The secret to empowering patients — changing their roles from passive recipients to active participants — lies in a health care provider’s ability to link them informatively into the decision-making process.
Imagine you are the new chief medical officer of your hospital or health system. An exasperated medical staff member relates this story to you: “One of my patients came into the office today with pain in the neck, and before I could provide my recommendations, the patient suggested that I order an MRI and physical therapy along with prescriptions for a muscle relaxant and nonsteroidal anti-inflammatory medication.”
Such interactions aren’t unique these days.
Welcome to the world of the informed patient and their use of online resources to gather information. Today’s “e-patients” and their families are likely to be more informed than ever about their health care and treatment options.1 They want more information, relief from symptoms, positive outcomes and control over their care, and their expectations of customer service from a provider are higher.2
Thanks to an abundance on online resources, patients today are likely to be more informed than ever about their health care and treatment options. They want more information, relief from symptoms, positive outcomes and control over their care, and their expectations of customer service are high.
How well are your physicians and your organization adapting to the changing dynamics of the patient-provider relationship? How well are you harnessing health information technology, or HIT, to make the relationship more valuable to all parties?
While considering the needs of patients, physician leaders also must understand the needs and expectations of their physician colleagues, other members of the care team and the administrative staff. Accommodating the complex interplay between patients, families, physicians, administrators and other key stakeholders requires a communication and decision-making bridge.
This bridge is your HIT system.
Effective HIT empowers patients and families with their own decision-making and changes the patient’s role from passive recipient of health care services to an active participant. Patients are informed, have choices and are involved in the entire process.3
Health care is no different from other industries regarding the value of maintaining the relationship between the organization and the customers it serves.4 The digital environment is so imbedded into our culture by linking customers and commerce in a wide variety of ways, that not ensuring robustness of your HIT system puts organizational sustainability at risk. To gauge your organization’s system, ask yourself: How functional and responsive is your HIT system to your patients, medical staff, and administration?
The complex interplay between patients and providers has been described like this: “Information is care. When good information is given to patients, patients become partners in their own care.”2 Health care information belongs to the patient and can be prescribed — just like a medication, a test or a treatment plan — as “information therapy.”2
HIT is much broader than an information exchange. It encompasses an ever-evolving variety of tools, including electronic medical records, personal health records, patient registries, mobile health applications, remote monitoring devices and wearables.5
In recent years, the U.S. government has promoted and offered incentives for the use of health information technology. In April 2004, President George W. Bush issued an executive order calling for widespread adoption of interoperable electronic health records within 10 years and established the Office of the National Coordinator for Health Information Technology.6 Subsequently, the Health Information Technology for Economic and Clinical Health Act of 2009 paved the way for organizations to accelerate using technology to improve health care quality, safety and efficiency.
The 2015-20 Federal Health Information Technology Strategic Plan5 has four major goals:
- Advancing person-centered and self-managed health.
- Transforming health care delivery and community health.
- Fostering research, scientific knowledge and innovation.
- Enhancing the nation’s health IT infrastructure.
Of particular note are the government’s stated objectives for the first goal — empower the individual, family and caregiver, and engage and foster individual, provider and community partnerships — and the second — improve health care quality, access and experience through safe, timely, effective, efficient, equitable and person-centered care; support the delivery of high-value health care; and protect and promote public health and healthy communities. Physician leaders must ensure that these objectives are addressed by their HIT environment.
An organization’s IT environment can be separated into three domains: network applications, enterprise systems and mobile technologies.7 Each has an important role in the care of patients. Forward-thinking organizations have begun using them to enhance their relationship with patients.
Communication and information exchange typically takes place across three types of networks: the internet, intranets and extranets.7
The wide-open internet gives physicians global access to other providers and access to information that can benefit their patients, while allowing patients to help manage their own health care by making informed decisions. This is best seen in the rise of telemedicine, which links patients and providers over long distances via video conferencing and chat technology, readily available on smartphones, tablets and computers. It also has created an environment in which patients are keeping their physicians accountable for their care, and physician leaders and health care organizations need to recognize how that has shifted the patient-doctor relationship.
An intranet is a closed information-sharing network that organizations establish and use internally. Many health care organizations use intranet technology to provide real-time connectivity with the software applications they use. Such an environment can readily accelerate the diffusion of knowledge throughout an organization.
An extranet is an intranet that can be accessed by authorized outside users. Many organizations establish one to connect with their supply chain partners. This allows them to streamline transactions and improve efficiencies of the linked organizations. In a health care environment, this allows patient records and other information to be shared securely among organizations — improving communication, information sharing and cost control.
The health care industry uses two other tools to manage knowledge and create connectivity between providers and their customers: enterprise resource applications and mobile technologies. ERA include such tools as decision support systems that allow providers to access the latest in evidence-based medical information, or serve as data repositories for financial, quality, and clinical outcomes for patients. The mobile technologies continue to evolve for smartphones and tablets that link patients to their providers, the internet and storage of health-related information.
What It Means
Today’s health care leaders are still trying to determine whether there is a financial benefit to investing in health information technology. The typical reasons for large technology investments are improvement of inter-organizational networks, reduction of costs, control of resources and improvement in quality.3
As with all patient interactions, organizations and physician leaders must be closely attuned to the ethical ramifications and challenges that the digital world presents, including individual patient data security and misinformation. For example, patients are more easily accessing evidence-based data, giving them a better understanding of the risks of specific treatments and their chances of dying, but this knowledge might diminish their quality of life by creating worry, misconception and doubt about their physicians’ recommendations.8
The internet can bring certain advantages for physician leaders, including more educated patients, stronger physician-patient relationships, easy patient access to online support groups, and physician education and decision support. On the other hand, there can be challenges, including inaccurate information, lack of access for some socio-economic groups, increased doctor for visits for patients with unnecessary questions or concerns, and liability risk for physicians who follow web-based information rather than standards of care.1
In 2013, the Institute for Healthcare Improvement published a white paper on how to select digital technology for health care.9 Here’s what it said should be considered:
- Population health management and predictive analytics to improve care coordination, care management, large-scale data interpretation, and population-level decision-making capability.
- Hospital and clinic administration technology for improved workflow, integrated billing and claims management, personnel management and financial decision-making.
- Telemedicine and teleconsultation to link patients and providers.
- Personalized software to allow patients to collect their own health data, and measure and make changes to their behavior.
- Remote patient monitoring technology to link patients’ physiologic data from their homes to their providers in real time.
- Enhancing patient/consumer engagement by linking patients with other patients to share experiences, information and ideas.
- Creating interoperability among separate technology systems to allow for efficient and seamless communication in a meaningful way.
- Diagnostic technology to interpret biometric data and provide diagnostic functionality,
- Clinical decision-support functions to support physicians and other providers in arriving at better diagnoses.
- Therapeutic technology, focused on treating an ailment directly in the form of a pharmacologic agent or device.
Eugene Fibuch, MD, CPE, CHCQM, FACPE, FABQAURP, is professor emeritus at the School of Medicine and co-director of the physician leadership program at the Henry W. Bloch School of Management at the University of Missouri in Kansas City.
Arif Ahmed, BDS, PhD, MSPH, is an associate professor of health administration in the Henry W. Bloch School of Management and co-director of the physician leadership program at the University of Missouri in Kansas City.
- Hedy SW, Dube CE, Anthony DC. Untangling the web: The impact of Internet use on health care and the physician-patient relationship. 2007. Patient Education Counseling. Vol. 68, pp. 218-224.
- Mettler M. Untangling the web: Bringing information therapy to the new health care consumer. 2001. GOAL/QPC. Fall, pp. 157-164.
- Demiris G, Afrin LB, Speedie S, Courtney KL, Sondhi M, Vimarlund V, Lovis C, Goossen W, Lynch C. Patient-centered applications: Use of information technology to promote disease management and wellness. A white paper by the AMIA Knowledge in Motion Working Group. 2008. J Am Med Inform Assoc. Jan-Feb; 15 (1): pp. 8-13.
- Fibuch EE, Ahmed A. Customer Relationship Management. 2015. Physician Leadership Journal. Jan-Feb, pp. 28-33.
- U.S. Department of Health and Human Services, 2011. Office of the National Coordinator for Health Information Technology. Federal Health Information Technology Strategic Plan 2011-15.
- Brailer DJ. The decade of health information technology: Delivering consumer-centric and information-rich health care. 2004. Office of the Secretary, National Coordinator for Health Information Technology, Washington, DC. pp. 1-38.
- Siau K. Health Care Informatics. 2003. IEEE Transactions on Information Technology in Biomedicine. Vol. 7 (1), March.
- Hallowell N, Foster C, Eeles R, Ardon-Jones A, Murday V, Watson M. Balancing autonomy and responsibility: the ethics of generating and disclosing genetic information. 2003. J Med Ethics; Vol. 29: pp. 74-79.
- Ostrovsky A, Deen N, Simon A, Mate K. A framework for selecting digital health technology. 2013. IHI, pp.1-21.