The Problem. Ambulatory physicians utilize many different types of standardized assessments, ranging from depression screening, to functional pain assessments for patients on opiates, to incontinence and benign prostatic hypertrophy screening for older women and men. Many of these assessments are used in both primary care and specialty practice. Which assessments are done at a given visit depends on the specific patient’s demographics (e.g., age, sex), when their last screening was and if they are due for another, and sometimes the patient’s diagnoses or medications.
The Barriers. There are several barriers to conducting timely, standardized, assessments tailored to the patient’s needs. 1. Currently this requires an individual – often the physician – to investigate and note that the patient should have a particular assessment. 2) These assessments are often time consuming to conduct in practice. 3) Many assessments are available in paper instruments for patients to complete themselves, but one-in-four patients have inadequate health literacy, and assessments are not always available in the patient’s preferred language. 4) The results of the assessment require physicians to document them in the note or scan them into APeX, and then they are not easily found or tracked.
The Solution. A platform that allows information to be pulled from APeX (e.g., demographics, relevant medications or diagnoses), and sent in real-time to a secure device which can provide low-literacy, multi-lingual, video-doctor directed assessments to the patient while they are waiting to see their doctor. The tablet will then integrate with the patient’s visit encounter to send the assessment information into a flowsheet or the progress note so that the physician can see the results and act on them. Each assessment would also be linked to an educational video for those patients who identify a problem (e.g. for stress incontinence a video about kegel exercises, or for depression an introduction to evidence based treatments), which the patient can view before or after the visit depending on timing. These videos could also be made available on-line for patients with a secure password that would be generated by their answers to the assessment.
Such a secure, low-literacy, multi-lingual application already exists. It is called Phrazer and is being used in other settings already (emergency department, inpatient), but has not been used in ambulatory care. http://www.myphrazer.com/ The company that has developed Phrazer is interested in partnering to develop content for ambulatory use and clinical integration.
Needs. Although the application exists, there is still need for the following: 1) UCSF to develop a platform to pull information from APeX and push it to another application for tailoring of assessments – such an platform would be useful for other applications in the future; 2) selection of best practice standardized assessments that will be useful for the largest number and range of patients presenting to primary care, and that would also be useful in various specialty care; 3) content of video-doctor educational modules with translations and bilingual-bicultural video-doctors in UCSF’s main non-English languages; 4) integration to push assessment information into APeX; 5) workflow assessments for use in clinical practice; 6) pilot use in practice with assessment of patient, staff, physician acceptability and perception of usefulness, measurement of process improvement metrics.
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