Friday, March 26

Patient centered care is core principal of Health IT and ARRA

HITECH ACT Section 3001- Patient centered care - Meaningful public input - Improve coordination of info

Section 3001 of the HITECH portion of ARRA.  The National Coordinator is to develop a “nationwide health information technology infrastructure that allows for the electronic use and exchange of information that”-- ‘(2) improves health care quality, reduces medical errors, reduces health disparities, and advances the delivery of patient-centered medical care; ‘(5) ensures the inclusion of meaningful public input in such development of such infrastructure;‘(6) improves the coordination of care and information.

One of key goals of  health care system is  patient-centered care.

Ever since the Institute of Medicine’s 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, we have been working towards a patient-centered care health care system that among other things: “establishes a partnership among practitioners, patients, and their families, to ensure, that patients have the information, communication, education and support they need to make decisions and participate in their own care"

IHI - Critical role for information sharing in informed  decision making.

The  Institute of Healthcare Improvement also identified  the “critical importance of information sharing and decision-making” as one of the four core concepts of patient-centered care.“ You need to include “patients on health care improvement and design teams” so that they “have the tools and support they need” to be empowered, educated, informed consumers and “effectively participate in their care and decision making. ”

Business Case –places with highest adoption rates engaged consumers first.

In an ideal “patient-centered system we would design our systems around patients and their care communities rather than around clinicians, doctor offices  and centered on the needs of the system itself. One system with the highest EMR adoption rates in the US, (50% of 540,000) accomplished this by using a collaborative model of consumer engagement at each stage of design,  implementation, adoption and optimization. Patients were actually  able to “write” to their chart via email and this helped pull the providers forward through the adoption stage.The resulting “Shared Care” EHR model  (vs a fragmented EMR/PHR) prioritized consumer needs (convenience, access to information).  In some family practices for example  up to 50% of all encounters are done remotely via technology, with clear cost savings and improved patient satisfaction scores.

Informed Patients - Cost savings  -  Patient satisfaction.

When patients are fully informed of their treatment options, they generally select the least invasive or costly one-to improve patient understanding of their health care options, to reduce the rate of procedural interventions, and most importantly to increase patient satisfaction with their care provided and confidence in the decisions they make." States Explore Shared Decision Making, Kuehn, JAMA.2009; 301: 2539-2541.

Current State - Expected Outcome

Consumers aren’t waiting for EMR’s or “Health IT. ” They are already using information technology to research health care concerns and find support  in increasing numbers. Pew Research  /California HealthCare Foundation  In order to end up with a patient centered health care system you must engage all of the stakeholders voices especially consumers at each point in the process in order to ensure success.

We aren't wiling to wait a couple of years to have email access to your providers, real time results reporting, the ability to take our records with us from one provider to another electroncially (that doesn't mean asking for something and waiting 48 hours) nor does it mean a PHR - which is often just a data repository.

 We are not only the patients and the customers of the healthcare system we are also the ones who are ultimately paying for the entire system of both healthcare and health IT, so it seems like it would make sense to not only consider our needs in the design but put them first..

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