Objectives:
To assess early experience with a digital health solution introduced to primary care.
Background:
Managing cardiometabolic conditions (diabetes, hypertension, and dyslipidemia) is challenging for patients and physicians. Patients often lack the understanding and motivation to adopt healthy behaviors and adhere to treatment plans. Physicians face the challenge of having limited time to engage and educate patients at the point-of-care. Electronic health records (EHRs) have not solved this problem; in fact, reports suggest that EHRs increase administrative tasks, reducing time with patients and contributing to burnout. To address these issues we developed CM-SHARE, a web-based application that provides physicians and patients a dashboard of critical health information needed at the point of care, actionable cues to address guideline-based care and quality gaps, and visual tools to educate patients.
Methods:
CM-SHARE was designed with input from practicing primary care physicians (PCPs) and launched in two clinics in April 2016. Physician use of CM-SHARE is voluntary, and regular feedback is elicited for ongoing development. Both quantitative and qualitative measures assess the impact of CM-SHARE. Quantitative measures included use (e.g., number of launches, duration of use, clicks on specific features and functions) and measures of physician efficiency based on the EHR audit file logs. Semi-structured interviews were conducted with both physicians and patients to assess perceptions of CM-SHARE’s impact on physician-patient communication, patients’ knowledge of their conditions and motivations to change health behaviors, as well as value, barriers/facilitators of use, and desired improvements. A pre-post, matched control design was used to assess early experience and impact.
Results:
From April 27, 2016 to November 1, 2017, CM-SHARE was used in 7,900 encounters for 3,712 patients by 6 PCPs. CM-SHARE was launched in 30% of all encounters, a rate that nearly doubled (to 59%) if cardiometabolic health issues were addressed in the visit. Use of CM-SHARE was associated with a 25%-35% reduction in time spent in the EHR during an encounter and an 11%-20% reduction in the number of EHR clicks during the encounter. Both patients and physicians reported that CM-SHARE enhanced the patient-physician communication, particularly for patients for whom behavior change is necessary to improve clinical measures (e.g., A1c). Following this early experience, CM-SHARE adoption has expanded to 30+ providers, including physicians and an expanded user base of chronic disease case managers and diabetes educators.
Conclusions:
Digital health solutions such as CM--SHARE can be successfully integrated into routine care settings and favorably influence physician efficiency and patient experience. Further research will explore the impact of CM-SHARE on longer-term health outcomes.
Non-use of Digital Health Consultations Among Swedish Elderly Living in the Countryside