http://journals.lww.com/academicmedicine/Fulltext/2012/04000/Commentary___Lost_in_Translation__How_Electronic.8.aspx

especially i would subscribe

EHRs and other forms of health information technology hold the promise of enabling users to provide more effective, more efficient, more coordinated, and safer care

My concern however is another. Since Healthcare in general runs a bit behind in providing adecuate information systems for the people involved in healtcare processes compared to other sectors, healthcare information models have a tendency to be kind of sticky. The EHR model is a bit old fashioned IMHO. A paper record is a perfect representation of the information model within the limits of paper technology. Diggin into the digital domain an EHR may be no more the perfect representation of digitally processed information. I am refering to the fact that RECORDS somehow relates to a data-centric models. No matter the complexity of the concrte EHR implementation. The notion is still a record.

A better approach would be a process oriented or even better Petient Centered model. Modeling healthcare from a patient centered perspective hepls to break down complexity. An EHR that approaches medicine in general could easily be outperformed by small application models that specifically solve small problems and give specific answes or support specific processes.

Another advantage of the application model is to measure application performance and to model application delivery chains

http://tech.fortune.cnn.com/2012/03/28/how-apps-transformed-it/?section=magazines_fortune

it starts by benchmarking its application performance. This means clearly defining what is, and what is not, acceptable application speed, based on the needs of its users.

• support processes and people instead of data
• modeling communication and relationships with information technology takes healthcare delivery beyond the restrictions of ancient delivery models
• the Patient Centered approach reduces complexity of healthcare with improved performance of healthcare processes
• the App model further reduces complexity and give a possibility to model healthcare chains

“We define the patient experience as the sum of all interactions, shaped by an organization’s culture that influence patient perceptions across the continuum of care.”

But why so distant? The patients perception may tell him: ‘I am fine’ but next day he’ dead. I think we must be more specific to address the patient experience within Patient Centeredness.

These are some points:

Patients Experience:

• is an inherent part of the patients health
• is a primary focus of healthcare because a good experience is an important contribution to a patients well being
• has to be treated as a primary goal in the healthcare process

These points express patients rights and safety in healthcare. The contribution of technology as Patient Centered IT must comply with the intention of the Patient Experience definition whatever it is. Patient Centeredness expresses the aim of an healthcare architecture with the patients as drivers. Patient Experience should is the fuel needed for driving

http://www.nejm.org/doi/full/10.1056/NEJMp1108040

Creating appropriate products for low-resource settings requires not only a rethinking of what is considered a health technology, but also cross-disciplinary innovation and in-depth understanding of the particular needs of each country. Location-specific needs assessment will help ensure that more appropriate devices reach people in need and will support parallel efforts to deploy novel devices, processes, or information technologies to cost-effectively reduce disease incidence. It will also help to prevent the adoption of ineffective or inappropriately costly technologies that could divert resources from other critical health care areas.

Exactly. Despite all good that is delivered by device centered health technology it is a big source of unequality because it means expensive development. Lot of money for some improvement that impresses on a tiny scale but fails in a global context. Considering information and the access to it as a health technology that scales up globally is the first step in rethinking health technolgy and its impact to societies. The power of information is that it is flexible. Access is not cheap however, but it inherently contains the notion of distribution. Cost effective health technology needs careful asessment in different contexts (see also: http://patient-centered-it.com/2010/04/10/the-economic-value-of-patient-centered-it/).

At the same time i subscribe to the idea of reverse innovation which is capable to tell the first world what is really a necessary health technology. Again information technology is able to provide the infrastructure to enable this process …

http://www.forbes.com/sites/sarikabansal/2011/10/07/mhealth-text-message-txt2stop/2/

To the delight of mobile health proponents around the world, the researchers found that nearly 11% of smokers in the intervention group quit smoking, as compared to 5% of those in the control group. They published their findings in the Lancet this summer.

This study is part of a growing trend towards using mobile phones as platforms to encourage healthy behaviors. With over five billion mobile phone connections worldwide, it is not surprising that the public health community is looking to use them to improve health outcomes. Proponents have even created a catchy term, “mHealth,” to encompass all medical practices supported by mobile devices.

This again show that there is indeed something about text messaging and healthy behaviour which is not fully understood.  Other examples are:

http://patient-centered-it.com/2010/09/30/text-messages-boost-patient-outcomes/

http://patient-centered-it.com/2010/07/30/e-mail-could-be-good-for-your-patients-health/

The question is: Why is text messaging so powerful and what are the constraints.? I’ll try to collect some more data on that. For now i have to admit in works in some situations. We know from other experiences  that reminders are good at keeping a patient on track because healthcare situations might  get complicated and inconvenient (http://dermatology.cdlib.org/149/letters/atopic/feldman.html). Maybe aherence is beyond borders of understanding the therapy such that a text message breaks a complicated therapy down in simple instructions. Or maybe it is just the right tool to enforce learning healthy behaviour as oposite of the learned unhealthy alternative. We need to understand contents and frequency of text messages among other things. Another dimension is interactivity

Another operational consideration is the look and feel of the texting systems. Researchers hypothesize that text message systems work better if they are interactive rather than one-way – meaning that users should be able to ask questions and receive more targeted health information if desired. To that end, Dr. Clauson’s team is currently conducting a study to monitor the differences in diabetes outcomes with uni-directional and bi-directional texting.

I bet the bidirectional variant is even more powerful since it implies some kind of creational act and self-reflection. This scenario maybe an important part of of a Patient Centered IT infrastructure

Communication for patients is an essential and non-disputable act in healthcare delivery. I totally subscribe to this statement:

There is no industry where communication is not an essential component to keep things running smoothly and efficiently. In healthcare, however, communication can save lives and that is beyond essential

It is absolutely necessary to improve communication skills of providers and patients in order to save lives. This is not a new claim and has always been an issue. The newer development with enhanced  possibilities of  information system together with the need for Patient Centered Applications just put an additional focus on this.

http://e-patients.net/archives/2011/08/nancy-finn-on-communication.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+E-patients+%28e-patients%29

we don’t know yet.  It appears to be a period of transition to something which is still not known. Patients discover a world of open communication about health related issues but are still tied to existential fears that they learned over a long time. The study mentioned in this post tries to find some relationship between behaviour and information categories.

People disclosed their conditions 23% more often on weekdays more than on weekends

It is this kind of analysis that is important for the development of transparency and security at the same time. Patients that do know about the value of information are able to perform mature communication and to protect themselves

http://healthpopuli.com/2011/07/22/why-patients-disclose-medical-diagnoses-online/

http://rds.epi-ucsf.org/ticr/syllabus/courses/2/2011/03/08/Lecture/readings/Sim_OpenmHealth_.pdf

This approach is one of the technical dimensions necessary to support patient centeredness in information infrastructure. A vertical architecture with open interfaces is very important to build a multitude of services on to of it. Mobile devices have the great virtue to be very close to the patient and his or her behavior. Access and availability is a key factor in a successful migration to patient centered services.

At the same time i have to say that a vertical architecture is not enough. Horizontal or service oriented patterns or best practices have to be designed too in order to support healthcare delivery and processes. A landscape of infrastructure services that are well known and established is important to the success and accceptabiliy of patient oriented services.

Details for this event can be found at:

http://www.mobile-monday.de/events/mobile-healthcare

This is what I learned

1. WOW. First emotion was kind of an eye opener to see the value of openness in education. In fact motivation to learn relates much more to a position of activity than passively consuming course materials.
2. THE PATIENT. A Patient Centered IT Blog takes care of patient education. Open education align perfectly with a situation patients are usually in. Highly motivated and with an excellent prognosis for their outcome if participating actively. Collaboration among patients and physicians aligns perfectly with transparency and openness in healthcare delivery.
3. BUT. Number 2. seems easy but it’s not. We are not dealing with openness in healthcare although we’d love to. The steps to design a self driven syllabus for patients have to be designed carefully and with participation of patients (virtually everybody ). This addresses a community which easily exceeds any reasonable number. This is intimidating but can be done with focus on particular problem domains like Epicondylitis humeri radialis.
4. THE WEB. The event was about webcraft skills. It is not easy to design Patient Centered Websites without the usual clutter and noise of medicine. The main reason is that patient thoughts and physician daily practice are so different. Any feasible collaboration requires education for the improvement of health literacy. Starting with a simple thing like finding a date for a radiography of the chest could be the starting point of an individual learning experience. Empower patient by powering Patient Centered Websites.
5. OER. Patients have knowledge. They deliberately provide it in many situations. Supporting collaboration in Patient Centered Environments makes patients OER’s which is just great
6. BADGES and CERTIFICATES. A key factor in healthcare delivery is transparency in terms of processes and quality. Community hosted certificates are a great idea. Put patients in the position where you want to have web developers too. In fact sometimes patients are tougher…
7. AWESOME was the most frequently used word @ drumbeat
8. CHEERS to Pippa, Chris, Chris, Janet and everyone for sharing this experience!