In a randomized controlled trial, Tang and his colleagues showed that the intervention group had significantly better diabetes control than the control group, as measured by A1c values, after six months. The difference disappeared after 12 months, but more patients in the experimental group lowered their A1c during the study period.
Some other PCC projects also showed improved outcomes. For instance, a PHR that gave patients direct access to information in their physician's EHR displayed tai-lored recommendations and reminders for 18 preventive services based on information in the EHR and a risk assessment completed by the patient. It resulted in the portion of recommended preventive services that were up-to-date rising from 68% to 74%.
Although the AHRQ projects did not create any "killer apps" that significantly improved patient outcomes, Tang noted that the PCC began at a time when few physicians had comprehensive EHRs and patient portals also were rare. Both of those technologies need to be in place, he said, to have a marked impact on patient engagement.
Since the passage of the HITECH Act in 2009, he said, there has been "a huge uptick" in adoption of EHRs. He estimated that around 25% of physicians now have a portal attached to their systems.
Patient engagement, a strong focus of Meaningful Use stage 2 and of the policy committee's stage 3 proposal, is an area where more research needs to be done, Tang said.
"Patients are now able to conveniently view their data on a patient portal," he pointed out. "Now we need to give them more information and more knowledge about their data so they know how to interpret it. Then we have to give them tools to manage their health when they have the feedback from their data. And we need a professional culture that supports shared decision making."
In addition, he said, more research needs to be done in the area of getting patients engaged. Studies by Judy Hibbard and others have shown a correlation between low activation and poorer outcomes. But it's still not clear what motivates patients to take control of their health, he noted, and how health IT can play a role in that.
As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital Big Data Analytics issue of InformationWeek Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.)