Remember patients? They are a driver in healthcare transformation—perhaps the most important one.
The Health IT and Quality Exchange that HealthLeaders Media held in La Jolla, California, last week for CMOs, CIOs, and CMIOs was eye-opening on a number of fronts.
The ideas, successes, and challenges that the gathered healthcare leaders shared in our small group sessions illustrated that changing a workflow or a process isn't nearly as important as changing an organization's focus from physicians and payers to patients.
Don't get me wrong—redesigning work and reengineering processes around efficiencies that are intended to improve patient care are important, too. But retooling inpatient and outpatient processes to put the patient at the center of care (the aim of a patient-centered medical home) isn't as intuitive as it sounds.
The PCMH is often pointed to as one of the ways that primary care can be redesigned around the patient. The path to achieve NCQA status is arduous. Organizations have to demonstrate care coordination with a team-based approach that cares for the patient as a whole person, not just a patient with a medical condition. It requires coordination on many levels from IT tools to basic human resources.
Even organizations that are not going after PCMH certification are modeling new care models based on the core PCMH principles.
One of the primary reasons that patient-centered care represents such a culture shift is because the foundation of care that several generations of physicians and patients know is based on a fee-for-service payment system.
That structure inherently puts payers and providers at the center of a patient's care, whether she is coming in for a cold or a colonoscopy. It's transactional, when it needs to be transformational–at least to the patient sitting in the waiting room anxiously awaiting to hear what the lab results mean, or to the patient waiting for a routine physical.
Patient Variations
"There's not just one generic patient out there, and our entire system has been built around our physicians, our nurses, our payers, our practices," says Stephen Moore, MD, CMO and senior vice president for Catholic Health Initiatives, the Englewood, Colorado-based system with more than 90 hospitals in 18 states.
The variation in patients may seem like a barrier to providing patient-centered care because it means giving the patient the right care at the right time for what they need. Those are a lot of conditions for building a care model for all different types of patients, but structures can be built to standardize some systems that gives patients more say in their care.
For example, in 2011 Geisinger Health System developed an online process that allowed patients to check the accuracy of their medication lists before seeing a doctor. Medication reconciliation can be a nightmare for physicians, and it is so important that medication reconciliation is a required measure of Stage 1 Meaningful Use.
A new study measuring the effect of giving patients access to their medical record reveals two important things that should qualm the fears of physicians who are queasy about handing over control to patients. One, medication list accuracy improved and two, patients accessed the online portal to Geisinger, called MyGeisinger, more often.
Many healthcare organizations are banking on portals engaging patients in their own healthcare, though to make it meaningful to the patient, there has to be some level of usefulness.
The Geisinger experiment bears this out. Of the 30% of patients who completed a form offering feedback to the system, 89% requested changes to their medication lists. Geisinger pharmacists did not make changes without reviewing the requested changes and following up with the patient. Over half of the medication request changes were granted.
A positive side benefit to the access Geisinger gave its patients is that engagement with the portal increased. The study's authors found that patients who updated their medication list logged into the MyGeisinger portal 2.3 times as often as an average patient. The study also found the patients who used the portal also used its secure messaging feature more often.
A Step Further
Altering the access a patient has to his or her medical record is being taken one step further at Mosaic Life Care (formerly Heartland Health). Patients there are actually writing their medical history directly into their personal health record. It's a narrative that allows insight to other parts of their life, such as social, economic, etc. challenges, that can have a deep effect on health.
These technologies are tools that get at what patients are looking for from their providers: access. Already and rapidly, retail clinics are filling that space because it's what patients are demanding. Their expectations will continue to rise and disruptive providers will likely continue to emerge, unless your system does something to fill the demand.
Patients are a driver in healthcare transformation, perhaps the most important one, says Moore.
"Our solutions are going to have to be tailored to patients."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.