COACH Column: Accelerating Change: Putting the Patient at the Centre of Care

Genome testing – using DNA analysis to determine genetic predisposition to various health conditions – still sounds like something out of a science fiction movie to many Canadians. But, the reality is that it’s available here, in North America, along with a constantly growing range of technology. While we haven’t quite reached the level of Star Trek’s tricorders yet, the pervasiveness of technology in society is now reaching the doorsteps of the healthcare system. Healthcare providers’ and consumers’ expectations that they can interact with the health system through mobile devices, access information seamlessly and use friendly tools and apps to achieve more engaged, effective and individualized care will accelerate change in healthcare, particularly the move towards patient-centred care.

As discussed in my past two columns, we are at a time of unprecedented opportunity for innovation. As health informatics (HI) professionals, we’re certainly used to change, but will need to tap our broad set of knowledge and skills in healthcare, technology, information and human behaviour in working with healthcare providers, leaders and consumers in successfully capitalizing on these opportunities. It is essential that we can support and accelerate the innovation that is starting to take hold in Canadian healthcare as documented in Jeffrey Simpson’s new book, Why Canada’s Health Care System Needs to be Dragged in to the 21st Century.

As HI professionals, we understand the importance of empowering people with information about their own health. The need to move away from health systems that require patients to adapt to the system and start focusing on patients’ individual needs and circumstances has been identified as an important problem by the World Health Organization (WHO), the Organization of Economic Cooperation and Development (OECD), the Institute for Healthcare Improvement (IHI) and other prominent bodies. The benefits, including better patient outcomes, more effective use of our skilled healthcare professionals and resources, improved quality and health system sustainability, are widely recognized.

While certainly e-Health is doing many good things to enable seamless access and continuity of care, patient care quality advocates such as Don Berwick, MD, MPP (former President and Chief Executive Officer of the Institute for Healthcare Improvement), advocate that we need to think about even more broadly about patient-centered care as:

“The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in healthcare.”

This is an exciting, history-in-the-making moment in healthcare, as we start to see the shift to a much more patient-centered care system taking shape.

“We are at a unique time in medicine, a veritable inflection point that can transcend mass medicine and bring us to one that takes each individual’s distinct properties into account.”
Dr. Eric Topol (who shares his ideas on the subject as a keynote speaker at the e-Health 2013: Accelerating Change Conference in Ottawa May 26 -29.)

Proponents of consumer healthcare technology and the dawning age of personalized medicine, such as Dr. Topol, challenge us all to think about how consumers will increasingly use smartphone apps (and clinicians may prescribe them as they do today with drugs and other therapies) to monitor their own health with the aid of increasingly sophisticated and inexpensive wireless sensors.

We are beginning to see a number of innovative uses of these technologies for engaging patients in their own care around the world, including in Canada, and are undoubtedly just at the beginning of this new frontier for healthcare and for e-Health. We know we still have much to learn about what will work, and how these technologies will be adopted by consumer and clinicians. A thoughtful approach to innovation will be important – one where we continually learn, collaborate, innovate, evaluate and improve upon how we can leverage new technologies to enable improvements in health.

Empowering Patients
Our e-Health Conference this year is both inspiring us with the opportunities inherent in enabling a much more patient-centered healthcare journey, but also highlighting some of the challenges and unknowns.

Patient empowerment is one of the greatest benefits of the patient-centred approach. We heard from John Halamka, MD, CIO, Beth Israel Deaconess Medical Center and Harvard Medical School and an electronic health record (EHR) pioneer, at e-Health 2012 about how personal access to EHRs is paramount for successful patient-centred care. He cited benefits that include increased patient satisfaction, more efficient clinician workflow and improved process flow for appointment making and medication renewal. “Patients should be stewards of their own data,” he has said.

In Canada, initiatives such as the MyHealth.Alberta.ca personal health portal, aim to help individuals take charge of their health with an array of information and tools, including a “symptom checker,” real-time hospital Emergency Department wait-time reports, travel alerts and medication guides. Fostering a personalized experience, Alberta’s vision is that any citizen can use the portal to access his/her secure, complete health record via any Internet connection, and that this will also:

  • improve coordination among care teams, through e-scheduling and other means,
  • boost engagement and communication by helping individuals understand conditions and treatments and
  • better prepare for interactions with the care team, and improve access to services.

In Australia, publicly accessible personal EHRs are now being made available to citizens on a nationwide basis through their new Personally Controlled eHealth Record System (PCERS) that provides an electronic health summary that an individual can access and share with trusted healthcare providers. Launched in July 2012 as a key element of the Australian Government’s national health reform agenda, individuals register for their PHR at http://publiclearning.ehealth.gov.au/. Together with telehealth and the National Broadband Network, the PCEHR aims to improve accessibility to health services and patient information, enhancing health outcomes. Much will be learned through a project of this scale and the full benefits of the PCEHR system are expected to be realized by consumers, their healthcare providers and the Australian community more broadly over the next 10 years. Louise Schaper, CEO, Health Informatics Society of Australia (HISA), shares her personal experience with PCEHR and the importance of clinician engagement at the e-Health Conference Clinician Symposium May 27.

In the US, the winds of change are sweeping health records with Meaningful Use and initiatives such as “Blue Button” technical capability that lets individuals download their health or claims information in an easy-to-read format. As of May 2012, nearly 1 million Americans had clicked on the Blue Button and downloaded their personal health data through federal and private-sector sources.

So…there are certainly a number of different approaches underway regarding consumer health records that we can learn from (the above being just a sampling). Yet there are many other promising avenues for supporting a more patient-centered health system as well, as we can see in the following examples.

For individuals living with chronic disease and other serious conditions, technology is also accelerating major improvements in care. About half of all Canadians are living with at least one chronic health condition.

The Ontario Telemedicine Network (OTN) has successfully completed a pilot project and OTN’s Telehomecare Expansion Project is now offering a new way to care for these patients, supporting inter-professional collaboration for more integrated care. Telehomecare also empowers patients to better manage their condition, reducing the costs associated with chronic disease management. Registered Nurses support patients with chronic obstructive pulmonary disease (COPD) and heart failure through remote monitoring and regular health coaching sessions. Patients become partners in their own care – right in their home.

Mental health, another emerging area and already the most commonly delivered telehealth service available in all jurisdictions surveyed for the 2013 Canadian Telehealth Report (see article elsewhere in this issue), is another patient-centred success story. Using “tele” technologies that reduce travel time and costs, telehealth has been instrumental in bringing mental healthcare to remote and rural Canadian communities where shortages of psychiatrists and psychologists have a particularly negative impact.  The opportunity to interact with providers online, instead of walking into an office in a close-knit community, may also reduce the stigma of seeking this kind of help.

The journey to patient-centred care is well underway, but it’s far from finished.

What are the keys to moving ahead, particularly for HI professionals? One important element is supporting clinicians. COACH has long recognized and valued the important role of clinicians; thus the launch of our new CCF: COACH Clinician Forum (see article elsewhere in this issue) as a vehicle for dialogue and engagement. If you’re reading this before or at the e-Health Conference, I encourage you to join the Clinician Symposium to soak up perspectives about and experiences with engaging this important group from Canada Health Infoway, our Australian colleagues at HISA and the Ontario Medical Informatics Working Group.

The COACH e-Health Safety Program is another key. It complements the existing culture of patient safety in clinical care delivery by fostering the adoption of safer e-Health solutions and health software and guiding the introduction of leading practices, directly supporting patient-centred care. Watch for more information about this initiative later this year.

We must also constantly strive to keep an open mind and think “outside the box” to make patient-centred care happen. In our diverse, multi-disciplinary profession, we need to draw on our wide range of talent and ideas – all for the ultimate goal of improving patient care. As captured in the Strategic Plan values, at COACH we strive to: “Demonstrate leadership by introducing innovation that accelerates the transformation of health service delivery values.”

Your Thoughts?
What are your ideas about patient-centred care? What can we do at COACH to accelerate our progress? Please let me know what you think through the COACH office at info@coachorg.com or via Twitter @COACH_HI.

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