I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.
1. There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category. While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say outcome) of patients by changing the focus from provider to patient. Physicians do care about their patients. However, they are finding less and less time to devote to direct patient care. This same situation will repeat itself with non-physician providers as they assume more responsibility for patient care. Unless physicians support efforts to provide patients with tools to increase self-management, patient-centric care will not succeed. Care must be seen as a partnership. Patients are not seeking a substitute for their physician. They are seeking a substitute for the unreturned phone calls, insecurities about whether to call in the first place, and tools for navigating the healthcare ecosystem. If physicians support them in these endeavors, they will be seen more as partners. This will not, unfortunately, change overnight because of the historic delay in changes to the culture of medicine.
2. Patients need great portals. Patient portals are the ultimate patient-centric tool. They can become the epicenter of the patient’s care universe. All of their physicians and providers can communicate with the patient across healthcare system and technological barriers. The ideal portal can house different EHR system information, communicate with language translation, act as a hub for patient education, instructions, navigation, and allow providers to communicate with each other about a given patient. In addition, and most importantly, it will allow the patient to change relevant information real-time. This can be critical when it pertains to allergies, medication, diagnoses, or change of clinical status. This will definitely not change overnight even though the technology is here. Interoperability issues, the low expectations and mandates of the government fueled by resistance from physicians, and burgeoning competition (with attendant technical disparity) of portal vendors are all barriers easily overcome.
3. Quality patient education and monitoring tools. There are many patient education and monitoring tools out there. Because of lack of reimbursement (isn’t it always about the money), there has been little adoption of health literacy appropriate education technologies. A patient-centric healthcare system would place both of these categories of technologies at the highest of priorities. They can both be tied to the portals described in the prior section. I would certainly want to see outcomes-based evaluations (which wouldn’t take long or millions of dollars to accomplish) of these tools (though intuitively one could imagine patients who receive instructions via a mobile device to be NPO for their procedure the following day being more compliant, resulting in less cancelled procedures). I would refer the reader to the immediately preceding posts on remote patient monitoring to become familiar with how these technologies can foster patient-centric care.
4. Patient-centric care must involve a caregiver. There is always a need for caregiver involvement. Even if a patient has full mental faculties, emotional and possibly logistical support is often needed. I saw many high level corporate executives as patients who had a significant other accompany them to visits or who called furnishing otherwise non-communicated critical information or questions. Not uncommonly emotional upset surrounding an acute or chronic condition cloud factual retention. The need for emotional support is borne out by the success of online communities even if they are anonymous like Treatment Diaries or others like Wego Health.
5. Attention to advanced directives. Most people think advanced directives are instructions to be conveyed to a physician in the ICU when things are grim. This is probably the biggest misconception about advanced directives. Others include thinking that they are irrevocable or immutable. I believe that advanced directives should be discussed in middle school health classes. They shouldn’t be made instantaneously and should be well thought out. Directives go way beyond the trite “Do not resuscitate.” Advance directives are more relevant and personal to all than many medical issues on network news, yet get little public attention. They are the most personal of decisions and therefore should be made by the individual before being incapacitated, not by someone else after the fact. They must be portable not papers in a safe in the bank. There is actually an app for that called My Healthcare Wishes. Providers must discuss this with patients early on in care delivery, so that options are explained, contemplated, and directives established. A 20-minute visit for a problem-focused encounter or follow-up visit is not going to be the right forum for this. Physicians and patients both must be incentivized (not monetarily necessarily) to address advanced directives.
These are only a few of what I consider significant ways in which one might approach designing patient-centric care. What are your thoughts? As a matter of disclosure, I have no financial relationships with any companies mentioned in this post.
David Lee Scher is a former cardiologist and a consultant at DLS Healthcare Consulting, LLC. He blogs at his self-titled site, David Lee Scher, MD.