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This article explores the challenges and changes in healthcare delivery, the role of consumer health informatics, and the concept of SMART patients. It discusses the need for clinicians to engage and empower patients, as well as restructure practice environments to capitalize on their talents. The article also addresses clinical practice and information system issues, and emphasizes the importance of patient-centered systems in healthcare 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!