I mentioned in my last post a new pocket EKG that connects wirelessly to NFC-enabled devices such as smart phones and tablets. NFC is Near Field Communication. NFC is not that widely used in the US, though its use is increasing. Reader Chris Wasden posted a comment that inexpensive add-ons are available to NFC-enable any smart phone. I was not aware of that. You need a reason to buy one and I don’t have that reason yet, but it’s good to know.
Last week and the week before I wrote about engaging patients at the point of care (POC). It’s a big topic and one I’m not sure I fully dug into, at least to get my point across. Today I’m writing about a related topic: do we want patients to be able to ask informed and pointed questions at the POC?
Away from the point of care, people see the value in helping patients ask questions and find answers. HealthTap, ShareCare, Patient Communicator, and Meddik have slightly different angles on how to do this. I can also think of countless initiatives (Direct, HIEs, etc.) and companies (Avado, MedSeek, Microsoft, Quest Diagnostics, etc.) seeking to provide patients with access to accurate and timely medical records, again, not at the point of care.
Combining access to medical records with forums that make asking questions and finding answers simple is a powerful combination for engaging patients, preventing errors, maximizing the value of patient and physician time at the POC, and ultimately improving outcomes.
In the virtual setting (away from the POC), the combination of timely information and ease of asking questions has several potentially good financial models: eyeballs/ads, reduced overhead from redirected patient calls, and preventing office and ED visits simple questions. Because of the revenue model, almost all the companies I listed above are funded startups poised to grow fast, fail fast, or be acquired fast.
If informed, connected, and presumably engaged patients are so valuable away from the POC, then why aren’t we fully informing and engaging them at the POC for the same benefits (minus a couple of financial ones?) For this post, I’m talking about inpatients and not the ambulatory side of the system.
Patients are often asked at the conclusion of rounds or a meeting with medical team, "Do you have any questions?" If the patient wants a clarification or has a burning question, this is the time to ask before the medical team moves on to the next patient.
The problem is that being an impatient is not terribly informing or empowering. Asking the right questions is a challenge, even if you have a good grasp of the health system and your condition.
Maybe we should start giving patients more timely and complete information about their care at the point of care. Help them more actively participate in the process.
Clinicians and hospitals might not want to do this. Care is evolving, and records or procedures or med schedules for the day might not be the same after morning labs. Clinicians might get inundated with questions. Nurses and staff might be constantly passing along questions.
What are the potential gains from providing patients with up-to-date records and med lists?
The first, though high level and hard to quantify, is moving patients and family toward becoming active members of the care team. This is what we want from patients and families, so we might as well start integrating that concept into all aspects of care.
The second is consistency. Medicine–hospital medicine in particular — is all about handoffs. I can’t remember the exact number, but patients are handed off from physician to physician several times each day (even more at academic centers) and at each nurse sign-out. Patients and families are a consistent presence — they don’t get to hand off.
The third potential benefit is that the patient — by nature of being informed, consistent, and asking questions — might actually help catch errors before they occur. Maybe they ask, "Why am I getting two of these pills today and not one like yesterday?" It’s a simple question that might not indicate an error, but is probably still a question that is worth answering. If that or any other question triggers a second look or a follow-up that prevents an error, that’s a pretty big upside.
This is high level and not specific. We should start by choosing information that’s readily available and exportable (such as like med lists) and providing it to patients daily. Maybe we can integrate it into TVs or iPads down the road, but we could start with paper to test the theory. It’s probably necessary to start by using a nurse or patient navigator/manager to help the patient understand what info are getting and why they are getting it.
From this point, see if patients like it and use it. Check to see if clinicians like it.
I’m curious to know what hospital clinicians think. Should we be helping patients ask better questions at the POC?