Towards truly two way communication in health care

A.R.J. (Rob) Halkes
A.R.J. (Rob) HalkesPrincipal consultant at Health Business Consult
Truly 2Way Communication
             Rob Halkes
  Ideagoras Madrid November 17th



Integrates care
Doctor & Patient
   Co-creating
 Care for Health
     Truly 2Way Communication
             Rob Halkes
  Ideagoras Madrid November 17th



Integrates care
The demands for actual and future care
   for health are too high to handle
Current systems of health care, are too expensive and
too much labour consuming to last for the next decade!
Current systems of health care, are too expensive and
too much labour consuming to last for the next decade!

       THE CATCH-CRY FOR CARE:
                  ► MORE VOLUME
               ► INCREASED QUALITY
                   ► LESS COSTS
Way out:
Way out:

   Medical Technology
            and
 Patient Self Management




“Lab on a chip”
Way out:
           Integrated Care
                     Peers
           Family             Coach

 Friend                                 Etc.
                    Patient




Industry             Nurse               Etc.

            PH        GP       Payors
Way out:
            Integrated Care
                     Peers
           Family             Coach

 Friend                                 Etc.
                    Patient




           1. Structuring of Process




Industry             Nurse               Etc.

             PH       GP       Payors
Way out:
            Integrated Care
                     Peers
           Family             Coach

 Friend                                 Etc.
                    Patient




           1. Structuring of Process

2. Coordination between care providers


Industry             Nurse               Etc.

             PH       GP       Payors
Way out:
              Integrated Care
                       Peers
             Family             Coach

   Friend                                 Etc.
                      Patient

3. Patient compliance and self management

             1. Structuring of Process

 2. Coordination between care providers


  Industry             Nurse               Etc.

               PH       GP       Payors
Towards truly two way communication in health care
e
             alu
       i   cV
     om
   on
Ec
                        Medical
                         Value
         e
       lu
    Va
 nt
             tie
                   Pa
Participatory Care for Health
Participatory Care for Health
Participatory Care for Health



Participatory Medicine .. a
movement .. patients shift from
being mere passengers to responsible
drivers of their health, and in which
providers encourage and value them
as full partners.
Participatory Care for Health

                                        Participatory Medicine is a
                                        cooperative model of health care that
                                        encourages and expects active
                                        involvement by all connected parties
Participatory Medicine .. a
                                        (patients, caregivers, healthcare
movement .. patients shift from         professionals, etc.) as integral to the
being mere passengers to responsible
drivers of their health, and in which
                                        full continuum of care. The
providers encourage and value them      ‘participatory’ concept may also be
as full partners.
                                        applied to fitness, nutrition, mental
                                        health, end-of-life care, and all issues
                                        broadly related to an individual’s
                                        health.
Collborative action and decision making
 to co-create the Patient’s experience
           In Care for Health
Collborative action and decision making
   to co-create the Patient’s experience
             In Care for Health


       Condition     Information
    ODL                   Review
Compliance
                  Data                   Nutrition
                         Support         evaluate
  Coaching          Chat Therapy
                                          Tracking &
LearningConsult
                   Medication           Tracing Health
                                         parameters
     Feedback Food
                         Life Style Adaptation
There’s ample research
Powerful new “Doctor becomes an e-patient” story in Journal ...                           http://e-patients.net/archives/2011/04/doctor-as-e-patient-jopm...




                                                 There’s ample research
                                                                    Home
                                                                    About Us
                                                                    Society for Participatory Medicine
                                                                    I Am An e-Patient

                                                               Search this website...                        GO


                                                              Powerful new “Doctor becomes an e-patient”
                                                              story in Journal of Participatory Medicine
                                                              by e-Patient Dave on April 18, 2011

                                                                                                    amednews: Participatory medicine: A high-tech alliance...
                                                                                                                                                        35                                                               http://www.ama-assn.org/amednews/2010/01/1
                                                                                                                                                                                                         tweets


                                                                            The Impact of eHealth on the thethat patient and Safety of
                                                                                        Two years ago we wrote “Let’s hear it for   ‘d-patients’”
                                                                                                                                  Quality
                                                              — doctors who become e-patients themselves. We said “D-patients prove
                                                                                                                                                  retweet


                                                              empowerment is anything but anti-doctor. Heck, sometimes it’s aOverview
                                                                            Health Care: A Systematic doctor preservation movement.”
September, 2011
                          TELEMEDICINE
                                   306                                                     WINKELMAN ET AL., Patient-Perceived Usefulness of Online EMR

Doctors, Patients & SocialTELEMEDICINE:
                                                 A new article inAshly D. Black1,Participatory MedicineTECHNOLOGY example: A Cresswell2, Tomislav Bokun1,
                                                                  our Journal ofAN ESSENTIAL provides a compelling 2, Kathrin
                                                                                         Josip Car1, Claudia Pagliari2, Chantelle Anandan
                           Media                 Physician’s Experience as a CancerREFORMED Majeed4, Importance2* Patient
                                                                 Brian McKinstry2, Rob of the Neck Patient: The Aziz Sheikh of
                                                                                                        3
                                                                                       FOR Procter , Azeem HEALTHCARE
                                                                                       AN ESSENTIAL TECHNOLOGY
                                   Research PaperParticipation. The author, Itzhakof Primary Care and makes our point: London, London, United Kingdom, 2 eHealth Research Group, Centre for Population
                                                  j              1 eHealth Unit, Department Brook MD, Public Health, Imperial College
                                                                              Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom, 3 National Centre for e-Social Science, University of Manchester, Manchester, United Kingdom,
                                                                                                    FOR REFORMED HEALTHCARE
                                                                              4 Department of Primary Care and Public BUSINESS
                                                                                                                        Health, Imperial College London, London, United Kingdom
                                   Patient-Perceivedfacedpersonal storydiagnosedOnline and undergoing will realizesurgeries. I am
                                               challenges
                                                            Usefulness the hope thatcancer Electronic Medical
                                               I am telling my
                                                                  by a patient
                                                                                   in of
                                                                                                with
                                                                                                       health care providers
                                                                                                                                  extensive
                                                                                                                                                the difficult

                                   Records: Employingthe importance of active participationinthe patient and their family members
                                               also discussing Grounded Theory of the Development of
                                                              Abstract

                                                              quality and safety of health care. Technologies for technologies are underway Participatory Health:
                                   Informationinand CommunicationtoImplementations of of eHealth solutions onUse by safety of health care,often to
                                                  all phases of care.
                                                              Background: There is considerable international interest in exploiting the potential of digital solutions to enhance the
 Journal of Participatory Medicine » My 8-Point Participatory ...                                                  transformative eHealth
                                                                       http://www.jopm.org/opinion/commentary/2011/09/06/my-8-...                                      globally,     at

                                   Patients Living with Chronic on eHealth various eHealthwe(emphasisonsystematic reviewsafety of care. reviews assessing the and Mobile Tools
                                                                                                                                                                      Online
                                                              very considerable cost. In order   assess the impact                         the quality and                       and
                                                              inform policy adds, in
                                                                                        Illness
                                            JoPM co-editor Charlie Smith decisions his introductory note: undertook aadded)
                                                              effectiveness and consequences of
                                                                                                  deployments,
                                                                                                                 technologies     the quality and
                                                                                                                                                   of systematic
                                - Journal of Participatory Medicine - http://www.jopm.org -
                                                           You may wonder whyand Findings: We account of his search strategies, conceptual mapshe health care quality, safety, and eHealth
                                                                            Methods a physician’s developed novel illness and the frustrations of experienced                                                           Help Chronically Ill
                                                           merit publication in this journal. But, if a doctor has this degree of anxiety, this the systematic review literature. Major
                                                                            interventions, and then systematically identified, scrutinised, and synthesised much
                 My 8-PointWARREN J. WINKELMAN, What Makes Me a
                                 Participatory Philosophy: MD, MBA, FRCPC, Khis care toLEONARD, MBA, PHD,
                                                           difficulty getting information about EVIN J.and this systematic reviews publishedsystematic1997 andthat focused on assessing
                                                                            biomedical databases were searched identify degree of struggle making good   between           2010. Related theoretical,                   Manage Their Care
                                                                            methodological, and technical material was also reviewed. We identified 53             reviews
                 Participatory Patient ROSSOS, decisions, then patients of eHealth interventions on why theyand/orso overwhelmed and incapable, at systematic reviews
                               PETER G.                     MD, FRCPC impact can easily understand the quality feel safety of health care and 55 supplementary
                                                                            the
                 Posted By Kathy Kastner On September 6, 2011 @ 5:41 pm In Commentary,Vol. 3, 2011 |
                 14 Comments
                                                           times, of truly providing relevant supportiveown care. What we are advocating for is found to be generally of substandard
                                                                             “participating” in their information. This systematic review literature was difficult in
                                                                            quality with regards to methodology, reporting, and utility. We thematically categorised eHealth technologies into three
                                                           the best of circumstances storing, managing,all hands on deck for(2) clinical decision support; and (3) facilitating care from a
                                                                            main areas: (1) and requires and transmission of data; the task!                                       September 2009
                                          Abstract         Objective: Patient useWe found that despite support fromrecords (EMR) holds relatively little empirical evidence to substantiate
                                                                             distance. of online electronic medical policymakers, there was the potential to improve
                   Abstract          health outcomes.and many other manystudy claims discover how patients living withwhen he inflammatory bowel disease
                                                      I – The purpose of to of thequality and in relation toDr. Brook meansWhether thesays: of those relatively few solutions identified
                                                                             this
                                                                             patients – is to made
                                                                                         know exactly what these technologies. chronic success
                                     (IBD) value e-patients, patient-physician communication, online safety would records. ifwww.georgebatesstudio.com] beyond the contexts in which they were originally
                   Keywords: Participatory medicine,
                                                     Internet-based patient improve to electronic patientby continue / these were deployed
                                                                                access                   [Illustration George Bates
                                                                                   developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment
                   communities.                           …both of these approaches [physicians who acted "half full" and "half empty"] deprived mepatients
                                                                                                   Participatory medicine: A high-tech alliance with
                                         Design: This was a qualitative, exploratory, descriptive study using in-depth interviews and focus groups of a total of 12
                                                                                 strategies are lacking.
                   Citation: Kastner K. My 8-point participatory philosophy: what makes me a participatory
                                         patients with IBD of at least one-year duration at is a large gap Health Network, a tertiary care center in Toronto, Ontario. possibly more financially advantageous to doctors and patients.
                   patient. J Participat Med. 2011 Sept 6; 3:e40.                Conclusions: There
                                                                                                      University between the postulated patient participation in medicine more workable -- and technologies.
                                                          of being truthfully and fully informed about my prognosis, which is essential for making
                                                                                                           Information technology is making
                                                                                                                                            and empirically demonstrated benefits of eHealth
                   Published: September 6, 2011.
                                                          logical choices concerning treatment. I preferred those who told me the truth about risks and
                                         Results: Four themes have been elucidatedthere is a lack ofBy a theoreticalon the risks of staff. Posted Jan. 18, 2010. information and
                                                                                 In addition, that compriserobust research framework implementing these technologies and their cost-effectiveness
                   Competing Interests: The author has declared that no competing interests exist.
                                                                                                              PAMELA LEWIS DOLAN, amednews of patient-perceived

                                          communication technology usefulness:if it was notof a sense ofbeing frequently promoted patient-drivenand ‘‘techno-enthusiasts’’ as if this was a
                                                          my prognosis, has yet to be demonstrated, despite illness ownership, of by policymakers communication, of
                                                                         even promotion rosy. I always voiced my preference to the physicians so that
Towards truly two way communication in health care
Towards truly two way communication in health care
A rightly designed
   E-Health Platform
To trigger and facilitate!
Towards truly two way communication in health care
Towards truly two way communication in health care
Towards truly two way communication in health care
Towards truly two way communication in health care
Towards truly two way communication in health care
Towards truly two way communication in health care
Towards truly two way communication in health care
Towards truly two way communication in health care
Towards truly two way communication in health care
Experience Co-Creating Care
            EC3
Experience Co-Creating Care
               EC3




     A method of development
to reach a common understanding
         between all parties
              based on
 insights into each others’ interest
EC3 is not the same as “working together”
            Traditional Strategy                 Co-Creative Strategy
            Creates value by delivering          Creates value by constantly
   Values   defined customer experience to
            targeted customer set
                                                 enhancing experiences for all
                                                 stakeholders

            Establishes strategic goals at       Uses the initial strategic goal as
   Goals    the outset and doesn’t               a starting point and lets the full
            significantly change them            strategy emerge over time
            On the interests of the firm: that
            is, how the firm can maximize its    Focuses on the interests of all
                                                 stakeholders and how the
   Focus    share of the created value
                                                 ecosystem can maximize the
            relative to the shares of its
            industry competitors                 size of the pie;

                                                 Achieves advantage through the
            Achieves advantage through           increased engagement of
            realizing economies of scale         stakeholders and by continually
Advantage   before competitors do and            building new interactions and
            making big, bold moves               experiences, which lead to higher
                                                 productivity, higher creativity, and
                                                 lower costs and risks
THANK YOU




Rob Halkes
BU Van Spaendonck – Value innovation in Medical and Life Sciences
T +31 418 578000
M+31 653 420722
E r.halkes@VanSpaendonck.nl              G.E.H. Tutein Noltheniuslaan 7
W www.medicalandpharmamarketing.com 4181AS Waardenburg
T @rohal                                 the Netherlands
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Towards truly two way communication in health care

  • 1. Truly 2Way Communication Rob Halkes Ideagoras Madrid November 17th Integrates care
  • 2. Doctor & Patient Co-creating Care for Health Truly 2Way Communication Rob Halkes Ideagoras Madrid November 17th Integrates care
  • 3. The demands for actual and future care for health are too high to handle
  • 4. Current systems of health care, are too expensive and too much labour consuming to last for the next decade!
  • 5. Current systems of health care, are too expensive and too much labour consuming to last for the next decade! THE CATCH-CRY FOR CARE: ► MORE VOLUME ► INCREASED QUALITY ► LESS COSTS
  • 7. Way out: Medical Technology and Patient Self Management “Lab on a chip”
  • 8. Way out: Integrated Care Peers Family Coach Friend Etc. Patient Industry Nurse Etc. PH GP Payors
  • 9. Way out: Integrated Care Peers Family Coach Friend Etc. Patient 1. Structuring of Process Industry Nurse Etc. PH GP Payors
  • 10. Way out: Integrated Care Peers Family Coach Friend Etc. Patient 1. Structuring of Process 2. Coordination between care providers Industry Nurse Etc. PH GP Payors
  • 11. Way out: Integrated Care Peers Family Coach Friend Etc. Patient 3. Patient compliance and self management 1. Structuring of Process 2. Coordination between care providers Industry Nurse Etc. PH GP Payors
  • 13. e alu i cV om on Ec Medical Value e lu Va nt tie Pa
  • 16. Participatory Care for Health Participatory Medicine .. a movement .. patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.
  • 17. Participatory Care for Health Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties Participatory Medicine .. a (patients, caregivers, healthcare movement .. patients shift from professionals, etc.) as integral to the being mere passengers to responsible drivers of their health, and in which full continuum of care. The providers encourage and value them ‘participatory’ concept may also be as full partners. applied to fitness, nutrition, mental health, end-of-life care, and all issues broadly related to an individual’s health.
  • 18. Collborative action and decision making to co-create the Patient’s experience In Care for Health
  • 19. Collborative action and decision making to co-create the Patient’s experience In Care for Health Condition Information ODL Review Compliance Data Nutrition Support evaluate Coaching Chat Therapy Tracking & LearningConsult Medication Tracing Health parameters Feedback Food Life Style Adaptation
  • 21. Powerful new “Doctor becomes an e-patient” story in Journal ... http://e-patients.net/archives/2011/04/doctor-as-e-patient-jopm... There’s ample research Home About Us Society for Participatory Medicine I Am An e-Patient Search this website... GO Powerful new “Doctor becomes an e-patient” story in Journal of Participatory Medicine by e-Patient Dave on April 18, 2011 amednews: Participatory medicine: A high-tech alliance... 35 http://www.ama-assn.org/amednews/2010/01/1 tweets The Impact of eHealth on the thethat patient and Safety of Two years ago we wrote “Let’s hear it for ‘d-patients’” Quality — doctors who become e-patients themselves. We said “D-patients prove retweet empowerment is anything but anti-doctor. Heck, sometimes it’s aOverview Health Care: A Systematic doctor preservation movement.” September, 2011 TELEMEDICINE 306 WINKELMAN ET AL., Patient-Perceived Usefulness of Online EMR Doctors, Patients & SocialTELEMEDICINE: A new article inAshly D. Black1,Participatory MedicineTECHNOLOGY example: A Cresswell2, Tomislav Bokun1, our Journal ofAN ESSENTIAL provides a compelling 2, Kathrin Josip Car1, Claudia Pagliari2, Chantelle Anandan Media Physician’s Experience as a CancerREFORMED Majeed4, Importance2* Patient Brian McKinstry2, Rob of the Neck Patient: The Aziz Sheikh of 3 FOR Procter , Azeem HEALTHCARE AN ESSENTIAL TECHNOLOGY Research PaperParticipation. The author, Itzhakof Primary Care and makes our point: London, London, United Kingdom, 2 eHealth Research Group, Centre for Population j 1 eHealth Unit, Department Brook MD, Public Health, Imperial College Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom, 3 National Centre for e-Social Science, University of Manchester, Manchester, United Kingdom, FOR REFORMED HEALTHCARE 4 Department of Primary Care and Public BUSINESS Health, Imperial College London, London, United Kingdom Patient-Perceivedfacedpersonal storydiagnosedOnline and undergoing will realizesurgeries. I am challenges Usefulness the hope thatcancer Electronic Medical I am telling my by a patient in of with health care providers extensive the difficult Records: Employingthe importance of active participationinthe patient and their family members also discussing Grounded Theory of the Development of Abstract quality and safety of health care. Technologies for technologies are underway Participatory Health: Informationinand CommunicationtoImplementations of of eHealth solutions onUse by safety of health care,often to all phases of care. Background: There is considerable international interest in exploiting the potential of digital solutions to enhance the Journal of Participatory Medicine » My 8-Point Participatory ... transformative eHealth http://www.jopm.org/opinion/commentary/2011/09/06/my-8-... globally, at Patients Living with Chronic on eHealth various eHealthwe(emphasisonsystematic reviewsafety of care. reviews assessing the and Mobile Tools Online very considerable cost. In order assess the impact the quality and and inform policy adds, in Illness JoPM co-editor Charlie Smith decisions his introductory note: undertook aadded) effectiveness and consequences of deployments, technologies the quality and of systematic - Journal of Participatory Medicine - http://www.jopm.org - You may wonder whyand Findings: We account of his search strategies, conceptual mapshe health care quality, safety, and eHealth Methods a physician’s developed novel illness and the frustrations of experienced Help Chronically Ill merit publication in this journal. But, if a doctor has this degree of anxiety, this the systematic review literature. Major interventions, and then systematically identified, scrutinised, and synthesised much My 8-PointWARREN J. WINKELMAN, What Makes Me a Participatory Philosophy: MD, MBA, FRCPC, Khis care toLEONARD, MBA, PHD, difficulty getting information about EVIN J.and this systematic reviews publishedsystematic1997 andthat focused on assessing biomedical databases were searched identify degree of struggle making good between 2010. Related theoretical, Manage Their Care methodological, and technical material was also reviewed. We identified 53 reviews Participatory Patient ROSSOS, decisions, then patients of eHealth interventions on why theyand/orso overwhelmed and incapable, at systematic reviews PETER G. MD, FRCPC impact can easily understand the quality feel safety of health care and 55 supplementary the Posted By Kathy Kastner On September 6, 2011 @ 5:41 pm In Commentary,Vol. 3, 2011 | 14 Comments times, of truly providing relevant supportiveown care. What we are advocating for is found to be generally of substandard “participating” in their information. This systematic review literature was difficult in quality with regards to methodology, reporting, and utility. We thematically categorised eHealth technologies into three the best of circumstances storing, managing,all hands on deck for(2) clinical decision support; and (3) facilitating care from a main areas: (1) and requires and transmission of data; the task! September 2009 Abstract Objective: Patient useWe found that despite support fromrecords (EMR) holds relatively little empirical evidence to substantiate distance. of online electronic medical policymakers, there was the potential to improve Abstract health outcomes.and many other manystudy claims discover how patients living withwhen he inflammatory bowel disease I – The purpose of to of thequality and in relation toDr. Brook meansWhether thesays: of those relatively few solutions identified this patients – is to made know exactly what these technologies. chronic success (IBD) value e-patients, patient-physician communication, online safety would records. ifwww.georgebatesstudio.com] beyond the contexts in which they were originally Keywords: Participatory medicine, Internet-based patient improve to electronic patientby continue / these were deployed access [Illustration George Bates developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment communities. …both of these approaches [physicians who acted "half full" and "half empty"] deprived mepatients Participatory medicine: A high-tech alliance with Design: This was a qualitative, exploratory, descriptive study using in-depth interviews and focus groups of a total of 12 strategies are lacking. Citation: Kastner K. My 8-point participatory philosophy: what makes me a participatory patients with IBD of at least one-year duration at is a large gap Health Network, a tertiary care center in Toronto, Ontario. possibly more financially advantageous to doctors and patients. patient. J Participat Med. 2011 Sept 6; 3:e40. Conclusions: There University between the postulated patient participation in medicine more workable -- and technologies. of being truthfully and fully informed about my prognosis, which is essential for making Information technology is making and empirically demonstrated benefits of eHealth Published: September 6, 2011. logical choices concerning treatment. I preferred those who told me the truth about risks and Results: Four themes have been elucidatedthere is a lack ofBy a theoreticalon the risks of staff. Posted Jan. 18, 2010. information and In addition, that compriserobust research framework implementing these technologies and their cost-effectiveness Competing Interests: The author has declared that no competing interests exist. PAMELA LEWIS DOLAN, amednews of patient-perceived communication technology usefulness:if it was notof a sense ofbeing frequently promoted patient-drivenand ‘‘techno-enthusiasts’’ as if this was a my prognosis, has yet to be demonstrated, despite illness ownership, of by policymakers communication, of even promotion rosy. I always voiced my preference to the physicians so that
  • 24. A rightly designed E-Health Platform To trigger and facilitate!
  • 35. Experience Co-Creating Care EC3 A method of development to reach a common understanding between all parties based on insights into each others’ interest
  • 36. EC3 is not the same as “working together” Traditional Strategy Co-Creative Strategy Creates value by delivering Creates value by constantly Values defined customer experience to targeted customer set enhancing experiences for all stakeholders Establishes strategic goals at Uses the initial strategic goal as Goals the outset and doesn’t a starting point and lets the full significantly change them strategy emerge over time On the interests of the firm: that is, how the firm can maximize its Focuses on the interests of all stakeholders and how the Focus share of the created value ecosystem can maximize the relative to the shares of its industry competitors size of the pie; Achieves advantage through the Achieves advantage through increased engagement of realizing economies of scale stakeholders and by continually Advantage before competitors do and building new interactions and making big, bold moves experiences, which lead to higher productivity, higher creativity, and lower costs and risks
  • 37. THANK YOU Rob Halkes BU Van Spaendonck – Value innovation in Medical and Life Sciences T +31 418 578000 M+31 653 420722 E r.halkes@VanSpaendonck.nl G.E.H. Tutein Noltheniuslaan 7 W www.medicalandpharmamarketing.com 4181AS Waardenburg T @rohal the Netherlands

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