September 9, 2016
The Empowered Patient, Part III
BY Mary Mahoney
Our Empowered Patient series has looked at how people are becoming more involved in their own health care and how the traditional medical practice is evolving. In Part I we considered how doctor-patient attitudes are changing. Part II looked at the “medical home” model of care. This final part of the series looks at how technology is working for patients as well as physicians.
The health-care industry is changing in new ways: While we think of medicine as a rapidly evolving, technologically advanced field, the vast organizational and administrative infrastructure of hospitals and medical offices has been stuck in the dark ages. But that is finally changing. Additionally, patients are becoming more proactive, and the doctor-patient dynamic is undergoing a transformation. Both developments offer tremendous opportunities to really make a difference in the thing that matters most: our health.
With increasing health-care costs and greater demand for medical care come a need to streamline the system. Electronic health records opened the door for creating greater accessibility in ways we could not have imagined.
For example, while many physicians still insist on sending test results only by fax, others offer online patient portals. While some of us still get shuttled from specialist to specialist, other patients benefit from the medical home concept, wherein a primary care physician coordinates and supervises all the patient’s needs. And while forgetting a medical appointment means missing important visits, text reminders help patients stay on track.
Patient portals are secure sites where patients can access summaries of doctor visits, lab results and medication histories. Since the doctor’s notes are entered as an electronic health record during the visit, the patient can review the information almost immediately via the portal without having to request a summary and wait for it to arrive in the mail. Patients also can email to the physician’s staff and schedule appointments, saving a lot of “phone tag” time.
The approach is relatively new but spreading rapidly. Various case studies show the pros and cons: One practice started to convert to electronic health records in 2007, only to encounter a three-year delay caused by a requirement to map out workflow.
One major challenge with the portal is the multiple-step registration process as well as remembering and managing passwords. For providers and staff, there is no way to know whether a web‐enabled patient actually uses the portal and reads messages.
Another study of a large health care center with 11,000 patients a year showed very low patient portal enrollment because of the language barrier, given the predominantly Spanish-speaking population it served.
A smaller practice in Delaware with six practitioners needed a system flexible enough for the different practice styles of the six health care providers and that would allow hospital-based information to automatically populate the patient’s records. Staff training was essential. They added a patient portal which allowed online bill payment.
A Missouri practice with 21 locations had to be proactive in changing long-held habits. “Providers need to complete their notes at the time of service and write in plain language because the summary will be read by patients, rather than relayed by medical personnel,” they noted. On the patient side, “staff must undertake promotional efforts, especially when new portal feature is rolled out.”
A U.S. News article from 2014 stresses that patient portals have their limitations. With some portals, lab results are only summarized, without actual reference numbers, which means the full picture is incomplete. On the other hand, too much information can lead to dangerous self-diagnosis, and the technology should not be used in the event of an emergency. “Don’t message me at three in the morning with chest pain,” one doctor said. “Go to the ER.” For some very small practices, a patient portal is too costly and adds another layer of work plus technological risks and challenges, according to the article.
The U.S. News Hospital of Tomorrow Forum found that for big facilities, electronic health records can make a big difference. One hospital avoided 180,000 medication errors and achieved savings from more outpatient procedures and increased efficiency. “To get these benefits, you need to have easy access to records for clinicians,” said one organizer.
Beyond portals, the health care industry is looking for innovative ways to address some basic issues that still get overlooked, including matching patients with the right specialists, making sure patients have transportation to get to appointments and connected doctors and at-home patients via video.
The upcoming Stanford Medicine X conference could be an interesting opportunity to see what other concepts are in the works. Stanford’s everyone included multidisciplined initiative “explores how emerging technologies will advance the practice of medicine, improve health and empower patients to be active participants in their own care.” Health-care students design health-care spaces, patients participate in the editorial teams of medical journals and researchers collaborate with their subjects to bring innovative solutions to clinical trials.
Indeed, while the Affordable Care Act has dominated headlines and everyday conversations for the last few years, there are other far-reaching, major changes in the doctor-patient relationship and the physician’s business model which will make health care look very different in the not-so-distant future.
What we do know — and what we have learned over the course of this specific series — is that medical care looks very different than it did 50 years ago, and from how it will look in another 50 years. These kinds of revolutionary shifts happen slowly over time, but they are happening. In our previous blogs we learned about patient rights and the consumer that now plays a more active role in their health care, questioning the doctor instead of accepting their word as gospel. We then looked at what the doctor’s office of the future is shaping up to be: patient-centered medical homes. And supporting all this is the robust electronic health system we learned about in this blog.
At the center of all these changes and the predictions for the future is one common thread: the consumer. How big the changes will be and how they impact the future depend on us.