“The two biggest pain points in healthcare today are communication and coordination.”
That’s what Christine Bechtel, vice president of the National Partnership for Women & Families, a group that, among other things, promotes access to healthcare, says. She believes mobile and wireless technologies can go a long way toward alleviating those problems.
The National Partnership last week led a coalition of 27 consumer, labor and patient advocacy groups called the Consumer Partnership for eHealth in releasing a potentially groundbreaking document that spells out a vision for a communication-centric healthcare system that makes patients the leaders and partners in their own wellness and care. “As active participants in a variety of roles, consumers can and will use health IT to help ensure the success of these collective efforts,” the Consumer Platform for Health IT, optimistically states.
Health IT means much more than EHRs. And IT really has to be ICT—information and communications technology—a term popular outside North America. Communication, of course, no longer is dependent on location.
“Consumers routinely search for health information online, and many information and communications technologies developed for other purposes could be used in a health context. In fact, some already are,” the report says. “For instance, the use of mobile devices, equipped with basic SMS text or more sophisticated smart phone applications to find, record and share information and to monitor, manage and improve health—along with the rapid growth in social communities such as Facebook, Twitter, Flickr and LinkedIn—indicate that individuals can integrate health more fully into their everyday lives.”
Patient-centered care means exactly that. The patient, not the physician, should be the hub. “Care is integrated into people’s lives. Instead of ‘going to the doctor’ for everything, we connect to the system on a regular basis whenever and wherever we need to,” the platform says.
When you talk about shifting care away from the doctor’s office or hospital, telehealth and wireless monitoring come into play. “Health data, which is securely collected by individuals and care team members outside of the care facility using mobile phones, remote medical devices or sensors, is accessible by all members of the care team,” according to the plan.
“Whether an individual’s health goals are primarily related to wellness and prevention or management of chronic illness, health IT can help individuals track, measure, understand and manage specific health needs. This is particularly important for individuals with multiple chronic conditions and their caregivers, who need to engage in ongoing disease management. Individuals who are empowered by information and emerging technologies, like remote monitoring devices and personal health records (PHRs), can more successfully maximize their health and the outcomes of clinical interventions they receive.”
Some of this is within reach, while other aspects are pie-in-the-sky. Yes, that’s my knee-jerk response whenever someone mentions PHRs. I have a similar reaction to statements such as this: “Consumers are enthusiastic about the benefits health IT will afford them.”
In general, consumers aren’t really engaged in healthcare right now, other than the financial and administrative aspects of the whole mess. That’s what happens when price transparency remains a myth, when public has been hoodwinked by politicians and media into believing that merely having health insurance gets you quality care and when the healthcare establishment refuses to consider the radical notion that patients, not institutions, own their medical records.
We’ve seen bold manifestos like this Consumer Platform for Health IT before. Twenty years ago, the Institute of Medicine called for the digitizing of medical records. It’s been slightly more than 10 years since the Leapfrog Group threw down the healthcare quality gauntlet on behalf of employers—you know, the sector that historically has footed most of the bill for the vast majority of Americans between the ages of 18 and 64.
Where consumers are “enthusiastic about the benefits of health IT” is in the answer to specific questions posed to them. The Consumer Partnership for eHealth referenced a survey by the California HealthCare Foundation suggesting that 55 percent of Americans wished their physicians shared more information with each other and that 50 percent believed it was difficult to keep track of all their health information. Those are hardly overwhelming numbers when you think of how siloed health data really are.
Bechtel, the lone consumer representative on the federal Health IT Policy Committee—unless you count Consumer Partnership for eHealth member SEIU, a labor union—says that the government’s EHR incentive program so far hasn’t fully addressed consumer elements. “Meaningful use hits the mark in some areas and misses in others,” she says.
Stage 1 “meaningful use” requires physicians to deliver electronic clinical summaries for 50 percent of their patients, though hospitals only have to do so for half of those who specifically ask for electronic copies of discharge summaries. But how often do patients really make such a request?
Bechtel believes it’s likely HHS will tighten standards for health information exchange with patients in Stage 2, but the Consumer Platform for Health IT says consumers also have to take a more active role in their own care and healthcare providers need to start trusting information provided by patients.
First, though, patients and providers have to start trusting each other and trusting that new means of communicating health information are secure. Only then will healthcare communication channels truly open up to promote the kind of coordination this new report envisions.
Yes, doctors will want to get paid for care coordination. Last year’s health reform legislation and the new, related regulations for Accountable Care Organizations make strides in that direction, but that’s another topic for another day.
