Patient Education & Medical Decision Making
- The Big Picture (Model 1):
- Evolving Medical Technologies
- The Evolving Role of Information Technology in the Health Care System
At the national as well personal levels, we are increasingly concerned about spiraling health care costs.
Information access, processes and technologies (IT) have become central to most propositions as to how health care
costs can be brought under control. Information processes and behaviors involving consumers (patients) are part of
this package. As in other areas of American society, volunteer work is essential in the transmission of health related
information and patient education.
CROSSING THE QUALITY CHASM: A New Health System for the 21st Century
[Committee on Quality of Health Care in America; INSTITUTE OF MEDICINE.
NATIONAL ACADEMY PRESS, Washington, D.C.
Ch.7: Using Information Technology [pp.164-180]
"... health care should be supported by systems that are carefully and
consciously designed to produce care that is safe, effective,
patient-centered, timely, efficient, and equitable. This chapter
examines the critical role of information technology (IT) in the design
of those systems.
- Health Technology Assessment Program (HTA)
[Washington State Health Care Authority]
Project Health Design
Project HealthDesign is forging a new vision of personal health records (PHRs) by exploring practical ways to capture
and integrate patient-recorded observations of daily living (ODLs) into clinical care.
American Health Information Community (AHIC)
The American Health Information Community (AHIC) is a federal advisory body, chartered in 2005 to make recommendations
to the Secretary of the U.S. Department of Health and Human Services on how to accelerate the development and adoption
of health information technology. AHIC was formed by the Secretary to help advance efforts to achieve President Bush’s goal
for most Americans to have access to secure electronic health records by 2014.
American Health Information Management Association (AHIMA)
"AHIMA (American Health Information Management Association) is a health information management (HIM) professional association over 63,000 members strong.
Since its founding in 1928, AHIMA has remained committed to quality healthcare through quality information."
American’s Health Insurance Plans:
Innovations in Health Information Technology
Certification Commission for Healthcare Information Technology (CCHIT)
Founded in 2004, and certifying electronic health records (EHRs) since 2006, the Commission established the first comprehensive,
practical definition of what capabilities were needed in these systems. The certification criteria were developed through a
voluntary, consensus-based process engaging diverse stakeholders,
and the Certification Commission was officially recognized by the federal government as a certifying body.
Commission on Systemic Interoperability
The Commission was charged with developing a strategy to make healthcare information instantly accessible at all times,
by consumers and their healthcare providers. On October 25, 2005, the Commission released its report, Ending the Document Game:
Connecting and Transforming Your Healthcare Through Information Technology, to the United States Congress, the Administration,
and the American public.
HIMSS Analytics supports improved decision making for healthcare organizations, healthcare IT companies and consulting firms by delivering high quality data and analytical expertise.
Healthcare Information and Management Systems Society (HIMSS)
HIMSS News and Research:
"HIMSS is the source for healthcare IT information. HIMSS’ industry intelligence empowers you to ask the right questions and implement the right solutions."
HL7 United States
Health Level Seven International (HL7) is the global authority on standards for interoperability of health information technology with members in over 55 countries.
The International Health Terminology Standards Development Organisation is an international not-for-profit organization based in Denmark.
IHTSDO acquires, owns and administers the rights to SNOMED CT and other health terminologies and related standards.
IHTSDO develops and promotes use of SNOMED CT to support safe and effective health information exchange.
SNOMED CT is a clinical terminology and is considered to be the most comprehensive, multilingual healthcare terminology in the world.
- Kaiser Permanente:
Care Connectivity Consortium: Better Data - Diagnosis - Counsel - Treatment - outcome [Information for better health care -- YouTube Video]
The Public and Doctors Overwhelmingly Agree on Health IT Priorities to Improve Patient Care [January 31, 2011 | Markle Health in a Networked Life]
"The Markle survey found that majorities of the US public and doctors share many of the same hopes for advancing health through information technology (IT). Responding to parallel surveys at a time when significant health care policy changes were being debated and implemented, the public and doctors overwhelmingly agree on key requirements for information technology to increase the quality, safety, and cost-efficiency of care, as well as core privacy protections."
"Microsoft in Health"
- Health Plan Sales:
Streamline marketing and sales processes and move them online to help achieve more efficient operations at lower costs.
- Enterprise Resource Planning:
Deliver services within your budget with better financial tracking and tighter business operations.
- Health Portals:
"Facilitate better communication by creating secure access to data, applications, and services."
"Delivering patient care, coordinating with specialists, managing administrative tasks,
interacting with payers, and staying up to date on evidence and protocols -
they all depend on accessing and sharing information in a secure manner."
- Electronic Medical Records Videos on YouTube
Organizational and Institutional Contexts and Changes (& their Impacts on Health Communication)
Shared Medical Records & Online Doctor - Patient Communication
One important component of these information processes involving the consumer is generally labeled "Record Sharing". Washington State, the University of Washington and
Group Health Cooperative have become leaders in this field. Thus, it is anticipated that more and more Port Ludlow residents will be confronted with "Record Sharing"
types of communication schemes in the near future .... as Group Health members in Kitsap County already are.
The Third Model: The Informed & Educated Patient
Structural changes in a developing economy, in general, and in health care, in particular tend to lead to more than proportional
increases in the cost of personal, face-to-face, one-on-one services, such as our visits with our physician. Adjustments are made to these increases in personal service
costs in the form of
- increasing charges to the consumer (or to the insurance companies, Medicare etc.),
- decreasing the relative salary levels for many medical
- shifting tasks to professionals with less qualifications and lower salaries;
- shifting tasks to the patient or the patient's family, and/or
- increasing the health professional's productivity, e.g., by substituting personal "patient-information time" by digital information processes.
The resulting communication
complexity and need for patient education are now increasingly tackled by computerization, i.e. increasingly, patient information is entered into the computer only once
information for the patient is transmitted by print-outs, the provider's secure Website or by Email. Group Health members are now also encouraged to contact their
doctors by Email which may not only be more convenient for patients but may also save time for the physician (whose income may not depend on frequent
patient visits). It is likely, however, that the most time is saved by an increasing shift of patient education from the doctor's office to the computer.
Patients are not only encouraged but increasingly required to inform themselves on the Internet.
Physicians, whether they are family practitioners or specialists, have hundreds of diseases, conditions and treatments
to keep up with, and each of these relate differently to specific patient situations. Even the most dedicated doctors
cannot follow all promising developments in ongoing medical and pharmaceutical research. Patients have the advantage
that they can concentrate their "research" on one, their own, condition. Yet patients are also vulnerable to succumbing to technological euphoria in the face of
ever more powerful hard- and softwares and the attractions of the Internet. “We must not
confuse the thrill of acquiring or distributing information quickly with the more daunting task of converting it into knowledge and wisdom.”
In a nutshell, there are ways in which consumers
can better inform and educate themselves to compensate for the ever shorter times in the doctor's office and thereby, at the same time, make sure that they fully
what the doctor has told them, ask better questions, make more informed suggestions, get second opinions and put the specific diagnosis and treatment regime into broader contexts. (gk)
The 4th Model: Informed Patients Make their own
Health Choices and share in Medical Decision Making.
In 2007, a new section (.033)was added by the legislature to Chapter 41.05 RCW(Revised Code of Washington) with the intent “to increase the extent to which patients make genuinely informed, preference-based treatment decisions…… by recognition of shared decision making and patient decision aids in the state’s laws on informed consent” (the forms you are given to sign prior to any procedure/ treatment option scheduled by your provider!) Our Education Resource Center has begun compiling reference materials for Patient Decision Aids for high priority health/wellness conditions, e.g., heart, stroke and diabetes, which nicely exemplify this legislation. As used in the RCW 7.70.060 section “Shared Decision Making,” patient decision aid “means a written, audio-visual, or online tool that provides a balanced presentation of the condition and treatment options, benefits, and harms…” (uk)
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