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The Future Of…Patient Engagement

Posted on March 19, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

Healthcare has a major challenge when it comes to the term “Patient Engagement.” $36 billion of government money and something called meaningful use has corrupted the word Patient Engagement. While meaningful use requires “5% patient engagement”, that’s a far cry from actually engaging with patients. Anyone that’s attested to meaningful use knows what I mean.

As we move past meaningful use, what then will patient engagement actually look like?

When I start to think about the future of patient engagement, I’m taken back to my experience with a new primary care provider that’s trying to Restore Humanity to Healthcare (see Restore Humanity to Healthcare part 2 as well). In this case, I’m exploring the idea of unlimited primary care along with a primary care team that includes a doctor, but also includes a wellness coordinator that’s interested in my wellness and not just my presenting problem.

Once you take the payment portion out of primary care, it dramatically changes the equation for me. Gone are the fears of going to the doctor because you don’t want to pay the co-pay. Gone are the days where a doctor needs to see you in the office in order to be able to make money from the visit. With unlimited primary care, an email, phone call or text message that solves the problem is a great solution for the doctor and the patient.

Of course, this model of primary care is only one example of the shift that’s going to drive us to patient engagement. ACOs and value based care models are going to require a much deeper relationship between doctors and patients. Trust me that 5% patient engagement through an online portal isn’t going to be enough in these new models.

Plus, these new models are going to really convert our current sick care system into a true healthcare system. I like to call this new model “Treating Healthy Patients.” Quite frankly we’re not ready for this change right now, but in the future we’ll have to adapt. The biggest change is going to be in how we define “patient” and “healthy.”

The wave of connected medical devices and innovation are going to completely reframe how we look at health. Instead of describing ourselves as healthy, the data will tell us that we’re all sick. We’re just at different points in the continuum of sickness.

In the future, patient engagement will be the key to treating each of us individually. The symptoms will change from coughing and vomiting to 85% risk for diabetes and 76% risk for a heart attack. We thought we had patient compliance issues when someone is coughing and vomiting (ie. something they want to fix). Now imagine patient compliance challenges when the patient isn’t feeling any pain, but they need to change something in order to avoid some major health problem.

I think this describes perfectly why we’re entering one of the most challenging times in healthcare. It’s a dramatic shift in how we think about healthcare and has a new set of more challenging problems that we’ve never solved. One of the keys to solving these new challenges is patient engagement.

We Need Technology to Scale Healthcare

Posted on June 2, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently talking with one of my healthcare IT friends about the future of technology in healthcare. As we were talking, they made this really interesting observation:

“We Need Technology to Scale Healthcare”

I don’t think I need to go into too much detail with readers of this blog about the possible shortage of doctors that could happen. In fact, Kyle Samani covered some of this shortage in his post, “The Nurse Will See You Now.” In that post he talks about the limited number of residency slots that are available. Not to mention the lengthy path to becoming a doctor. I read an astute observation recently that the only reason we don’t have a real crisis in general medicine is because there’s a limited number of residency slots for the other specialties. When a med student can’t get into their desired specialty, then they fall back into general medicine. The idea of general medicine being a “fall back” profession doesn’t bode well for us, but that’s a topic for another day.

Consider the supply and demand constraints that Kyle talks about, we’re going to have a growing problem where the demand for healthcare outstrips the supply of doctors. Kyle covered the move towards nurse care, but I think there’s also an important case to be made for how technology can help to scale healthcare as well. As one example, Telemedicine has the potential to make our healthcare visits much more efficient. Properly implemented technology can do that across a wide variety of healthcare. Plus, technology has the potential to reduce unneeded office visits as well.

What I find even more intriguing is that right now we look at a visit to the doctor as a last resort for our healthcare. How many of us go to the doctor in order to remain healthy? Almost no one. If we really want to scale health care to the point that we’re providing health care and not just sick care, then that will require a scale that healthcare has never seen. I personally call this movement “Treating Healthy Patients” and I think this movement will be data driven with technology at its core.

Lest those reading at home get confused. I don’t think most of the healthcare technologies out there today work on scaling healthcare. Most of the healthcare IT solutions out there today are about optimizing the status quo. That’s very different than what will be required to scale health care. I’m excited to see these later technologies come to fruition.

What Value Does a Healthy Patient Get from a PHR?

Posted on November 11, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my previous post about a Patient Controlled Medical Record, I asserted that such a thing would be a challenge to get to work in the US, but that there was a lot of potential internationally. I did provide one caveat when it came to chronic patients where I think there is potential in the US as well. Although, some argued against even that group being interested in the comments.

Let me further expound on why I think the patient controlled medical record fails for a healthy patient (and this includes people who think they’re healthy, or at least relatively healthy…ie. they don’t go to a doctor for any chronic condition). In many respects this is my talking from my own personal perspective as a young, healthy adult (although I guess all of those descriptors could be argued).

The problem for someone that’s healthy is that their medical record basically has no data. The reason you want a patient controlled medical record is so that you can extract value from the data. I don’t need to look at my online medical record to see that I don’t have any drug allergies, that I had a cold or flu 3 years ago, that I got my flu shot 4 years ago, and that when I was 15 I had a hernia operation.

The point being that my medical record is so short that there’s so little value in me trying to aggregate that record in once place. What value do I get from doing so?

I think there could be value in doing so, but not today. For example, if by keeping a patient controlled medical record I could avoid filling out the crazy stack of paperwork that’s given you at every new doctor you visit, I and every other patient would want to keep an online patient record. This should be a solvable problem, but I won’t go into the hundreds of systemic reasons why it’s not going to happen anytime soon. Although, we’ll start with the doctor preferring your allergies to be in the upper right corner in red. Now scale that request up to 700,000 doctors.

Similar to the above item, there are other ancillary functions (ie. appointment scheduling, prescription refills, message your doctor, etc.) that could be tied to your medical record that would make people want to use a PHR or other similar system. However, most people would use it for the ancillary functions and not to be able to control their medical record in one place. For many of the ancillary services this portal will need to be tethered to a PHR.

One trend that I hope will change my description above is the wave of new health sensors that are hitting the market. As those health sensors get better I believe we’ll see a new type of portal that is attractive for even a “healthy” person to visit. This concept coincides with what I call Treating a Healthy Patient. All of this new sensor data could make it worth my time as someone who thinks I’m healthy to check and aggregate my data in one location. The volume of data available would be much more than what I have stored in my memory and so it will make sense for me to visit somewhere that stores and processes my whole medical record.

How these portals full of health sensor data will work with doctors is a topic for another blog post. Until then, I’ll be surprised how many healthy patients really get on board collecting their patient data in a patient controlled medical record.

The TEDMED Experience

Posted on April 18, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those who follow Hospital EMR and EHR as well, you might have noticed my first post about The Healthcare Forum at TEDMED. That was a great starter event for my experience at TEDMED. A day and a half into TEDMED and I started to wonder if I could describe TEDMED in a couple words. I can’t, but I’m glad I was invited to attend the event as a guest of Xerox.

Instead of trying to describe the experience of TEDMED, I thought I’d offer some of the insights that the TEDMED speakers shared. Just realize that all of these speakers are surrounded by plenty of breathing room where you’re interacting with other TEDMED “delegates.” I’ve had conversations ranging from cancer treatments to genomics to EHR to public health and everything in between and around. In fact, you’re never quite sure who you might meet next and that’s what makes the experience unique.

As for the speakers – you’ll be able to see them all online eventually – but here are some key quotes, insights, comments, and assertions that were made by various speakers.

Anytime Jonathan Bush speaks is a highlight for me. The man does not know how to mince words and so you’re sure to get his raw, unadulterated feelings on a subject. You may disagree with him on some of the things he says, but he often opens your eyes to new areas of healthcare you hadn’t considered. In this case, Jonathan Bush was taking aim at many of the screwed up features of our healthcare system with healthcare costs clearly in focus.

Jonathan offered the following two insights on some of the current healthcare issues:
“The biggest problem is that our profit motive is trapped in a weak marketplace.”

“The tactics non-profit hospitals use would make John D Rockefeller blush.”

Of course, he also followed that up with a number of suggestions on what we need to do to improve healthcare:
“We need to let go of Precious. It will be OK. It’s a $2 trillion baby.”

“Entrepreneurs need to get out there and start delivering care, never mind corporate medical law..Get a lawyer and figure it out.”

“Why do the best doctors in the world only get to treat people in eastern Massachusetts?”

What might have been my favorite talk (and I think the only standing ovation at TEDMED so far) was Zubin Damania (better known as ZDoggMD). It’s not even fair to try and sum up Zubin’s TEDMED talk. I’m certain that once it’s out and available I’ll be embedding the whole video. However, I will highlight one really powerful point he made. When he became a doctor he realized he was “Doing something TO people, rather than something FOR people.” With Zubin’s move to Las Vegas and participation in the Downtown Project, he’s now excited to finally live the physician dream: “Do something FOR people, rather than TO people.”

Deborah Estrin made a really strong case for “packaging up your small data.” She said, “There’s a lot that I can learn about my personal health from my digital behavior.” For example, the app could create a comparative picture of your daily function this month relative to last month, by automatically analyzing motion, location, and vocabulary data plucked from your digital traces. I love the power of small data, but in this case it’s small data because it’s for an individual.

Gary Slutkin provided one of the most insightful TEDMED presentations at this point. He did an amazing job explaining violence as a disease. Even more powerful was how he then showed how violence can be treated similar to the way we treat diseases. The parallels were stunning and provided a unique insight to a challenging problem.

On the first night of TEDMED, the passionate America Bracho offered the following insight “Awareness increases in the presence of contradiction.” America made a number of other passionate comments about community health, but this comment really stood out to me. She highlighted how many of us ignore the plight of our communities so we don’t become aware of the contradictions around us. However, I think this concept applies in so many other areas of healthcare IT. We often turn a blind eye to a healthcare IT issue so we don’t have to recognize the contradiction. Awareness of issues is the first step to solving the contradictions.

One of the most powerful concepts I’ve heard was from Danny Hillis. He talked about the idea of disease preemption instead of disease prevention. Some might argue that disease preemption is just really early stage disease prevention. However, the concept of trying to preempt a disease that could be developing is incredibly powerful. I’ve talked about this from the perspective of treating healthy patients in the past. In this scenario, we could treat someone who appears healthy in order to preempt future health issues. This is a powerful concept that is also incredibly hard to deliver, but we could get closer to it with the right data and sensors.

Mike Pazin, director of ENCODE, called his genome work “fun.” We need more Mikes in healthcare having fun with the genome and we’ll quickly realize the benefits of genomics.

“What if obesity is a cover mechanism? What if diabetes resistance causes obesity as opposed to obesity causing diabetes resistance?” Peter Attia flipped the idea of obesity and diabetes on the head with this question.

Amy Abernethy and Elizabeth Marincola discussed the idea of healthcare information hoarding. Amy asked the important question, “What should healthcare information donation look like?” Elizabeth offered, “Science, Money, and the Public’s Right to Know are on a collision course.” and then “You can have your cake and eat it too. You can be profitable and still share the scientific research.” I’d have loved to hear more examples of how Elizabeth sees this vision happening, but I’m hopeful she’s right that, “The future of medicine is where every student and researcher can access any research done anywhere in the world.”

I know that’s a lot to chew on. Now sprinkle the above knowledge together with the entertainment – the raw dance motions of David Odde & Black Label Movement, the unique one man band of Kishi Bashi, the all star entertainer Richard Simmons, and many other fine artists – and you’ll have a small window into the TEDMED experience.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox Blog and follow @XeroxHealthcare.