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Implications of Information Technology and Consumer Participation in Health Care. Patricia Flatley Brennan, RN, PhD, FAAN Moehlman Bascom Professor School of Nursing and College of Engineering University of Wisconsin-Madison. Challenges and Changes in Health Care Delivery.
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Implications of Information Technology and Consumer Participation in Health Care Patricia Flatley Brennan, RN, PhD, FAAN Moehlman Bascom Professor School of Nursing and College of Engineering University of Wisconsin-Madison
Changes in Health Care • Shifting responsibilities, shifting costs, shifting values • Shortened Length of Stay • Emphasis on evidence and outcomes • Broader idea constitutes health
What is health care & who’s involved? Disease Self Help Self Care Management Patient Professional
Patients are Changing, too! at least some of them
Transitions in our view of patients • From ‘flat and silent’ • To Collaborative Problem Solvers
What makes patients change? • clinical recognition of the importance of patient participation • social valuing of autonomy, self-help and self-determination • withdraw of previously-delivered service • changing cost model
Contemporary Health Care rests on a successful partnership betweenPatients, Clinicians, and Delivery Systems
Consumer Health Informatics: Putting Information Resources in the hands of Consumers • Accepted and Alternative Health • General Health Information • Personal Health Data
Delivering CHI • Broadcast and print media • The Internet • Health-related WWW sites • Self help BBS, Listsrvs & e-mail groups • Freestanding kiosks, CD-ROMs, and SmartCards
Evaluating CHI • Perspectives: Credentialling sites or Educating consumers • Involved groups • ODPHP Scientific Panel • HITI, Inc (Mitretec) • AMIA Internet Working Group
SMART Patients • Self-assured • Motivated • Aware • Resourceful • Talented
Remember they may also be: • Scared • Minors! • Anxious • Reluctant • Time consuming
Common behaviors of SMART patients • self triage • values and preference clarification • participative • collaborative • independently engage in health promotion
What they aren’t : • complacent • quiet • unchallenging • similar
SMART Patients: Who needs ‘em? • we do! • Why? • partners in care • Clinicians have too much to do • episodic nature of care doesn’t work any more
Clinician’s responses to the SMART patient: • engaging • tolerant • dismissive • condescending
The Challenges for Clinicians • Use technology to help make patients smart • treat them as a resource • Change our practice activities to capitalize on their talents • Reorganize our practice environments
What are we expecting patients to do? • case manage • monitor • perform therapeutics • initiate conversation with us
Information tools needed: • access to their clinical records • Personal Case Management tools • CHI and assistance with using it (access, interpretation)
Clinical Practice Issues • Henderson “...what the patient can do...” • Re-examining every action • Trusting our colleagues • Timing of interventions
Clinical Roles • Content Expert • Envision a clinical practice that makes use of the patient as a resource • Re-organize care and care activities to incorporate patients
Constructing a Health Care Delivery System responsive to SMART Patients
Clincial Systems Issues • Collaborative with other disciplines • reciprocity of change • Practice Standards • Optimized work patterns • Incentive Structures
Information Systems Issues • Patient-centered care • Language: • Data relevant to all care providers • Mapping from professional to vernacular • Inter-organizational communication • Security • Cost model • Clinical information systems integration
InformationTechnology’s Response Patient- Centered Systems
Patient-Centered Systems • Clinical Records • Network Communication • Consumer Health Informatics
Patient-Centered Information Systems Clinic Physician Office Computer-based Patient Record Pharmacy Dentist Furtive Records Consumer Health Information Hospital
There are degrees of SMART! Not all patients are equally SMART -- nor are they smart in the same way but we must seek that which is SMART in each patient
Seen any ‘SMART’ patients lately? ...they’re there, everywhere!