Navigating Healthcare – Patient Safety and Personal Healthcare Management

We the Patient Want to be Included in Meaningful Use

Posted in Healthcare Information, Personal Health Record, Primary Care by drnic on May 22, 2009

There is a great post on THCB “Bringing Patients into the Health IT COnversation About ‘Meanaingful Use‘” by David Kibbe. We are looking at $34 billion of our money being used over the next several years to improve our health

After all, we, the taxpayers, will pay for all this hardware, software, and associated
training. There are many more consumers of health care than doctors or health care professionals. Shouldn’t we have a say in what matters – in what is meaningful – to us?

As is often the case the end user is forgotten. Clinicians often complain they are forgotten in the design and build of EMR’s. The same is true of the HITECH and ARRA investments for patients. Their voice is hard to hear if not completely absent. But as the article clearly points out we are already using technology and find much of what we need online without recourse or even the desire to contact our local healthcare provider. When we do the process is archaic at best and fails miserably to provide the necessary information in a form we can use. In a recent discussion in a medical office I asked the question what clinical system the office used…..they had no idea. So it was not a great surprise when I asked for my records in digital form that they looked at me with blank stares akin to the deer in headlights! I have yet to have a reasonable response to this simple request.
The suggested included elements to cater to patients for meaningful use were:

  • Prevention and screening reminders. As appropriate, these should be shared along with a personal health plan and full access to one’s records.
  • Patient decision aids for major surgery and procedures. This might include messaging pre-and post-surgery to help avoid waits and delays.
  • Patient instructions for acute and chronic conditions. What to do at home; what signs of problems or improvements to look for; when to call if symptoms develop or improvements don’t occur as expected.
  • Guided self-management messaging for chronic conditions.  Instructions in self monitoring, lifestyle, medications management, action plans, etc.
  • Visit preparation for scheduled visits.  This could include questions to ask the doctor or provider and biometric instructions, e.g. the need to fast before a test.

A great start but still a long way to go since it does not guide the interoperability issues and the need of the patient to have the data in a form they can use (paper or any proprietary format just doesn’t count). You can bet we will start down this track with the usual suspects producing their proprietary system that you have to log in and set up an account for each and every office and facility you visit. None talking tot he other or sharing he information in a way that allows other systems to use. Reminds me of the status with ATM’s when you had to find your bank’s ATM since cards only worked in that ATM. It was also a non connected network (this particular fact worked in favor of an old medical school friend who used this to extract cash from his empty account after midnight when the machine was unable to check his balance and therefore had to allow him access to cash!)

Meanwhile we the consumer must fight tooth and nail with these systems and facilities that are focused on their profits and keeping their patient’s – god forbid they made it easy for a patient to select another doctor or facility by providing information that was portable. Until the incentives and the money lines up behind this it seems unlikely that things  will change dramatically.Meanwhile there is a big lobby of interested parties focused on keeping control and the information (seen as power) out of the hands of the consumer.


Healthcare Historical Solutions

Posted in Healthcare Information, Healthcare Policy, Personal Health Record by drnic on May 13, 2009

Unfortunately history does not bode well for our ability to solve the current healthcare crisis and while it seems the accepted norm to find blame in all manner of elements and contributors it turns out that we have tried much of this in the past and as this chart shows
Over the last 35 years we have seen all manner of attempts but none have managed to curb costs and expenditure……Health Affairs featured a short piece titled “The Sad History of Health Care Cost Containment” which makes sobering reading. Interesting in the Carter years there was a similar sequence of events with the government flexing its muscles and the health care industry quick to offer

what it called the “Voluntary Effort.” The rate of increase in per capita private-sector health spending fell rapidly but then bounced back within a few years

Sound familiar….? Same old story same old special interests. At some point the we the consumer will have to take control over our own destiny and apply market pressures and economics. Get ready to take control of your own healthcare and become an e-patient as described in this white Paper: e-Patient’s and the focus of the site