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Healthcare Reform

Breakaway: A Look Behind the Curtain

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Ever wonder what the cinematic classic The Wizard of Oz, and modern healthcare have in common?  The yellow brick road, flying monkeys, or perhaps the man behind the curtain could all describe some facet of healthcare. At the Healthcare Forum 2013, sponsored by  The Breakaway Group, CT Lin, MD, Chief Medical Information Officer, University of Colorado Hospital & Health Sciences Center, presented “The Man Behind the Curtain” to discuss his research and insights on sharing real-time results with patients. Real-time result sharing allows patients to participate alongside the physician in the treatment decision-making process. It also demystifies the role of the physician and shifts the paradigm from an all-knowing and all-powerful “Oz” (aka wizard) to a collaborative healthcare partner.

At the University of Colorado Hospital, Lin started his research initiative to demystify the man behind the curtain with a study program titled “We Make Mouse Calls.” This study focused on online provider messaging with patients regarding requests for prescription refills, specialist referrals, and appointments. Although “We Make Mouse Calls” was modeled after a project at Yale University, Lin’s research affirmed that patients are open and receptive to taking a more active role in the care process.  The study found that 86 percent of patients preferred receiving online messages versus telephone calls for non-urgent communications. Initially, many physicians feared a “floodgate” of constant messaging.  However the study revealed that most messaging occurred after hours, and on average, physicians received only 10 messages per day. And these messages replaced telephone calls – one online message could replace the typical three to four calls needed to resolve one issue. Patients also felt empowered that their messages went directly to the provider. After six months of research with a group of 300 participants, patient satisfaction dramatically improved. In contrast with the control group of patients, overall communication improved by 32 percent and overall care improved by 11 percent.

In 2002 Lin took the research a step further by releasing test results online directly to patients. One of Lin’s colleagues likened the format of online results to the Wall Street Journal version of the patient record. The results were accessible and reflected real-time medical data. Patients were provided some guidance on what results would be available and the normal ranges for these results. Here, patients could see real-time results, such as their Basic Metabolic Profile (BMP), and any other tests relevant to their condition.

Why is releasing results directly to patients so profound?

It almost instantaneously shifts the relationship from a doctor-centric model to a patient-centric model. The study found that sharing real-time results with patients increased patient trust and empowerment, increased patients’ understanding of their conditions, and also increased adherence to treatment.

The curtain is pulled, what’s next?

Real-time result sharing provides an opportunity for patients to participate in selecting treatment options. Granted, not all patients want to know about – or be involved in – this process. For those patients, physicians can still prescribe orders without collaboration.

On a personal note, I recently experienced the dichotomy of doctor-centric and patient-centric care. My mother-in-law was admitted to the hospital for severe liver failure. The initial part of her stay was focused on stabilizing her enzyme levels, and at times we were not sure if she would survive. In many regards, we felt isolated and in the dark about her care. We constantly wondered when her physician would meet with the family. When the attending physician finally arrived, he diagnosed her condition as end stage, placed a few dietary and pharmacy orders, and briefly spoke with our family about End Stage Liver Disease (ESLD). This was preceded by nurses providing a stack of handouts on her diagnosis and giving us a phone number for their Patient Advocate if we had any questions. When we asked to speak with a physician or had questions about ESLD, we received blank stares from the nursing staff and it took several days, and many attempts, for the Patient Advocate to even get the physician to call us back.

After her condition stabilized, my mother-in-law was assigned a new attending physician and the paradigm of care shifted. Our family was able to talk directly to the physician on a more regular basis about her results and condition. Our anxieties were dramatically reduced. We finally had the opportunity to ask questions and discuss potential outcomes. Perhaps if we had a more direct connection with the physician before her condition stabilized, we wouldn’t have felt like a pride of cowardly lions nervously waiting for the man behind the curtain.

carrie paykoc

Carrie Paykoc is HIT Project Lead and Instructional Designer for The Breakaway Group, A Xerox Company.