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Healthcare Basics Newsletter, April 13, 2016

Communication, Collaboration, Coordination, Innovation

The New Era in Healthcare


 Image result for communication in healthcare electronic health records

The new era of digitizing patient records so they can be accessed in real-time by multiple health care providers, patients and caretakers has finally arrived. The paper files that physicians held onto for so long, (some are still using them) have been replaced with digital health records. The good news according to the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. is that more than 75% of all physicians now use some type of electronic record system, up from 18% in 2001,

Over 65% of American doctors also “routinely” send patient prescriptions electronically to the pharmacy and more than half use digital tools for basic clinical tasks, such as receiving alerts, and sending and receiving electronic lab reports to and from their medical record systems.

In a report sent to Congress in 2015, the Department of Health and Human Services stated that hospital adoption of at least a basic electronic record system has markedly increased to 59% of all hospitals.

These digital records put our health information in one place where it can be searched, parsed out, and shared. This means that wherever we go for care our full information is available.



Our dialogue with our clinicians has changed as well. We are demanding, and getting, our visit notes so that we can check their accuracy and participate fully in our care. The one-way discussions where the physician told patients what their treatment protocols would be and did not allow for a debate because, “what did the patient know anyway?” no longer exists in many clinician settings. A convergence of several powerful social, economic and technological factors have changed the culture of care, enabling collaboration so that patients are now invited to be involved and weigh in on their diagnosis, treatment plans and other health choices.

Digital communication technology, including email, secure portals, text messaging, skype and even facetime now enables better communication, and empowers clinicians and patients to work as a team to make shared decisions, based, not only on best practices, but on patient preferences and patient values.


Image result for Images Coordination of care

 A variety of new and exciting apps, medical devices and resources contribute to this new culture of collaboration and eliminate the silos of information that created obstacles to coordination in the past. It is now possible for clinicians to easily share patients’ health information with colleagues and specialists, so that when the patient needs a consult, or when a patient is on a trip and far from their medical home base, their information can be available to health professionals to whom they turn for care, including: nurse practitioners in retail clinics, doctors in urgent care clinics, online clinicians, as well as clinicians in the ER.


We are also living through one of the most innovative periods in the history of mankind. Amazing new technologies and scientific/medical discoveries have brought about profound changes in the way disease is addressed and care is delivered. Although it is a long way from the bench to the patient, there are many amazing advancements for combating disease, managing long-term conditions and analyzing and determining treatment protocols using genetics and genomics.

What is the glue that is holding all of this together? There has been a confluence of factors – legislative, economic, social and cultural, sitting on this foundation of technological advancement that fosters the new care delivery culture, empowering everyone on the health care team to improve compliance and outcomes, and reduce cost of care.

Research conducted by the Robert Wood Johnson Foundation and published in February, 2014, indicated that patients who are actively involved in their healthcare are the most likely to stay healthy, manage their health conditions, and can reduce their cost of care as much as 21 percent.

All of these indicators point to a future where engaged and empowered patients are actively involved in disease management and are becoming comfortable and familiar with many medical devices and apps. This will result in immeasurable benefits to individual patients, caretakers, families and the health care system in the form of more accurate, personalized, efficient and effective care..






Communication, a Challenge to Participatory Medicine

Communication or the exchange of thoughts, opinions, or information by speech, writing, video or signs that include body language continues to be a hotly debated,   difficult to execute practice in healthcare. There have been hundreds of studies over the years that reinforce the correlation between good communication among patients and providers and improved health outcomes. Health information gathered from patient interviews, laboratory tests, face-to-face exams email interactions, and e-visits, is essential to guiding strategic health behaviors of patients and providers, enabling them to collaborate on treatment decisions and ongoing health monitoring. Participatory medicine depends on the availability of health information to all members of a care team.

However, low expectations regarding teamwork and communication have for many years encouraged a culture where teamwork and collaboration are difficult to achieve. It’s ironic that ever since the publication in 2000, of the original IOM report, To Err Is Human,  healthcare  organizations have worked hard to improve  patient systems and patient safety  but most have failed to address poor communication habits that  would enhance  information sharing. It is clear that when health care professionals do not know what their colleagues are doing to manage a patient they are seeing, and when patients do not have the opportunity to share the information held by their providers,  all the patient safety rules in the world cannot compensate.

During the past 25 years there has been a lot of talk about the need for training medical students in communication skills. It was not until June, 2004, that a communication skills component was added to the U.S. Medical Licensing Exam to test medical students on their ability to gather information from patients, perform a physical examination and communicate their findings to patients and colleagues.

 The Agency for healthcare Research and Quality has developed CAHPS,   (Consumer Assessment of Healthcare Providers and Systems) a public-private initiative to develop standardized surveys of patients’ experiences with ambulatory and facility-level care. These surveys ask consumers and patients to report on and evaluate their experiences with health care in areas such as the communication skills of providers and the accessibility of services. The results of these surveys help determine where there are strengths and weaknesses in the system.   CAHPS also publishes guidelines for patients to help them understand the important communication skills they need to improve their ability to share information with providers. These guidelines include four areas:

  1. Record Sharing- patient access to the electronic health record
  2. Patient Question Lists – what to ask the doctor at a typical visit
  3. Feed Forward – a questionnaire filled out by the patient prior to receiving care
  4. Coached Care- teaching patients how to ask the right questions and be more assertive during a face-to –face visit with their physician

Other organizations including many hospitals and medical centers strive to enforce good communication habits among their physicians and encourage their patients to participate in their care and collaborate with their providers. Many payers work with enrollees to help them understand communication skills needed in their increased participatory role. 

As e-Patients become more invested in the partnership model they have to improve their own ability to share information. Health care consumers are inherently well-equipped to judge the ability of their clinicians to communicate with them effectively. Helping them understand when and how to ask the right questions and be more aggressive about speaking up when they do not understand an explanation is a leap forward toward better communication for better healthcare.