Care coordination requires that the right information reaches the right people within an optimal time frame, so that a patient’s full information is always at the point of care, and all of the follow-up clinical work, as well as the claims processing behind it, is in place.
This system works pretty well in a contained health care setting such as Kaiser Permanente, the VA or Group Health in Seattle, that has an established digital health record, a viable patient portal and a committed patient population that works with their providers to insure their care coordination.
For the rest of the health institutions and group practices in this country that are not in a contained health care setting, care coordination is difficult at best. There is no question that electronic health records, patient portals and health information exchange that provide access to patient information are critical for care coordination.
Although these are in place in many practices; absent in many others, it is not enough.There has to be a culture of cooperation between physicians and patients that is often missing.
Today, communication of orders for care, health histories, lab results, treatment information, medications, allergies and other vital data are often missing when the patient arrives to receive care.
How can that change?
(1) By having the tools for collaborative exchange of information in place. With cloud computing there are no longer bandwidth restrictions for enabling these technologies, although the costs have to come down. Even with the tools in place, there has to be the desire on the part of the all of the stakeholders in the provider community – primary care physicians, specialists, hospital administrators, pharmacists, labs, payers, and patients – to work together to address this problem and take appropriate actions to make it happen.
(2) By involving patients, encouraging them to establish personal health records, and enabling them to assume some of the responsibility for bringing their information needed at the point of care with them so that it is available when they seek care. There are three distinct configurations available to individuals who want to establish personal health records:
(a) Stand alone data repositories that enable patients to create their own personal health record, and store and maintain it on a secure web site (e.g. WebMD and Revolution Health).
(b) Tethered systems that are an extension of an individual’s provider health record which the individual can access through a portal. (e.g.PHRs created at a payer’s web site)
(3) Interconnected PHR, an external repository of an individual’s health data created by the individual(e.g. Microsoft Health Vault or Dossia).
We cannot assume that patients are going to remain passive recipients of health care, leaving it to their providers to worry about coordination of care. Patients can, and must become part of the team that is managing their health. They must take positive actions to assume control over their health information so care coordination will become a reality and patients will receive better quality, safer health care.
Join me as I discuss patients portals and their role in patient engagement and collaboration.
Great thoughts and discussion of vital points. The largest weakness I see is the patient side and getting them involved. Too many are just passive patients and do not want to be involved. As a patient myself, I am working to influence my fellow patients to become e-patients, but it is a long and tedious process. The informal group that I belong to, all of us see neighbors that go to several different doctors and use several different pharmacies to prevent information from getting to the other doctor or pharmacy. We even tell them that Medicare, supplemental insurance, and Part D insurers do see what is happening. They either don’t believe us or state let them pass this information to the wrong doctor or pharmacy and get sued.
Also missing is the hospitals which mostly oppose patients having access to the information in their files. It is also unfortunate that many doctors oppose having patients involved as part of a team.
I agree that many patients are passive and are either afraid to become involved or are apathetic. You are right that urging patients to become e-patients and achieving a critical mass among the patient population is going to be a long process. Physicians and institutions will have to give patients the tools such as portals and access to their health information. This is happening but very slowly and in isolated silos around the country. As you indicate the system is complicated. That said it is important that people like you and me continue to advocate for involving groups of patients a little at a time. So keep up the good work.