The Patient of the Future

Physicians suggest. Patients ignore. Technology alone won't bring them together. But a new relationship just might.

A patient enters the waiting room and is greeted warmly by her personal navigator, who hands her a tablet-sized computer preloaded with her personal demographic information and health records. She answers a series of questions and the computer compiles a list of possible diagnoses for her physician.

In his office, the physician is reading an e-mail from a patient who has forwarded an interesting study about his particular medical condition. The physician forwards the study to the rest of the patient's care team, including the patient's acupuncturist.

In the exam room, a specialist and patient sit together in front of a computer—the physician is showing the patient which sites have the most reliable medical information that she can use to learn more about her recent diagnosis. Next door, a physician is talking to a patient who has unusual symptoms; the doctor consults her PDA, which is loaded with a decision-support application.

Down the hall, an employee e-mails to a prospective patient a detailed, itemized list comparing the costs of hip replacement surgery at a number of area hospitals.

And, by the way, everyone in the waiting room is fit and trim. Nobody smokes anymore. People with diabetes check their blood sugar regularly. Everyone shows up for their colonoscopy appointments. People are knowledgeable about their health, empowered to participate as partners in their care, and engaged enough to comply with their physicians' directives.

Scoff if you want, but in many ways the patient of the future is already here. Obstacles include the current reimbursement model and patients themselves. But physicians also deserve a large chunk of the blame. "I'm impressed how well the medical profession has inadvertently trained patients not to be engaged," says Ted Eytan, MD, medical director for delivery systems operations improvement at The Permanente Federation LLC in Washington, DC, which supports the Medical Groups of Kaiser Permanente. If you go to the doctor and you're sick, they'll ask, "Why did you wait so long?" And if patients aren't sick enough, they say, "You came in too soon." Whenever the patient comes in is the right time, Eytan says. We have to get patients comfortable with saying "I deserve more. I want to be healthy. I want to help manage my care and my health. I want to see every piece of data you have."

Technology connects patients and providers
In the future, patients will communicate with their doctors via e-mail, online chat room, Web portal, mobile device, remote monitoring technology (or some other method or medium that hasn't yet been invented), thus avoiding a long wait for a short appointment that might not have been necessary anyway.

Doctors don't get paid for phone or e-mail consultations, nor do they want to risk missing a diagnosis because they chatted online instead of face-to-face with a patient. Engage on a personal level? Physicians have five to 10 minutes to see a patient, listen to his or her complaints, make a clinical decision and move on to the next appointment.

There is an entire generation that has never known a world without computers—and their parents and grandparents are picking up their habits, chatting on their mobile phones, learning how to attach photos to e-mails, signing up for Facebook accounts, and looking up health information online in numbers too large to ignore. A huge portion of the population can't imagine life without Google or text messages. And they can't understand why healthcare hasn't embraced technology, too.

Neither can Art Papier, MD, a dermatologist who is on the faculty at the University of Rochester (NY). "If you ran the aviation system this way, some pilots would use all the modern navigation, and some pilots would put their finger out the window," says Papier, who is cofounder of Logical Images, a medical software company in Rochester, NY. "That's what we're tolerating in medicine."

What is one of the biggest barriers to technology such as decision-support tools? Doctors don't want to look dumb. If they have to look up information, they worry the patient will realize they are not omniscient after all.

In fact, the opposite is true, many argue. Obviously, physicians cannot read every study or know about every single new treatment option or medication. And today's patients are impressed by physicians who embrace technology. So looking up the answers doesn't make the doctor look dumb—it makes them look modern and tech-savvy.

"A whole bunch of improvements that have happened over the past 30 years with IT in other industries are going to evolve in healthcare and that will result in transformation as to how the whole process will work," says Dave deBronkart, an advocate for patient engagement and empowerment and communication as well as patient-caregiver collaboration.

Patients prefer providers who use Internet-based tools to augment care, according to Deloitte's 2009 survey of healthcare consumers. More than half (55%) want to communicate with their doctors via e-mail to exchange health information and get answers to questions, for example. And 68% are interested in remote monitoring devices that allow self-monitoring of their condition and electronic reporting of results to their physician. The figure was even higher for seniors (78%) and consumers with chronic conditions (75%).

One recent IT development has sprung from the nation's obsession with cell phones and applications. Mobile health, or m-health, allows patients and physicians to perform a variety of healthcare-related tasks. Phones and PDAs can collect community and clinical health data and deliver it to physicians, researchers, and patients. They can help track the spread infectious diseases such as swine flu and the rates of conditions such as diabetes. Patient monitoring devices emit real-time vital signs to caregivers.

The beauty of m-health is that it can reach almost every American. For example, studies show Latinos don't use the Web as often as other demographics, Eytan says. But they do use cell phones. "The engaged patient will include every American," not just engineers and others who are technologically adept.

Access to EHRs creates engaged patients
Empowered and engaged consumer-patients are armed with customized information about their unique health conditions gleaned from a variety of sources. They have easy, inexpensive, and portable electronic access to their personal health records that they can easily share with whomever they choose.

Physicians argue that electronic health records are too complicated, too expensive, and too time-consuming to implement and maintain. Especially with online records, there's too great a risk that privacy of personal health information will be breached.

Eighty years ago, physicians were similarly skeptical of the telephone, Eytan says. Professional organizations warned physicians they wouldn't get paid for taking phone calls and that patients would call them nonstop.

And while many Americans are satisfied with the status quo, Eytan says there will soon come a day when they will demand access to their personal health records. Kaiser Permanente now has 3 million people on a PHR and that number is growing. The tipping point will come when those health records ambassadors, as Eytan calls them, move to other states and demand that healthcare providers and insurers offer PHRs.