implications of information technology and consumer participation in health care patricia flatley...

Implications of Information Technology

and Consumer Participation in

Health CarePatricia Flatley Brennan, RN, PhD, FAAN

Moehlman Bascom Professor

School of Nursing and College of Engineering

University of Wisconsin-Madison

Challenges and Changes

in Health Care Delivery

Changes in Health CareShifting responsibilities, shifting

costs, shifting valuesShortened Length of StayEmphasis on evidence and

outcomesBroader idea constitutes health

What is health care & who’s involved?

Patient

Professional

Disease Self Help Self Care Management

Patients are

Changing, too!at least some of them

Transitions in our view of patients

From ‘flat and silent’

To Collaborative Problem Solvers

What makes patients change?

clinical recognition of the importance of patient participation

social valuing of autonomy, self-help and self-determination

withdraw of previously-delivered service changing cost model

Moving the site of care

Contemporary Health Care rests on a

successful partnership betweenPatients, Clinicians, and Delivery

Systems

Consumer Health Informatics: Putting Information Resources in the

hands of Consumers

Accepted and Alternative Health General Health Information Personal Health Data

Delivering CHIBroadcast and print mediaThe InternetHealth-related WWW sitesSelf help BBS, Listsrvs & e-mail

groupsFreestanding kiosks, CD-ROMs, and

SmartCards

Evaluating CHI

Perspectives: Credentialling sites or Educating consumers

Involved groupsODPHP Scientific PanelHITI, Inc (Mitretec)AMIA Internet Working Group

CHI JIT Y2K

SMART Patients

SMART Patients Self-assured Motivated Aware Resourceful Talented

Remember they may also be:

Scared Minors!

Anxious Reluctant Time consuming

Common behaviors of SMART patients

self triagevalues and preference clarificationparticipativecollaborativeindependently engage in health

promotion

What they aren’t :complacentquietunchallengingsimilar

SMART Patients: Who needs ‘em?

we do!Why? partners in careClinicians have too much to do episodic nature of care doesn’t work

any more

Clinician’s responses to the SMART patient:

engaging tolerant dismissive condescending

The Challenges for Clinicians

Use technology to help make patients smarttreat them as a resourceChange our practice activities to capitalize

on their talentsReorganize our practice environments

What are we expecting patients to do?

case managemonitorperform therapeuticsinitiate conversation with us

Information tools needed:

access to their clinical recordsPersonal Case Management

toolsCHI and assistance with using

it (access, interpretation)

Clinical Practice IssuesHenderson “...what the patient can

do...”Re-examining every actionTrusting our colleaguesTiming of interventions

Clinical RolesContent ExpertEnvision a clinical practice that

makes use of the patient as a resource

Re-organize care and care activities to incorporate patients

Constructing a Health Care Delivery

System responsive to

SMART Patients

Clincial Systems Issues

Collaborative with other disciplinesreciprocity of change

Practice StandardsOptimized work patternsIncentive Structures

Information Systems Issues

Patient-centered careLanguage:

Data relevant to all care providersMapping from professional to vernacular

Inter-organizational communicationSecurityCost model

Clinical information systems integration

InformationTechnology’s Response

Patient- Centered Systems

Patient-Centered Systems

Clinical Records Network CommunicationConsumer Health

Informatics

Clinic

Hospital

Physician Office

Pharmacy

FurtiveRecords

Dentist

Patient-Centered Information Systems

What can you do differently tomorrow?

There are degrees of SMART!

Not all patients are equally SMART -- nor are they smart in the same way

but we must seek that which is SMART in each patient

Seen any ‘SMART’ patients lately?

...they’re there,

everywhere!