The demographic and financial paths before the Western developed world are proving to be catalysts to address what were once considered intractable problems with delivery of widespread quality health care. Finally focus is moving towards the outcomes of medical care as a means for evaluating the success (or otherwise) of interventions. However to measure outcomes, we need to establish a baseline prior to treatment and then establish a transparent and reliable measure of the treatment’s impact on the life of the recipient – the patient. Patient centred outcome measures are emerging as a potentially powerful tool to direct and improve medical decisions with outsized cost reductions at the same time.
As the media comes across such stories, we at eHealthier will post the links and associated commentary on our blog page for interested parties to follow up.
Looking through a publication from Yale by the Center for Outcomes Research & Evaluation (CORE), I came across the following.
This first article gives the opinions of 11 medical experts in America on how to fix the health system. Interesting that most see the use of patient data and even a reversal of the roles of doctor patient, as crucial for improving health outcomes. Three of the opinions are copied below.
When consumers choose health care, they have precious little information on the outcomes that are meaningful for them. How long will I be out of work? How well is my pain controlled? How likely am I to get an infection if I have this procedure done by this doctor? If consumers had as much information about health care as they do about consumer products, we would see dramatic improvements in quality — and reduced costs. If consumers and employers and insurers had access to this data, perhaps then we would begin to reduce the disparities and the variation in quality of care among health care organizations. When you buy an airline ticket, do you ever think of checking to see how safe the airline is? No, safety is guaranteed. The airline industry has institutionalized safe practices so all the airlines are safe. You choose your ticket on price, or on service. That’s where we need to go with health care. Part of that is being transparent about where we are doing well and where we are falling short.”
We talk about patient-centered care, but we really have doctor-centered care. What I want are tools that patients can use to empower themselves. Right now I’m the doctor. I have all the knowledge. I’m in control. I want to flip that dynamic. In the same way I am required by law to ask about allergies and medications, and talk about a past medical history, I want doctors to take the time to sit down, slow down and ask a patient: What’s a good day for them? What’s important for them? What are their values? What are their religious beliefs, their ritual beliefs? I want to know what their hopes and fears are for medical care, and where they want to spend the end of their life. I want to be required to have to ask that of all patients, at least to give them the opportunity. And sure, there may be some patients who are not ready to have that conversation, but I want them to know that I am open to having that conversation. It’s the ultimate wellness pitch, I tell people: We are all going to die someday, and part of living well means addressing this life’s final chapter. That’s not about end of life. It’s about a good life, for as long as you can, as best as you can.”
Put health data to work
The real change that needs to happen is one that puts patients in control of their data. Hospitals are monetizing your data all the time. Hospitals hold data and allow people to look or copy, but it is not always easy to bring together all the information. You should have control over your data and have the ability to share it securely with anyone you want. This will shift the balance of power toward the patient, allowing people to do comparative shopping for their health care, and reducing costs, because today it’s easier to repeat tests than get the data from another doctor or hospital. Sometimes bad things happen because critical information isn’t available; sometimes it’s because people are getting care at different places and the information never comes together in one place. There are personal health records out there, but they require the patient to do a lot of work. We need to get to a system where patients have access to their own data that they can use seamlessly. Ideally, it would be like your bank account. You can easily access all of your financial information online. Why not your health records?