The AMA blog has a post under the fascinating title “Patient First Technology” http://www.ama-assn.org/ama/ama-wire/post/patient-first-technology-improving-care-chronically-ill.
It reports that Harvey Fineberg, MD, president of the Gordon and Betty Moore Foundation, has urged the use of technology to put patients first.
- “Educating the public so that every individual knows what their entitlement is for the control of their own care and their own life destiny.
- “Looking at the payment system, because if the payment system is going to pay up to, let’s say, $100,000 for a pill you need to extend your life … but will not pay for hot meals delivered to your home, we have a problem.
- “Better development of the workforce; we need clinicians, doctors, and nurses who understand that the goals of the patient are what we begin and end with. . .
- “Design model programs in communities, because institution-based systems will not solve this problem. . .
- “A monitoring system to track the workforce and make sure the public is fully educated and prepared to do their part as well.”
Agreed, and excellent points.
But what’s special about technology that makes this possible? Some suggestions.
- Technology enables patients to understand, share, and monitor compliance with their own health care goals – quality over length, consciousness over freedom from pain (although well managed that should not need to be a choice), activity over risk, etc. At Johns Hopkins I have seen a project that is testing the idea of patients, family, and caregiving team putting in their understanding of the goals, and the system alerting everyone when they are not in congruence.
- Technology can alert everyone when treatment decisions might be inconsistent with goals, and can provide patients and families with treatment choices and statistics on the implications of those different treatment choices. That information can be provided in a wide variety of ways.
- Technology can connect people facing similar health problems around the world for support, ideas, etc. This includes support on standing up for your concerns even when the professionals do not seem to be hearing.
- Technology can bring all the elements that impact a patient’s life together. Why does a lead paint poisoning not generate an automated legal referral, with the doctor’s affidavit for submission to the landlord, housing authority, court etc.? What about the documents that get you on the required public benefits? That’s just one example.
We could develop an assessment tool that looks at whether each change in medical care increases or decreases patient partnering. Does the technology give as much information as possible to the patient and family? Does it provide the flexibility the patient may want? Are the outcomes and the measures patient-oriented? Does it enhance patient-team communication? Patient centeredness is as important as cost or longevity outcomes.
Hopefully the patient partnering movement will brainstorm more and more about how design, build, and assess the most appropriate technologies to do this.