“Deep Support” in Patient Care Reengineering Healthcare to Support Patient-Centered Communication and Continuity of Care Bradford W. Hesse, PhD Chief, Health Communication & Informatics Research Wednesday, June 18, 14
Jan 26, 2015
“Deep Support” in Patient CareReengineering Healthcare to Support Patient-Centered
Communication and Continuity of Care
Bradford W. Hesse, PhDChief, Health Communication & Informatics Research
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Wednesday, June 18, 14
A Lonely Road*
Limited Support
Estranged from research enterprise
Subject to common errors of omission in
care
Cloistered knowledge
Struggle with adherence
Silo’ed & inaccessible
records
Fragmented care
Doctor centric medicine
* Hoffman, Jan. (2005, August 14, 2005). Awash in Information, Patients Face a Lonely, Uncertain Road, New York Times. Wednesday, June 18, 14
“Greatest innovators (e.g., Henry Ford) ... discovered the possibility
of a new kind of convergence between consumers’ desires, technological capabilities, and organizational innovations.”
The Support Economy
SOURCE: Zuboff, Shoshana, & Maxmin, James. (2002). The support economy : why corporations are failing individuals and the next episode of capitalism. New York: Viking.
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“Deep support provides ongoing relationship based on advocacy, mutual respect, trust, and the acute
alignment of interests.”
The Support Economy
SOURCE: Zuboff, Shoshana, & Maxmin, James. (2002). The support economy : why corporations are failing individuals and the next episode of capitalism. New York: Viking.
“The new digital technologies are essential to the successful
consolidation of this new ... logic.”
Example
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SOURCE: Hesse, B. W., & Shneiderman, B. (2007). eHealth research from the user's perspective. Am J Prev Med, 32(5 Suppl), S97-103.
The Support Economy
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Why important?
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Just a 1% reduction would save $400 billion
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Source: Leyden WA, Manos MM, Geiger AM, Weinmann S, Mouchawar J, Bischoff K,Yood JG, Taplin SH (2005). Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process. JNCI, 97(9), 675-683.
FAILURE IN SUPPORTThe Case of Cervical Cancer
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Systemic Errors in Medicine
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Accoun&ng for Two Types of Error
Errors of Commission: Doing something wrong (root cause of detectable errors)
Errors of Omission: Failing to do something right (e.g., Pap failure - leads to more insidious consequences)
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Communica&on Errors at Root
Source: Mazor KM, Roblin DW, Greene SM, et al. Toward patient-centered cancer care: patient perceptions of problematic events, impact, and response. J Clin Oncol. May 20 2012;30(15):1784-1790.
• Interviews with 416 cancer patients across 3 clinical sites (Mazor, et al, 2012)
• Asked about events where something “went wrong,” the event could have been prevented, and the event could have caused significant harm.
Results*• 28% described problem with
medical care
• 47% described a communication problem
• 24% described problem with both communication and medical care
* Of those reporting error
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2008
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Friedberg MW, Coltin KL, Safran DG, Dresser M, Zaslavsky AM, Schneider EC. Associations between structural capabilities of primary care practices and performance on selected quality measures. Ann Intern Med 2009;151(7):456-63.
EHRS as Structural Capability
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HITECH Act
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Source: Hesse BW. Public Health Informatics. In: Gibbons MC, editor. eHealth Solutions for Healthcare Disparities. New York, NY: Springer; 2007. p. 109-129.
Engaging Patients, Managing Populations
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Meaningful Use as Building Blocks
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Where are we?
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Surveillance
July 27, 2012
See also: Hesse BW, Nelson DE, Rutten LF, Moser RP, Beckjord EB, Chou W-YS. National Health Communication Surveillance Systems. In: D. K. Kim ASGLK, ed. Global Health Communication Strategies in the 21st Century: Design, Implementation, and Evaluation. New York, NY: Peter Lang; In Press.
.
Health Situa+onal Awareness
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*NIH Nominee to White House for “Open Science Champion,” May 14 2013.
Data BriefsStatisticalGuides
Peer Reviewed Publications
Web Platform for Participation*
Health Informa+on Na+onal Trends Survey (HINTS)
Surveillance
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HINTS Brief #1: Trust in channels and cancer informa+on seeking
Source: Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.
Surveillance
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Where would you prefer to go for cancer informa+on?
Source: Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.
Surveillance
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Where did you go for cancer informa+on?
Source: Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. Dec 12-26 2005;165(22):2618-2624.
Surveillance
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How do Survivors get their cancer informa+on?
Source: Hesse BW, Arora NK, Beckjord EB, Finney Rutten LJ. Information Support for Cancer Survivors. Cancer. 2008;112(11S):2529-2540.
Cancer Survivors
Patient to Survivor: Lost in Transition?
Surveillance
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Source: Hesse BW, Moser RP, Rutten LJ. Surveys of physicians and electronic health information. N Engl J Med. Mar 4 2010;362(9):859-860.
Trends: 2002-‐2003, 2005, 2008Surveillance
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HITECH* Act passed in 2009*Health I.T. for Economic & Clinical Health Act
Health I.T. as Foundation for Evidence
Implementation
Source: Hesse BW, Ahern DK, Woods SS. Nudging best practice: the HITECH act and behavioral medicine Translational Behavioral Medicine. 2011;1(1):175-181.
Surveillance
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Source: Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E. Physician adoption of electronic health record systems: United States, 2011. NCHS data brief. Jul 2012(98):1-8.
National Ambulatory Medical Care SurveySupply SideSurveillance
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Health Information National Trends SurveyDemand SideSurveillance
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Building Deep Support
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Two antiquated cultures inmodern times -- the mechanisticand humanistic world views -- areleading to a “hidden epidemic” oferror and chaos.
- Kim Vicente,The Human Factor
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Competing World ViewsMechanistic World View• Actors: Engineers, biological scientists• Question: How can we create new
technologies?• Focus: Physical Object
Vicente KJ. The human factor : revolutionizing the way people live with technology. 1st ed. New York: Taylor and Francis Books; 2003.
Humanistic World View• Actors: Social scientists, physicians• Question: How can we create new
people?• Focus: Person
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RESULTS
Competing World ViewsMechanistic World View• Actors: Engineers, biological scientists• Question: How can we create new
technologies?• Focus: Physical Object
Vicente KJ. The human factor : revolutionizing the way people live with technology. 1st ed. New York: Taylor and Francis Books; 2003.
Humanistic World View• Actors: Social scientists, physicians• Question: How can we create new
people?• Focus: Person
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Mechanistic World View• Actors: Engineers, biological scientists• Question: How can we create new
technologies?• Focus: Physical Object
Humanistic World View• Actors: Social scientists, physicians• Question: How can we create new
people?• Focus: Person
Competing World Views
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Institute of Medicine’s “Crossing the Quality Chasm” report
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Restructuring the decisional architectures of medicine*
Hospital Based EHR Data
Hospital Based EHR Data
Health Information Exchange
MedicalTeam
Patient &
FamilyHospital System
DecisionSupportNeeds
Subjective• Chief complaint• Patient Reported Outcomes
• Risk modeling• Diagnostic support • Treatment selection • Guideline adherence• Error detection/correction
Medical Researcher
• Situational awareness• Population health• Continuity of care• Identify side effects• Inform discovery
Objective• Clinical measures• Laboratory findings • Sensor data
Assessment• Diagnosis• Categorical reporting• Prognosis
Plan• Treatment planning• Self-care planning• Post treatment• Surveillance
Source: Hesse BW. Decision Architectures. In D Bowen, M. Diefenbach, S. Miller (Eds.) Handbook of Health Decision Making. Springer Verlag, New York, NY (in press).
Meaningful Use
Safety, efficiency
Consumer engagement
Continuity of care
Population health
Privacy
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Source: Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood). Mar 2011;30(3):464-471.
Preponderance of evidence is showing a positive influence on care
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Bringing patients into the quality control process
• 92% of patients opened notes
• 60% reported better medication compliance
• 77% reported being in greater control of care
• 86% agreed that open notes would be factor in choosing care
• 99% wanted open notes to continue
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Patient engagement in quality control endorsed by physicians
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How often is medicine “evidence-based”?
• Medicine gets it right 54.9% of the time*
• Pernicious incentives divert from evidence-based treatment**
• Explosion of information makes it impossible to stay abreast of field
• Historical premium on opinion-based care
* McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348(26):2635-45 (June 26).** Brawley OW, Goldberg P. How we do harm : a doctor breaks ranks about being sick in America. 1st ed. New York: St. Martin's Press; 2012.
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Create a self-improving healthcare system, with patients as partners
Oncology as information science: “The Learning Health Care System”
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I.T. accounts for productivity growth in most sectors, but not Health
Friends of the NLM Meeting
2009
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But initial deployment is disrupting workflow
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National Research Council 2009 Report
Computational Technology for Effective Health Care advocates re-balancing the portfolio of investments in health care IT
• Greater cognitive support for physicians, patients, and caregivers
• Observing user-centered design principles
• Accelerating research related to health care in the computer and social sciences and in health/biomedical informatics
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Eric Topol, a cardiologist who directs the Scripps Translational Science Institute in San Diego, says apps that monitor blood pressure or glucose rates can be more valuable than prescriptions to keep these conditions in check.
"When we use a medication, we don't know if it's going to work or not. It's much better when a person's taking their blood pressure on a frequent basis," says Topol.
"The average person looks at their smartphone 150 times a day, so all of a sudden they're able to diagnose if their blood pressure's adequately controlled and what are the circumstances when it's not."
Patients lead the way
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But, with resistance ...
The Case of Hugo
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But, with resistance ...
The Case of Hugo
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But, with resistance ...
The Case of Hugo
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Stimulating the market for consumer-facing apps
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How do we communicate at “point of need,” not just “point of
care?”
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Moving toward a patient-centric model
Source: Zuboff S, Maxmin J. The support economy: why corporations are failing individuals and the next episode of capitalism. New York: Viking; 2002.
Technologies focusing on the long term rela&onship with a customer contribute to business success*
Move away from a “transactional”
model to a “relationship” model
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Use new infrastructure to ensure equitable treatment across populations
Meaningful Use Phase 3 will emphasize
population health
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Erasing the barriers between clinical and public health
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Final Thoughts
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Rebuilding healthcare is like building a plane in flight ...
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Meaningful Use Can Guide Redesign
Source: Hesse, Bradford W. (in press). Decisional Architectures. In M. A. Dieffenbach, S. M. Miller & D. Bowen (Eds.), Handbook of Health Decision Science. New York, NY: Springer Verlag.
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Target: Empowered Partners
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Deep Support
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Thank you!
Slideshare.nethttp://www.slideshare.net/BradfordHesse
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