Patient Centered IT

Crossing The Digital Divide

This blog is about Patient Centered Information Technology. It assumes that there is a true and realistic benefit for people using information technology for their healthcare compared to those that doesn’t. This may be hard to prove but with more and more people engaging in this and havin the possibility the culture of healthcare is changing making this a reality. However it needs basic access and technological support for everyone. This study depicts the situation for people not having enough resources to participate dreamstime_xs_21179918

http://www.jmir.org/2013/5/e93/

Given vulnerable low-income homebound older adultsâ€™ substantial health and mental needs, examining their ability to search for high-quality health information/resources and make informed decisions about applying the information to improve their quality of life may be particularly useful.

Internet access and education must become a first order resource for healthcare and should be paid by health insurance plans and considered by welfare organizations. Just like any other measures that improves outcomes.

Patients with full EHR access are empowered

The following study contains some promising results

http://www.jmir.org/2013/3/e65/

Patients with full EHR seem to be encouraged to particpate more in healthcare delivery. The EHR access triggers some behaviour to improve health literacy and active participation to cope with and handle zhe information contained in EHR. This is all in line with the concepts of the Patients Centered Process which i will document in a follow-up post

Especially this is important:

Concern about workload is likely more complex. Patientsâ€™ accounts suggest that sharing all records reduce workload in some areas, for example, fewer visits or decreasing requests for copies of records. At the same time, participantsâ€™ experiences also challenge traditional roles for patients and physicians.

This references a change in culture and is related to the effort done in healthcare delivery. Patients claim a different role in an active position.

Healthcare is social

Rethinking the process how modern healthcare was founded by social welfare actions somehow opened my mind ybout the fact that participation is a central issue in well being. Healthcare delivery is based on moden technology and science for a number of reasons at least in the western societies. It is proven that this is a succesful path. However not alwas the most effective. On the other hand the revolution to establish a healthier society was that healthcare systems were based on some kind of risk sharing or insurance system. This is all about money, because in the end illness and treament costs money. But the core of these systems are participations between the people involved. I am pretty dreamstime_xs_23050411 convinced that modern healthcare is too often reduced to function below optimum due to the fact that a patient is treated as an individual and isolated case. This is reasonabel but leads also to a misconception that social interaction and/or community building is not perceived as an effective tool in healthcare delivery. This article mentions the aspect of marketing

http://www.healthcarecommunication.com/Main/Articles/3fe9d117-6342-4923-a59f-927d43b9b6c8.aspx

In the discussion of their results, the researchers advocated a social marketing approach as a â€œpotential â€˜win-winâ€™ situation for both older adults and society. EC demonstrates how marketing principles could be used to guide future health policy initiatives based on older adult national and community service.â€

I think it is worth to rethink healthcare delivery as a social interaction among and between enabled communities. Patient Centered doesn’t mean isolated but in the center of attention of a participating crowd. The tools are just about to be invented

Effective patient-physician communication through EHRs?

I pretty much agree with the general message behind this post

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

Patient Experience

This post gives a definition of the patient experience

â€œWe define the patient experience as the sum of all interactions, shaped by an organizationâ€™s culture that influence patient perceptions across the continuum of care.â€

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: dreamstime_xs_20366890

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

Health Technologies and Innovation in the Global Health Arena

The following article caught my attention

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 …

Can text messages be used to improve health outcomes

Another remarkable result is contributed by this post:

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, â€œmHealth,â€ 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.Â Other examples are: Smart phone reminder to join gym

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 experiencesÂ that reminders are good at keeping a patient on track because healthcare situations mightÂ 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 â€“ meaning that users should be able to ask questions and receive more targeted health information if desired. To that end, Dr. Clausonâ€™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, A Vital Skill for Participatory Medicine

I would like to cite a post on http://e-patients.net which mentions the importance of patient communication in healthcare delivery which has been addressed in previous posts (Patients communicate , The economic value of Patient Centered IT, Online Communities vs. Treatments) on Patient Centered IT. dreamstime_xs_18404768

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 enhancedÂ possibilities ofÂ 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

How patients disclose medical diagnoses online

Re people open or closed facing health communication. The answer is

we don’t know yet.Â 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/

: Source: Seeking Social Solace, Russell Herder

Open mHealth Architecture

dreamstime_xs_19219970 The following link depicts the demand for an open mhelth architecture

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.

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