use of prescribed medications. Of course, efforts are required on the part of the medical staff to respond quickly. Still, instead of a telephone call, which is difficult to connect and does not keep records, it is possible to provide easy-to-understand information and support for anxiety to assist self-management. In addition, quick access to reliable medical advice is ensured for these communications.
5) Involvement of family and friends
It supports family involvement since the family can download the visit record for patients, healthcare professionals, and family members and friends.
6) Continuity and secure transition between health care settings
Information can be shared with social workers, school nurses, etc., through the app, allowing all parties to work together to achieve patient-centered care.
7) Physical comfort
Since the patient can contact well in advance, they can receive efficient medical care on the day of visit.
(8) Coordination of care
The ability to share information appropriately within a medical institution also prevents unnecessary interviews.

As described above, “MyChart” has functioned under the eight principles of Patient-Centered Care, and I was satisfied with the application when I used it as a patient.

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Development of “MyChart”
Currently, there are more than 90 mobile personal health products on the market in the U.S. (3), but data shows that only about 7% of American adults, excluding chronically ill patients, use them(4). The main obstacles to use are users’ beliefs that their doctors do not keep proper records and that they would be better off keeping their records(5), as well as the design of the app itself(4).

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