Posts made in December 2013

In 2014, the baby boomers (individuals born between 1946 and 1964) will turn 65 at a rate of nearly 10,000, individuals a day. Over the next five years 17 million baby boomers turn 65.  That’s a lot of people retiring, joining the Medicare system developing chronic health conditions, and needing more care as they age.  The question is how the healthcare system will manage the needs of this generation and of other consumers of health in 2014.

The good news is that legislative mandates passed during the Obama Administration that kick in during 2014, focus on care collaboration, care coordination, and patient-centered care as well as using technology that should result in better outcomes for everyone.

The bad news is that the Accountable Care Act website and some of the healthcare exchanges that were supposed to be ready at the start of the year, and that would provide healthcare for everyone, at a reasonable cost, are a mess, with no easy solutions available.

Notwithstanding the problems with the healthcare.gov site (which will get fixed) there are a lot of exciting advances that we will see 2014.  These include:

New models of care such as the patient-centered medical home with a “whole person” orientation that designs care around a health team that coordinates care and brings the patient into the decision process will be one of the dominant trends.

Meaningful Use Stage 2, the statute that shifts payments to clinicians from a fee for services to performance or value-based compensation takes effect.  This includes requirements that providers must electronically enter orders for in-patients and electronically write prescriptions as well as give patients access to their health data.  It will bring about significant changes in patient/provider relationships particularly with more open communication.

Communication technology is going to be pervasive in 2014. More and more sophisticated m-Health apps will roll out, including apps that offer simple, unidirectional tips via text messages and reminders, to sophisticated, bidirectional apps that track patient vital signs, interact with electronic health records (EHRs) and communicate information back to the providers for evaluation and action.

More than 86% of clinicians and physicians and  56% of all adult patients  now use smartphones and tablet computers to  monitor chronic conditions such as asthma, diabetes, heart disease, cancer, and even autism and insomnia.

In 2014, patients will use their smartphones and tablets to ask their doctors questions, make appointments or get medical test results, access information in their electronic health record, and monitor their health. They will also use them for chronic care management including: monitoring  blood pressure,  blood sugar, weight fluctuation, heart rate, pulse rate, oxygen levels and  peak flow.

Physicians will use their smartphones and tablets chiefly for a number of apps that help them keep current on prescribing, safety information, and best practices.  These include:

Epocrates: which enables physicians to review drug prescribing and safety information, select health insurance formularies for drug coverage information, perform calculations.

Medscape: which offers prescribing and safety information for drugs, procedure, videos, a medical calculator and access to continuing medical education materials

MedCalc: a decision support tool which features an exhaustive list of formulas, scales, scores and  calculations

Doximity: a professional network for physicians which offers the opportunity to connect with other doctors and comes with HIPAA compliant faxing, emailing and text messaging.

Up To Date: a reference service that includes evidence-based recommendations, mobile optimized calculators and a CME tracker.

Chronic care monitoring tools for patients will include a variety of wearable devices that clip onto their wrists or are sensors that are embedded or woven into clothing.  This includes bio-sensing apparel to track daily health and wellness as well as monitor heart rate, breathing and activity levels.  There are also tracker devices that record the intensity and duration of work- outs and can automatically track the calories that people are consuming.

Social networking will continue to play a major role in 2014 as patients connect with others so they can compare symptoms and treatments, and offer empathy and encouragement. These online health communities give patients a way to understand their illness, both individually and in the context of everyone else. For people facing a new diagnosis, undergoing treatment, or living with chronic illness, social networks enable them to tap into larger groups of individuals where they can share information and opinions.

Social media in 2014 is going to transform how doctors and patients interact with each other. For example, doctors will increasingly use options such as Google Hangouts, as an innovative economical way for them to deploy technology to connect with patients and set standards for a transparent, patient-centric model of healthcare that helps them capture and resolve patient issues and increase loyalty and satisfaction. These social media strategies open the communication channels with patients and enable feedback and better service.

Population health: The ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of this data to those responsible for preventing and controlling various disease will be another hot button in the health care world of 2014. Enabling tools are available that allow researchers to aggregate information from multiple sources to track disease clusters in real-time.  More disease surveillance programs that identify and take actions on outbreaks for strep, whooping-cough and bacterial meningitis, hepatitis and many other diseases will emerge this year.  Additionally doctors will be doing a lot more with data analytics that come from genetic and genomic testing as the costs go down and the ability to identify specific genome markers becomes more widespread.

In the hospital, Accountable Care  Organizations,  (ACO), will continue to be the watchword. ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily  to foster payment and care delivery models that seek to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients..

The 2014  hospital will also see the increasing use of wireless sensing, radio frequency identification (RFID) and near-field communication (NFC), bar codes that help these institutions move toward safer, more efficient and intelligent hospitals. Near field communication (NFC) is a set of standards for smartphones and similar devices to establish radio communication with each other by touching them together or bringing them into proximity, usually no more than a few inches.

Retail Clinics: Retail Clinics will continue to proliferate because they  are generally open during evening and weekend hours when patients have very few choice about where to go for treatment if they do not want to go through the hassle of the emergency department. Many payers are beginning to  cover treatment delivered by a Retail Clinic.

Kiosks that are in pharmacies, shopping malls, and  airports and that  enable people to get basic vital signs read and allow them to connect with an online doctor for quick advice about a medical condition at a low price point will also become more common.

In spite of the many problems that continue to plague U.S. healthcare, in 2014 we will move toward a more connected system where technology will enable patients and providers to communicate more effectively to achieve better results.  The hope is that we do not lose sight,  this year, of the urgent need to use these same technology advances to educate and support our consumer populations so they better understand their care delivery options and costs.

 

Even in this day and age with all of our smartphones, internet savvy and media hype, when we go to the physician for a check-up many of us tend to sit back, listen and nod in response to a doctor’s advice on our conditions or treatments.  Not very participatory, is it?

Many efforts are underway to engage patients to become part of their healthcare team.  These attempts at communication and shared decision-making represent a critical step in moving patients closer to the core of their care, and our health system closer to patient-centered care.  The availability of technology that fosters information exchange amongst all parties, as well as cultural changes among health professionals who are caring for patients, is enabling this partnership of collaborative care.

To push the envelope even further, the health care legislation that mandated that all physicians must have electronic health records, also mandated that by 2014 providers need to more actively engage patients by providing them with the capability to electronically view, download and transmit relevant information from their provider’s electronic health records, including lab test results, a list of current medications and hospital discharge instructions.  The legislation also requires that physicians engage in email with patients.

It all comes down to good doctor-patient communication.  When patients are given access to their medical information and assisted so that they understand what it is about, they respond to their treatment options in a more open and rational, less emotional way.

Collaboration enables patients and providers to better identify  needs, perceptions and expectations.  It results in patients who are satisfied with their care, who follow advice and adhere to the prescribed treatment, which generally results in a better outcome. There are many barriers to good communication in the doctor-patient relationship, including patient’s anxiety and fear, and  doctors heavy workload,  fear of litigation and unrealistic patient expectations.

We know that patients are first turning to the Internet to find health information and often bring that information to their office visit and ask questions about what they have read.  According to a PEW Internet and American Life Survey, “fully 80% of adult Internet users or about 93 million American have searched for at least one of 16 major health topics online.  This makes the act of looking for health or medical information one of the most popular activities online after email and researching a product or service before making a purchase.”

Collaborative care goes way beyond Internet surfing and gathering health information.  Patient to provider, provider to provider, clinician to patients and caretakers; these interactions are all part of the effort to give patients their health data and include them as a part of the health care team.   It is a cultural change for both patients and providers when each team member’s unique knowledge, skills, needs and abilities are considered, as well as the  demographic, social, and  financial considerations of the patient.

Some of the ground rules for this collaborative care model include:

Patients have the right to see their information that physicians have historically kept to themselves. They are entitled to obtain copies or summaries of their medical record and  to have their questions answered.

Patients and providers must mutually discuss the benefits, risks and cost of appropriate treatment alternatives.

Patients should receive guidance from their physicians as to the optimal course of treatment

Patients have the right to make an informed decision regarding the health care that is recommended by their physician and can accept or refuse any recommended medical treatment.

Patients have the right to independent professional opinions

Patients are entitled to courtesy, respect, dignity, responsiveness and timely attention to their needs.

Patients have the right to confidentiality and their health information cannot be shared without their consent.

Physicians have the obligation to coordinate patients’ care so they experience continuity of care.

When I see my doctor and discuss my complicated health issues with him, by having access to my health information, I know that I can make intelligent health decisions.  When I am a respected member of my health team and experience collaborative, patient-centered care, I know that this is  right for me, for my family and for the millions of health care consumers who need to become a more integral part of their own health care. Not only will this approach improve the quality of care for everyone, but it will, over time, reduce the cost of care because patients will take more responsibility, better adhere to treatment and conserve our limited health resources.