Leslie Kelly Hall, Senior Vice President, Healthwise Don Kemper, CEO, Healthwise
Dr Jones runs a thriving cardiology practice. Apart from being a very competent doctor and an expert in his field, there's an all-important ingredient in his formula for success - Patient Response. Dr Jones' team uses Electronic Medical Records(EMRs)whichareaccessibletothepatient through a patient portal; and ensures that appropriate feedback is obtained after every consultation. Patients are proactively asked if they have any concerns about their treatment plan; and regular emails are sent to ensure that patients are coping well. This active involvement of patients in their treatment is what truly sets him apart from many other well-meaning abut less proactive doctors.
The greatest untapped resource in healthcare is the patient. More often than not, an engaged and activated patient can make the difference between healthcare success and failure.
Through EMR systems, we have begun to tap that resource by prescribing information to the patient just in time to help him or her make a better health decision or to support a higher quality of self-care. Still, there is something important to consumer empowerment that is missing. Consider this:
But today, there is no good way to get the patient's voice captured within the medical record. Until we can 'pay' better attention to the patient's perspective, much of the patient's potential will continue to go untapped. Pull, push, and pay strategies are all needed to maximize engagement.
Patient response is a new way to ensure that the patient's voice is well heard in creating care plans, in deciding among treatment options, and in advancing the doctor-patient partnership. With patient response, patient-centered care becomes possible. Only by paying attention to the values and preferences of our patients can we achieve sufficient patient engagement to put the patient at the centre of care.
Patient response defined:
Patients who are actively involved through information prescriptions and patient response will make better care plan decisions with their doctors and be more successful with self- management actions at home. Physicians who ask their patients to do more self-management and shared decision making can achieve better clinical outcomes, raise patient satisfaction, and reduce the cost of care. When patients are involved and informed, they can ask for the care they need, say'no' to care they do not need, and do as much for themselves as possible. There is no better way to engage patients than to assure them that their voice will be heard in treatment and care plan decisions.
The stage is set for patient response Stage 1 of the 'meaningful use' rules is helping to define new ways in which electronic health records (EHRs) and related health information technologies (HIT) can more actively engage patients in their care. Meaningful use rules require that clinicians prescribe 'patient-specific educational resources' through their EHR systems. They also require hospitals to send discharge summaries and preventive services reminders to patients. These rules will help more patients to receive the information and tools that they need to play a more effective role in their own care. This information prescription phase is a necessary step toward full patient engagement.
One-way information is not enough
While informing patients is a key step in unlocking the patient's potential, one-way information, by itself, is not enough. Until the physician can see, in the clinical record, the patient's response to a query or decision aid, there is little chance that the patient's voice will be heard. Patient-centered care will never be attained until the patient's voice is in the clinical record and the doctor pays attention to it.
A patient response is much like a medical test result
You can think of a patient response as being much like a medical test report that comes back into the record for the clinician to use in making a better diagnosis or treatment plan.
Physicians are often unaware of what their patients are thinking. Did I answer all her questions? Is he planning to change his diet to prevent diabetes? Does she agree with the care plan? Did she have important symptoms that I didn't ask about? Is she also using complementary medicines to manage her complaints? Too often there is just no time in a clinic visit to probe for the answers.
Patient response can improve the doctor-patient relationship and care outcomes by promoting empathy. With patient response, the doctor gets to learn the patient's perspective in a short time, and the patient gets the satisfaction of knowing that his voice was heard. Both enjoy the rewards of improved medical outcomes.
Here are five examples of patient response with benefits for both doctors and patients:
Patient response allows the physician to appreciate successes, empathize with struggles, and provide motivation for additional efforts.
Patient response implemented across a spectrum of uses such as those described above will enhance the doctor-patient partnership while encouraging patient inputs to a shared care plan. And with a bit of creative thinking, we can motivate higher degrees of patient accountability by tracking patient responses.
Patient response and quality
Patient response supports quality initiatives in many areas of policy, reform, and health improvement. Consistent with the government's Partnership for Care initiative to provide better care at lower costs, patient response provides a concrete way to bring together patients and their caregivers. Patient response can validate that the patients and their families understand how to be safe from hospital-acquired diseases; that the care plans are understood; and that instructions given to patients are acted upon as they transition between care settings and home.
When patients are allowed to report on their care experiences, quality-reporting initiatives are supported and customer service improvement opportunities are created. Patient response allows for patient participation in research and surveys in a meaningful way, integrated within existing workflows.
Standardizing patient response
Observations and results provided to clinician orders are a fundamental feature in all EHRs. Thousands of these transactions move within any one hospital, hundreds of thousands between providers and labs, and millions across large integrated delivery systems, on a daily basis.
To maximize mainstream adoption, the existing HL7 technology standards and inter operability framework must be enhanced to integrate patient response into the clinician's current work flow. The case for building on existing standards is a strong one:
At last, a reason for the public to embrace EMRs
Until now, the public's response to their $30 billion investment in EMRs has been less than enthusiastic. Their biggest concern is that someone will steal their data and they don't yet see a compelling benefit to justify the risk. The combination of information prescriptions and patient response will dramatically change public opinion about the value of EMRs. People have concerns about electronic banking as well, but their fears are overpowered by the convenience that electronic banking gives them. In the same way, when people experience how being an informed, engaged, and respected member of the healthcare team helps them to get better care, their fearsof the harms from medical data theft will be greatly moderated.
Conclusion
At this point, patient response is just a gleam in the eyes of a handful of healthcare innovators. However, the path from idea to reality can be travelled quickly. It took less than 10 years from the publication of Information Therapy to the publishing of the meaningful use rules that took information prescriptions mainstream.And now that Information Therapy has paved the way for patient response, its road can be travelled far more quickly.
To make this happen, work is needed in three areas:
If we want patients to behave as empowered partners in their own healthcare, we need to respect them. Patient response is a great tool that allows patients to speak up - and doctors to listen!
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