Five Imperatives of Patient-Centric Healthcare


In previous posts I discuss how patient-centric care differs from patent-centered care and how patient empowerment must precede patient engagement.  I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.

1.    There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category.  While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say outcome) of patients by changing the focus from provider to patient.  Physicians do care about their patients.  However, they are finding less and less time to devote to direct patient care. This same situation will repeat itself with non-physician providers as they assume more responsibility for patient care. Unless physicians support efforts to provide patients with tools to increase self-management, patient-centric care will not succeed.  Care must be seen as a partnership.  Patients are not seeking a substitute for their physician.  They are seeking a substitute for the unreturned phone calls, insecurities about whether to call in the first place, and tools for navigating the healthcare ecosystem.  If physicians support them in these endeavors, they will be seen more as partners. This will not, unfortunately, change overnight because of the historic delay in changes to the culture of medicine.

2.    Patients need great portals.  Patient portals are the ultimate patient-centric tool.  They can become the epicenter of the patient’s care universe.  All of their physicians and providers can communicate with the patient across healthcare system and technological barriers. The ideal portal can house different EHR system information, communicate with language translation, act as a hub for patient education, instructions, navigation, and allow providers to communicate with each other about a given patient. In addition, and most importantly, it will allow the patient to change relevant information real-time. This can be critical when it pertains to allergies, medication, diagnoses, or change of clinical status.  This will definitely not change overnight even though the technology is here.  Interoperability issues, the low expectations and mandates of the government fueled by resistance from physicians, and burgeoning competition (with attendant technical disparity) of portal vendors are all barriers easily overcome.

3.    Quality patient education and monitoring tools.  There are many patient education and monitoring tools out there. Because of lack of reimbursement (isn’t it always about the money), there has been little adoption of health literacy appropriate education technologies.  A patient-centric healthcare system would place both of these categories of technologies at the highest of priorities. They can both be tied to the portals described in the prior section.. I would certainly want to see outcomes-based evaluations (which wouldn’t take long or millions of dollars to accomplish) of these tools (though intuitively one could imagine patients who receive instructions via a mobile device to be NPO for their procedure the following day being more compliant, resulting in less cancelled procedures). I would refer the reader to the immediately preceding posts on remote patient monitoring to become familiar with how these technologies can foster patient-centric care.

4.     Patient-centric care must involve a caregiver.  There is always a need for caregiver involvement.  Even if a patient has full mental faculties, emotional and possibly logistical support is often needed.  I saw many high level corporate executives as patients who had a significant other accompany them to visits or who called furnishing otherwise non-communicated critical information or questions.  Not uncommonly emotional upset surrounding an acute or chronic condition cloud factual retention.  The need for emotional support is borne out by the success of online communities even if they are anonymous like Treatment Diaries or others like Wego Health.

5.    Attention to advanced directives.  Most people think advanced directives are instructions to be conveyed to a physician in the ICU when things are grim. This is probably the biggest misconception about advanced directives. Others include thinking that they are irrevocable or immutable. I believe that advanced directives should be discussed in middle school health classes. They shouldn’t be made instantaneously and should be well thought out.  Directives go way beyond the trite “Do not Resuscitate.’  Advance directives are more relevant and personal to all than many medical issues on network news, yet get little public attention.  They are the most personal of decisions and therefore should be made by the individual before being incapacitated, not by someone else after the fact. They must be portable not papers in a safe in the bank.  There is actually an app for that called My Healthcare Wishes.  Providers must discuss this with patients early on in care delivery, so that options are explained, contemplated, and directives established.  A 20-minute visit for a problem-focused encounter or follow-up visit is not going to be the right forum for this.  Physicians and patients both must be incentivized (not monetarily necessarily) to address advanced directives.

These are only a few, what I consider significant ways in which one might approach designing patient-centric care.  What are your thoughts?  As a matter of disclosure, I have no financial relationships with any companies mentioned in this post. 

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About davidleescher

David Lee Scher, MD is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a former cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he is uniquely qualified to address both clinical and operational concerns of clients. Scher was Chair of Happtique's Blue Ribbon Panel which established standards for certification of medical apps in the categories of safety, operability, privacy, and content. He is a well-respected expert in mobile and other digital health technologies and lectures worldwide on technology and its impact on patients and healthcare systems.
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9 Responses to Five Imperatives of Patient-Centric Healthcare

  1. Well put David. Patient centric healthcare does not have to be isolated from healthcare providers. It is about developing collaborative models between patients and providers.
    The need for providing patients with the right tools is also critical, we can’t expect patients to take responsibility for the week or healthcare if we don’t provide them with the right tools and the education to use them. Over time they will develop their own tools and models which will lead to further improvements. However in the mean time we need to ensure they are at least on a common information basis as the providers they will be collaborating with.

  2. Reblogged this on Dr George Margelis' Blog and commented:
    David Lee Scher has a great blog I recommend to everyone. His insight as both a doctor as well as a technologist is awesome.

  3. I have been involved in a couple of EMR adoptions for internal medicine practice. There are many (painful) lessons learned! The prescription module was the most popular with providers — although it was slower than scribbling out a prescription, the time saved in record keeping, nurse phone questions and faster refills at next visit won the day for the EMR projects. Also, the patient should not be shut out from the EMR — it is very helpful for the patient to see what is on the screen as the provider works on the material — it’s remarkable how much better both the provider and the patient feel if they deal with “the computer” together. The skeptical provider gets a real boost when a patient says “wow!”. Also, providers find the picture of the patient to be unexpectedly helpful — they look at the picture before entering the exam room and then they do a much better job of remembering the person and getting the visit off to a good start.

  4. Pingback: Five Imperatives of Patient-Centric Healthcare | Health Care Social Media Monitor

  5. Jonathan says:

    There are four reasons traditional patient portals and PHRs fail:

    1) In healthcare, one size does not fit all. It’s not like balancing your checking account which everybody does in pretty much the same fashion. In healthcare, people with diabetes have very different objectives than people with cancer, or families struggling with dementia, or substance abuse. Stakeholders need different user experiences based on their objectives.

    2) Patient portals must include information from all sources. Again using the checking account analogy, using a tethered patient portal is like balancing your check book with only some of your deposits and payments. To be successful, the system must include information from all sources including clinical information from non-clinical sources which go beyond even that which is available through an HIE like SHIN-NY.

    3) The system must give new and perceived value to ALL stakeholders. Most patient portals today automate simple communications functions, like appointment requests, med refills, lab results. These are important transactions, but the impact on total health is tangential at best, giving only moderate value to either the patient or the provider. They certainly do not give value that results in frequent and persistent interaction that improves outcomes and cost.

    4) And finally, (this is the big one) a patient portal or technology-enabled patient engagement system more broadly is not fundamentally a Healthcare IT system. It is a Public Health IT system. That means we have to understand the cultural and demographic barriers that keep patients and families from more effectively engaging the healthcare system, and design solutions from that context. Anything less will fail.

    Addressing patient engagement with this framework is the key to success. Integration is an absolute necessity, but integration alone will not accomplish the objectives of the Triple Aim.

  6. Jonena says:

    David, Awesome post. I’ve been touting participatory medicine before the term became popular, but we have a long way to go. Docs need to trust patients’ instincts more, communicate better at a level we can understand (not doc speak) and allow us to be part of the healing solution. Patients need to be willing to follow through and do what their docs ask them to do, i.e. take their meds as prescribed, exercise and eat right.

    Physician Assistants “get it” and there is no reason why docs won’t catch on soon!

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