Sands - Engaging e-Patients - NoCal HIMSS 2014€¦ · Title: Sands - Engaging e-Patients - NoCal HIMSS 2014.pptx Author: Dr. Danny Sands Created Date: 5/20/2014 10:46:52 PM

Sands&'&Engaging&e'Pa-ents& 5/20/14&

1&

!&

Daniel&Z.&Sands,&MD,&MPH&@DrDannySands&Society&for&Par-cipatory&Medicine&Beth&Israel&Deaconess&Medical&Center&Harvard&Medical&School&Boston,&MA&

Engaging&e(Patients&in&a&Digital&World:&How$Consumer,Facing$Technology,$Collabora8on,$and$Transparency$Changes$Everything&

©"Copyright"2014"D."Z."Sands,"All"Rights"Reserved">"@DrDannySands"

Disclosure&of&Financial&Relationships&

!  Conversa&Health&–&Consultant&/&CMO&

!  Kinergy&Health&–&Consultant&/&CMO&

!  SeniorLink,&Inc.&/&Caregiver&Homes&–&Consultant&&

Daniel"Z."Sands"has&rela-onships&with&en--es&producing,&marke-ng,&re'selling,&or&distribu-ng&health&care&goods&or&services&consumed&by,&or&used&on,&pa-ents.&



2&

!&Connecting&and&Agenda(Setting&


!&e(Patient&Dave&deBronkart&First&of&Ten&Fundamental&Truths,&Let$Pa'ents$Help,&2013;&hVp://epa-entdave.com&$


Pa-ent&is&not&a&third&person&word…your$'me$will$come."


3&


h6p://illness.DrDannySands.com$

h@ps://www.paDentsite.org""

The&Technology&Foundation:&&A&Patient&Portal&



4&

Services:&" Prescrip-on&refills&" Appointment&requests&" Referrals&" View&bill&

EducaDon:&" Search&" Info&prescrip-ons&" Pa-ent&selected&links&" Predefined&collec-ons&


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.



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!



www.myopennotes.org&&


6&


“Aaer&the&first&year,&99%&of&the&pa-ents&surveyed&wanted&‘open&notes’&to&con-nue,&85%&of&the&pa-ents&indicated&that&ready&access&would&be&important&for&their&future&choice&of&a&provider&or&system,&and&no&doctors&chose&to&discon-nue&the&prac-ce.”&

What&Do&e(Patients&Want?&


Involvement&in&&

Care&

Communica-on&

Convenience&Informa-on&


7&



Communica-on&

�Sorry,$Dr.$Sands$no$longer$sees$people.$He$e,mails$them.�$©"Copyright"2014"D."Z."Sands,"All"Rights"Reserved">"@DrDannySands"

Dr.&Sands&not&seeing&patients&


8&

!  Includes&encrypted&e'mail&or,&more&commonly,&secure&web&messaging&

!  Enables&efficient&communica-on&because&it&is&asynchronous&

!  Is&cost'effec-ve&and&benefits&both&pa-ents&and&physicians&

!  Augments&rela-onship&building&

!  Is&a&channel&for&care&delivery&


What&Have&We&Learned&About&e(Messaging?&&

Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.

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?


Not&Just&for&Problems:&Visit&Planning&


9&

!&The&Visit&


The&Incidental&Finding&



10&

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.


!&Diagnosis,&Information,&and&Support&



11&


Lesion&1&–&Left&Upper&Lobe&39x43mm&


Primary&Tumor&Found&


12&



Informa-on&

hVp://www.nlm.nih.gov/share/image/Nlm_building_lg.jpg&hVps://twiVer.com/HMSCountway&


Information&is&No&Longer&Locked&Up&

&This&work&by&Old&Shoe&Woman&is&licensed&under&a&&Crea-ve&Commons&AVribu-on'Non'Commercial'ShareAlike&2.0&Generic&License.&

hVp://cnn.com&


13&


!&Pierre&Lévy,&PhD&Philosopher,&cultural&theorist,&and&media&scholar,&University&Of&OVawa,&1997&


No&one&knows&everything.&&&Everyone&knows&something.&&All&knowledge&resides&in&networks.&

&This&photo&by&cpfl&cultura&is&licensed&under&a&Crea-ve&Commons&AVribu-on&2.0&Generic&License.&


14&


h@ps://www.acor.org""

“We$met$online.”$



15&

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">"@DrDannySands"

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">"@DrDannySands"


16&

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">"@DrDannySands"



Convenience&


17&

…stand&in&line&for&a&&bank&teller?&

…make&airline&reserva-ons&through&a&travel&agent?&&


How&Many&of&&You…&

hVp://thingsmykidswontknow.tumblr.com& hVp://www.triporama.com/&


Then&Why&Is&Healthcare&So&Backwards?&

The doctor’s booked for

the next five months!!


18&


It&Doesn’t&Have&To&Be&

hVp://www.zocdoc.com/&


Ideally,&What&Is&Patient&Care?&


19&


Patient&Care&Is&a&Collaboration&…&


…&But&Collaboration&≠&In&Person&

Source:&natr/Community&Telco&


20&


The&Consumerization&of&Health&&and&the&Virtualization&of&Care&

Diagnose and Treat

Prevent and

Maintain

Physical Resources

Virtual Resources

Drivers:"•  Burden&of&chronic&illness&•  Aging&popula-on&•  Resource&maldistribu-on&

•  Cost'containment&

•  Consumer&demand&

Health Treatment

Hospital

Home

Anywhere

Built&on&ideas&from&Michael&Gill&

$$$$$"

$"

Would&You&Like&a&Visit&With&That&Care?&

Technology" Synchronous?" InformaDon"Density"

Telephone" #& $$&

E>messaging" %& $&

Text"messaging/IM" %/&#& $&

Remote"monitoring" #&& $&

Telemedicine" #&(usually)& $$$&

Advanced"Telemedicine" #&& $$$$&

Office"visit" #&& $$$$$&



21&


We&Must&Focus&More&on&Chronic&Disease&Prevention&and&Management&


Successful&Treatment&

Baseline: 39x43 mm 50 weeks: 20x12 mm


22&

!&Sir&Francis&Bacon&English&author,&cour-er,&&&philosopher&(1561&'&1626)&"


Knowledge&is&power.&

Online&Population&Rising…&



23&

…And&Health&Info&Seeking&Popular…&


Online&Health&Habits&of&US&Adults&

Sources:&www.pewinternet.org;&PwC&HRI&Social&Media&Consumer&

Survey,&2012&

!  80%&of&online&adults&have&looked&for&health&info&!  Rising&over&-me&!  Each&day,&more&people&search&for&health&informa-on&than&see&a&physician!&&!  More&than&half&act&on&the&informa-on&

!  1/3&have&read&about&others’&health&experiences&

!  1/4&have&tracked&their&health&informa-on&online&

!  1/3&use&social&media&for&health&



24&


20K"iPh

one"con

sumer"h

ealth"ap

ps"in"201

4"

Source:$hBp://itunes.apple.com$and$hBp://mobihealthnews.com/13368/report,13k,iphone,consumer,health,apps,in,2012/$$&


Patient(Generated&Health&Information&

Opportu

nity?"


25&

Fun&Mobility&Facts!&


!  90%&of&US&adults&have&a&mobile&phone&!  63%&use&it&to&go&online&!  34%&go&online&mostly&using&phones!&

!  58%&of&US&adults&have&a&smartphone&!  But&only&19%&of&those&65+&!  But&only&47%&of&those&earning&<&$30k/yr&

!  42%&of&US&adults&have&a&tablet&computer&

!  44%&sleep&with&their&phones&

!  Messaging&and&accessing&internet&most&popular&

Fun&Mobility&Facts!&

©"Copyright"2014"D."Z."Sands,"All"Rights"Reserved">"@DrDannySands"hVp://www.pewinternet.org/fact'sheets/mobile'technology'fact'sheet/&


26&

e(Patients&Want&To&Be&Engaged…&

Involvement&in&&

Care&

Communica-on&

Convenience&Informa-on&


…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)&


Source:&Harris&Interac-ve&9/10/12&at&hVp://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)&

Opportu

nity!"


27&

Meaningful&Use&and&Patients&



No&Problem—I&Can&Write&an&App!&


28&

But&It’s&Not&So&Easy&&

Physician&Reluctance&

Pa-ent&Reluctance&

Business&Issues&

Clinical&impact&

Workflow&

Standards&

Regula-on&

Liability&

Data&Integra-on&


Shifting&Paradigm?&

!  Informa-on&asymmetry&! Physician&as&oracle&! Comfortable&! A&burden?&

!  Informa-on&symmetry&! Physician&as&partner&! Threatening&vs.&libera-ng&! Physician&as&healer&



29&

It’s&About&Engagement&

Engaged Equipped Empowered Educated Enlightened Etc.


It’s&Not&About&Meaningful&Use&Alone&

Pa-ent&Engagement&>>&Meaningful&Use&

Meaningful&Use&>>&&Checking&the&Boxes&

Meaningful&Use&is&a&Floor&&Not&a&Goal!&



30&

h@p://parDcipatorymedicine.org"

Par-cipatory&Medicine&is&a&coopera-ve&model&of&health&care&&that&encourages&and&expects&ac-ve&involvement&by&all&connected&

par-es&(pa-ents,&caregivers,&healthcare&professionals,&etc.)&&as&integral&to&the&full&con-nuum&of&care.&&

Society&for&Par-cipatory&Medicine&

Community& Advocacy& Research& Educa-on&

©&Copyright&2014&D.&Z.&Sands,&All&Rights&Reserved&'&@DrDannySands&

Patients&and&Physicians&Each&Have&Expertise&



31&

Patients&Can&(and&Must)&Help&


!&Slack&WV.&CyberMedicine:,How,Computing,Empowers,Doctors,and,Patients,for,better,Health,Care.&Jossey(Bass&2001.&&&

It&can&be&argued&that&the&largest&yet&most&neglected&health&care&resource,&worldwide,&is&the&pa-ent…&



32&


Changing&Nature&of&Relationship&

Information Asymmetry Information Symmetry

Passive Recipient Active Partner

Patient-Physician Consumer-Provider

Paternalism Participation



33&

Conclusions&

!  Physician&and&pa-ent&partnership&are&cri-cal&

!  Par-cipatory&Medicine:&an&important&paradigm&shia&!  A&new&dance&that&both&partners&need&to&learn&

!  Transforms&pa-ent&and&clinician&experience&

!  Promises&to&improve&quality&and&reduce&costs&

!  Connected&technology—including&secure&e'messaging,&&portals,&pa-ent'generated&health&informa-on,&and&online&resources—lowers&barriers&to&engagement,&empowering&and&enabling&all&stakeholders&




34&

Questions?

Questions&and&e(mail&address&

[email protected]"

h@p://www.DrDannySands.com""

@DrDannySands"©"Copyright"2014"D."Z."Sands,"All"Rights"Reserved">"@DrDannySands"

Documents

Sands - Engaging e-Patients - NoCal HIMSS 2014€¦ · Title: Sands - Engaging e-Patients - NoCal HIMSS 2014.pptx Author: Dr. Danny Sands Created Date: 5/20/2014 10:46:52 PM