My daughter wonders why it would be preferable for everyone to listen to the same music in her art class. Surely it would be better if everyone could listen to their own music on their own iPods or other music players.
The art teacher points out that the point of listening to the same music is to have a shared moment, not merely to inspire a painting. But in a society populated now with people listening to their own private music or media, it's like swimming against a current.
When you think about it, those shared moments can be few and far between these days. Whether we're watching TV, or surfing the Web, or listening to music, it's all too easy to slip into solitary, passive receptivity.
Within healthcare it's all too easy to slip into that same kind of passivity, even (or especially) when information in the IT system is flowing fast and furious. Sure, patients can demand their medical records, but can they read them and act upon the deluge of info they may find there?
"We silence the conversation with technology," says Steven D. Freedman, MD, Ph.D, chief of the division of translational medicine and professor of medicine at Harvard Medical School. Now, Freedman is about to begin a clinical trial to change that, and it starts at the very moment that patient meets doctor.
Freedman's initiative, called Passport to Trust, will provide greater structure to doctor-patient interactions through a technology that will ultimate sit on top of any electronic medical record.
It won't be the first time that technology jumped from the financial world into healthcare, this time using technology from NexJ Systems. "Their approach brings together all the different digitized information and data, but leaves the original source at the original database in the hospital, which is very important to hospitals and security," says Camilia Martin, MD, MS, a member of the Passport to Trust team who developed the initial electronic prototype.
"These decision points and the knowledge must be formed around the patient, not so much formed around what the physician, or practice, or hospital, is doing," Martin says.
The trick is to allow the physician, within the workflow of a typical day, to generate a care plan and give a copy to the patient before the end of the visit, while putting a copy of the plan in the medical record, Martin says.
"Once we have that, then we're going to move forward in expanding that so that then it's accessible through the Internet and the Web by anybody and everybody that's given permission," she says.
Beth Israel Deaconess Medical Center, where Freedman practices, was just named by InformationWeek as the number one technology innovator this year, beating out IT powerhouses such as John Deere, Zynga, and Acxiom Corp.
And yet, it's a reflection of many hospitals, having more than one EMR: in this case, its homegrown Online Medical Record, as well as cloud-based eClinicalWorks out in the practices. Passport to Trust will have to work with both.
In the Passport to Trust model, office visits get structure by inserting a time-out into the visit, a little like the time-outs in operating rooms where patient identity and operational details are reviewed, Freedman says.
"I go over, okay, so what is your problem, what at least is in my mind as to potential causes of that problem, and then how would any tests or treatments truly change management, and then what's our stepwise plan?" he says. "What are we doing, each week, until I have you better? And then lastly, what are your thoughts and concerns, from the patient side? And so that's how I've structured things."
"It's interesting that everyone has a slightly different take on what they think would be an important outcome measure to show," Freedman says. "Insurers want whatever the trial is by whomever to show decreased cost, and that at least you don't worsen healthcare quality." But the project won't truly succeed unless it shows patient engagement, he adds.
A paper-based pilot study found patient satisfaction rising from 34 percent to 94 percent being satisfied with having a plan of action from their doctor. "People were actually astounded that they had a simple plan that they could then follow," Freedman says.
"The EMRs are essentially a one-way archive," Freedman says. "We dump in lots of data—your lab results, imaging—and the patients really don't have very good access to it, and if they do, it's in a language that's, for the most part, not understandable to them, and that's why we're trying to create this."
"No one ever thinks about the fact that the whole relationship that's built around the patient and the physician starts at that office visit or that encounter," Martin says.
"No one's trying to structure that, yet there's been plenty of literature to suggest that patient satisfaction, literacy, and understanding the issues actually dictates their compliance. It dictates their follow-through. It dictates everything they do after leaving that office, that drives cost. That plan that's generated in the office is the biggest driver of cost, but no one's just looking at that simple relationship."
In a CYA healthcare culture, just getting doctors to justify tests and procedures to patients during those consultations will save money. The clinical trial, still being designed, will focus on diseases such as abdominal pain or lower back pain, comparing participating doctors to a control group of doctors who won't be using the Passport to Trust techniques, comparing the number of lab tests and radiological scans ordered. But Freedman admits it won't be easy showing changes in cost in a short time.
So the first trial will almost certainly be followed by others. NextJ is providing the current funding for the digitization of Passport to Trust, but Freedman envisions applying to the Robert Wood Johnson Foundation or the Commonwealth Fund for additional funding. The clinical trial will last a year. "We have had many conversations with different stakeholders—insurers, employers, other healthcare groups, physicians, PBMs," he says.
Imagining a patient population that is truly informed, engaged, and passionate about their care is surely one of the brass rings of everything we write about at HealthLeaders. In the rush to implement Meaningful Use, patient engagement is not at the top of many health executives' plates today. But sooner or later, it will be. The office encounter should be a conversation, not just a data download. Efforts like Passport to Trust will be leading the way.
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.