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Semelhante a Patient Care as Collaboration (20)
Patient Care as Collaboration
- 1.
Patient Care as Collaboration:
Why Episodic Care Fails and How IT Can Maintain the Connection
Daniel Z. Sands, MD, MPH, FACP, FACMI
@DrDannySands
Society for Participatory Medicine
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, MA
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 2. Disclosure of Financial Relationships
Daniel Z. Sands has relationships with entities producing,
marketing, re-selling, or distributing health care goods or
services consumed by, or used on, patients.
Conversa Health Consultant / CMO
Kinergy Health Consultant / CMO
SeniorLink, Inc. / Caregiver Homes Consultant
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 3. Think Back to Your Last Medical Visit…
• Time and cost?
• Experience?
• Necessity?
• Timeliness?
• Connection?
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 4. There is Rising Demand for
Management of Chronic Conditions
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 5. But We Don’t Have Enough Clinicians…
https://members.aamc.org/eweb/upload/The%20Complexities%20of%20Physician%20Su
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
pply.pdf
- 6. …We Can’t Afford Our Current System…
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 7. ...And Our System Is Optimized for
Managing Acute and Episodic Care
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 8. http://content.healthaffairs.org/content/20/6/64.full
Our care systems were organized historically to
respond rapidly and efficiently to any acute
illness or injury that came through the door. The
focus was on the immediate problem, its rapid
definition and exclusion of more serious
alternative diagnoses, and the initiation of
professional treatment.
Edward Wagner, MD
Director, MacColl Institute for Healthcare Innovation at the Center for Health Studies, Group Health
Cooperative of Puget Sound, and director of Improving Chronic Illness Care
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 9. We Must Focus More on Chronic Disease
Prevention and Management
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 10. What Should Patient Care Be?
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 11. A Collaboration On The Patient’s Health
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 13. Curing Health Care
Non-Visit-
Based Care
Patient
Engagement
New Care
Models
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 14. The Consumerization of Health
and the Virtualization of Care
Diagnose
and Treat
Prevent
and
Maintain
Anywhere
Virtual
Resources
Home
Physical
Resources
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
Drivers:
• Burden of chronic illness
• Aging population
• Resource maldistribution
• Cost-containment
• Consumer demand
Health Care Health
Hospital
Built on ideas from Michael Gill
$$$$$
$
- 15. Some Attributes of
Collaboration Channels
Technology Synchronous? Information Density
Telephone
E-messaging
Text messaging/IM /
Remote monitoring
Telemedicine (usually)
Advanced Telemedicine
Office visit
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 16. Personnel Also Have Attributes
Patient
Self-care
Counselor/
Educator
Clinical
Nurse
NP/PA Physician
Different personnel can provide care
Each has attributes
Each should practice at “top of his/her license”
Can add others to this list, even perhaps, Watson…
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 17. Optimizing Channel and Personnel
Patient
Self-care
Counselor/
Educator
Clinical
Nurse
NP/PA Physician
Telephone
E-messaging
Text
messaging/IM
Remote
monitoring
Telemedicine
Advanced
Telemedicine
Face-to-face visit
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 18.
It can be argued that the
largest yet most neglected
health care resource,
worldwide, is the patient…
Slack WV. CyberMedicine: How Computing Empowers Doctors
and Patients for better Health Care. Jossey-Bass 2001.
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 19. What Do Engaged Patients Want?
Communication
Patient
Engagement
Information Convenience
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 21. …And Health Info Seeking Popular
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 22. Online Health Habits of US Adults
Sources: www.pewinternet.org;
PwC HRI Social Media Consumer
Survey, 2012
80% of online adults have looked for health info
Rising over time
Each day, more people search for health information than see a physician!
More than half act on the information
1/3 have read about others’ health experiences
1/4 have tracked their health information online
1/3 use social media for health
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 23. What Do e-Patients Want?
Information
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 24. Information is No Longer Locked Up
http://www.nlm.n https://twitter.com/HMSCountway ih.gov/share/image/Nlm_building_lg.jpg
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
This work by Old Shoe Woman is licensed under a
Creative Commons Attribution-Non-Commercial-ShareAlike 2.0 Generic License.
http://cnn.com
- 25. © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands http://www.nytimes.com/pages/health/
- 26. Googling for Health:
What We Must Know and Teach
Quantities of good versus bad sites
Qualities of good versus bad sites
Deciphering medical jargon
Patients should not be afraid to ask
Resources:
http://drds.us/MLANet
http://drds.us/109p1tp
http://drds.us/ZNQy3P
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
This photo by Thierry Le Ridant is licensed under the Creative
Commons Attribution-Share Alike 2.5 Generic license.
- 27. Asking
Tacit
Approval
Honest
Disclosures
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 28. Shifting Paradigm?
Information asymmetry
Physician as oracle
Comfortable
A burden?
Information symmetry
Physician as partner
Threatening vs. liberating
Physician as healer
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 29.
No one knows everything.
Everyone knows something.
All knowledge resides in
networks.
Pierre Lévy, PhD
Philosopher, cultural theorist, and media scholar, University Of Ottawa, 1997
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
This photo by cpfl cultura is licensed under a Creative Commons Attribution 2.0 Generic License.
- 31. My doctor prescribed ACOR
and it saved my life.
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved.
- 32. What Do e-Patients Want?
Communication
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 33. “Sorry, Dr. Sands no longer sees people. He e-mails them.”
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 34. What Have We Learned About e-Messaging?
Includes encrypted e-mail or, more
commonly, secure web messaging
Enables efficient communication
because it is asynchronous
Is cost-effective and benefits both
patients and physicians
Augments relationship building
Is a channel for care delivery
Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 35. What Do e-Patients Want?
Convenience
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 36. …stand in line for a
bank teller?
…make airline reservations
through a travel agent?
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
How Many of You…
http://thingsmykidswontknow.tumblr.com http://www.triporama.com/
- 37. Then Why Is Healthcare So Backwards?
The doctor’s
booked for
the next five
months!
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 38. The Era of Inconvenience Is Ending
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
http://www.zocdoc.com/
- 39. …But We Make it Difficult:
Mismatch Between Desires and Service Offering
"Thinking now of new technologies your health care provider could implement, how important
would each of the following be to you?” (of patients who saw physician in past year)
0% 10% 20% 30% 40% 50% 60% 70%
Online Appts
Online Billing/Pmts
Online Costs
E-mail
Viewing Record
Available Desired (Important/Very Impt)
© Copyright 2014 D. Z. Sands and D. deBronkart, All Rights Reserved
Source: Harris Interactive 9/10/12 at http://goo.gl/VzfmT
- 40. The Technology Foundation:
A Patient Portal
https://www.patientsite.org
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 41. Services:
Prescription refills
Appointment requests
Referrals
View bill
Education:
Search
Info prescriptions
Patient selected links
Predefined collections
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
Mail:
Secure
Automated routing
Task assignment
Records:
Secure
All system records
Upcoming appointments
Meds, Problems, Results
… and Notes!
Personal records
- 42. Where and How Do We
Share Health Records?
In the office
EHR as collaboration tool not barrier
Sharing is encouraged when all align:
Attitude
Geometry
Communication habits
Workflow challenges
Beyond the office: patient access to records online
Workflow challenges (patient)
Comprehension challenges (patient)
Portability?
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 43. Dave (Pre-diagnosis)
This is too cool. It's almost SILLY
that things can be this easy. I am
having a very good patient/customer
experience so far.
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 44. Affective Impact: 61M Minister with DM and Chronic Pain
I have a lot of medical issues. This
email system has left me feeling
comfortable and in good hands!
Otherwise, I would feel as cold,
depleted, and alone, as the lifeless
tree in my front yard in the deepest
of winter!
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 45. Engaging Patients Leads to Benefits
Better
outcomes
Triple
Aim
Improved
satisfaction
Reduced
costs
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 46. http://participatorymedicine.org
Participatory Medicine is a cooperative model of health care
that encourages and expects active involvement by all connected
parties (patients, caregivers, healthcare professionals, etc.)
as integral to the full continuum of care.
Society for Participatory Medicine
Community Advocacy Research Education
© Copyright 2014 D. Z. Sands, All Rights
Reserved - @DrDannySands
- 47. Health is What Happens
Between Episodic Care…And Dwarfs It
Visit Visit Visit
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 48. Frequent Light Touches May Be Better
Visit Visit Visit
As payment changes to reward value (better
outcomes at lower cost), patient satisfaction,
and panel size, we can rethink practice model
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
Support
self-care
and
caregivers
Understand
social and
cultural
determinants
- 51. Tertiary
Secondary
Primary
Self-Care
(Off the Map)
Professional
Care
Discouraged Encouraged
$
¢
Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 52. Individual self-care
Friends and families
Self-health networks
Professionals as
facilitators
Professionals
as
partners
Professionals
as
authorities
Professional
Care
Discouraged Encouraged
¢
$
Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995.
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
- 53. Conclusions
Traditional health care is not adequate
Viewing patient care as a collaboration can
open our minds to health care
transformation
Non-visit based care, new care models, and
patient engagement all leverage HCIT and
offer tremendous opportunities for
research, development, and healthcare
transformation
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands