MyGiHealth: Reimagining the Dialogue Between Patients and Physicians
As pharmaceutical industry professionals and consumers of healthcare, we are well aware of the inefficiencies, limitations, and frustrations often associated with point-of-care interactions between patients and physicians. We've all experienced it firsthand: filling out duplicative forms each time we get to the doctor's office; waiting while the office staff slogs through billing, pharmacy forms and other paperwork; rushing through our face-to-face time with the doctor while he or she types notes and stares into the exam room computer; and leaving the office thinking, “I didn't have time to ask about …”
There is much interest in improving this process. In fact, transformation is essential not only in an effort to better the quality of the patient experience, but also to try to enable more accurate medical diagnoses, appropriate treatment recommendations, improved health outcomes, fewer return visits, and improved cost-effectiveness and efficiency. It was this vision that inspired Dr. Brennan Spiegel and Dr. William Chey to create the My GI Health project, a multidisciplinary, public-private partnership designed to leverage technology to advance the quality of patient-doctor engagement.
Dr. Spiegel, of the University of California, Los Angeles, and Dr. Chey, of the University of Michigan, are gastroenterologists, so they are familiar with the often overlapping digestive system symptoms such as abdominal pain, constipation, bloating, cramping and heartburn that their patients suffer from, often due to overlapping gastrointestinal disorders such as irritable bowel syndrome, chronic constipation, dyspepsia, or reflux disease. They know that many patients are not satisfied with their current treatments.
This dissatisfaction drives patients to make frequent visits to the doctor's office…but that's where the interaction often breaks down. Patients are often embarrassed and don't want to fully discuss their symptoms with their doctor, or they rush to complete forms and can't recall how long their symptoms have been occurring, or how frequently. As a result, the doctors often aren't getting a complete picture of what the patient is experiencing; thus, their task of arriving at an accurate diagnosis may be more difficult.
Enter My GI Health, a patient-provider portal (P3) that allows the patient to complete a structured symptom assessment at home, translates this assessment into a report for the physician, creates symptom graphs, provides disease-state animations designed to facilitate discussion between the patient and the doctor during their visit, and allows the doctor to send the patient an “educational prescription,” which provides in-depth information relating to the symptoms and diagnosed condition, following the visit.
The process begins in the comfort of the patient's own home, where the patient logs in through the My GI Health website to enter information about their symptoms using a structured questionnaire. This assessment tool walks the patient through a series of questions about their symptoms, using adaptive technology that takes into consideration the answers provided and asks relevant follow-up questions. My GI Health then provides the patient with a “Symptom Profile” that shows how the symptoms they describe compare in severity to other people, with the goal of facilitating increased knowledge about their condition and activating them to engage in their care.
For more information about My GI Health, visit www.mygihealth.org and watch the accompanying video.
My GI Health then takes the patient's questionnaire responses and “translates” them into a medical history for the physician. The physician can review the patient's information prior to the appointment and integrate this information as desired into an electronic health records (EHR) system, leaving more time for interaction and conversation with the patient during the visit. My GI Health also provides animations the physician can use during the face-to-face visit with the patient and indicates relevant “educational prescriptions” the doctor can email to the patient following the visit. For example, the educational prescription may focus on contrasting normal GI tract function with abnormalities in functional GI disorders pertinent to an individual patient.
By allowing the physician to review the patient's GI symptom scores and medical history before the exam begins, My GI Health can advance EHR technology into a tool that can facilitate interaction and conversation between the doctor and the patient, support continuity of care over time, and possibly lead to more mutually attentive, productive and satisfying office visits.
Development, Testing and Beyond
Drs. Spiegel and Chey initiated the My GI Health project in 2010, collaborating with gastrointestinal therapeutics company Ironwood Pharmaceuticals*, computing experts from UCLA's Computing Technologies Research Lab and education experts at the University of Michigan's Center for Health Communications Research.
Drs. Spiegel and Chey and other investigators at UCLA and the University of Michigan conducted rigorous clinical research and end-user research with patients and physicians, culminating in the development of My GI Health. The program is currently being beta tested with select gastroenterologists. Initial results from the beta testing are impressive: the history of presenting illness compiled by My GI Health based on patient assessments was viewed as more complete, more organized, containing more useful information and making an overall better impression on the physicians than patient histories gathered via the more traditional method.
Beta testing of the system is still ongoing, and new partners have joined the collaboration, including government agencies, physician professional societies, patient advocacy groups and companies involved in the pharmaceutical, nutrition and electronic health records industries.
Exciting improvements to the system are under way. For example, My GI Health recently began a partnership with MEDL Mobile, which creates, develops, markets and monetizes mobile apps. MEDL Mobile is working with the My GI Health team to create an iOS7 optimized experience designed to enhance the existing platform with native iPhone and iPad functionality. Additional improvements are planned, as additional partners and collaborators are identified.
In time, the developers of the My GI Health program believe it can be expanded to other diseases and disorders. The developers believe that the platform could easily support a My Nutrition Health, My Heart Health, My Skin Health, My Joint Health and more.
We at Ironwood believe the platform represents an opportunity for healthcare companies to work with other healthcare stakeholders not only on how to address the needs of patients through the development of new diagnostics and medicines, but also on how to enhance the quality, cost-efficiency and overall patient experience in the delivery of healthcare.
Achieving this will require collaboration among pharmaceutical and diagnostics companies, insurance companies, academia, government, advocacy organizations, professional organizations, doctors and patients. The My GI Health model is helping to advance this vision by aligning multiple stakeholders around the design and implementation of tools, systems and processes intended to drive improvement in patient health outcomes by positively reconstructing how patients and their physicians communicate and partner.