View
189
Download
0
Category
Preview:
Citation preview
3/21/14
1
ì
Daniel Z. Sands, MD, MPH @DrDannySands Society for Par=cipatory Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA
© Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands
Leveraging Technology to Empower and Engage Patients Where High-‐Tech Meets High-‐Touch
© Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands
Go Cats!
3/21/14
2
Commercial Disclosures
ì Best Doctors, Inc. – consultant
ì Kinergy Health, Inc. – consultant
ì SeniorLink, Inc. – consultant
ì PostWire, Inc. – consultant (2013)
© Copyright 2014 D. Z. Sands, All Rights Reserved
I will not be discussing products or services of any of these companies in my presenta8on.
ì Palliative Care Definition US Center for Medicare and Medicaid Services
© Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands
Pallia=ve care means pa=ent and family-‐centered care that op=mizes quality of life by an=cipa=ng, preven=ng, and trea=ng suffering.
Pallia=ve care throughout the con=nuum of illness involves addressing physical, intellectual, emo=onal, social, and spiritual needs and to facilitate pa8ent autonomy, access to informa8on, and choice.
3/21/14
3
ì Connecting and Agenda-‐Setting
© Copyright 2014 D. Z. Sands, All Rights Reserved
h?ps://www.paCentsite.org
Bringing It All Together: Patient Portals
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
3/21/14
4
Services: § Prescrip=on refills § Appointment requests § Referrals § View bill
EducaCon: § Search § Info prescrip=ons § Pa=ent selected links § Predefined collec=ons
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Mail: § Secure § Automated rou=ng § Task assignment
Records: § Secure § All system records § Upcoming appointments § Meds, Problems, Results … and Notes § Personal records
Dave (Pre-‐diagnosis)
This is too cool. It's almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
5
Affective Impact: 61M Minister with DM and Chronic Pain
I have a lot of medical issues. This email system has left me feeling comfortable and in good hands! Otherwise, I would feel as cold, depleted, and alone, as the lifeless tree in my front yard in the deepest of winter!
© Copyright 2014 D. Z. Sands, All Rights Reserved
ì e-‐Communica=on includes encrypted e-‐mail or, more commonly, secure web messaging
ì e-‐Communica=on can provide an efficient means of communica=on because it is asynchronous
ì This is cost-‐effec=ve and benefits both pa=ents and physicians
© Copyright 2014 D. Z. Sands, All Rights Reserved
Connecting with Patients: e-‐Communication
Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.
3/21/14
6
Hi - there are several things I want to go over when we meet. I suspect several will require referrals, and given the time it takes to get a slot, I'm thinking of making those appointments now. (It's easy to cancel and create an opening for someone else.) I'm 56 and I generally don't have any complaints. Here are the symptoms I'm concerned about: […] What do you think?
© Copyright 2014 D. Z. Sands, All Rights Reserved
ì The Visit
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
7
The Incidental Finding
© Copyright 2014 D. Z. Sands, All Rights Reserved
The Incidental Finding
INDICATION: Right shoulder pain.
COMPARISONS: Comparison is made to a chest radiograph from December 23, 2003.
TECHNIQUE: Right shoulder, three views.
IMPRESSION:
1. Degenerative changes of the acromioclavicular joint. Normal radiographic appearance of the glenohumeral joint.
2. 3.3 cm right upper lobe lung mass needs further evaluation with a chest CT to exclude malignancy.
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
8
ì Diagnosis, Information, and Support
© Copyright 2014 D. Z. Sands, All Rights Reserved
© Copyright 2014 D. Z. Sands, All Rights Reserved
Lesion 1 – Left Upper Lobe 39x43mm
3/21/14
9
© Copyright 2014 D. Z. Sands, All Rights Reserved
Primary Tumor Found
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
10
© Copyright 2014 D. Z. Sands, All Rights Reserved
ACOR is great. I posted two messages tonight and got responses in 4 and 11 minutes. One responder also sent a private note mentioning Robin and Cathy. The other responder was Cathy. :) Through that list I've also found several other useful sites.
Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved. © Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
11
My doctor prescribed ACOR and it saved my life.
Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved. © Copyright 2014 D. Z. Sands, All Rights Reserved
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
12
© Copyright 2014 D. Z. Sands, All Rights Reserved
© Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands
And There Are More Tools Available…
3/21/14
13
© Copyright 2014 D. Z. Sands, All Rights Reserved
Successful Treatment
Baseline: 39x43 mm 50 weeks: 20x12 mm
ì Sir Francis Bacon English author, cour=er, & philosopher (1561 -‐ 1626)
© Copyright 2014 D. Z. Sands, All Rights Reserved
Knowledge is power.
3/21/14
14
Online Population Rising…
© Copyright 2014 D. Z. Sands, All Rights Reserved
…And Health Info Seeking Popular…
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
15
Online Health Habits of US Adults
Sources: www.pewinternet.org; PwC HRI Social Media Consumer
Survey, 2012
ì 80% of online adults have looked for health info ì Rising over =me ì Each day, more people search for health informa=on than see a physician! ì More than half act on the informa=on
ì 1/3 have read about others’ health experiences
ì 1/4 have tracked their health informa=on online
ì 1/3 use social media for health
© Copyright 2014 D. Z. Sands, All Rights Reserved
e-‐Patients Want To Be Engaged…
Involvement in
Care
Communica=on
Convenience Informa=on
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
16
…But We Make it Difficult: Mismatch Between Desires and Service Offering
0% 10% 20% 30% 40% 50% 60% 70%
Online Appts
Online Billing/Pmts
Online Costs
E-‐mail
Viewing Record
Available Desired (Important/Very Impt)
© Copyright 2014 D. Z. Sands, All Rights Reserved
Source: Harris Interac=ve 9/10/12 at hlp://goo.gl/VzfmT
"Thinking now of new technologies your health care provider could implement, how important would each of the following be to you?” (of pa=ents who saw physician in past year)
Shifting Paradigm?
ì Informa=on asymmetry ì Physician as oracle ì Comfortable ì A burden?
ì Informa=on symmetry ì Physician as partner ì Threatening vs. libera=ng ì Physician as healer
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
17
The Power of “I Don’t Know”
© Copyright 2014 D. Z. Sands, All Rights Reserved
Asking Tacit Approval
Honest Disclosures
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
18
It’s About Engagement
Engaged Equipped Empowered Educated Enlightened Etc.
© Copyright 2014 D. Z. Sands, All Rights Reserved
Ter=ary
Secondary
Primary
Self-‐Care (off the Map)
Professional Care
Dis
cour
aged
E
ncou
rage
d $
¢
Industrial Age Medicine Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. © Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
19
Individual self-‐care
Friends and families
Self-‐health networks
Professionals as facilitators Professionals
as partners Professionals
as authori=es
Professional Care
Dis
cour
aged
E
ncou
rage
d ¢
$
Information Age Healthcare Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. © Copyright 2014 D. Z. Sands, All Rights Reserved
Do We Need Most F2F Visits?
Technology Synchronous? InformaCon Density
Telephone þ ««
E-‐messaging o «
Text messaging/IM o/ þ «
Remote monitoring þ «
Telemedicine þ (usually) «««
Advanced Telemedicine þ ««««
Office visit þ «««««
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
20
h?p://parCcipatorymedicine.org
Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected
parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. The “participatory” concept may also be applied to fitness, nutrition, mental health, end-of-life
care, and all issues broadly related to an individual’s health.
Society for Par=cipatory Medicine
Community Advocacy Research Educa=on
© Copyright 2014 D. Z. Sands, All Rights Reserved
© Copyright 2014 D. Z. Sands, All Rights Reserved
Patients and Physicians Each Have Expertise
3/21/14
21
© Copyright 2014 D. Z. Sands, All Rights Reserved
Patients Can (and Must) Help
ì Slack WV. CyberMedicine: How Computing Empowers Doctors and Patients for better Health Care. Jossey-‐Bass 2001.
© Copyright 2014 D. Z. Sands, All Rights Reserved
It can be argued that the largest yet most neglected health care resource, worldwide, is the pa=ent…
3/21/14
22
The Web Connects to Information, Caregivers, and Each Other (and to Providers)
© Copyright 2014 D. Z. Sands, All Rights Reserved
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
23
© Copyright 2014 D. Z. Sands, All Rights Reserved
Changing Nature of Relationship
Information Asymmetry Information Symmetry
Passive Recipient Active Partner
Patient-Physician Consumer-Provider
Paternalism Participation
© Copyright 2014 D. Z. Sands, All Rights Reserved
3/21/14
24
Conclusions
ì Provider, pa=ent, and carer engagement are cri=cal
ì Par=cipatory Medicine and an important paradigm shir ì “Facilitates pa=ent autonomy, access to informa=on, and choice” ì A new dance that both partners need to learn ì Transforms pa=ent and clinician experience ì Helps shir balance of power
ì Connected technology, including secure e-‐messaging, PHRs, and online resources lowers barriers to engagement, empowering and enabling pa=ents, carers, and providers
© Copyright 2014 D. Z. Sands, All Rights Reserved
© Copyright 2014 D. Z. Sands, All Rights Reserved
Recommended