Barriers and Drivers to Use of Health IT by the Elderly, Chronically, and Underserved (Text Version)

On September 14, 2009, Paul Gorman made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (3.6 MB).

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Slide 1

Barriers & Drivers to Use of Health IT by the Elderly, Chronically, & Underserved

• Prepared by Oregon
• Evidence Based Practice Center
• Holly Jimison, Paul Gorman, Susan Woods, Peggy Nygren, Miranda Walker, Susan Norris, William Hersh

 

Slide 2

Background

• Better outcomes w/ self management
  • Diabetes - DCCT trial; warfarin; asthma
• Technologies facilitate process
  • Home CBG, BP, INR, expanding array of health IT
• Questions
  • Which Conditions? Which patients?
  • Which Technologies? especially HIT
  • What are barriers and drivers of use?

 

Slide 3

AHRQ Evidence Report

• Create analytic framework
• Define key questions
• Define inclusion, exclusion criteria
• Comprehensive literature search
• Quality assessment of studies
• Synthesis of results

 

Slide 4

Analytic Framework
 

Use of Consumer HIT
Intermediate Outcomes
(self-efficacy, physiologic measures)
Patient Outcomes
(QoL, Cost, Satisfaction)
 

Slide 5

Key Question 1 - 4
 

Among elderly, chronically ill, and underserved populations,
What is the current level of use of health IT?
What types are most useful and usable?
What barriers hinder use of interactive health IT?
What drivers facilitate use of interactive health IT?

 

Slide 6

Key Question 5
 

Among elderly, chronically ill, and underserved populations,
Is interactive consumer health IT effective?
How does effectiveness vary among these populations?
How does effectiveness differ from general population?

 

Slide 7

Inclusion: Populations

 

Slide 8

Slide 8. Inclusion: Technologies

Inclusion: Technologies

 

Slide 9

Spectrum of Information Interventions

 

Slide 10

Literature Search

• Published literature since 1990
• MEDLINE
• PsychINFO
• Cochrane Controlled Trials Register and Database of Systematic Reviews
• ERIC
• AARP Ageline
• Grey literature: conferences, technical reports,.

 

Slide 11

Results: Literature Search
 

Slide 12

Major Findings: Use

• Many studies of use of interactive HIT in populations of interest: rural, elders, underserved
  • But no comparison to general population
• Use of interactive HIT higher if perceived health benefit and trusted advice
• Access, ease of use, convenience key to wider use.
• Most frequently used functions are online peer group support and disease self-management tools.
• Anonymity, nonjudgmental nature of computer system an advantage with sensitive disorders

 

Slide 13

Major Findings: Impact

• Effective HIT Provided Complete Loop:
  • Monitoring of current patient status
  • Transmission of patient data to clinic or system
  • Interpretation by clinician, comparison to goals
  • Adjustment of management plan
  • Communication back to patient
  • Repeat cycle at intervals appropriate to condition

 

Slide 14

Impact of Interactive HIT
Examples

 

Slide 15

Implications

• For Patients and Clinicians
  • These systems can help achieve better outcomes in chronic conditions
• For Developers and Researchers
  • Usability issues must be resolved prior to trials
  • Need clarity, consistency of methods, measures
• For Policymakers
  • These systems help achieve better outcomes
  • Practice environment does not support use

 

Slide 16

Recommendations for Future Research

• Questions about technology
  • Optimal frequency of use by patient
  • Optimal frequency of interaction with clinician
  • Whether success requires revision of management plan or just reminding
• Questions about populations
  • irect comparison of elderly, underserved, chronically ill with general population

 

Slide 17

Questions?

• Gormanp at ohsu.edu

 

Slide 18

NASA Techology Readiness Levels

 

Slide 19

Systematic Review is a Satellite View

Let's you see the forest, obscures the trees
 

 

Slide 20

On The Ground
You Need to Focus On the Trees

 

Slide 21

Driving to Surprise Lake

Satellite View Shows the Forest

 

Slide 22

Hiking to Surprise Lake

Sometimes You Need to See the Trees

 

Slide 23

Key Question 2

Among elderly, chronically ill, and underserved populations,
What types of HIT are most useful and easy to use?
How useful are various types of interactive HIT?
What are usability factors associated with HIT?

 

Slide 24

Key Question 3 & 4
 

Among elderly, chronically ill, and underserved populations,
What barriers and drivers affect use of interactive HIT?
How do these factors vary by population?
How do these factors vary by type of HIT application?