Creating SMART Patients: Consumer Health Informatics and the Implications for Clinical Practice

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Creating SMART Patients Consumer Health
Informatics and theImplications for Clinical
Practice

• Patricia Flatley Brennan, RN, PhD
• University of Wisconsin-Madison
• Supported by Grants from NIH, UW-Madison Graduate
  School, and numerous conversations with friends,
  colleagues, and patients

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Imagine, sometime in the next year

• Mary, a 57 year old woman, feels ill at ease
• ? Should she call the NP
• ? Should she go to the Urgent care clinic?

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Health technologies in the Home

• Mary activates the Plans Health Advisor
• Mary enters her sx responds to questions
• Recommendation Come in to Urgent Care

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Plans Health Advisor

• Pages the Clinician on the cell phone
• Transmits relevant clinical records to all
• Initiates admission procedure in Urgent Care

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Meanwhile, at Urgent Care...

• Mary is greeted
• Non-invasive devices assess and record Vs
• Protocols are activated
• Results transmitted to the clinician via wireless
  page

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Resolution

• Mary returns home reassured treated, and
  smarter
• Her records updated and added to the Data
  Repository
• The Health Advisors Knowledge Base renewed

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Goals

• Identify the defining characteristics and
  behaviors of patients with the knowledge,
  motivation and resources to be SMART
• Describe how Medical Informatics supports SMART
  patients
• Propose modifications in contemporary health care
  system to capitalize on the SMART patient as a
  clinical resource

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Changes and Challenges in Health Care Delivery
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Changes in Health Care

• Shifting responsibilities, shifting costs,
  shifting values
• Shortened Length of Stay
• Emphasis on evidence and outcomes
• Expanded idea of Health Care

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Challenges

• Defining our Nature Using Resources wisely

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What is health care whos involved?
Disease Self Help
Self Care Management
Patient
Professional
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Patients are Changing, too!
at least some of them
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Transitions in our view of patients

• From flat and silent to Collaborative Problem
  Solvers

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What makes patients change?

• Social values of autonomy, self-help and
  self-determination
• Clinical recognition of the importance of
  patient participation
• Changing cost model
• Withdraw of previously-delivered service

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Moving the site of care
altering the time factor
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How can Medical Informatics better serve
patients all of health care?
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General focus of Medical Informatics
Disease Self Help
Self Care Management
Patient
Professional
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Consumer Health Informatics
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Consumer Health Informatics Putting Information
Resources in the hands of Consumers

• Communication
• General Health Information
• Personal Health Data

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Delivering CHI

• Broadcast and print media
• Freestanding kiosks, CD-ROMs, and SmartCards
• Network wireless pathway --gt CPR
• The Internet
• Health-related WWW sites
• Self help BBS, Listsrvs e-mail groups

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Evaluating CHI

• Language, meaning value
• Quality Relevance
• Perspectives Credentialling sites or Educating
  consumers
• Groups involved in promulgating tools and
  standards
• Impact on clinical outcomes

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An example or two
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Clinical NetworksComputerLink

• a special community-based computer network
  service
• provides home care support to patients and
  caregivers
• accessed via terminals placed in the home

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ComputerLink Services

• Communication
• Information
• Decision Support

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Participants Experiences
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What do they say?

• Ask for Help
• ...I have been having trouble getting my
  husband to change his clothes at night so he can
  go to bed... It is disturbing to have this
  reaction at bedtime because it upsets me so that
  I cannot go to sleep myself... I feel so
  helpless sometimes and I think that there must be
  some way that I can handle this.

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Evidence from the ComputerLink project

• Naive persons will use computer networks
• Increased confidence and reduced isolation
• Communication services used on over 90 of all
  encounters, but access to INFORMATION leads to
  change

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More examples

• HeartCare WWW-based cardiac recovery
• NetWellness - state wide health information
• CHESS AIDS, Breast Cancer, Heart Disease
• Sapient Professional coaching in a
  peer-interactive environment (www.sapient.net)
• Clinical Records Initiatives
• Columbia
• PICASSO

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PATIENTS with the knowledge, motivation
resource
CONSUMER HEALTH INFORMATICS
HEALTH CARE IN THE 90s
PEER SUPPORT
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SMART Patients
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SMART Patients

• Self-assured
• Motivated
• Aware
• Resourceful
• Talented

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Remember, they may also be

• Scared
• Minors!
• Anxious
• Reluctant
• Time consuming

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Common behaviors of SMART patients

• self triage
• values and preference clarification
• participative
• collaborative
• independently engage in health promotion

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What they arent

• complacent
• quiet
• unchallenging
• similar

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Smart Patients Who needs em?

• we do!
• Why?
• partners in care
• nurses have too much to do
• episodic nature of care doesnt work any more

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What are we expecting patients to do?

• monitor
• case manage
• perform therapeutics
• initiate conversation with us

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Clinicians responses to the SMART patient

• engaging
• tolerant
• dismissive
• condescending

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The Challenges

• 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

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Tools needed by patients

• Health Information Literacy
• Access to their clinical records
• Personal Case Management
• CHI and assistance with using it (access,
  interpretation)

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Clinical Roles

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

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Constructing a Clinical System responsive to
SMART Patients
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A message from Brother Bill (Gates, that is!)
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Business _at_ the Speed of Thought

• 12 Principles to get the best use from the
  Digital Nervous System
• Extends appropriately to health care because
• Health organizations expend one-fifth as much on
  information than does banking, an industry
  similar in terms of time-dependency, security,
  and information density
• CHI must have a business case
• Like other industries, health care must view its
  customers as collaborators

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12 PRINCIPLES

• Use only E-mail to insure monitoring and response
• Study data to find patterns share insights
• Shift Knowledge workers from analysis to thought
• Create cross- department virtual teams
• Convert every paper process to digital process
• Use digital tools to change single-task jobs

• Give employees a feedback loop for key metrics
• Route customer complaints correctly
• Refine business nature and boundaries
• Trade information for time make every process
  JIT
• Eliminate the middle from transactions
• Help customers help themselves

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What can you do differently tomorrow?
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There are degrees of SMART!

• Not all patients are equally SMART -- nor are
  they SMART in the same way
• We must seek that which is SMART in each
  patient and work with it to insure care

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Seen any SMART patients lately?

• theyre there, everywhere!

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