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Curbside Consult with Dr. Jayne 8/15/22

August 15, 2022 Dr. Jayne 3 Comments

As clinical informaticists, many of us wonder whether the technology that we are championing really hits the mark. I was excited to see this study that appeared recently in Applied Clinical Informatics. Titled “Health Information Technology Use among Chronic Disease Patients: An Analysis of the United States Health Information National Trends Survey,” it attempted to look at several important factors, including: perceptions of health between patients with disease and those without; usage of health information technology depending on which chronic diseases might be present; the evolution of health information technology over the last half decade; and whether patients with specific chronic diseases are more likely to use specific IT tools.

This is exactly the kind of thing that gets us out of bed in the morning – being able to better understand how people might use the tools we deploy, and whether we can shift what we’re working on to improve how we meet their needs. We all know that chronic diseases are a problem and that the sickest 5% or so of the population are using the majority of healthcare resources. Chronic diseases also kill people, and many of them steal away patients’ productive years and the time they have to spend with loved ones. Many organizations are spending a great deal of technology resources to try to better manage chronic diseases, so it’s important to know how patients are interacting with those offerings.

What did the authors define as chronic diseases? They used a straightforward definition, namely those diseases lasting longer than a year that require lifestyle change and ongoing medical attention. In the US, approximately 60% of us have chronic diseases, with 40% having two or more. In crafting the plan for the study, they also had to identify a consistent description of health information technology: “the electronic systems health care professions and patients use to store, share, and analyze health information.” This includes electronic health records, medication adherence solutions, virtual reality therapy applications, and more.

The authors used the Health Information National Trends Survey (HINTS) with data from 2014 to 2020, comparing self-perceived health factors with health information technology usage and presence of chronic disease. The HINTS database is interesting because it is generated by the results of consumer-facing surveys that are obtained via mail. The survey instrument includes over 120 questions. Controls were put in place for demographics and comorbid conditions. Part of the survey involves questions on self-perception of health, including asking patients to score their health on a five-point scale from excellent to poor. They were also asked about their confidence in their ability to take good care of their healthcare needs.

The authors found that certain patient groups, such as those with lung disease, depression, and cancer, had an increased likelihood of technology use. Patients with other conditions, including diabetes, hypertension, and cardiovascular disease, tended to use technology tools at rates similar to patients without chronic disease. As far as confidence levels, patients with chronic disease were less likely to be confident in their ability to take care of their own health. Patients without any diseases were more likely to be “completely confident” than those with comorbid conditions.

The authors also found that over the time period studied, patients generally increased their use of health information technology offerings. They found that age had an impact on technology usage, with a 3% decrease in odds of using a tool for every year increase in age, even when controls were in place for race / ethnicity, educational attainment, chronic disease, and smoking status. They noted that usability and availability could be motivating factors for technology use and pointed out mental health applications as an example: “Previous review studies have shown the sheer among of online CBT [cognitive behavioral therapy] tools, the wide range in styles of therapy, and the statistically significant improvement in outcomes for patient engaging with these tools. With such effective tools already available for depression patients, it makes sense that more patients with depression are engaging with HIT.”

They concluded that additional study is needed to gain better understand of the specific factors that may influence adoption of health technology and that the knowledge gained from those studies should be used to improve technology offerings and user experience in an effort to improve overall utilization. One summary sentence gave me a chuckle: “…studies have shown that when providers encourage online medical record use, patient usage goes up, but many providers are not encouraging use…” I just had a conversation the other day with an early-career clinical informaticist who was asking for tips on increasing patient portal adoption as a way to reduce the use of laboratory results letters. It didn’t sound like their practice had done any of the basics, such as providing information to patients during the office visit either as discussion, formal handouts, or exam room signs. They had yet to include information on the availability or functionality of the portal on billing statements or other existing communication streams. Given those factors, it wasn’t surprising that adoption was poor. I explained how one hospital I worked with used summer interns in facility lobbies to help register patients. My colleague was surprised that the approach was even a thing.

The authors also noted the need to look at the impact of COVID-19 on technology usage beginning in 2020. They also identified limitations in the HINTS data including its relatively low response rate, the fact that the survey has evolved over time, and that earlier versions of the questionnaire didn’t include questions that could have contributed to the study. HINTS also didn’t include adequate data on newer technologies, such as remote patient monitoring, or certain chronic conditions such as kidney disease or post-stroke complications.

I’ll definitely be reaching out to some of my informatics colleagues as we gather around the virtual water cooler. It will be interesting to see what they think and whether their institutions are doing anything formal to look at these factors. We’re always looking for a silver bullet that will really help us drive the needle and include clinical outcomes, although it’s never quite as simple as we would like it to be.

For the six in 10 of us with chronic conditions, are you doing anything personally to engage with health information technology with respect to your condition? Do you think it makes a difference, or is just another thing that takes up time or falls by the wayside? Leave a comment or email me.

Email Dr. Jayne.



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Currently there are "3 comments" on this Article:

  1. HIT has tremendous potential for patients… if they are aware and capable of using it. Having worked in the industry for several years (HIT vendor) I watched provider organizations, with HITECH incentives dive into technology deployment. The tech was geared toward clinicians who often resisted it as it interfered with their workflow v complementing and enhancing it. The patient viewpoint was mostly missing, added as an almost afterthought add on. To effectively engage patients in their own care, education is critical. Physicians and staff don’t have the time to educate. Many/most patients don’t self educate. Our education systems prepare students to live in the world. Health related skills are a vital part of coping with life. It’s time to include “health skills” in curriculum, including… understanding elements of good health, patient level diagnosis to determine when to seek and how to follow clinical intervention, how to understand their health information and how to use it to properly research and use the vast resources on the internet and elsewhere.

    • This part of your comment stood out for me: “Many/most patients don’t self educate.”

      While I can agree with most of your comment, and I even agree with the above statement? Who will take ownership of a clinical condition if not the patient? Who will ever care more about a disease than the person experiencing that disease? And this is further muddied by the fact that most of us, once in care, tend to cede much of the care decisions to the clinicians and health system treating us.

      Patient education is a worthy goal, certainly. Healthcare needs to make sure their patients have access to the good stuff.

      My observation is that some patients are highly motivated by their own condition. These people are the easiest to reach, with the main risk being that we fall short of their expectations. There are a lot more people who view this as “just one more responsibility of life.” This group of people is also reachable.

      Once you get to the “I don’t care” groups, and the “internet research and conspiratorial thinking led me astray” groups, you ought to let these ones go. There’s a role for responsibility in life choices here.

  2. We need more support for training nurses and care mangers in prospective HIT tools to work hand in hand with patients to increase the use of technology for Patients with Chronic disease: “Patients with other conditions, including diabetes, hypertension, and cardiovascular disease, tended to use technology tools at rates similar to patients without chronic disease.”







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