Remote+Access

__Group 5: Remote Access __ LIS4785_FinalReport[FINAL] -- Group 5

*NOTE: Any apparent formatting inconsistencies (especially the superscripts used in citations) were caused when the information was copied from MS Office Word 2013 and could not be set to match that which pasted correctly from within the limited functions of the wiki editing interface. The link above this statement corroborates these claims.*

Authors: All text and images are hereby the property of these respective authors and cannot be used or reproduced without their express written permission in any format or type of media. © 2014

Alriel Gunn Email Cell: (850)597-0708

Juan Marengo Email Cell: (850)-591-8452

Nicole Swadlow Email Cell: N/A

Anthony Valente Email Cell: (321)-946-8142


 * Problem Statement **

Patients are having problems getting into direct contact with their physicians when it comes to their health. We think that they should have the potential advantage that could be given by storing patient records electronically. The reasoning behind this is that, in some cases consulting with a physician becomes easier and more accessible without regard to distance. As a matter of fact, telephone and email use is already very popular among the variety of cash-based or concierge physicians. It may also seem that doctors may increasingly use HIT to help assist patients in managing and treating chronic diseases. 1

Additionally, if we increase the use of technology between patients and physicians then the doctors will be able to better utilize their time spent with the patients. This is an important issue when it comes to health informatics because this is the use of technology to better a patient and physicians communication with one another instantaneously. It is important to solve this problem because we want to maximize patient care and give everyone the best treatment they can get. When the problem is fixed then physician/patient care will reach its full effectiveness and everyone will be able to get the treatment they need in the fastest amount of time. If this problem is not resolved then patients will continually not be able to see their physicians in the time period they need and stay sick or worst case dying.

Remote access to health care options may aid users dealing with chronic disease management, telephone or email for those with limited mobility options, and may aid physicians with remote patient monitoring. Additionally, solo practice and MinuteClinic are options to further improve access to individuals. Some examples of chronic disease management include online weight loss programs for the obese and asthma control for adolescents or others that struggle with self-management. A further additional benefit of increased use of remote access to health care solutions is the ability to be treated quickly, in general, for non-major problems. This means that an available doctor with the necessary knowledge or expertise can aid the patient(s) immediately instead of them having to wait on a particular doctor who may be in the middle of surgery or some other more critical situation that would cause a delay in care to the inquiring patient(s). Cancer Treatment Centers of America (CTCA) have already benefited from the integrated use of many areas of HIT into its treatment programs, including remote access options. It is believed by both sides that this improves the quality of care and treatment available to their patients. The statistics below show the effectiveness. An important part of the implementation of these style systems is that government mandates are withheld from the equation. The reasoning behind this is that the involvement of such mandates almost always hinders care providers from the best innovation practices. They should be permitted to innovate and profit if they are able to provide the same level of care at a lower cost.


 * Statistical Evidence **

After using the 1995 Commonwealth Fund Survey it was discovered that around “41% of physicians have noticeably seen a decline in the time spent with each patient”. 2 This statistic shows that all these doctors have too many patients to see, and therefore, don’t have enough time in their 9:00 to 5:00 schedule to see all of their patients for a reasonable amount of time. Physicians are rushing through appointments in order to see more patients a day. According to data collected in 2012, “36% of the physicians surveyed said that their relationship with patients has improved after implementing an EHR. Five percent of the physicians confirmed having lower costs after implementing the EHR. And 23% said that they have seen an increase in efficiency after implementing the EHR.” 3 This is saying that when using technology (EHR) in their practice, the doctors had more efficiency, more effective and positive relationship with their patients. In the year 2013, according to a study by “Chun-Ju Hsiao, Ph.D., and Esther Hing, M.P.H.”, 48% of physicians in the US that practice in an office-based location have confirmed that they have “a system that met the criteria for a basic system”, that’s a 37% increase since 2006. “The percentage of doctors with basic systems ranged from one state to the other, from 21% in New Jersey to 83% in North Dakota”. 4 This statistic shows that the technology is meeting their basic needs as a physician and benefiting the quality care they give to their patients in the long run. Most patients who have the ability to access and use the Internet (roughly 90%) would also like to be able to use such access for online consultations with their physicians, but only about 5 percent of those do so, as shown in a Harris Interactive poll. 5 One poll shows that survival rates of Cancer Treatment Centers of America (CTCA) patients are often higher than the national average in comparison to similarly diagnosed breast cancer patients:
 * After one year, the rate of survival tends to be 27.7 points higher than the current average across the nation.
 * Following two years the rate of survival is roughly 19.2 points above the national average.
 * After three years, survival is around 13.7 points above the national average.
 * Four years into treatment, CTCA's patients' rate of survival is 4.4 points above the national average. 6

** Approach and Reasoning **
Our chosen approach was to make a web portal that both physicians and patients can access and contains relevant and useful functionality for the facilitation of patient treatment and interaction between the relevant parties. It includes access to patient information as well as providing alerts to notify both patients and physicians of upcoming appointments, etc. within their respective portals. The physician portal includes an area where they can check appointments, send messages, use their personal calendar, patient history and treatment, and video chat. This decided approach was chosen to include all the necessary tools required to provide the best possible online interaction between physicians and patients, bidirectionally.

**Initial:**

 * A web-based mobile application that includes reminders, physicians' scheduling, allows you to directly contact your physician for prescriptions without having to go in, update on symptoms if their minute, less of a copay because you’re not directly seeing the doctor, “web MD” from the source of your doctor.
 * Wearable/internal bio stat monitoring devices that sync with your phone, physicians' devices, offsite server, insurance provider, employer health program, or home computer.
 * Online health portals similar to the structure and use of College Student Apartment complex online user portals.
 * Incentives for accessing care remotely instead of in person.

**Final:**

 * Provide an online system that is easily accessible for both patients and physicians
 * A unique portal for each and would include video chat functionality, notes, appointments, calendar, and a variety of other useful functions
 * A simplistic, streamlined, frustration-free tool for communicating and interacting with healthcare providers for general practice, specific monitoring, and geo-distant interactions
 * A web-based application that meets the functionality previously designed
 * Providing incentives for accessing care remotely instead of in person
 * An in-the-works functional prototype for a mobile application that ties in to the original web-based application, currently in beta

** Existing and/or Alternate Solutions **

 * S ome existing EHR systems that others have attempted follow: Amazing Charts, Eclinicalworks, and eHealthfiles.
 * You can schedule, chart, message on all of these similar to what we did except that these actions take place exclusively via a stationary computer system.

** Feasibility of each solution **
The feasibility and implementation of a system identical or similar in nature to this project in its entirety highly depends on the current standards and regulations defined within the field of Health Informatics. Without knowledge as to the specific universal specifications that must be met, it is hard to project whether such a system would be successfully applied by the institutions and users it has been designed for. However, when making the assumption that the desired conditions of a universally accepted set of standards and specifications are well defined and understood, the implementation of such a system as ours is very feasible and need only a few tweaks at most to mesh with the already established databases and electronic records. The mobile prototypes could then be very easily finished and connected to the web-based portal. Once a specific governing body is established (either the US gov’t or an International governing body), such details will be taken into account and used to modify and finalize this project into a fully functioning and beneficially useful product.

[[image:timeline.png width="471" height="272"]]

 * September
 * Planning stage where we collected our ideas and thoughts on what our application demo would cover and put it into a 2-page proposal
 * September 24th 2-page proposal due
 * October
 * Research different kinds of EHR systems and develop concrete ideas for how to formulate an initial design template
 * November
 * Have our application demo done and ready to present to the class
 * Nov 5- first application demo presentation
 * December
 * Make our final touches on our application demo and present a 2nd time to the class with the classes feedback
 * December 3rd-2nd presentation
 * Evaluate our proposal and turn it into a final report that includes everything in our application and explains the process of coming up with this idea and working on it as a group
 * December 8th—final report

** Team Workload and Roles **
We all fed off of one another's ideas and added/deleted things where and when we thought it was necessary.
 * Ariel Gunn: 25% --> She was in charge of researching the statistics and feasibility
 * Juan Marengo 25% --> He was in charge of looking up alternate/existing solutions and our chosen approach and reasons as well as contributions to the web-based application designs
 * Nicole Swadlow 25% --> The original design of the web portal and worked on citations
 * Anthony Valente 25% --> Final solution, mobile prototype interfaces, and next step

** Meeting minutes **
Meeting 1: we got to meet each other and decide roughly what we wanted to do for the group project.

Meeting 2: we met to talk more about the possible topics we liked and decided which one to use for our group project. We wanted to do a tele-health web site where patients can see their physicians via video chat. We also decided that we wanted to try and incorporate an app to go along with the web site.

Meeting 3: we met to work on the project proposal.

Meeting 4: we met to revise the proposal and correct the errors that we had.

Meeting 5: we met to design the application template demo and make the PowerPoint presentation to show our project to the class.

Meeting 6: we met to work on the final project, used the feedback given to us in class after the application template demo presentation to fix and improve our website. We worked on the final presentation PowerPoint.

** Solution Prototypes **
Figure 1. Click figure above to view all images in pdf

** Final Solution **
The final solution for this project was presented to the group of intellectual peers and instructor. The reception was almost exclusively positive with only a few minor criticisms. Most of the rest of the implementation process depends on the standardization of the many critical areas of the Health Informatics field including security, data integrity, and interoperability standards among others. The final solution includes a separation of patient and physician portals that were not included in the original design. This fix was greatly received and applauded as being a very functional and ideal working interface structure. Comments were made on the innovation of the ideas contained within the project. Satisfaction abounds for the creators of this project that success was found in and given about the project from the evaluating members composing the audience.

** Next Steps **
Continuing from the final solution of this project would include a great many things, many of which cannot be commented on because these ideas, uses, and functionalities may not currently exist or are currently only in the beginning stages of development in the minds of associated and relevant innovators. One of the major next steps would be the integration of this interface into the current existing systems and linking it to the various databases to provide the relevant information to the appropriate parts of the application. However, first a universal sorting or organizational method must first be decided on and implemented. A good solution for this necessary set of conditions would be the integration and standardization of Group 1’s Medical Identification Number project. If the US government, or governing International organization, decided to standardize this idea throughout the entire health field and collated this information into a highly secure database on secured servers, the Remote Access project could easily be incorporated into a compatible form to access, use, and provide such data within the effectively designed interface of the project itself. There are other many useful steps and applications that can be integrated or make use of this developed application. Such as connecting it to various CDSS’s for clinicians, WebMD for patients, and a physician/patient lookup system to allow users (whether patient or physician) to find the necessary and relevant party they need to (physician finding patient and patient finding relevant physician). Creating these relevant links to associated parties would further simplify treatment and interaction between said parties and can easily be accomplished by this project.

** Resources (Citations) **
1 National Center for Policy Awareness. Health Information Technology: Benefits and Problems. Policy Report No. 327 by Devon M. Herrick, Linda Gorman and John C. Goodman April 2010.

2 Dugdale, David C., Ronald Epstein, and Steven Z. Pantilat. "EFFECTS OF TIME ON PATIENT CARE." National Center for Biotechnology Information. U.S. National Library of Medicine, 19 June 0005. Web. 20 Oct. 2014. < [] >.

3 "15 Statistics on How EHR Impacts Physician Practices." N.p., n.d. Web. 20 Oct. 2014. < [] >.

4 Hsiao, Chun-Ju, Ph.D, and Esther Hing, M.P.H. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 17 Jan. 2014. Web. 20 Oct. 2014. < [] >.

5 “Patients Want Online Communication with Their Doctors,” Medscape Medical News, April 17, 2002; and “Patient/Physician Online Communication: Many Patients Want It, Would Pay for It, and It Would Influence Their Choice of Doctors and Health Plans,” Harris Interactive Healthcare News, Vol. 2, No. 8, April 10, 2002. Also, Robin A. Cohen and Barbara Stussman, “Health Information Technology Use Among Men and Women Aged 18-64: Early Release Estimates from the National Health Interview Survey, January-June 2009,” National Center for Health Statistics, U.S. Centers for Disease and Prevention, February 2, 2010.

6 Information on CTCA was taken from company Websites, CTCA materials, including personal discussions and a day-long on-site visit with company officials and the CEO. See [].