Leveraging Technology to Empower and Engage Patients

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3/21/14 1 Daniel Z. Sands, MD, MPH @DrDannySands Society for Par=cipatory Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands Leveraging Technology to Empower and Engage Patients Where High-Tech Meets High-Touch Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands Go Cats! 3/21/14 2 Commercial Disclosures Best Doctors, Inc. consultant Kinergy Health, Inc. consultant SeniorLink, Inc. consultant PostWire, Inc. consultant (2013) Copyright 2014 D. Z. Sands, All Rights Reserved I will not be discussing products or services of any of these companies in my presenta8on. Palliative Care Definition US Center for Medicare and Medicaid Services Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands Pallia=ve care means pa=ent and family-centered care that op=mizes quality of life by an=cipa=ng, preven=ng, and trea=ng suffering. Pallia=ve care throughout the con=nuum of illness involves addressing physical, intellectual, emo=onal, social, and spiritual needs and to facilitate pa8ent autonomy, access to informa8on, and choice. 3/21/14 3 Connecting and Agenda-Setting Copyright 2014 D. Z. Sands, All Rights Reserved h?ps://www.paCentsite.org Bringing It All Together: Patient Portals Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands 3/21/14 4 Services: Prescrip=on refills Appointment requests Referrals View bill EducaCon: Search Info prescrip=ons Pa=ent selected links Predefined collec=ons Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands Mail: Secure Automated rou=ng Task assignment Records: Secure All system records Upcoming appointments Meds, Problems, Results and Notes Personal records Dave (Pre-diagnosis) This is too cool.It's almost SILLY that things can be this easy.I am having a very good patient/customer experience so far. Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 5 Affective Impact: 61M Minister with DM and Chronic Pain I have a lot of medical issues. This email system has left me feeling comfortable and in good hands! Otherwise, I would feel as cold, depleted, and alone, as the lifeless tree in my front yard in the deepest of winter! Copyright 2014 D. Z. Sands, All Rights Reserved e-Communica=on includes encrypted e-mail or, more commonly, secure web messaging e-Communica=on can provide an efficient means of communica=on because it is asynchronous This is cost-effec=ve and benefits both pa=ents and physicians Copyright 2014 D. Z. Sands, All Rights Reserved Connecting with Patients: e-Communication Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004. 3/21/14 6 Hi - there are several things I want to go over when we meet. I suspect several will require referrals, and given the time it takes to get a slot, I'm thinking of making those appointments now. (It's easy to cancel and create an opening for someone else.) I'm 56 and I generally don't have any complaints. Here are the symptoms I'm concerned about: [] What do you think? Copyright 2014 D. Z. Sands, All Rights Reserved The Visit Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 7 The Incidental Finding Copyright 2014 D. Z. Sands, All Rights Reserved The Incidental Finding INDICATION: Right shoulder pain. COMPARISONS: Comparison is made to a chest radiograph from December 23, 2003. TECHNIQUE: Right shoulder, three views. IMPRESSION: 1. Degenerative changes of the acromioclavicular joint. Normal radiographic appearance of the glenohumeral joint. 2. 3.3 cm right upper lobe lung mass needs further evaluation with a chest CT to exclude malignancy. Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 8 Diagnosis, Information, and Support Copyright 2014 D. Z. Sands, All Rights Reserved Copyright 2014 D. Z. Sands, All Rights Reserved Lesion 1 Left Upper Lobe 39x43mm 3/21/14 9 Copyright 2014 D. Z. Sands, All Rights Reserved Primary Tumor Found Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 10 Copyright 2014 D. Z. Sands, All Rights Reserved ACOR is great. I posted two messages tonight and got responses in 4 and 11 minutes. One responder also sent a private note mentioning Robin and Cathy. The other responder was Cathy. :) Through that list I've also found several other useful sites. Copyright 2012 D. Z. Sands and R. D. deBronkart. All rights reserved. Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 11 My doctor prescribed ACOR and it saved my life. Copyright 2012 D. Z. Sands and R. D. deBronkart. All rights reserved. Copyright 2014 D. Z. Sands, All Rights Reserved Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 12 Copyright 2014 D. Z. Sands, All Rights Reserved Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands And There Are More Tools Available 3/21/14 13 Copyright 2014 D. Z. Sands, All Rights Reserved Successful Treatment Baseline: 39x43 mm 50 weeks: 20x12 mm Sir Francis Bacon English author, cour=er, & philosopher (1561 - 1626) Copyright 2014 D. Z. Sands, All Rights Reserved Knowledge is power. 3/21/14 14 Online Population Rising Copyright 2014 D. Z. Sands, All Rights Reserved And Health Info Seeking Popular Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 15 Online Health Habits of US Adults Sources: www.pewinternet.org; PwC HRI Social Media Consumer Survey, 2012 80% of online adults have looked for health info Rising over =me Each day, more people search for health informa=on than see a physician! More than half act on the informa=on 1/3 have read about others health experiences 1/4 have tracked their health informa=on online 1/3 use social media for health Copyright 2014 D. Z. Sands, All Rights Reserved e-Patients Want To Be Engaged Involvement in Care Communica=on Convenience Informa=on Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 16 But We Make it Difficult: Mismatch Between Desires and Service Offering 0% 10% 20% 30% 40% 50% 60% 70% Online Appts Online Billing/Pmts Online Costs E-mail Viewing Record Available Desired (Important/Very Impt) Copyright 2014 D. Z. Sands, All Rights Reserved Source: Harris Interac=ve 9/10/12 at hlp://goo.gl/VzfmT "Thinking now of new technologies your health care provider could implement, how important would each of the following be to you? (of pa=ents who saw physician in past year) Shifting Paradigm? Informa=on asymmetry Physician as oracle Comfortable A burden? Informa=on symmetry Physician as partner Threatening vs. libera=ng Physician as healer Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 17 The Power of I Dont Know Copyright 2014 D. Z. Sands, All Rights Reserved Asking Tacit Approval Honest Disclosures Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 18 Its About Engagement Engaged Equipped Empowered Educated Enlightened Etc. Copyright 2014 D. Z. Sands, All Rights Reserved Ter=ary Secondary Primary Self-Care (off the Map) Professional Care Discouraged Encouraged $ Industrial Age Medicine Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 19 Individual self-care Friends and families Self-health networks Professionals as facilitators Professionals as partners Professionals as authori=es Professional Care Discouraged Encouraged $ Information Age Healthcare Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. Copyright 2014 D. Z. Sands, All Rights Reserved Do We Need Most F2F Visits? Technology Synchronous? InformaCon Density Telephone E-messaging o Text messaging/IM o/ Remote monitoring Telemedicine (usually) Advanced Telemedicine Office visit Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 20 h?p://parCcipatorymedicine.org Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. The participatory concept may also be applied to fitness, nutrition, mental health, end-of-life care, and all issues broadly related to an individuals health. Society for Par=cipatory Medicine Community Advocacy Research Educa=on Copyright 2014 D. Z. Sands, All Rights Reserved Copyright 2014 D. Z. Sands, All Rights Reserved Patients and Physicians Each Have Expertise 3/21/14 21 Copyright 2014 D. Z. Sands, All Rights Reserved Patients Can (and Must) Help Slack WV. CyberMedicine: How Computing Empowers Doctors and Patients for better Health Care. Jossey-Bass 2001. Copyright 2014 D. Z. Sands, All Rights Reserved It can be argued that the largest yet most neglected health care resource, worldwide, is the pa=ent 3/21/14 22 The Web Connects to Information, Caregivers, and Each Other (and to Providers) Copyright 2014 D. Z. Sands, All Rights Reserved Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 23 Copyright 2014 D. Z. Sands, All Rights Reserved Changing Nature of Relationship Information Asymmetry Information Symmetry Passive Recipient Active Partner Patient-Physician Consumer-Provider Paternalism Participation Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 24 Conclusions Provider, pa=ent, and carer engagement are cri=cal Par=cipatory Medicine and an important paradigm shir Facilitates pa=ent autonomy, access to informa=on, and choice A new dance that both partners need to learn Transforms pa=ent and clinician experience Helps shir balance of power Connected technology, including secure e-messaging, PHRs, and online resources lowers barriers to engagement, empowering and enabling pa=ents, carers, and providers Copyright 2014 D. Z. Sands, All Rights Reserved Copyright 2014 D. Z. Sands, All Rights Reserved 3/21/14 25 Questions? Questions and e-mail address Danny@DrDannySands.com h?p://www.DrDannySands.com @DrDannySands Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands

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