The pendulum of the doctor-patient relationship has tilted towards the direction of the patient. The traditional active-passive relationship whereby the doctor plays the dominant role in the decision making process and the consumer taking a passive role is slowly eroding. What is taking place now is we have consumers who are informed and with the knowledge that they acquired through the Internet and their personal health record (PHR), they demand an active participation in the decision-making process and management of their health. I believe that this is a disruptive movement that will continue to pickup an even stronger momentum over the next few years. It will have a very significant impact in the landscape of health care delivery methodology because their goal is to position the consumers at the center of health care reform. The rise of healthcare consumerism, e-patients, participatory health, consumer empowerment, patient power and activated participation are the new terms to describe this consumer movement of increasing popularity. PHR provides consumers the ability to review and modify their medical records and thanks to the Internet, consumers can access their PHR anytime and anywhere. Smart phones are by far the most popular mobile device due to its convenience. There is an increasing development of clinical applications for the smart phones and soon according to Bettencourt (2010) “you can send and store health care information, research, and monitor your biometrics wherever you are. You don’t have to carry an extra device either; it’s all on your phone”.
What are the changing forces behind this movement?
• Foremost is the Internet. According to a Pew research on The Social Life of Health Information, 61% of adults go online to search for health related issues.
• We are seeing an increase in PHR popularity due to the adoption of health information technology and the Internet. Deloitte’s 2009 survey of healthcare consumers shows that 42% of consumers want online PHR that is connected to their doctor. Kaiser Permanente reports that as of 2008, 40% of’ their membership signed on to their PHR eleven or more times. On the same report, their second quarter 2009 survey shows that 91% of their members who signed up for PHR are either satisfied or very satisfied with their patient portal which is kp.org.
• The Internet paved way to blogs, emails, social networks and text messages for open forums and exchange ideas. Secretary of State Hilary Clinton in her speech on Internet freedom said, “We stand for a single internet where all humanity has equal access to knowledge and ideas”.
• Consumers are no longer confined to workstations and personal computers to access the Internet, emails, social media and such. The advent of mobile devices as a portable convergent device allowed consumers instantaneous communication whenever and wherever they are.
• Although by no means perfect, government polices are addressing the demands of the consumers by passing legislations in response to consumers’ clamor of active participation of their healthcare. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) grants patients with access to their medical record and make amendments to it if appropriate. In addition, one of the goals of the American and Rediscovery Act (ARRA) of digitizing health information is to “provide patients and their families with timely access to data, knowledge and tools to make informed decisions and to manage their health”.
• The health care information and wellness promotions by the media, libraries, employers and community centers are contributing to health care awareness of consumers.
What are the key consumer groups that will demand changes to the future landscape of the doctor-patient relationship? The aging baby boomers who are both patients and care givers are actively involve in managing theirs and their family’s health care. They demand quality health care and home based care. This group is showing an upward trajectory in the utilization of PHR’s as well as social media tools such as social niches, blogging and chatting. Those with chronic care problems are drawn especially to social media primarily for support groups and self-help. A study by the California Healthcare Foundation in 2008 reported that safety net populations of this same age group are also eager to access their electronic health records and have sufficient computer skills to do so. Safety net populations are typically those situated in rural areas and have a lower social-economic status. Their limited computer access will be solved when patient-centric applications will be made available through the smart phones. The second group is what the Pew categorizes as the millennials who fall under the age bracket of 18-29. According to a Pew survey on Demographics of Internet Users, 93% of this age group uses the Internet. Digital technology and social media are deeply entrenched in their daily activities. While older physicians tend to favor in-person consultation, the younger doctors are comfortable with email communications, video consultations and self-care. I think the combination of the younger clinicians and the millennials will fully utilize “technology as enabler” and will embrace and will integrate those initiatives that have seen slow in adoption such as EMR, telemedicine and social media into their health care management. I think email will become the de-facto communication for doctors and patients. Lastly, I think electronic messaging will become extensions of PHR for alerts, reminders and such and utilizing computers for what they are best at using the rule of complementary.
Since my background is in IT customer support, I was curious to know what are the challenges faced by health care providers in providing customer support to online PHR applications. Contrary to one’s belief, consumers require a significant technical support more so than clinical or educational support. Security and privacy remain the number one concern of health care consumers; consequently, access to PHR requires a time sensitive activation key/code and a multi-step authentication factor process that can be challenging if not frustrating to some consumers. A study done by Wiljer, Urowitz, Apatu, et al (2010) reports that “access to their PHR with real time test results warrants a support centre and should be staffed by a person that can assist with technical support contacts by phone, email or in person and be able to refer users to clinical and educational support if necessary”. Currently technical support of PHR is offered in a variety of methods primarily through email, phone and a combination of both if customers are having a great deal of problems. Support hours range from business hours only to 24x7. Since this service is not reimbursable by any means, providers are minimally offering it. As part of cost containment measure, IT customer service is primarily offered to internal staff only and staffing is typically based on a penetration rate of approximately 1.1% of total user population. With increasing number of consumers signing up for PHR, I predict that there will be more studies in the very near future regarding the cost, benefits and the efficacy of such a service. Additional recommendations from the study include designing a streamlined online registration process, reasonable duration and length of activation keys and a self-service password-reset process.
The success of PHR is measured on how engage consumers are to it and whether the consumers will perceive it as a ‘value-added’ to their health management process. In my opinion, the following are considerations relating to the future of PHR design.
1. What is the best infrastructure to support PHR? Will it be Health 2.0 which is the Health-on-the-web?
2. Is standalone PHR better or will a pre-populated PHR with flexible, standardized and interoperable data more conducive? Today, although thriving and evolving, there are no standards relating to PHR. There is plenty of work to be done relating to standardization and data inter-operability, both of which also plague the electronic medical record (EMR) development process.
3. What are the PHR design considerations that will elicit the most and best response from consumers? Leonard et al. (2008) suggest that patients’ involvement should not be limited to access to lab results, etc., but “a comprehensive information source and support – essentially a decision support tool that promotes learning and self-management”.
4. How can we measure efficacy of the PHR based on consumer outcomes?
5. What are the support design considerations with regards to security and confidentiality that can ensure quick and appropriate access to PHR?
In conclusion, there are plenty of development opportunities for PHR in the future. Active participation of consumers and the integration of technology information are important key components in its development.
References
Bettencourt, A. (2010, March 8). Smartphones Lead the mHealth [ Web log post ]. Retrieved from http://rememberitnow.com/blog/2010/03/08/smart-phones-lead-the-way-in-mhealth/
Clinton, H. (2010). Remarks on Internet Freedom. Retrieved from http://www.state.gov/secretary/rm/2010/01/135519.htm
Demographics of Internet Users. Retrieved from http://www.pewinternet.org/Static-Pages/Trend-Data/Whos-Online.aspx
Eytan, T., Potter, H. (2010, March). Driving Total Health with Health IT and Health 2.0. Symposium conducted at the meeting of the HIMSS Annual Conference & Exhibition, Atlanta, GA.
Leonard, K., Casselman, M. Wiljer, D. (2008). Who will demand access to their Personal Health Record?. Futurethink, Healthcare Quarterly. (Vol. 11, p. 4).
Siedman, J., Eytan, T. (2008). Helping Patients Plug In: Lessons in the Adoption of Online Consumer Tools. Retrieved from http://www.chcf.org/search/index.cfm?qt=seidman
The Social Life of Health Information. Retrieved from http://www.pewinternet.org/Reports/2009/8-The-Social-Life-of-Health-Information.aspx?r=1
Wiljer, D., Urowitz, S. Apatu, E., Leonard, K., Quartey, N., Catton, P. Understanding the Support Needs of Patients Accessing Test Results Online, JHIM, 24(1), 57-62.
“2009 Survey of Health Care Consumers: Key Findings, Strategic Implications”. Deloitte Center for Health Solutions (2009). Retrieved from http://www.deloitte.com/view/en_US/us/Industries/health-care-providers/center-for-health-solutions/health-care-consumerism/60ea5a1264001210VgnVCM100000ba42f00aRCRD.htm
Sunday, March 21, 2010
Sunday, March 7, 2010
Second LifeTM in doctor-patient relationships
Forensic television shows attempt to paint the picture of what goes through the mind of the murderer or the serial killer. For Hollywood, these psychological behaviors give a never ending source of movie “thriller” themes. Despite the gruesome scenes and the addition of Hollywood theatrics, viewers get an inside glimpse of the personality of the offenders and for some viewers, they come away with some sort of transactional analysis and a social vindication at the end.
With the advent of virtual reality which is also known as virtual environment, researchers found that this sense of experiencing “somebody else’s world” or the sense of “somewhere else” has been successful in both psychotherapy and in medical treatments (i.e. rehabilitation) and that there has been a significant increase in the development of applications and devices related to virtual reality exposure therapies. Researchers also found that these virtual environments are so real; patients elicit the same psycho-motor responses like in a real environment.
One such application is Second Life. As a requirement for my class in “The Internet and the Future of Patient Care” students created their avatars and met up on a designated landmark at Davis Island. Our first meeting included a hallucination tour and based on this experience and my research, I came up with how Second Life or for that matter virtual reality can be useful in a doctor-patient relationship:
1) Convenience: Through the use of virtual reality environments, patients and doctors do not leave their offices. In addition, patients confidentiality is not compromised because treatments are not done out in the public.
2) Access: Therapy and treatments are easily scheduled because there is no travelling required. Meetings are easy to schedule so long as there are common availability for both the patient and the doctor. There could be technical difficulties that have to be dealt with just like we experienced in our virtual reality class at Davis Island.
3) From both of the above, virtual reality therapies offer reduce cost of treatment and it is aligned with green initiatives.
4) Speed: Learning how to maneuver the avatar can be accomplished within a handful of hours or training sessions and patients can be ready to begin their therapies fairly quickly. Like in our virtual meetings, in the beginning, I see the therapist playing the traditional active role in leading and controlling the sequence of events. As the patients get comfortable navigating in the virtual realm, the patient can begin driving the process of the treatment such as making decisions and choices.
4) Psychotherapy Treatment: The computer simulated environment offers a non-evasive method of psychotherapy treatment. Through simulated exercises, patients both young and adult can combat their fears, phobias, anxiety disorders, post-traumatic stress disorder (PSDT) disorders and even psychoses like the hallucination exercise we had.
5) Fun: I think the virtual simulations can be both fun for both the young and adult patients. For someone like me who needs a stress reliever every now and then, the infusion of virtual reality at the slot machines draws me to the casinos. Nowadays, there are high definitions and sense-surround slot machines and I find myself gravitating towards those. I probably end up spending more at the casino than an actual therapy session but for my needs, this once in a while entertainment is a worthwhile diversion.
In conclusion, virtual reality is a value added in a doctor-patient relationship in the areas of psychotherapy and medical treatment. For some, it can be purely entertainment and that works too!
With the advent of virtual reality which is also known as virtual environment, researchers found that this sense of experiencing “somebody else’s world” or the sense of “somewhere else” has been successful in both psychotherapy and in medical treatments (i.e. rehabilitation) and that there has been a significant increase in the development of applications and devices related to virtual reality exposure therapies. Researchers also found that these virtual environments are so real; patients elicit the same psycho-motor responses like in a real environment.
One such application is Second Life. As a requirement for my class in “The Internet and the Future of Patient Care” students created their avatars and met up on a designated landmark at Davis Island. Our first meeting included a hallucination tour and based on this experience and my research, I came up with how Second Life or for that matter virtual reality can be useful in a doctor-patient relationship:
1) Convenience: Through the use of virtual reality environments, patients and doctors do not leave their offices. In addition, patients confidentiality is not compromised because treatments are not done out in the public.
2) Access: Therapy and treatments are easily scheduled because there is no travelling required. Meetings are easy to schedule so long as there are common availability for both the patient and the doctor. There could be technical difficulties that have to be dealt with just like we experienced in our virtual reality class at Davis Island.
3) From both of the above, virtual reality therapies offer reduce cost of treatment and it is aligned with green initiatives.
4) Speed: Learning how to maneuver the avatar can be accomplished within a handful of hours or training sessions and patients can be ready to begin their therapies fairly quickly. Like in our virtual meetings, in the beginning, I see the therapist playing the traditional active role in leading and controlling the sequence of events. As the patients get comfortable navigating in the virtual realm, the patient can begin driving the process of the treatment such as making decisions and choices.
4) Psychotherapy Treatment: The computer simulated environment offers a non-evasive method of psychotherapy treatment. Through simulated exercises, patients both young and adult can combat their fears, phobias, anxiety disorders, post-traumatic stress disorder (PSDT) disorders and even psychoses like the hallucination exercise we had.
5) Fun: I think the virtual simulations can be both fun for both the young and adult patients. For someone like me who needs a stress reliever every now and then, the infusion of virtual reality at the slot machines draws me to the casinos. Nowadays, there are high definitions and sense-surround slot machines and I find myself gravitating towards those. I probably end up spending more at the casino than an actual therapy session but for my needs, this once in a while entertainment is a worthwhile diversion.
In conclusion, virtual reality is a value added in a doctor-patient relationship in the areas of psychotherapy and medical treatment. For some, it can be purely entertainment and that works too!
Tuesday, February 16, 2010
Commentary on PHR Inclusion
The goal of Personal Health Record (PHR) is the empowerment of patients and their families and friends to manage their clinical health records. HIPAA states that PHR will “provide patients and their families with timely access to data, knowledge and tools to make informed decisions and to manage their health.” This provision allows patients the ability to view, revise and make corrections to their medical records, billing records, enrollment and claim forms.
The increasing popularity of PHR is forcing the debate on how much detail should be made available to patients. At this time, there is no specific wording in any regulation about this matter. The patient advocacy group demands that all health records should be made available while health care providers argue that full disclosure without the appropriate patient education may cause unnecessary alarm and potentially might do more harm than good. Even health care institutions with some significant EMR experiences have put in place different approaches. Some have full disclosures. Some do not disclose at all but continues the practice of having the health care providers discuss and review results to patients face-to-face. While some others have a hybrid of the first two and that is they publish the results with direct links to relevant materials that patients can check into. While still some others who have practiced one approach later changed their stance to another. Kaiser for instance first started with full disclosures on laboratory results and later pulled back to report only normal ranges.
Here are some questions related to this debate. Who should determine the specificity of the disclosure? Will we leave it to the hands of the health care providers or should it be the patients? How can we accommodate patients who demand more control over their records? Are health care institutions intentionally not fully disclosing due to the high price tag of responding to patients’ questions? What about patient education?
After my daughter’s doctor visit recently, I was handed the results of her blood tests. The doctor informed us that the results checked normal and if we decide to proceed with additional treatments that we should call her back. She explained in some detail how to read the results and I will not claim that I fully understood all the clinical jargon she used in her explanations. After the visit, my daughter and I checked the Internet. I am fortunate to have a sister who is an internist in San Diego so I called her up and I asked for her expertise as a second opinion. My daughter asked her friends at school too. She shared me the things that she found out from her friends and I shared her what my sister told me. We discussed all the information that we gathered. In the end, she decided not to proceed with the additional treatments and I was happy with her decision.
Based on my experience, in my opinion, it is the right of patients to have full disclosure on their health records. This is a tall order, I understand. With this right comes the responsibility of patients in seeking proper education in understanding their health records and their health conditions. Patients need to seek all sources of information they can find. The Internet has been and continues to be the primary search engine of health care information but because it is not regulated, it is necessary for both patients and health care providers to partner together. Family members, friends and support groups are also invaluable sources of information.
The increasing popularity of PHR is forcing the debate on how much detail should be made available to patients. At this time, there is no specific wording in any regulation about this matter. The patient advocacy group demands that all health records should be made available while health care providers argue that full disclosure without the appropriate patient education may cause unnecessary alarm and potentially might do more harm than good. Even health care institutions with some significant EMR experiences have put in place different approaches. Some have full disclosures. Some do not disclose at all but continues the practice of having the health care providers discuss and review results to patients face-to-face. While some others have a hybrid of the first two and that is they publish the results with direct links to relevant materials that patients can check into. While still some others who have practiced one approach later changed their stance to another. Kaiser for instance first started with full disclosures on laboratory results and later pulled back to report only normal ranges.
Here are some questions related to this debate. Who should determine the specificity of the disclosure? Will we leave it to the hands of the health care providers or should it be the patients? How can we accommodate patients who demand more control over their records? Are health care institutions intentionally not fully disclosing due to the high price tag of responding to patients’ questions? What about patient education?
After my daughter’s doctor visit recently, I was handed the results of her blood tests. The doctor informed us that the results checked normal and if we decide to proceed with additional treatments that we should call her back. She explained in some detail how to read the results and I will not claim that I fully understood all the clinical jargon she used in her explanations. After the visit, my daughter and I checked the Internet. I am fortunate to have a sister who is an internist in San Diego so I called her up and I asked for her expertise as a second opinion. My daughter asked her friends at school too. She shared me the things that she found out from her friends and I shared her what my sister told me. We discussed all the information that we gathered. In the end, she decided not to proceed with the additional treatments and I was happy with her decision.
Based on my experience, in my opinion, it is the right of patients to have full disclosure on their health records. This is a tall order, I understand. With this right comes the responsibility of patients in seeking proper education in understanding their health records and their health conditions. Patients need to seek all sources of information they can find. The Internet has been and continues to be the primary search engine of health care information but because it is not regulated, it is necessary for both patients and health care providers to partner together. Family members, friends and support groups are also invaluable sources of information.
Monday, January 18, 2010
Introduction
My name is Gelin Ordona. I am a Service Desk manager at a county medical center in northern California. Prior to this position, I was an applications support manager for a behavioural health department. My career has been in the I.T. support of health care professionals. I am pursuing a Health Informatics certificate program at U.C. Davis Extension.
I created this blog to chronicle my progress in the class which I am currently enrolled "The Internet and the Future of Patient Care". With all the buzz around healthcare nowadays, I thought I name my blog site as "GO eHealth" as GO is also my initials.
I created this blog to chronicle my progress in the class which I am currently enrolled "The Internet and the Future of Patient Care". With all the buzz around healthcare nowadays, I thought I name my blog site as "GO eHealth" as GO is also my initials.
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