Patient Centric Care&Telemedicine

Sigi Marmorstein ,MSN, PHN, FNP-BC

If it isn't broken, don’t fix it…• US health care cost is spiraling • Fee for service and volume based medicine is still the driver • Quality of care is measured by patient satisfaction • Care is mostly intermittent (doctor visits) and reactive (illness)• 80% illness care 2o% preventative care• 15-20 minute blocks of care, scheduled visits • Lack of health education and patient engagement • Polypharmacy with over 4 billion prescriptions written in 2015• Depression, anxiety, Rx drug abuse and social isolation• Silos in care, no integration or collaboration

The NIH defines patient-centered care as follows: “health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs and preferences and solicit patients’ input on the education and support they need to make decisions and participate in their own care.” 

The patient-centric movement will be changing the mental framework of providers and the public to both transition true focuses on the patient. Patient-centered medicine’s use of technology is provider-focused, with information still emanating from the provider. Patient-centric healthcare creates the information from the patient as source.

Goals of Telehealth development

• Accessible – home, work, cell• Capable – integration, patient shared information• Affordable – reduce current costs• Transform the patient experience (?)• Better population management • Better management of service utilization • Catering to changing patient expectations (?)• Health care providers work from home on their

own terms

What do patients want?1. Access to care 2. Reduce waiting in line for doctors, labs, pharmacy, x-ray, ER3. More time spent with the doctor/nurse/care provider4. Feel that they are important, not “just a number”5. Consistent care by the same provider 6. Increased understanding of their condition7. Increased understating of their options8. Access to their medical information9. Less medications (prescription)10.Security and trust

Kaiser foundation patient survey results 2012-2014. © 2016 Kaiser Family Foundation

Devices and Safety • Multiple life saving devices were found

hacked with malware installed (that can go undetected for months), like insulin pumps and pacemakers• Many medical devices collect data that

can be used for aggregated data• Wearables collect personal data and can

be easily transmitted and hacked• There is no clarity on which government

agency is in charge of regulation• Little enforcement mechanisms are in

place

Telehealth Projects – Success and Failure• Intermountain •USC- VHH•Renown•La Centre’ Clinics•MedCare Live •Kaiser

Challenges – Report • Slow to adopt physicians• Slow to adopt system – business model must change• Security – 12,000 security breaches in 14 days • Legality- what we can and cannot do with Telehealth?

What are the risks? • Measuring clinical outcomes • Assuring quality and uniformity of care – over or

under prescribing, clinical protocols

Challenges • Supply driven demand• Determination of strategic focus• Training- clinicians and support staff • Work flow design• Upfront costs with unknown ROI • Reduced patient satisfaction and increased medical

lawsuits • Not following the process- see next slide

Be careful what we wish for ….• Lots of consumer driven products and enthusiasm• Very crowded space with lots of competition, not enough

collaboration• Lots of vendors, offering many promises, not enough

randomized controlled trials • The use of internet for health information and public reporting

changed the “value” of medicine • The ability to judge care, costs, satisfaction and other

parameters of outside organizations create value based competition that did not exist before • Malware/viruses, data breaches and stolen medical records

Next steps to innovate patient centric care• Innovative programs need to resolve a problem not augment it• Visit need to be longer, informative and educative• Trust building• Culture changing • Reduction in cost vs profit • Care protocols keeping patient in center• One size does not fit all• Technology must be safe and predictive• Collaboration