From Patients to ePatientsDriving a new paradigm for online clinical

collaboration and health management

From Patients to ePatientsDriving a new paradigm for online clinical

collaboration and health management

David Bennett, SVP, Interactive SolutionsStayWell Custom Communications

Anthony Chipelo, Director, Portal StrategiesCareTech Solutions

Follow us on @ eHealthSeries

The FutureThe Future

…When patients participate more actively in the process of medical care, we can create a new healthcare system with higher quality services, better outcomes, lower costs, fewer medical mistakes, and happier, healthier patients. We must make this the new gold standard of healthcare quality and the ultimate goal of all our improved efforts.

Not better hospitals.Not better physician practices.Not more sophisticated electronic medical systems.Happier, healthier patients.

– Charles Safran – Chief, Division of Clinical Informatics Beth Israel Deaconess Medical Center

Source: e-Patients: How They Can Help Us Heal Healthcare.

Getting There: 7 Getting There: 7 Preliminary ConclusionsPreliminary Conclusions

1. e-Patients have become valuable healthcare resources and providers should recognize them as such.

2. The art of “empowering” patients is trickier than we had thought.

3. We have underestimated patient’s ability to provide useful online resources.

4. We have overestimated the hazards of imperfect online health information.

5. Whenever possible, healthcare should take place on the patient’s “turf.”

6. Clinicians can no longer go it alone.

7. The most effective way to improve healthcare is to make it more collaborative.

e-Patients as e-Patients as Valuable ResourcesValuable Resources

• Little impact on clinical workflow

• Few clinicians:– Ask patients what they know about their illness or what they should do.– Introduce “like” patients to one another or promote online support

communities.

• Many provider organizations do not:– Collect patient email addresses– Ask patients to provide critiques of the services they receive– Invite patients to collaborate with them

• Clinicians that support their patient’s essential role in self-management find they:– Exhibit fewer symptoms– Demonstrate better outcomes– Require less professional care

Art of Empowering Art of Empowering PatientsPatients

• Empowering patients requires a change in the patient’s level of engagement

• Clinician-provided content:– Has little effect in the absence of patient engagement.– Must successfully communicate to patients they can effectively manage

their health.

• Professional interventions will not empower patients unless underlying relationships between patients and clinicians are fundamentally transformed:– Unwillingness to address important issues of knowledge, power, and

control among providers and patients.– Most medicine is 10 parts culture to 1 part real science. – A good deal of what happens in healthcare is invisible to most clinicians.

Patients & Online Patients & Online ResourcesResources

• More Websites being developed by patients/patient advocates versus healthcare organizations/professionals.

• Things clinicians know and things self-helpers know can compliment each other.

• Patients learning that:– They are qualified through experience, knowledge, and concern– Capable of contributions no professional can make– Linking efforts/coordinating with professionals can advance well being.

Hazards of Online Hazards of Online Health Information?Health Information?

• Are patients injured due to bad online information? Two studies:– Study #1 – First decade of Internet, one case reported that resulted in fatality.– Study #2 – First 4 years of project, one case reported of possible fatality.

• Offline: – 42% of US adults reported they experiences a medical error– Institute of Medicine – Hospital deaths due to medical errors = 44,000 – 98,000

annually (195,000 annually as reported by HealthGrades).– Adverse reactions to common medications sent 700,000 people to the

emergency room annually. – JHU study – Healthcare hazards third leading cause of death.– Things clinicians know and things self-helpers know can compliment each other.

• Summary:– Putting oneself in the hands of medical professionals may be considerably more

dangerous than attempting to learn about ones medical condition on the Internet.– Over generalized warnings clinicians give patients about the bad quality of

information on the Internet will in retrospect be considered counter productive and ill-advised.

Healthcare on Healthcare on Patient’s TurfPatient’s Turf

• Professional space: – Within medical professionals realm of control– Patients must conform to clinician’s rules, procedures, standards, and

schedules.– Experiences, needs, and capabilities of patients has evolved

dramatically:• Professionals operating in this space tend to ignore this reality• Prevents ability to respond to patients needs

• Consumer space:– Space and choices made belong to the patient– Patient sets rules of relationship:

• Relationships not constructed mechanistically• Out of necessity relationships are intimate and authentic

– Relationships build over time out of mutual respect and interpersonal trust.

• Self-help cyberspace: Autonomous patients use online health resources of their choosing and within realm of their control.

Clinicians Going it Clinicians Going it AloneAlone

• In past century medical information has increased exponentially, but capacity of brain to store and process it has not.

• Not possible for medical professionals to stay updated on long list of medical conditions.

• Patients can learn more from Internet than their provider

• Informed patients are blessing not curse:– Can lift burden of care off shoulders of overworked clinicians– Upgrade customer service and improve quality of care – avoid, detect,

and manage medical errors.– Become colleagues and partners

Collaborative Collaborative HealthcareHealthcare

• Cannot replace old physician-centered model with patient-centered model.

• New collaborative model required that draws on strengths of both traditional and emerging healthcare systems.

• Help 21st century physicians and 21st century patients work together in 21st century ways.

Healthcare ReformHealthcare Reform

Like it or not the recent legislation will have far reaching impacts on society including our relationship with our providers as well as the way we will need to deliver healthcare.

With the addition of an additional 30 Million+ individuals with health coverage we will be faced with many new challenges in the next 10 years.

Savvy organizations are at last realizing this and focusing on solutions to address the expected tidal wave.

The Wave’s ImpactThe Wave’s Impact

With 30 Million potential new customers with insurance coverage hospitals and health systems will focus on capturing their fair share of these new consumers.

As a result, consumer focused healthcare will continue to grow.

As health consumers become more knowledgeable they will naturally gravitate to organizations that not only have high quality outcomes but also are able to provide higher levels of service along with better than average patient satisfaction scores.

Chronic Conditions Chronic Conditions are here to Stayare here to Stay

It is estimated that health care costs for chronic disease treatment account for over 75% of U.S. expenditures.

With the aging of our population we will see increased numbers of individuals with chronic conditions.

The 50/50 RuleThe 50/50 Rule

Patient Portals can aide in the aggregation of information and tools that allow the consumer to better manage his/her health while engaging the consumer/patient.

• 50% of prescribed medications are not taken

• 50% of preventative screenings are not done

• 50% of the population is obese

• 50% of recommended vaccinations in adults do not occur

• 50% of follow up mammograms in women diagnosed and treated with Breast CA are not done (ACS 2006 statistic)

Participatory Participatory MedicineMedicine

“Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.”

From: Society for Participatory Medicine

Value Added ServicesValue Added Services

Consumers will also seek value added services from providers that allow them to better manage both their health and the health of other family members.

Organizations and providers that can deliver on these value added services will see an ever increasing market share and corresponding improvements in patient satisfaction.

Engagement is KeyEngagement is Key

• Consumers want more than just static information.• Consumer want more “Do it Yourself Services” • Merely presenting passive information offers marginal value to

the average healthcare consumer.• Interaction is key to engagement.• Organizations/ providers will need to focus on engagement that

leads to positive experiences and outcomes.

Technology offers a Technology offers a SolutionSolution

With fewer physicians treating more patients, consumers will be even more responsible for managing their own health issues. Physician shortages are increasing, especially in Primary Care and are projected to be as high as 159,300 by 2025.

As the government focuses on controlling costs, quality & outcomes will become increasingly important over the next decade. We can expect that those organizations that deliver high quality outcomes while containing costs will be rewarded.

Innovation will be at the core of success.

Limited ResourcesLimited Resources

With a finite number of healthcare providers organizations will need to embrace new technologies to augment the traditional delivery and patient support models.

Provider portals provide a platform for organizations to aggregate health information, patient education, personal health records, decision assist tools and even innovative programs such as digital coaching.

Limited resources call for new solutions

EngagementEngagement

The Key to successful engagement is to provide the patient tools and information that allow him/her to better make decisions around their particular condition.

Organizations that readily invest in the deployment of such tools and resources will continue to see significant returns in the form of improved patient satisfaction, retention and outcomes.

Examples include:

- Condition Specific Patient Education - Web based Informed Consent Programs- Decision support tools such as those developed by Harvard

Diabetes Diabetes ManagementManagement

In this scenario, the patient is offered the Health Risk Assessment (HRA). This HRA data would feed the electronic medical record (EMR) and be available for the provider to view. Based upon the visit to the Provider, and subsequent diagnosis of Diabetes, the Provider has the option to offer three digital coaching interventions to augment and extend his/her reach. They could include the Care For Diabetes™ program to help the patient manage their Diabetes. Since eating habits and physical fitness are key components of managing Diabetes, the provider could optionally offer the Nutrition™ and Move™ programs.

Takes the Succeed HRA

Patient

Has HRA data available in the

EMR

Provider

DX= DiabetesPrescribes Digital

Coaches Care For Diabetes

Nutrition

Diet Under ControlPrescribes Digital

CoachMOVE for Fitness

Provider Patient Provider Patient

Heart Health Heart Health Program, Pre & Post Program, Pre & Post

ProcedureProcedureIn this scenario the patient is also offered a HRA. After taking the HRA and identifying out of range blood pressure, cholesterol and BMI, the patient is automatically recruited for the Control™ intervention for blood pressure management, the Achieve intervention for cholesterol management, and the Balance™ program to help manage diet.

Again the HRA data can feed the EMR and be available for the physician to review. When the patient is seen by the Provider (which is recommended by the digital coach), the treatment options may include medication and/or surgery. In either scenario, the physician can prescribe or recommend post procedure the Balance™ and Move™ interventions.

Takes the Succeed HRA

Patient

High BP?

High Cholesterol?

High BMI?

Self Enrolled into Control to Manage

BP

Self Enrolled into Achieve to manage

cholesterol

Self Enrolled into Balance

EMR View of Coaching Activities

My prescribe Meds or surgery

Provider

CardiacCath

CABG

Patient

Patient

Optional Post Procedure

Coaches Available as Needed:

BalanceMoveRelax

AchieveControl

Depression

PatientPatient

Patient

Patient

Questions and AnswersQuestions and Answers

David.Bennett@StayWellCustom.com Anthony.Chipelo@CareTech.com