Editor’s Note: In the post below, Healthwise CEO Don Kemper discusses empowering patients through information therapy. Kemper will participate in a panel on this topic at the 2010 National Health Policy Conference, which will take place February 8 and 9 in Washington DC. The conference, cosponsored by AcademyHealth and Health Affairs, will include discussion of hot topics in health policy, including extensive coverage of health care reform. You may register for the conference online or view the full conference agenda.
Health care reform, by any name, can only achieve affordable, quality care for all by tapping the potential of the one health care resource which is both abundant and far underutilized—the patient.
The concept of patient engagement is simple yet powerful. We just need to incorporate three simple rules into health care:
- The Self-Care Rule: Help people provide as much quality care for themselves as they can.
- The Guidelines Rule: Help people ask for the care they need.
- The Veto Rule: Help people say “no” to care that is not in their best interest.
While the concept of patient engagement is simple, implementing it in the midst of our dysfunctional, uncoordinated, and fee-for-service-driven system is far from simple. But it simply must be done.
It sounds intuitive, doesn’t it? Nobody wants an unneeded bypass operation or back surgery. Few people would choose to forgo treatments proven to cost-effectively improve the quality of their lives. And most would say they already do what they can to care for themselves.
But the facts are that our population’s fitness is dropping, our collective waistline is expanding, and most major treatment decisions are made with the patient largely in the dark.
What’s missing? Two things: Information therapy and accountability.
Information therapy is the prescription of the right information to the right person at the right time as part of the process of care. Information therapy changes the role of patient information from being about your care to being a critical part of the care itself.
The meaningful use requirements for EMRs should require that every patient—at every moment in care—receives a personally relevant information prescription that helps him or her with all three rules. The information, tools, and infrastructure to deliver the needed decision support are ready today. And yet, only a small percentage have been prescribed by physicians.
That should change. And it may well change sooner than you think because meaningful use requirements for EMRs now include patient-facing applications. It should also change because of new attention to an HL7 Infobutton standard (officially called the Context-Aware Information Retrieval standard.)
An infobutton is a way to automatically use data about the patient, condition, and care in an EMR to trigger information queries from a content set. Although generally used to bring up information to the clinician’s attention, infobutton applications can and should also be designed to automatically query and deliver information helpful for the patient.
By requiring a consumer-facing infobutton as a part of meaningful use, CMS and others can advance the three rules of consumer engagement easily and effectively.
Enter the Era of Patient Accountability
Clearly, information prescriptions to every person at every encounter can do much to help—but only so far as patients are ready to take advantage of the information provided. Enter patient accountability. People must be encouraged—and incented—to take better care of their selves.
Now I know that there are smart, vigilant defenders of justice who will see “accountability” as yet another possible path toward blaming the victim, stepping on the downtrodden, or repressing the disadvantaged. That risk may exist, but we can avoid it. We can and must find ways to encourage people, within their own abilities, to make better decisions about their health and health care—not just to assure that health care becomes affordable, high quality, and available to all, but because it will make their own lives better.
Let the passage of this historic health care reform bill begin an era of discovery around patient accountability. Let the bill start a process for helping patients do more to improve their own health and to use patient decision aids both to ask for the care they need and to decline offers of treatment that are not in their best interest.
Let’s find the incentive and accountability systems that work well to reduce costs, work well to improve health, and are fair to all elements of our population. Let the era of patient accountability begin.