What is being patient centric? Patient-centricity as a healthcare value
The transformation of health care delivery, envisioned by the underlying tenets of Meaningful Use, is one that has the elements of (1) coordination of care between all the different places where patients get care, and (2) patient-centricity, or a participatory approach to healthcare delivery. For many physicians, this represents a fundamental cultural change.
We have talked about coordination of care, with moves toward Patient Centered Medical Homes (at the practice level), and Accountable Care Organizations (at the regional level). Though ACOs (a hot topic these days in health policy circles) are a Medicare fee-for-service structure, once established they may serve as a delivery platform for other kinds of healthcare, including commercial health plans.
Patient-centricity, however, represents an emerging vision for health care delivery. What does that mean, really? The traditional view is that “patient centricity” means that the patient is at the center of a hub of delivery services, but that the energy and decision-making still rely upon the expertise of the “spokes” – the patient, though the center of everyone’s attention, is still fairly passive.
The better vision for “patient centricity” is that of a more empowered, active, participatory e-patient. This implies that patients have access to their data – on-demand, at-will. It also implies a more collaborative and participatory relationship between patients and health care providers (the doctor, the Medical Home team, the hospital, etc.). For doctors, it implies a change in the role of physician from being the source of expertise (the Internet has changed where people search for health-related information – the “raw data”) to being a safe, welcoming place that can help interpret the overwhelming information available (put it into context, and give meaning) and also coordinate the patient’s interaction with the whole healthcare delivery ecosystem.
Given that this new relationship model represents a fundamental cultural shift, movement in that direction will likely be incremental. It may be embraced by “early adopter” forward-thinkers, but as a way-of-being that characterizes the whole healthcare delivery system, it will take time.
The first steps in this ground-shift is the delivery of data to patients on-demand. Several Meaningful Use criteria focus on this – giving patients clinical summaries of each visit, making electronic summary information available promptly upon request, and providing patient-specific health education resources for each patient. Much of this can be accomplished by providing a patient portal for display of information collected by the physician, lab, etc. It is still fairly passive, but it is a first step.
A subsequent step is using these patient portals to actively facilitate two-way interaction between patients and their clinicians. That means secure email-like messaging, self-creation of appointments, and similar activities that substitute for phone calls to the office. Even e-visits fit in here – an experimental concept tried by several private health insurance plans, where non-emergent structured questionnaire-based messages from patients can result in medical decision-making (which is therefore reimbursable), and are in lieu of an office visit (similar to an after-hours phone call). Payment for such services has still not yet found widespread support, including from CMS.
Farther down the road of migration to participatory medicine will be data-empowered and connected patients who can feed information into their own portal (an EHR-connected PHR) either by hand through the PHR web portal, or by connectivity with mobile devices that can deliver specific kinds of data (like blood glucose monitors, or novel mHealth smartphone apps). Disconnected PHRs won’t do – we have seen that with the failure of Google Health. And PHRs that connect with only one physician EHR is (though better than nothing) still too limited. In the future, the PHR will be a patient-centered hub that connects real-time with all the different physicians and hospitals, using whatever EHR systems they may have. That technology has yet to materialize, and will require the maturation of the EHR-to-EHR connectivity market – a center of attention now, and in the next few years.
Patient empowerment, patient-centricity and the resulting need for coordinated healthcare delivery is an irreversible sea-change facing health care. Technology will be a backbone that must help facilitate (and even lead) this change. Quality measurement, evidence-based decision support, care coordination (with Primary Care Physicians as the central, valued center of this coordination) are all things that will (1) result in cost moderation, (2) improve outcomes, and (3) improve satisfaction. The changes that are coming can be resisted, or they can be embraced – regardless, they will happen anyway.