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

Changes in Health Care ßShifting responsibilities, shifting costs, shifting values ßShortened Length of Stay ßEmphasis on evidence and outcomes ßBroader idea constitutes health

What is health care & who’s involved? Patient Professional Disease Self Help Self Care Management

Patients are Changing, too! at least some of them

Transitions in our view of patients ßFrom ‘flat and silent’ ßTo Collaborative Problem Solvers

What makes patients change ? ß clinical recognition of the importance of patient participation ß social valuing of autonomy, self-help and self-determination ßwithdraw of previously-delivered service ß changing cost model

Moving the site of care

Contemporary Health Care rests on a successful partnership between Patients, Clinicians, and Delivery Systems

Consumer Health Informatics: Putting Information Resources in the hands of Consumers ßAccepted and Alternative Health ßGeneral Health Information ßPersonal Health Data

Delivering CHI ßBroadcast and print media ßThe Internet ßHealth-related WWW sites ßSelf help BBS, Listsrvs & groups ßFreestanding kiosks, CD-ROMs, and SmartCards

Evaluating CHI ßPerspectives: Credentialling sites or Educating consumers ßInvolved groups ßODPHP Scientific Panel ßHITI, Inc (Mitretec) ßAMIA Internet Working Group

CHI JIT Y2K

SMART Patients

ß Self-assured ß M otivated ß A ware ß R esourceful ß T alented

Remember they may also be: ß Scared ß M inors! ß A nxious ß Reluctant ß Time consuming

Common behaviors of SMART patients ßself triage ßvalues and preference clarification ßparticipative ßcollaborative ßindependently engage in health promotion

What they aren’t : ßcomplacent ßquiet ßunchallenging ßsimilar

SMART Patients: Who needs ‘em? ßwe do! ßWhy? ßpartners in care ßClinicians have too much to do ßepisodic nature of care doesn’t work any more

Clinician’s responses to the SMART patient: ß engaging ß tolerant ß dismissive ß condescending

The Challenges for Clinicians ßUse technology to help make patients smart ßtreat them as a resource ßChange our practice activities to capitalize on their talents ßReorganize our practice environments

What are we expecting patients to do? ßcase manage ßmonitor ßperform therapeutics ßinitiate conversation with us

Information tools needed: ßaccess to their clinical records ßPersonal Case Management tools ßCHI and assistance with using it (access, interpretation)

Clinical Practice Issues ßHenderson “...what the patient can do...” ßRe-examining every action ßTrusting our colleagues ßTiming of interventions

Clinical Roles ßContent Expert ßEnvision a clinical practice that makes use of the patient as a resource ßRe-organize care and care activities to incorporate patients

Constructing a Health Care Delivery System responsive to SMART Patients

Clincial Systems Issues ßCollaborative with other disciplines ßreciprocity of change ßPractice Standards ßOptimized work patterns ßIncentive Structures

Information Systems Issues ßPatient-centered care ßLanguage: ßData relevant to all care providers ßMapping from professional to vernacular ßInter-organizational communication ßSecurity ßCost model ßClinical information systems integration

InformationTechnology’s Response Patient- Centered Systems

ßClinical Records ß Network Communication ßConsumer Health Informatics

Clinic Hospital Physician Office Pharmacy Furtive Records Dentist Patient-Centered Information Systems

What can you do differently tomorrow?

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!