Fixing any one of these problems could be accomplished with a fairly straightforward approach. Fixing all three concurrently requires a more fundamental re-engineering of the healthcare system.
Dell’s Chief Medical Officer, Harry Greenspun, recently argued that aggressive implementation of information technology is necessary to make reform work. A position that has been enthusiastically embraced as part of the American Recovery and Reinvestment Act’s HITECH provisions.
While I agree with Greenspun’s assessment, it illustrates a gap in the way current reform implications are viewed. Implementing information technology in healthcare organizations is critical but not sufficient to fix the problems with our healthcare system. Providers also need to be using technology to reach out directly to patients.
In other words, if we really want to improve healthcare, patient-centered eHealth must be adopted alongside internal advances in information technology.
While this, too, has support in the current HITECH Meaningful Use requirements, it’s the piece that ‘s most often ignored by healthcare I.T. I’ve watched healthcare I.T. presentations that provide an overview of Meaningful Use and simply leave out the goal of engaging patients and families in their care!
Let’s look at a few ways in which patient-centric eHealth can improve care outcomes.
Problem: Patients don’t remember the majority of information that their doctor tells them.
How eHealth is the answer: By providing patients with access to core pieces of their medical record online such as diagnoses, visit summaries and lab results, provider organizations are giving them the tools they need to become engaged in their own care.
In addition, many patients don’t comply with their recommended treatment plans. A third of patients do not fill their prescriptions and 20 percent of Medicare discharges are readmitted within 30 days. There are certainly many contributors to the lack of compliance, but the inability to remember care plans and discharge instructions are a large contributor.
As this information is assembled and added to over time, the only practical way to make this available whenever it is needed is through a patient portal or other Personal Health Record (PHR).
Problem: Patients don’t understand what they are told.
How eHealth is the answer: Even when patients can recall what their physicians have told them, they often don’t fully understand the information or implications of their medical situation. Here, education is the key. Pairing diagnoses and instructions with relevant patient education is an important step in ensuring patients make appropriate care decisions.
Living with a disease or condition means patients make many day-to-day decisions that have a big impact on their clinical outcomes. For a diabetic, this translates into dozens of decisions daily about what to eat, how much to exercise and how to manage insulin usage. Many patients, particularly those with chronic diseases, need to become an expert in their disease in order to handle daily management of their condition successfully.
While handing out-patient education materials is a good start to this process, few patients file this information for long-term availability. Printed resources also rarely go into the depth needed for patients with chronic issues. Further, research shows that many people learn more effectively when video, audio or other interactive tools are used to supplement printed materials.
Connecting patients with education resources digitally, through their personal patient portal, is an effective way to make these resources available to them at whatever point they may need them.
Problem: The one size fits all approach to healthcare is failing.
How eHealth is the answer: We need more options for engaging patients based on their individual needs. Roberts Health Solutions segments the population into the following groups:
- Healthy or at risk patients (79% of the population/13% of healthcare costs)
- Patients with acute or chronic issues (20% of the population/57% of healthcare costs)
- Complex and end-of-life patients (1% of the population/30% of healthcare costs)
New models of care delivery using online tools offer more flexibility in providing the right care to each patient, improving outcomes and reducing costs.
- Patient-Centered Medical Homes help manage patients with challenging chronic conditions.
Chronic patients, such as diabetic patients, are managing their health issues constantly. When that management is not going well, a high degree of engagement with healthcare professionals is needed to get them back on track before a serious issue occurs. Patient portals that facilitate regular communication between the patient and their care team are an ideal way to provide that engagement. For example, diabetic patients can submit blood glucose readings to their care team and then logic built into the portal will automatically alert the appropriate care team members when the patient requires an intervention. Other communications can be managed through secure email messaging in the portal or by phone.
- Virtual visits help deliver care when it just doesn’t work to get the patient and physician in the same room. There are many scenarios where the logistics of delivering care get in the way.. Providing online alternatives for delivering care ensure that more patients get the care they need while making the best use of the limited number of healthcare professionals available. There are a number of approaches available to address different challenges and scenarios:
- Direct patient-to-physician communications – With the growth in computer adoption and Internet connectivity, patients could have virtual visits with their physicians. This approach reduces lost work time and is more convenient for patients, improving their overall satisfaction with their healthcare and increasing the odds that they’ll consult their care team with issues that arise. Such virtual visits can take the form of a simple secure email communication, a short online questionnaire to which the physician responds or a video-based telemedicine appointment linking the physician’s office to the patient’s home.
- Remote facility-to-facility communications – Patient-to-physician communications isn’t the only option. More sophisticated telemedicine techniques have been used to create remote clinics, often staffed by a nurse, with access to physicians based remotely. These clinics can serve the needs of rural or inner city populations that are difficult to staff with physicians and can provide specialty care from remote locations.
Engaging Patients Key to Reform Success
So, as you can see, keeping patient-centered eHealth in the healthcare reform conversation is vital. There are so many ways that consumer-facing technology can improve not only the care experience but also clinical outcomes.