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Implications of Information Technology and Consumer Participation in Health Care

This article explores the challenges and changes in healthcare delivery, the role of consumer health informatics, and the concept of SMART patients. It discusses the need for clinicians to engage and empower patients, as well as restructure practice environments to capitalize on their talents. The article also addresses clinical practice and information system issues, and emphasizes the importance of patient-centered systems in healthcare delivery.

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Implications of Information Technology and Consumer Participation in Health Care

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  1. 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

  2. Challenges and Changes in Health Care Delivery

  3. Changes in Health Care • Shifting responsibilities, shifting costs, shifting values • Shortened Length of Stay • Emphasis on evidence and outcomes • Broader idea constitutes health

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

  5. Patients are Changing, too! at least some of them

  6. Transitions in our view of patients • From ‘flat and silent’ • To Collaborative Problem Solvers

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

  8. Moving the site of care

  9. Contemporary Health Care rests on a successful partnership betweenPatients, Clinicians, and Delivery Systems

  10. Consumer Health Informatics: Putting Information Resources in the hands of Consumers • Accepted and Alternative Health • General Health Information • Personal Health Data

  11. Delivering CHI • Broadcast and print media • The Internet • Health-related WWW sites • Self help BBS, Listsrvs & e-mail groups • Freestanding kiosks, CD-ROMs, and SmartCards

  12. Evaluating CHI • Perspectives: Credentialling sites or Educating consumers • Involved groups • ODPHP Scientific Panel • HITI, Inc (Mitretec) • AMIA Internet Working Group

  13. CHI JIT Y2K

  14. SMART Patients

  15. SMART Patients • Self-assured • Motivated • Aware • Resourceful • Talented

  16. Remember they may also be: • Scared • Minors! • Anxious • Reluctant • Time consuming

  17. Common behaviors of SMART patients • self triage • values and preference clarification • participative • collaborative • independently engage in health promotion

  18. What they aren’t : • complacent • quiet • unchallenging • similar

  19. SMART Patients: Who needs ‘em? • we do! • Why? • partners in care • Clinicians have too much to do • episodic nature of care doesn’t work any more

  20. Clinician’s responses to the SMART patient: • engaging • tolerant • dismissive • condescending

  21. The Challenges for Clinicians • Use technology to help make patients smart • treat them as a resource • Change our practice activities to capitalize on their talents • Reorganize our practice environments

  22. What are we expecting patients to do? • case manage • monitor • perform therapeutics • initiate conversation with us

  23. Information tools needed: • access to their clinical records • Personal Case Management tools • CHI and assistance with using it (access, interpretation)

  24. Clinical Practice Issues • Henderson “...what the patient can do...” • Re-examining every action • Trusting our colleagues • Timing of interventions

  25. Clinical Roles • Content Expert • Envision a clinical practice that makes use of the patient as a resource • Re-organize care and care activities to incorporate patients

  26. Constructing a Health Care Delivery System responsive to SMART Patients

  27. Clincial Systems Issues • Collaborative with other disciplines • reciprocity of change • Practice Standards • Optimized work patterns • Incentive Structures

  28. Information Systems Issues • Patient-centered care • Language: • Data relevant to all care providers • Mapping from professional to vernacular • Inter-organizational communication • Security • Cost model • Clinical information systems integration

  29. InformationTechnology’s Response Patient- Centered Systems

  30. Patient-Centered Systems • Clinical Records • Network Communication • Consumer Health Informatics

  31. Patient-Centered Information Systems Clinic Physician Office Computer-based Patient Record Pharmacy Dentist Furtive Records Consumer Health Information Hospital

  32. What can you do differently tomorrow?

  33. 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

  34. Seen any ‘SMART’ patients lately? ...they’re there, everywhere!

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