1. Today’s Health Care System Physician Health Insurance Self-Care Information Overload Media The Patient

2. How to heal a sick healthcare system How to heal a sick healthcare system Dr Aniruddha Malpani, MD Medical Director, HELP Health Education Library for People World’s largest free health library www.healthlibrary.com

3. What’s wrong with healthcare today? Remember your last visit to your doctor ? Remember your last visit to your doctor ?

5. Poorly organised patients + rushed doctors = badly performed consultation = poor medical care Poorly organised patients + rushed doctors = badly performed consultation = poor medical care How can we improve this ? How can we improve this ?

6. The commonest complaints patients have today are: Doctors are too busy – they make me wait too long Doctors are too busy – they make me wait too long I don’t understand what they say – they don’t have time to explain their jargon. They don’t share information or respect my preferences I don’t understand what they say – they don’t have time to explain their jargon. They don’t share information or respect my preferences Care is fragmented amongst specialists Care is fragmented amongst specialists Doctors are not transparent or accountable. How do I know his advise is reliable and trustworthy ? Doctors are not transparent or accountable. How do I know his advise is reliable and trustworthy ? Too expensive ! Too expensive !

7. Doctors are unhappy too ! They are stressed out, because of the large number of patients they need to see, and feel that patients expect too much from them. The feel that patients unfairly blame doctors for all bad outcomes. They are stressed out, because of the large number of patients they need to see, and feel that patients expect too much from them. The feel that patients unfairly blame doctors for all bad outcomes. They also feel that many patients waste their valuable time by asking stupid and irrelevant questions; because they are too disorganized; and don’t bother to educate themselves or do their homework. They also feel that many patients waste their valuable time by asking stupid and irrelevant questions; because they are too disorganized; and don’t bother to educate themselves or do their homework.

10. Result? Breakdown in Doctor-Patient Communication Patients don’t trust doctors as much as they used to in the past Patients don’t trust doctors as much as they used to in the past Doctors are getting burnt out Doctors are getting burnt out They practice defensive medicine to protect themselves from malpractise suits They practice defensive medicine to protect themselves from malpractise suits Overspecialisation – specialists have tunnel vision Overspecialisation – specialists have tunnel vision No one to look after the “whole” patient No one to look after the “whole” patient Doctors have become technicians – lost the human touch Doctors have become technicians – lost the human touch

12. Major reason for a sick healthcare system Everything is doctor-centric - the doctor is the center of the medical care system Everything is doctor-centric - the doctor is the center of the medical care system Healthcare is therefore fragmented and disorganised Healthcare is therefore fragmented and disorganised Too many specialists, most of whom have tunnel vision Too many specialists, most of whom have tunnel vision

14. Solution Need to reform the healthcare ecosystem ! Need to reform the healthcare ecosystem ! Put patients at the center – “ patients are the largest untapped healthcare resource “ ! Put patients at the center – “ patients are the largest untapped healthcare resource “ !

15. Assumption Patients ( or their relatives and friends) are : intelligent and capable; and because they have a lot at stake, they are motivated to get good health care, and will be willing to invest time and energy if given the right tools to ensure a good outcome. Patients ( or their relatives and friends) are : intelligent and capable; and because they have a lot at stake, they are motivated to get good health care, and will be willing to invest time and energy if given the right tools to ensure a good outcome.

16. Patient centered healthcare Self-care Self-care Personalization Personalization Transparency Transparency Quality Quality Control Control

17. Information Therapy “ The right information to the right person at the right time to help make better health decisions” “ The right information to the right person at the right time to help make better health decisions” What information do patients want ? To choose doctors and treatments with good outcomes To choose doctors and treatments with good outcomes To communicate effectively with doctors To communicate effectively with doctors To know what the doctor should do To know what the doctor should do

18. Blended model Click and mortar Click and mortar Provide information in the real world Provide information in the real world Provide information on the web Provide information on the web

19. Patient information centers At every point of clinical contact At every point of clinical contact Clinics Clinics Labs Labs Diagnostic centers Diagnostic centers Chemists Chemists Hospitals Hospitals

20. Patients have questions ! We need to answer these proactively We need to answer these proactively Win-win situation ! Win-win situation ! Helps to improve patient satisfaction Helps to improve patient satisfaction Helps to improve patient compliance Helps to improve patient compliance Can be answered by all healthcare professionals Can be answered by all healthcare professionals Great way of marketing Great way of marketing

21. Patient education is an untapped area in India today ! Patient education is an untapped area in India today ! Anyone who provides this will create a USP Anyone who provides this will create a USP Improve brand recognition and market share ! Improve brand recognition and market share ! Works very well in the USA ! Works very well in the USA !

22. Our experience with Information Therapy in the real-world HELP – world’s largest free health library HELP – world’s largest free health library Established in 1998 Established in 1998 Mission - to empower people by providing them with the information they need to promote their health, and prevent and treat medical problems in the family in partnership with their doctor. Mission - to empower people by providing them with the information they need to promote their health, and prevent and treat medical problems in the family in partnership with their doctor. We are a registered charitable trust and a non- profit organisation. We are a registered charitable trust and a non- profit organisation.

23. We help patients save money on medical care 1. Promote SelfCare. Help them to do as much for themselves as they can 1. Promote SelfCare. Help them to do as much for themselves as they can 2. Provide Evidence-Based Guidelines, so they can ask for the right medical treatment that they need - no more and no less 2. Provide Evidence-Based Guidelines, so they can ask for the right medical treatment that they need - no more and no less 3. Help them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery. 3. Help them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery.

29. What we provide Easy to read materials – for patients and by patients Easy to read materials – for patients and by patients Wide variety of styles – from single page pamphlet to books Wide variety of styles – from single page pamphlet to books Comprehensive – from stress management, exercise, diet, all illnesses, alternative medicine Comprehensive – from stress management, exercise, diet, all illnesses, alternative medicine Over 300 DVDs Over 300 DVDs

30. Our focus areas now are: 1. encouraging health insurance companies to invest in patient education 1. encouraging health insurance companies to invest in patient education 2. advocating information therapy 2. advocating information therapy 3. setting up a national network of patient education centers 3. setting up a national network of patient education centers 4. developing patient educational materials in Indian languages for the web 4. developing patient educational materials in Indian languages for the web

31. HELP is growing ! National Network Every hospital should have a Patient Education Resource Center Every hospital should have a Patient Education Resource Center Win-win situation Win-win situation Great tool to empower patients Great tool to empower patients Helps doctors and hospitals too ! Helps doctors and hospitals too !

32. Patient Information Center Core collection of books Core collection of books DVDs DVDs PC with internet connection PC with internet connection Printer Printer Staff member Staff member “Corner” centers – need just about 100 sq ft “Corner” centers – need just about 100 sq ft

34. New locations Mini-libraries in pharmacies Mini-libraries in pharmacies Mini-libraries in medical laboratories Mini-libraries in medical laboratories Mini-libraries in clinics Mini-libraries in clinics

35. Online Information Therapy Free Free 24/7 24/7 Easily accessible Easily accessible Increased internet penetration Increased internet penetration Answer questions free by email ! Answer questions free by email !

38. How do we provide the right information to the right patient ? Free floating information is useless Free floating information is useless Information Therapy needs to be prescribed to them, tailored to their needs, based on their medical problems Information Therapy needs to be prescribed to them, tailored to their needs, based on their medical problems How can we do this ? How can we do this ? PHR PHR

39. PHR – Personal Health Record For the Tax Department, you are your tax return For the Tax Department, you are your tax return For the Bank, you are your bank statement For the Bank, you are your bank statement For the healthcare system, you are your medical record. For the healthcare system, you are your medical record.

40. PHR Technology to help patients to store their medical records on their personal website. Interactive forms and templates so they can fill in the details online. Images, ECGs can be scanned in Technology to help patients to store their medical records on their personal website. Interactive forms and templates so they can fill in the details online. Images, ECGs can be scanned in This is NOT an EMR ! This is NOT an EMR ! Using CCR information standards, the PHR can exchange data with other databases so that the PHR can be automagically updated ( for example, with lab test results ; with the chemist’s prescription; with the hospital EMR; with health insurance company data) Using CCR information standards, the PHR can exchange data with other databases so that the PHR can be automagically updated ( for example, with lab test results ; with the chemist’s prescription; with the hospital EMR; with health insurance company data)

42. Yos Technologies Yos Technologies ( www.yostechnologies.com) is based in Bangarore and provides a comprehensive "Personal Healthcare System" which includes PHRs, Healthcare tools and applications for Preventive and Continuous Care Yos Technologies ( www.yostechnologies.com) is based in Bangarore and provides a comprehensive "Personal Healthcare System" which includes PHRs, Healthcare tools and applications for Preventive and Continuous Care I am an angel investor I am an angel investor

45. Why will patients use the PHR ? Three players Three players Patients Patients Doctors Doctors Health insurance companies Health insurance companies

46. PHR = organised medical information = improved medical care Patients have a lot at stake ! Patients have a lot at stake ! Keeping this record will help them to get better medical care. Keeping this record will help them to get better medical care. Patients need to manage their own health record. Patients need to manage their own health record.

47. Patient benefits Instantly available on your mobile, wherever you are Instantly available on your mobile, wherever you are Information is shared amongst all the specialists who participate in your care Information is shared amongst all the specialists who participate in your care Available during emergencies Available during emergencies Always updated Always updated Ensures you don’t forget allergies and drug reactions Ensures you don’t forget allergies and drug reactions Automated reminders ( for example, for checkups ) using SMS Automated reminders ( for example, for checkups ) using SMS

48. Patients own this information. Part can be secure, private, and confidential; part can be public Part can be secure, private, and confidential; part can be public Patients can add a lot of value to the healthcare system using Patient to Patient ( P2P) networking. Patients can add a lot of value to the healthcare system using Patient to Patient ( P2P) networking. Social networking – an online community, in which patients share information Social networking – an online community, in which patients share information “ Wisdom of the crowds” “ Wisdom of the crowds” “Expert patients “ can act as mentors and email buddies. “Expert patients “ can act as mentors and email buddies. Patients can grade their doctors and hospitals ( using the amazon.com review model ) and compare treatments ( www.askapatient.com). Patients can grade their doctors and hospitals ( using the amazon.com review model ) and compare treatments ( www.askapatient.com).www.askapatient.com

49. How do we get patients to sign up ? Reach out to patients directly Reach out to patients directly Highly motivated patient groups Highly motivated patient groups Patients with chronic illness, such as cancer, infertility, HIV Patients with chronic illness, such as cancer, infertility, HIV Pregnant women Pregnant women Mothers ( for their children) Mothers ( for their children) Corporates Corporates Employee wellness Employee wellness

50. PRM – Patient Relationship Management ! PHR can help doctors improve their practise PHR can help doctors improve their practise Because patients are better organized; and the doctor has easy access to all the relevant medical records, the doctor’s productivity will improve Because patients are better organized; and the doctor has easy access to all the relevant medical records, the doctor’s productivity will improve Good medical records reduce medical errors. Important in risk management, thus reducing the doctor’s medicolegal liability. Good medical records reduce medical errors. Important in risk management, thus reducing the doctor’s medicolegal liability.

51. More doctors now have their own websites Websites are effective marketing tools for doctors which can help them to promote their practice Websites are effective marketing tools for doctors which can help them to promote their practice As doctors move online, they will want their patients to move with them ! As doctors move online, they will want their patients to move with them ! Email is a much more effective form of communication than a phone call ! Email is a much more effective form of communication than a phone call ! Can also integrate with the doctor’s EMR Can also integrate with the doctor’s EMR

54. Major player – health insurance companies Initially, health insurance companies can offer the PHR as a value-added service to their clients Initially, health insurance companies can offer the PHR as a value-added service to their clients Later, the health insurance company could make this compulsory for all their clients Later, the health insurance company could make this compulsory for all their clients

55. How the PHR helps health insurance companies They could use this for providing health education to their clients, which would help to reduce their medical bills. They could use this for providing health education to their clients, which would help to reduce their medical bills. It would reduce their transaction costs, because the data processing ( collecting premiums, authorizing payments, issuing payments) could all be done electronically, and much more efficiently It would reduce their transaction costs, because the data processing ( collecting premiums, authorizing payments, issuing payments) could all be done electronically, and much more efficiently

56. How the PHR helps health insurance companies They could mine the data these records warehouse, to improve the quality of their services and obtain more accurate actuarial data. They could mine the data these records warehouse, to improve the quality of their services and obtain more accurate actuarial data. Online disease management ( based on the PHR) would help them reduce costs for patients with chronic illnesses (http://www.lifemasters.com/index.asp) Online disease management ( based on the PHR) would help them reduce costs for patients with chronic illnesses (http://www.lifemasters.com/index.asp)http://www.lifemasters.com/index.asp

57. White-labelled PHRs

58. Applications being developed 1. Google Earth – to map the nearest doctor; nearest chemist; nearest hospital 1. Google Earth – to map the nearest doctor; nearest chemist; nearest hospital 2. Databases of doctors, hospitals, medicines and their prices 2. Databases of doctors, hospitals, medicines and their prices Changing the healthcare ecosystem using Web 2.0 Changing the healthcare ecosystem using Web 2.0

59. Why haven’t more hospitals adopted IT ? Bugs in software Bugs in software Difficult to get skilled IT manpower to run the systems Difficult to get skilled IT manpower to run the systems Difficult to scale up Difficult to scale up Connectivity issues Connectivity issues

60. Better model Software as a Service ! Software as a Service ! All the technology is outsourced to Yos All the technology is outsourced to Yos Webware ( Web 2.0) Webware ( Web 2.0) No installation or maintenance needed No installation or maintenance needed Always updated Always updated Can be easily scaled Can be easily scaled Always available – from anywhere ! Always available – from anywhere !

61. Risks Need a critical mass of patients to adopt this Need a critical mass of patients to adopt this Privacy issues Privacy issues Legal liability issues Legal liability issues

62. Today’s Health Care System Physician Health Insurance Self-Care Information Overload Media The Patient

63. The Patient as Integrator Care Choice Information & Feedback The Empowered Patient – with the help of Information Therapy