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Patient Care as Collaboration

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Keynote for Rhode Island Certified Diabetes Outpatient Educators Annual Conference, Providence, RI, 10/2014

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Patient Care as Collaboration

  1. 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. 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. 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. 4. There is Rising Demand for Management of Chronic Conditions © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  5. 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. 6. …We Can’t Afford Our Current System… © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  7. 7. ...And Our System Is Optimized for Managing Acute and Episodic Care © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  8. 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. 9. We Must Focus More on Chronic Disease Prevention and Management © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  10. 10. What Should Patient Care Be? © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  11. 11. A Collaboration On The Patient’s Health © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  12. 12. Communication Knowledge Co-Creation © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands Mutual Respect Information Sharing
  13. 13. Curing Health Care Non-Visit- Based Care Patient Engagement New Care Models © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  14. 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. 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. 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. 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. 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. 19. What Do Engaged Patients Want? Communication Patient Engagement Information Convenience © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  20. 20. Online Population Rising… © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  21. 21. …And Health Info Seeking Popular © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  22. 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. 23. What Do e-Patients Want? Information © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  24. 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. 25. © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands http://www.nytimes.com/pages/health/
  26. 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. 27. Asking Tacit Approval Honest Disclosures © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  28. 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. 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.
  30. 30. https://www.acor.org © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  31. 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. 32. What Do e-Patients Want? Communication © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  33. 33. “Sorry, Dr. Sands no longer sees people. He e-mails them.” © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  34. 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. 35. What Do e-Patients Want? Convenience © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  36. 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. 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. 38. The Era of Inconvenience Is Ending © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands http://www.zocdoc.com/
  39. 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. 40. The Technology Foundation: A Patient Portal https://www.patientsite.org © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  41. 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. 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. 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. 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. 45. Engaging Patients Leads to Benefits Better outcomes Triple Aim Improved satisfaction Reduced costs © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  46. 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. 47. Health is What Happens Between Episodic Care…And Dwarfs It Visit Visit Visit © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  48. 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
  49. 49. © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  50. 50. Patient-Generated Health Information © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands
  51. 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. 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. 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
  54. 54. Questions? Danny@DrDannySands.com http://www.DrDannySands.com © Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands @DrDannySands

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