My Care Team, My Prerogative: It's Time to Plug in
DECEMBER 16, 2013
Harry Bailes and Doug Patton
Keeping up with the latest connectivity options has become an essential task for pharmacists as health care migrates from paper to electronic systems.
In a world where information is instantly available, it is certain that patient demand for a care team that is connected and responsive to his or her individual needs will be a hallmark of the future of health care.
It is remarkable that today’s patients and their families, for all practical purposes, are not connected with their care teams. While evidence of movement in the right direction does exist, such as physician migration from paper to electronic systems, and “meaningful use” requirements that will allow patients to have access to their health records (and can contribute valuable information about themselves that only they may know for use by their health care providers), we are a long way from the finish line.
Formation of a Care Team
We go about our lives relatively unaffected by the health care system until an illness or accident occurs, prompting the formation—whether formal or informal—of a care team to meet the patient’s needs. The care team must gather and share information surrounding the event. While composition of the care team is patient- and situation-specific, the patient and the patient’s family are always at the center. The transfer of needed information required to prevent or treat conditions is severely lacking today.
The Need for Connectivity
Connectivity allows for effective communication among all members of a care team—both professional and non-professional. Particularly in the case of older adults, connectivity promotes coordination of care that can circumvent the need for acute care, and more effectively manage post-acute care. Medication management following hospitalization is critical for older adults, as 72% of adverse events post-discharge are medication-related. It is important for a care team to know the medications a patient is taking and any changes that mark a transition in care requiring reconciliation of medications. Unfortunately, consumers don’t know or understand many of the implications of taking medications.
Medicare beneficiaries with multiple illnesses account for 88% of all prescriptions filled and they receive, on average, 50 different prescriptions per year. Additionally, they see 13 different physicians on average, and account for 76% of all hospital admissions. The need for technologies that assist in medication use and facilitate the connectivity between patients and their health care providers, as well as their non-professional care team, has never been greater.
In addition to the need for better medication management, many aspects of care coordination and delivery exist in settings that are, in fact, outside of traditional health care delivery. Technology can be tremendously helpful in coordinating post-acute care and also in preventing events that would otherwise require a hospital readmission.
Social networking tools currently provide instant interaction. They include Facebook, Twitter, Caring Bridge, Lots of Helping Hands, and a host of others. In addition, we have telephones, e-mail, texting or SMS, and even Skype or video visits. Patients Like Me, for example, is allowing people with certain diseases to share experiences with and learn from others going through the same circumstances. One Health is allowing support groups to form virtually and coaching to occur. Yet, for the most part, these technologies have not connected members of the care team to solve the real needs of the patients and their families.
A number of factors affect the development of and access to emerging connectivity solutions, including privacy, reimbursement, access, language, and interoperability. The primary reason is misalignment of reimbursement models and a lack of incentives to encourage patients to participate in their own health improvement. Rapid change is occurring, driven by access to information. We have a wealth of information available at our fingertips, via relatively low-cost devices such as tablets and smartphones. These devices are no longer a novelty or just for the young or computer literate. They are just essential to everyday life.
Consumers are gaining access to increasing amounts and varieties of information about their own health care. Some of the major drivers are “Blue Button,” health information exchanges (HIEs), personal health records (PHRs), patient portals, and a plethora of health apps, with increasing levels of integration.
A brief look at each of these is worthwhile.
Blue Button was originated to connect veterans with their health records. Blue Button now extends to Medicare beneficiaries and is being expanded and embraced by major insurers, and it provides patients access to information, functioning similarly to an HIE.
Personal Health Records
To be most beneficial, a patient’s PHR should contain all of their providers’ records, as well as the patient’s own journals and personal requests. Additionally, it may include the information contributed by family members, such as immunizations, family histories, and other important information. Connectivity that allows appropriate sharing of a patient’s information, as well as context, among health care professionals—physicians, nurses, and pharmacists—as well as the patient’s non-professional care team, will promote better care, well-coordinated and aligned to produce optimal health outcomes.
Patient portals began primarily as a convenient place for providers to make information available to patients, such as appointment information and lab results. Today, they are being extended to serve as a way to deliver information to patients around a variety of topics, including educational materials and care plans.
Health Apps and Platforms: A Distinction
There are tens of thousands of health care apps available today. The subset of apps that actually improve communication between patients, their families, and all of those involved in the care process is much shorter. In fact, until recently, there were no smartphone or mobile applications for patients and providers to connect with each other. At the recent Pharmacy Home Annual Pharmacy Project meeting, a presentation was given on mobile technology and the medication-use process (see http://tedxpharm.wordpress.com/ mhealth-pharmacy/).
Joseph C. Kvedar, MD, director of the Center for Connected Health stated in a recent interview, “If we can exploit the addictive quality of smartphones, it will be the most important characteristic of mobile health as we move forward.” According to Kvedar, “People check their smartphones more than 100 times per day.”
Additionally, Kvedar reports that patients who use smartphones to connect as part of health programs tend to be more diligent in adhering to the program because their health care provider is “watching.”
There is great promise in the connections between patients, their families, and their care teams. While much about health and behavior remains unknown, technology is driving change with new insights that provide better connectivity and coordination of care and promote improved patient outcomes.
Playing catch up is not fun—and in this fast-moving era likely is not even possible. Someone more nimble will take your place. This point was driven home by Michael Melby, MS, FASHP director of pharmacy and clinical informatics at Indiana University Health at the Pharmacy Home meeting. Citing an example in his marketplace Michael said, “We should have stepped up to the plate and filled the demand when people told us they wanted it because it is going to be filled with us, or without us.” This change is rapidly approaching and will most certainly be consumer-driven. It’s time to connect or be left behind.
It’s time to plug in.
Doug Patton, chief knowledge officer of Family Health Network, was co-founder of KOZ.com and brings unique insight into all aspects of this business. He is currently finishing a degree in public health policy and has spent most of his life developing and understanding how society embraces technology and uses it. He began his career at Bell Labs, worked with Harry at Image Technology, spent years traveling the world to hone his knowledge in global markets, and rejoined Harry to help launch Family Health Network.
Harry Bailes, founder and CEO of Family Health Network, is a lifelong successful entrepreneur. He is a former attorney and early adopter who led the introduction of technology to the legal profession. Later, he joined Image Technology, Inc, an industry leading company acquired by MCI after a rapid period of growth. He was a co-founder of KOZ.com, an early entrant to the internet and social networking. Mr. Bailes has spent his life in the formation and development of companies leading their industries. He recently spoke at Healthcare Unbound, in San Diego and at Wireless 2012, Duke University’s Fourth Annual Wireless Technologies and Consumer Health Care Conference. Family Health Network’s Connected For Lifesm represents a model for the future of care delivery involving the patient, family, community, and both professional and non-professional caregivers.