Implications of Information Technology and Consumer Participation in Health Care Patricia Flatley...
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Transcript of Implications of Information Technology and Consumer Participation in Health Care Patricia Flatley...
Implications of Information Technology
and Consumer Participation in
Health CarePatricia Flatley Brennan, RN, PhD, FAAN
Moehlman Bascom Professor
School of Nursing and College of Engineering
University of Wisconsin-Madison
Challenges and Changes
in Health Care Delivery
Changes in Health CareShifting responsibilities, shifting
costs, shifting valuesShortened Length of StayEmphasis on evidence and
outcomesBroader idea constitutes health
What is health care & who’s involved?
Patient
Professional
Disease Self Help Self Care Management
Patients are
Changing, too!at least some of them
Transitions in our view of patients
From ‘flat and silent’
To Collaborative Problem Solvers
What makes patients change?
clinical recognition of the importance of patient participation
social valuing of autonomy, self-help and self-determination
withdraw of previously-delivered service changing cost model
Moving the site of care
Contemporary Health Care rests on a
successful partnership betweenPatients, Clinicians, and Delivery
Systems
Consumer Health Informatics: Putting Information Resources in the
hands of Consumers
Accepted and Alternative Health General Health Information Personal Health Data
Delivering CHIBroadcast and print mediaThe InternetHealth-related WWW sitesSelf help BBS, Listsrvs & e-mail
groupsFreestanding kiosks, CD-ROMs, and
SmartCards
Evaluating CHI
Perspectives: Credentialling sites or Educating consumers
Involved groupsODPHP Scientific PanelHITI, Inc (Mitretec)AMIA Internet Working Group
CHI JIT Y2K
SMART Patients
SMART Patients Self-assured Motivated Aware Resourceful Talented
Remember they may also be:
Scared Minors!
Anxious Reluctant Time consuming
Common behaviors of SMART patients
self triagevalues and preference clarificationparticipativecollaborativeindependently engage in health
promotion
What they aren’t :complacentquietunchallengingsimilar
SMART Patients: Who needs ‘em?
we do!Why? partners in careClinicians have too much to do episodic nature of care doesn’t work
any more
Clinician’s responses to the SMART patient:
engaging tolerant dismissive condescending
The Challenges for Clinicians
Use technology to help make patients smarttreat them as a resourceChange our practice activities to capitalize
on their talentsReorganize our practice environments
What are we expecting patients to do?
case managemonitorperform therapeuticsinitiate conversation with us
Information tools needed:
access to their clinical recordsPersonal Case Management
toolsCHI and assistance with using
it (access, interpretation)
Clinical Practice IssuesHenderson “...what the patient can
do...”Re-examining every actionTrusting our colleaguesTiming of interventions
Clinical RolesContent ExpertEnvision a clinical practice that
makes use of the patient as a resource
Re-organize care and care activities to incorporate patients
Constructing a Health Care Delivery
System responsive to
SMART Patients
Clincial Systems Issues
Collaborative with other disciplinesreciprocity of change
Practice StandardsOptimized work patternsIncentive Structures
Information Systems Issues
Patient-centered careLanguage:
Data relevant to all care providersMapping from professional to vernacular
Inter-organizational communicationSecurityCost model
Clinical information systems integration
InformationTechnology’s Response
Patient- Centered Systems
Patient-Centered Systems
Clinical Records Network CommunicationConsumer Health
Informatics
Clinic
Hospital
Physician Office
Pharmacy
FurtiveRecords
Dentist
Patient-Centered Information Systems
What can you do differently tomorrow?
There are degrees of SMART!
Not all patients are equally SMART -- nor are they smart in the same way
but we must seek that which is SMART in each patient
Seen any ‘SMART’ patients lately?
...they’re there,
everywhere!