Adding the Patient Voice to the EHR

March 5, 2019
Froedtert Health and Medical College of Wisconsin expand on pilot of PatientWisdom platform to record patients’ preferences, values

In 2001, the Institute of Medicine developed a quality assessment framework with six aims for the health care system, one of which was being patient-centered, defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” To address that aim, the regional network of Froedtert Health and the Medical College of Wisconsin is using a technology platform called PatientWisdom to bring the patient’s voice and preferences to the center of conversations about their care.

Based on narratives the patient writes, PatientWisdom creates an “Insight Summary,” an at-a-glance view in their electronic health record to help the care team know what’s important to the patient as a person. “We ask patients to provide things about their life: their joys, their challenges, their preferences and their values regarding their care,” says Jeana Holt, D.N.P., R.N., a primary care postdoctoral research fellow in the Department of Family and Community Medicine at the Medical College of Wisconsin. In patient focus groups, she adds, they have been very supportive and say this is the first time they have been asked these types of questions. “It causes them to positively reflect on what their goals and values are regarding their health.”

If patient voice is becoming more important, healthcare systems are starting to look for tools to help record it. The EHR is excellent at collecting objective data such as body mass index or cholesterol, Holt says, but not so great at moving beyond those checklist data points.

Currently, PatientWisdom is integrated in 18 of the 22 primary care clinics in the Froedtert & the Medical College of Wisconsin regional health network. “Primary care is an excellent place to pilot this tool,” Holt says. “When we interviewed clinicians, even ones who had patients they have been seeing for over a decade, they were still learning new pieces of information that did not come up in a traditional clinic visit. For instance, in PatientWisdom you can input your preferred name. One clinician said she had been referring to a patient with a different name the entire 10 years he was in her practice. As small as that may seem, when you are welcomed into a healthcare setting by a name you prefer, that really sets the tone for the visit.”

Here is how it works: The patient gets an e-mail before an upcoming appointment, saying, “If you also have a PatientWisdom account, now would be a great time to update it.” PatientWisdom is fully integrated with the Epic EHR, and there are two places the healthcare team can see it, Holt says.  On the schedule of patients for the day there will be a PatientWisdom icon to alert the team that there is a PatientWisdom profile available for that patient. When any of the providers pull up the patient’s EHR record, there is a tab that they click to access the one-page Insight Summary.

Holt adds that there are areas in PatientWisdom that help get to the patient’s shared decision-making preferences. “One question elicits how much of a part do I want to play in medical decision making,” she said. It displays where someone’s responses put them on a continuum from wanting to drive their care themselves to wanting the provider to make the decisions.

Although they started in primary care, there has been some organic growth in specialty clinics that have seen PatientWisdom. “If I am a primary care patient with a PatientWisdom profile, if I go to my pulmonologist, my pulmonologist also can see my PatientWisdom profile,” Holt explains.

“We are sensitive about wanting it to be seen as a positive tool,” she says. “We are happy to onboard the specialty clinics, and as we scale up in primary care, we continue to learn lessons about what we need to do to make this a more useful tool to increase patient-contextual data, optimize patient voice and minimize the thinking that this is just one more click in the EHR.”

Froedtert & the Medical College of Wisconsin, through its digital healthcare innovation arm, Inception Health,  invests time and money in some of its strategic partners to bring the best innovations to its community and beyond. Inception Health says it helped to fund and develop the PatientWisdom platform because nothing comparable was available on the market. 

Froedtert Health and Medical College of Wisconsin isn’t the only health network taking advantage of PatientWisdom. Yale New Haven Health has expanded its use of the PatientWisdom solution across the continuum of inpatient and outpatient care, including the Yale Medicine practices, and Allina Health in Minnesota just announced a new partnership with PatientWisdom Inc.

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