Gauntlet is Thrown - Why I Believe in Consumer-Centric Care II

Blogger's Note: This lengthy post attempts to make up for time lost during last week's vacation, so if you're looking for a quick, easy read, come back tomorrow. If you've been waiting for a follow up to earlier posts dealing with consumer-centric healthcare, take a deep breath and read on. Better yet, join the conversation. When I say "healthcare consumer," I mean YOU.

The pessimist complains about the wind; the optimist expects the wind; the realist adjusts the sails — Anonymous

Recently I wrote this 'dear diary' style confessional post, which is quite a departure from my normal approach to writing for Health Management Rx. I took a big risk in revealing my patient backstory, but I believe it's paid off.

The post details (at a personal level) why I believe (at a professional level) a consumer-centric orientation is the only thing that can improve both efficiency and empathy within our healthcare system.

I paused before hitting the “publish” button on this post numerous times, but a wise blogger (thanks Drew!) told me that at some point revealing a personal anecdote contributes sufficient value to the ongoing discussion -especially when it’s coming from an e-patient.

Today’s post, then, is concerned with:

1. Continuing the conversation;

2. Formatting a response that drives readers toward further discussion; and

3. How to follow through and develop new business ideas that expand the current limited scope of the traditional 'healthcare consumer' (with actual scenarios detailing new business approaches).

Since I’ve committed a cardinal blogger's error by waiting so long to publish a follow-up post, I suggest you read the original post first, as well as the comments.

Now on to Part II of Why I Believe in Consumer Centric Care.

First, we must stop treating patients and other healthcare consumers as the "cheap gas that fuels our sector."

If you don't believe this, stop reading now.

The quote above is from the blog "Perspectives from the Pipeline," detailing the career of rising nonprofit czarina Rosetta Thurman - Rosetta, couldn't have said it better. (Congrats again on your new professorship you amazing nonprofit leader you!)

Although Rosetta was discussing the 'disposable' nature of young, idealistic nonprof employees who are used/abused until they burn out and leave 503c waters for greener corporate pastures, the quote also applies aptly to how we currently bill and treat patient encounters in the US healthcare system.

Healthcare consumers are currently (pick one):

A. The "cheap gas that fuels our sector;"

B. Passive receivers of care 'products' and service bundles;

C. Brief, disposable interludes of episodic care delivery; or

D. An illustration of how our interactions with providers are ruled by payment, pricing, and promotion of our current hierarchical structure.

E. All of the above.

If you answered all of the above, there's only one system big enough and powerful enough to connect disparate consumer segments and generate a small series of 'microquake' developments that aggregate into big change - the web.

Future web-based, consumer-directed applications, a subsector of HIT that has yet to live up to its potential, present an opportunity to do just this.

Here's my position: The entrepreneurial creation of semantic web applications is the only movement chugging along fast enough to join patients and providers before the healthcare spend bankrupts our economy.

We can't rely totally on government, advocacy groups like IHI, certification bodies like JCAHO, etc. A commerce-based, consumer-centric approach, driven by companies that pave the way using web-based tech, is the only thing that will move us quickly towards improvement. If a significant portion of the American population starts using 'killer apps' for healthcare, the rest of these organizations will jump onboard.

(Blogger's Note: If you want to hear more about how to harness the power of the semantic web to advance consumer-centric care modalities, come watch as co-author and neXthealth partner in crime Maarten den Braber and I present the concept at SWWS 08 in July - we'll be talking about how the "Semantic Web Sparks Evolution of Health 2.0" and providing "A Road Map to Consumer-Centric Healthcare").

Taking a completely understandable, traditional healthcare perspective, some readers respectfully disagree.

After reading my post and some earlier commentary on PHRs, Dr. Ian Furst, one of the most prolific medblog commentors I know, and whom I'll have the great fortune to meet at Medicine 2.0 Congress, threw down this gauntlet.

After rereading Ian's post, I find one of the only points where our opinions truly differ is that I do believe the internet concretely allows physicians (and patients) to reach out to each other with “greater richness.”

I am, however, sorry to see Ian takes exception to my assertion (and certainly not mine alone) that the web will help save healthcare – the Health 2.0, consumer-centric partyline "goes that the internet will allow you’re [sic] doctor to reach more people with greater richness than ever before. Don’t believe them – it’s bullshit."

And yet the internet is allowing us to do just this. All of our blogs allow us to do this. Ian's blog, written and richly informed by his commitment to his profession as a doctor, allows him to do just that, doesn't it?

To Ian: Do your patients read your blog? Do you tell them about it during visits? Do you invite them to comment and participate in the online conversation?

I won't argue with most of the rest of Ian's entry, as it's spot on - including the point that we're still stuck in Web 1.0 and Health 1.0. I agree wholeheartedly.

As an industry (the business of healthcare) and as an 'art', we're still largely focused on what content, sometimes on what content + community (Health 2.0) can do for primary care, when we need to be moving beyond and focusing on developing a realistic roadmap that will guide us towards efficient, empathic consumer-centric care in a wide spectrum of sectors.

And yes, this means breaking wide the 'traditional' definition of consumers in healthcare mentioned in the comments section by Dr. Wes.

First, my confessional style was not a play for anyone's pity - I don't need or want it - but rather a plea for professionalism and respect as we continue to advance the conversations between patient and provider on how to improve the system for both.

If one more person who reads it begins to think of herself as as 'healthcare consumer' then we're one step closer to improving care, one person, one patient, one provider, one caregiver at a time.

After reading responses and comments from Ian, Dr. Wes, and Drew from Our Own System, I am extremely proud to know professional physicians (and health admin students - there IS hope for the future Drew!) who are equally passionate about improving doctor-physician relationships.

So here's point 2 for the day: We obviously 'get it' here in the blogosphere, and although we differ on smaller issues (Just how much DOES a good consumer website cost, Georgia? IBM?) we're still talking to those with similar views and then patting ourselves on the proverbial backs.

We've ALL got to get out there and pay it forward.

I'm walking the walk here in Holland with a bunch of amazing folks founding neXthealth NL.

What are you doing, dear readers, to talk about consumer-centric care outside our comfort zones? Become cheerleaders for the cause? Seek out voices of dissent?

What we need in the medical and healthcare blogosphere is a classic case of "less me, more we"…How do we connect patient-centric medicine bloggers with policy wonks?

If we get that debate going we might see some real fireworks, instead of just pushing at each other with sticks to drive site traffic.

My question for today is this, dear readers:

Why would we NOT try ANY and ALL measures available to improve patient care, even if it is a PHR designed by a consumer-company or a consumer portal that costs 5.2M?

Let's answer the question above using actual business case scenarios, and detailing how future web-based developments may help expand the current healthcare consumer spectrum.

Dr. Wes detailed a dose of healthy skepticism about 'consumer centric care' in the comments section of my original post.

He implied that if I was in an ambulance on my way to an ER I wouldn't stop and check the ER's ratings on my mobile phone. Let's start with this example and examine how the semantic web might help drive us towards consumer-centric care.

First, Dr. Wes's assertion is not entirely correct. My main point with pushing the consumer-centric discussion is that if companies build these types of services, SMARTLY consumers will use them.

If a mobile, web-based app was available on my Blackberry for me to quickly and easily access ER ratings info (within the 'holy trinity'- 3 clicks to information access), I would use it - yes, even from the back of an ambulance if I was capable of doing so.

Of course, that's the big "IF"...and there's simply no way to predict if I'll be conscious and cognizant enough to use such a service. But I'm not the only consumer who would find such data valuable in this scenario. Let's flesh out the example a bit.

Scenario I using Dr. Wes's example: PATIENT AS CONSUMER (during care).
If I was in an ambulance on the way to an ER and physically/mentally able to use my mobile phone and access a web-based app that lets me check quality and safety ratings (i.e. not coding and conscious), I might indeed check to see if an ER was listed in the top 10 in my area.

If I have a rare, chronic condition for which I'm currently under treatment, I might also use this service to send an email to my treating specialist using my cell's address book, letting the office know I'm on my way to that ER. This would provide continuity of care, especially if my condition were to worsen en route or after arrival.

Scenario II using Dr. Wes's example: PATIENT AS CONSUMER (prior to care).
But most likely I wouldn’t NEED to go that far, because if I was conscious I’d be able to recall looking at a website to see top EDs BEFORE I’d need them, when I read a blog post or press release or saw a news article about this new 'killer' app (no pun intended).

And now I'll push the point even further.

Follow along carefully because here's where things really get going.

When we succeed in creating a truly consumer-centric American healthcare system, quick-thinking, fast-moving startups will create services and products for consumers outside the 'traditional' categories, like patient and provider.

Scenario III using Dr. Wes's example: AMBULANCE CREW AS CONSUMER.
In this instance, if I was on my way to an ED, my ambulance crew might use a web-based application to check wait times/availability at several area hospitals simultaneously without radioing to all separately.

This would allow them to choose a route more quickly, accept it on the mobile device, and instantaneously upload driving directions to the in-ambulance GPS unit. Meanwhile this killer 'Paramedic 911' app might also transmit arrival time and patient stats to the hospital ER prior to arrival.

In this case the paramedic crew is the 'consumer.'

Scenario IV using Dr. Wes's example: FAMILY/FRIENDS AS CONSUMER.
Also, even if I’m unconscious, if I’m in an accident or injury and a family member, friend or spouse is following the ambulance, there’s a good chance THEY would be checking on a mobile, web-based application to see if the hospital where we were headed was highly rated.

In this case the family member following my ambulance is the 'consumer.'

The scenarios above are a bit out there, but not too far out in the future - the web-based infrastructure to build these services is in place.

Now all it takes are startup teams with vision, drive, a really good developer or 20, and dollars. Health 2.0, neXthealth NL crews - who wants to take these concepts and make them a reality?

One of my main points in the original post was that current ‘consumer-centric care’ includes both the patient and physician in the care process, which may (or may not) be facilitated by technology and ‘corporations.’

One of my main points today is that a fully-realized ‘consumer-centric’ system involves many more parties than just the patient and physician. So anyone using a mobile phone to check hospital rankings then becomes a consumer (including the hospital Board member or exec who is checking to see how they rate).

And a further point of clarification. I don't seek to raise the perspective of the patient over that of the physician. To the contrary - I in no way want to unilaterally make “all” of my healthcare decisions, and I don't want the web to replace the relationship I have with my docs. I want it to augment and support that relationship.

It is this example of mobile, highly personal interaction with tech that demonstrates perfectly my deep, individual support of your main theses, Drs. Ian and Wes - that relationships between physicians and patients are intensely personal, and that ANY tool we test, including the web, MUST improve communications and care rather than clutter up the airwaves.

Tools not used are tools wasted waiting for an applied purpose.

Tools used incorrectly are a drain on systemic productivity.

But who currently defines whether or not the tools that enable us to possibly enhance care are used "incorrectly?"

In a more 'democratic' system, BOTH patients and providers, as partners in care, must co-determine which tools allow us to move towards more efficient, empathic, consumer-centric delivery.

In a more democratic healthcare system then, many segments of consumers will use tools such as the web to move towards consumer-centric care.

But first, give e-patients - empowered patients - the tools we need to communicate better with our physicians, to harness the power of personal goal setting (and attainment), and that, my physician friends, will change "our" system.

The web is just one of many tools in our arsenal to save healthcare, but it is a big honking John Deere rather than a wimpy garden spade.

My point is that nothing short of massive collaboration, continuously evolving entrepreneurial activity, and a new way to view the communications between all stakeholders in the healthcare system will save the private-public hybrid that is the current American healthcare system.

The web is ready and waiting for companies to develop applications that do just that.

The government is also getting ready though

But Dr. Wes's point in the comments section is excellent - it's absolutely going to take a he&% of a lot more than a government/industry partnership, as illustrate by this example of Philly's failed 'universal wireless' project.

Do we want to see federally funded universal care programs administered by HMOs enacted in 2010 and failing by 2015?

And us consumers?

We're tired to death of having traditional choke-hold messages forced down our captive throats in other industries - but we haven't yet risen up to protest spoon-feeding (or more aptly syringe-feeding) in healthcare.

We haven't yet seen the rise of consumer-oriented, web-based service companies that show us the light, show us how things could be. That show us we can look and want and need and buy and participate more in BOTH the art and the business of getting better.

But these firms are out there, and the scenarios I describe above are on the way - make no mistake.

The telephone, the internet, Google, neXthealth - some entrepreneur will step up and show us what being at the center of the healthcare web, literally and in tech lexicon, can look like.

And once we realize all the choices out there, we'll need help navigating the system.

Lucky for you, Dr. Wes, we're still at the point where we'll largely come to our docs for this type of assistance.

We still trust you MDs...
we don’t want to replace you with tech - let's all keep it that way by being open beta testers of innovations that could improve care -web-based or otherwise.

The mainstream media, in addition to the blogosphere, are already on the case, one prophet at a time, convincing consumers to move towards proactive wellness goalsetting.

It's happening in other industries. Let's take telecom again for example...30 percent of us now receive most or even ALL of our calls on cell phones.

As a physician, you appropriately emphasize the importance of communication. So, Dr., how are you adapting your communication style to keep up with new conversational pathways?

It's only a matter of time before consumers realize our healthcare is entrenched in methodologies as antiquated as the gramophone.

Yes, medical technologies wide and wonderful have been introduced. But the care process, the actual design of hospital and healthcare delivery, has changed little since the Roaring 20s.

We also thought we would be fine without penicillin, the x-ray, respirators, ex-fixators, chemotherapy. Of course we would - we didn't know any better until a game-changing innovation, often, gasp, a technology, modified the care process.

And, my friend, I warn you - once we know this, and our money talks, where we can't interact at will - we will walk. And you will too.

Your best hope, if you want to avoid this big-bang evolution, is to pray for federally-funded healthcare and a completely socialized system.

Plus, only 14% of 940,000 docs in the US have minimally functioning EMRs in place, so you've got 84% of market capitalization to rest your laurels upon before you have to actually implement change.

I say the semantic web will save healthcare because it will help unleash increasingly powerful market forces of supply and demand.

But it is certainly not the ONLY factor to do so - current disruptive innovations like retail clinics and "focused factory" specialty hospitals, as well as concierge care, all turn consumers minds (consumers = patients, providers, payors, physicians, pundits, etc.) to a more robust discussion of value in healthcare...

And this circles us right back around to the control issue.

What IS value in the current healthcare system? Who defines it? And why the he@% didn't anybody invite patients to the prom sooner?

Vanderbilt sets the bar higher than ever before with a “no tolerance for unprofessional behavior.” The goal? To ensure a quality patient experience. Get it? Professional behavior in the medical sector = QUALITY EXPERIENCE.

Until we start thinking, developing, and implementing tools to ensure a quality experience for ALL consumers who interact with the healthcare system, we're still sitting dead in the water. Get going. Stop waiting for someone else to throw you the oars.

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