Today’s Health Care System Physician Health Insurance Self-Care Information Overload Media The Patient

How to heal a sick healthcare system Dr Aniruddha Malpani, MD Medical Director, HELP Health Education Library for People World’s largest free health library www.healthlibrary.com

Dr Aniruddha Malpani, MD

Medical Director, HELP

Health Education Library for People

World’s largest free health library

www.healthlibrary.com

What’s wrong with healthcare today? Remember your last visit to your doctor ?

Remember your last visit to your doctor ?

Poorly organised patients + rushed doctors = badly performed consultation = poor medical care How can we improve this ?

Poorly organised patients + rushed doctors = badly performed consultation = poor medical care

How can we improve this ?

The commonest complaints patients have today are: Doctors are too busy – they make me wait too long I don’t understand what they say – they don’t have time to explain their jargon. They don’t share information or respect my preferences Care is fragmented amongst specialists Doctors are not transparent or accountable. How do I know his advise is reliable and trustworthy ? Too expensive !

Doctors are too busy – they make me wait too long

I don’t understand what they say – they don’t have time to explain their jargon. They don’t share information or respect my preferences

Care is fragmented amongst specialists

Doctors are not transparent or accountable. How do I know his advise is reliable and trustworthy ?

Too expensive !

Doctors are unhappy too ! They are stressed out, because of the large number of patients they need to see, and feel that patients expect too much from them. The feel that patients unfairly blame doctors for all bad outcomes. They also feel that many patients waste their valuable time by asking stupid and irrelevant questions; because they are too disorganized; and don’t bother to educate themselves or do their homework.

They are stressed out, because of the large number of patients they need to see, and feel that patients expect too much from them. The feel that patients unfairly blame doctors for all bad outcomes.

They also feel that many patients waste their valuable time by asking stupid and irrelevant questions; because they are too disorganized; and don’t bother to educate themselves or do their homework.

Result? Breakdown in Doctor-Patient Communication Patients don’t trust doctors as much as they used to in the past Doctors are getting burnt out They practice defensive medicine to protect themselves from malpractise suits Overspecialisation – specialists have tunnel vision No one to look after the “whole” patient Doctors have become technicians – lost the human touch

Patients don’t trust doctors as much as they used to in the past

Doctors are getting burnt out

They practice defensive medicine to protect themselves from malpractise suits

Overspecialisation – specialists have tunnel vision

No one to look after the “whole” patient

Doctors have become technicians – lost the human touch

Major reason for a sick healthcare system Everything is doctor-centric - the doctor is the center of the medical care system Healthcare is therefore fragmented and disorganised Too many specialists , most of whom have tunnel vision

Everything is doctor-centric - the doctor is the center of the medical care system

Healthcare is therefore fragmented and disorganised

Too many specialists , most of whom have tunnel vision

Solution Need to reform the healthcare ecosystem ! Put patients at the center – “ patients are the largest untapped healthcare resource “ !

Need to reform the healthcare ecosystem !

Put patients at the center – “ patients are the largest untapped healthcare resource “ !

Assumption Patients ( or their relatives and friends) are : intelligent and capable; and because they have a lot at stake , they are motivated to get good health care, and will be willing to invest time and energy if given the right tools to ensure a good outcome.

Patients ( or their relatives and friends) are : intelligent and capable; and because they have a lot at stake , they are motivated to get good health care, and will be willing to invest time and energy if given the right tools to ensure a good outcome.

Patient centered healthcare Self-care Personalization Transparency Quality Control

Self-care

Personalization

Transparency

Quality

Control

Information Therapy “ The right information to the right person at the right time to help make better health decisions” What information do patients want ? To choose doctors and treatments with good outcomes To communicate effectively with doctors To know what the doctor should do

“ The right information to the right person at the right time to help make better health decisions”

What information do patients want ?

To choose doctors and treatments with good outcomes

To communicate effectively with doctors

To know what the doctor should do

Blended model Click and mortar Provide information in the real world Provide information on the web

Click and mortar

Provide information in the real world

Provide information on the web

Patient information centers At every point of clinical contact Clinics Labs Diagnostic centers Chemists Hospitals

At every point of clinical contact

Clinics

Labs

Diagnostic centers

Chemists

Hospitals

Patients have questions ! We need to answer these proactively Win-win situation ! Helps to improve patient satisfaction Helps to improve patient compliance Can be answered by all healthcare professionals Great way of marketing

We need to answer these proactively

Win-win situation !

Helps to improve patient satisfaction

Helps to improve patient compliance

Can be answered by all healthcare professionals

Great way of marketing

Patient education is an untapped area in India today ! Anyone who provides this will create a USP Improve brand recognition and market share ! Works very well in the USA !

Patient education is an untapped area in India today !

Anyone who provides this will create a USP

Improve brand recognition and market share !

Works very well in the USA !

Our experience with Information Therapy in the real-world HELP – world’s largest free health library Established in 1998 Mission - to empower people by providing them with the information they need to promote their health , and prevent and treat medical problems in the family in partnership with their doctor. We are a registered charitable trust and a non-profit organisation.

HELP – world’s largest free health library

Established in 1998

Mission - to empower people by providing them with the information they need to promote their health , and prevent and treat medical problems in the family in partnership with their doctor.

We are a registered charitable trust and a non-profit organisation.

We help patients save money on medical care 1. Promote SelfCare . Help them to do as much for themselves as they can 2. Provide Evidence-Based Guidelines , so they can ask for the right medical treatment that they need - no more and no less 3. Help them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery .

1. Promote SelfCare . Help them to do as much for themselves as they can

2. Provide Evidence-Based Guidelines , so they can ask for the right medical treatment that they need - no more and no less

3. Help them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery .

What we provide Easy to read materials – for patients and by patients Wide variety of styles – from single page pamphlet to books Comprehensive – from stress management, exercise, diet, all illnesses, alternative medicine Over 300 DVDs

Easy to read materials – for patients and by patients

Wide variety of styles – from single page pamphlet to books

Comprehensive – from stress management, exercise, diet, all illnesses, alternative medicine

Over 300 DVDs

Our focus areas now are: 1. encouraging health insurance companies to invest in patient education 2. advocating information therapy 3. setting up a national network of patient education centers 4. developing patient educational materials in Indian languages for the web

1. encouraging health insurance companies to invest in patient education

2. advocating information therapy

3. setting up a national network of patient education centers

4. developing patient educational materials in Indian languages for the web

HELP is growing ! National Network Every hospital should have a Patient Education Resource Center Win-win situation Great tool to empower patients Helps doctors and hospitals too !

Every hospital should have a Patient Education Resource Center

Win-win situation

Great tool to empower patients

Helps doctors and hospitals too !

Patient Information Center Core collection of books DVDs PC with internet connection Printer Staff member “ Corner” centers – need just about 100 sq ft

Core collection of books

DVDs

PC with internet connection

Printer

Staff member

“ Corner” centers – need just about 100 sq ft

New locations Mini-libraries in pharmacies Mini-libraries in medical laboratories Mini-libraries in clinics

Mini-libraries in pharmacies

Mini-libraries in medical laboratories

Mini-libraries in clinics

Online Information Therapy Free 24/7 Easily accessible Increased internet penetration Answer questions free by email !

Free

24/7

Easily accessible

Increased internet penetration

Answer questions free by email !

How do we provide the right information to the right patient ? Free floating information is useless Information Therapy needs to be prescribed to them, tailored to their needs, based on their medical problems How can we do this ? PHR

Free floating information is useless

Information Therapy needs to be prescribed to them, tailored to their needs, based on their medical problems

How can we do this ?

PHR

PHR – Personal Health Record For the Tax Department, you are your tax return For the Bank, you are your bank statement For the healthcare system, you are your medical record .

For the Tax Department, you are your tax return

For the Bank, you are your bank statement

For the healthcare system, you are your medical record .

PHR Technology to help patients to store their medical records on their personal website. Interactive forms and templates so they can fill in the details online. Images, ECGs can be scanned in This is NOT an EMR ! Using CCR information standards , the PHR can exchange data with other databases so that the PHR can be automagically updated ( for example, with lab test results ; with the chemist’s prescription; with the hospital EMR; with health insurance company data)

Technology to help patients to store their medical records on their personal website. Interactive forms and templates so they can fill in the details online. Images, ECGs can be scanned in

This is NOT an EMR !

Using CCR information standards , the PHR can exchange data with other databases so that the PHR can be automagically updated ( for example, with lab test results ; with the chemist’s prescription; with the hospital EMR; with health insurance company data)

Yos Technologies Yos Technologies ( www.yostechnologies.com) is based in Bangarore and provides a comprehensive "Personal Healthcare System" which includes PHRs, Healthcare tools and applications for Preventive and Continuous Care I am an angel investor

Yos Technologies ( www.yostechnologies.com) is based in Bangarore and provides a comprehensive "Personal Healthcare System" which includes PHRs, Healthcare tools and applications for Preventive and Continuous Care

I am an angel investor

Why will patients use the PHR ? Three players Patients Doctors Health insurance companies

Three players

Patients

Doctors

Health insurance companies

PHR = organised medical information = improved medical care Patients have a lot at stake ! Keeping this record will help them to get better medical care. Patients need to manage their own health record.

Patients have a lot at stake !

Keeping this record will help them to get better medical care.

Patients need to manage their own health record.

Patient benefits Instantly available on your mobile, wherever you are Information is shared amongst all the specialists who participate in your care Available during emergencies Always updated Ensures you don’t forget allergies and drug reactions Automated reminders ( for example, for checkups ) using SMS

Instantly available on your mobile, wherever you are

Information is shared amongst all the specialists who participate in your care

Available during emergencies

Always updated

Ensures you don’t forget allergies and drug reactions

Automated reminders ( for example, for checkups ) using SMS

Patients own this information. Part can be secure, private, and confidential; part can be public Patients can add a lot of value to the healthcare system using Patient to Patient ( P2P) networking. Social networking – an online community , in which patients share information “ Wisdom of the crowds” “ Expert patients “ can act as mentors and email buddies. Patients can grade their doctors and hospitals ( using the amazon.com review model ) and compare treatments ( www.askapatient.com ).

Part can be secure, private, and confidential; part can be public

Patients can add a lot of value to the healthcare system using Patient to Patient ( P2P) networking.

Social networking – an online community , in which patients share information

“ Wisdom of the crowds”

“ Expert patients “ can act as mentors and email buddies.

Patients can grade their doctors and hospitals ( using the amazon.com review model ) and compare treatments ( www.askapatient.com ).

How do we get patients to sign up ? Reach out to patients directly Highly motivated patient groups Patients with chronic illness, such as cancer, infertility, HIV Pregnant women Mothers ( for their children) Corporates Employee wellness

Reach out to patients directly

Highly motivated patient groups

Patients with chronic illness, such as cancer, infertility, HIV

Pregnant women

Mothers ( for their children)

Corporates

Employee wellness

PRM – Patient Relationship Management ! PHR can help doctors improve their practise Because patients are better organized; and the doctor has easy access to all the relevant medical records, the doctor’s productivity will improve Good medical records reduce medical errors. Important in risk management , thus reducing the doctor’s medicolegal liability .

PHR can help doctors improve their practise

Because patients are better organized; and the doctor has easy access to all the relevant medical records, the doctor’s productivity will improve

Good medical records reduce medical errors. Important in risk management , thus reducing the doctor’s medicolegal liability .

More doctors now have their own websites Websites are effective marketing tools for doctors which can help them to promote their practice As doctors move online, they will want their patients to move with them ! Email is a much more effective form of communication than a phone call ! Can also integrate with the doctor’s EMR

Websites are effective marketing tools for doctors which can help them to promote their practice

As doctors move online, they will want their patients to move with them !

Email is a much more effective form of communication than a phone call !

Can also integrate with the doctor’s EMR

Major player – health insurance companies Initially, health insurance companies can offer the PHR as a value-added service to their clients Later, the health insurance company could make this compulsory for all their clients

Initially, health insurance companies can offer the PHR as a value-added service to their clients

Later, the health insurance company could make this compulsory for all their clients

How the PHR helps health insurance companies They could use this for providing health education to their clients, which would help to reduce their medical bills. It would reduce their transaction costs, because the data processing ( collecting premiums, authorizing payments, issuing payments) could all be done electronically, and much more efficiently

They could use this for providing health education to their clients, which would help to reduce their medical bills.

It would reduce their transaction costs, because the data processing ( collecting premiums, authorizing payments, issuing payments) could all be done electronically, and much more efficiently

How the PHR helps health insurance companies They could mine the data these records warehouse, to improve the quality of their services and obtain more accurate actuarial data . Online disease management ( based on the PHR) would help them reduce costs for patients with chronic illnesses ( http://www.lifemasters.com/index.asp )

They could mine the data these records warehouse, to improve the quality of their services and obtain more accurate actuarial data .

Online disease management ( based on the PHR) would help them reduce costs for patients with chronic illnesses ( http://www.lifemasters.com/index.asp )

White-labelled PHRs

Applications being developed 1. Google Earth – to map the nearest doctor; nearest chemist; nearest hospital 2. Databases of doctors, hospitals, medicines and their prices Changing the healthcare ecosystem using Web 2.0

1. Google Earth – to map the nearest doctor; nearest chemist; nearest hospital

2. Databases of doctors, hospitals, medicines and their prices

Changing the healthcare ecosystem using Web 2.0

Why haven’t more hospitals adopted IT ? Bugs in software Difficult to get skilled IT manpower to run the systems Difficult to scale up Connectivity issues

Bugs in software

Difficult to get skilled IT manpower to run the systems

Difficult to scale up

Connectivity issues

Better model Software as a Service ! All the technology is outsourced to Yos Webware ( Web 2.0) No installation or maintenance needed Always updated Can be easily scaled Always available – from anywhere !

Software as a Service !

All the technology is outsourced to Yos

Webware ( Web 2.0)

No installation or maintenance needed

Always updated

Can be easily scaled

Always available – from anywhere !

Risks Need a critical mass of patients to adopt this Privacy issues Legal liability issues

Need a critical mass of patients to adopt this

Privacy issues

Legal liability issues

Today’s Health Care System Physician Health Insurance Self-Care Information Overload Media The Patient

The Patient as Integrator Care Choice Information & Feedback The Empowered Patient – with the help of Information Therapy