leveraging technology to empower and engage patients

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3/21/14 1 Daniel Z. Sands, MD, MPH @DrDannySands Society for Par=cipatory Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA © Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands Leveraging Technology to Empower and Engage Patients Where HighTech Meets HighTouch © Copyright 2014 D. Z. Sands, All Rights Reserved @DrDannySands Go Cats!

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Daniel  Z.  Sands,  MD,  MPH  @DrDannySands  Society  for  Par=cipatory  Medicine  Beth  Israel  Deaconess  Medical  Center  Harvard  Medical  School  Boston,  MA  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  @DrDannySands  

Leveraging  Technology  to  Empower  and  Engage  Patients  Where  High-­‐Tech  Meets  High-­‐Touch  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  @DrDannySands  

Go  Cats!  

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Commercial  Disclosures  

ì  Best  Doctors,  Inc.  –  consultant  

ì  Kinergy  Health,  Inc.  –  consultant  

ì  SeniorLink,  Inc.  –  consultant  

ì  PostWire,  Inc.  –  consultant  (2013)  

 

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

I  will  not  be  discussing  products  or  services  of  any  of  these  companies  in  my  presenta8on.  

ì  Palliative  Care  Definition  US  Center  for  Medicare  and  Medicaid  Services  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  @DrDannySands  

Pallia=ve  care  means  pa=ent  and  family-­‐centered  care  that  op=mizes  quality  of  life  by  an=cipa=ng,  preven=ng,  and  trea=ng  suffering.    

Pallia=ve  care  throughout  the  con=nuum  of  illness  involves  addressing  physical,  intellectual,  emo=onal,  social,  and  spiritual  needs  and  to  facilitate  pa8ent  autonomy,  access  to  informa8on,  and  choice.  

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ì  Connecting  and  Agenda-­‐Setting  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

h?ps://www.paCentsite.org    

Bringing  It  All  Together:  Patient  Portals  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  -­‐  @DrDannySands  

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Services:  § Prescrip=on  refills  § Appointment  requests  § Referrals  § View  bill  

EducaCon:  § Search  § Info  prescrip=ons  § Pa=ent  selected  links  § Predefined  collec=ons  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  -­‐  @DrDannySands  

Mail:  § Secure  § Automated  rou=ng  § Task  assignment  

Records:  § Secure  § All  system  records  § Upcoming  appointments  § Meds,  Problems,  Results  …  and  Notes    § Personal  records  

Dave  (Pre-­‐diagnosis)  

This is too cool. It's almost SILLY that things can be this easy. I am having a very good patient/customer experience so far.

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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Affective  Impact:  61M  Minister  with  DM  and  Chronic  Pain  

I have a lot of medical issues. This email system has left me feeling comfortable and in good hands! Otherwise, I would feel as cold, depleted, and alone, as the lifeless tree in my front yard in the deepest of winter!

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

ì  e-­‐Communica=on  includes  encrypted  e-­‐mail  or,  more  commonly,  secure  web  messaging  

ì  e-­‐Communica=on  can  provide    an  efficient  means  of  communica=on  because  it  is  asynchronous  

ì  This  is  cost-­‐effec=ve  and  benefits  both  pa=ents  and  physicians  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Connecting  with  Patients:  e-­‐Communication  

Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.

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Hi - there are several things I want to go over when we meet. I suspect several will require referrals, and given the time it takes to get a slot, I'm thinking of making those appointments now. (It's easy to cancel and create an opening for someone else.) I'm 56 and I generally don't have any complaints. Here are the symptoms I'm concerned about: […] What do you think?

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

ì  The  Visit  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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The  Incidental  Finding  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

The  Incidental  Finding  

INDICATION: Right shoulder pain.

COMPARISONS: Comparison is made to a chest radiograph from December 23, 2003.

TECHNIQUE: Right shoulder, three views.

IMPRESSION:

1. Degenerative changes of the acromioclavicular joint. Normal radiographic appearance of the glenohumeral joint.

2. 3.3 cm right upper lobe lung mass needs further evaluation with a chest CT to exclude malignancy.

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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ì  Diagnosis,  Information,  and  Support  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Lesion  1  –  Left  Upper  Lobe  39x43mm  

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©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Primary  Tumor  Found  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

ACOR is great. I posted two messages tonight and got responses in 4 and 11 minutes. One responder also sent a private note mentioning Robin and Cathy. The other responder was Cathy. :) Through that list I've also found several other useful sites.

Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved. ©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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My doctor prescribed ACOR and it saved my life.

Copyright © 2012 D. Z. Sands and R. D. deBronkart. All rights reserved. ©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  @DrDannySands  

And  There  Are  More  Tools  Available…  

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©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Successful  Treatment  

Baseline: 39x43 mm 50 weeks: 20x12 mm

ì  Sir  Francis  Bacon  English  author,  cour=er,  &  philosopher  (1561  -­‐  1626)    

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Knowledge  is  power.  

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Online  Population  Rising…  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

…And  Health  Info  Seeking  Popular…  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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Online  Health  Habits  of  US  Adults  

Sources:  www.pewinternet.org;  PwC  HRI  Social  Media  Consumer  

Survey,  2012  

ì  80%  of  online  adults  have  looked  for  health  info  ì  Rising  over  =me  ì  Each  day,  more  people  search  for  health  informa=on  than  see  a  physician!    ì  More  than  half  act  on  the  informa=on  

ì  1/3  have  read  about  others’  health  experiences  

ì  1/4  have  tracked  their  health  informa=on  online  

ì  1/3  use  social  media  for  health  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

e-­‐Patients  Want  To  Be  Engaged…  

Involvement  in    

Care  

Communica=on  

Convenience  Informa=on  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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…But  We  Make  it  Difficult:    Mismatch  Between  Desires  and  Service  Offering  

0%   10%   20%   30%   40%   50%   60%   70%  

Online  Appts  

Online  Billing/Pmts  

Online  Costs  

E-­‐mail  

Viewing  Record  

Available   Desired  (Important/Very  Impt)  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Source:  Harris  Interac=ve  9/10/12  at  hlp://goo.gl/VzfmT  

"Thinking  now  of  new  technologies  your  health  care  provider  could  implement,  how  important  would  each  of  the  following  be  to  you?”  (of  pa=ents  who  saw  physician  in  past  year)  

Shifting  Paradigm?  

ì  Informa=on  asymmetry  ì Physician  as  oracle  ì Comfortable  ì A  burden?  

ì  Informa=on  symmetry  ì Physician  as  partner  ì Threatening  vs.  libera=ng  ì Physician  as  healer  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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The  Power  of  “I  Don’t  Know”  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Asking   Tacit  Approval  

Honest  Disclosures  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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It’s  About  Engagement  

Engaged Equipped Empowered Educated Enlightened Etc.

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Ter=ary  

Secondary  

Primary  

Self-­‐Care  (off  the  Map)  

Professional Care

Dis

cour

aged

E

ncou

rage

d $

¢

Industrial Age Medicine Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. ©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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Individual  self-­‐care  

Friends  and  families  

Self-­‐health  networks  

Professionals  as  facilitators  Professionals  

as    partners  Professionals  

as  authori=es  

Professional Care

Dis

cour

aged

E

ncou

rage

d ¢

$

Information Age Healthcare Source: Ferguson, T. Consumer Health Informatics. Healthcare Forum Journal, 1995. ©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Do  We  Need  Most  F2F  Visits?  

Technology   Synchronous?   InformaCon  Density  

Telephone   þ   ««  

E-­‐messaging   o   «  

Text  messaging/IM   o/  þ   «  

Remote  monitoring   þ     «  

Telemedicine   þ  (usually)   «««  

Advanced  Telemedicine   þ     ««««  

Office  visit   þ     «««««  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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h?p://parCcipatorymedicine.org  

Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected

parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. The “participatory” concept may also be applied to fitness, nutrition, mental health, end-of-life

care, and all issues broadly related to an individual’s health.

Society  for  Par=cipatory  Medicine  

Community   Advocacy   Research   Educa=on  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Patients  and  Physicians  Each  Have  Expertise  

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©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Patients  Can  (and  Must)  Help  

ì  Slack  WV.  CyberMedicine:  How  Computing  Empowers  Doctors  and  Patients  for  better  Health  Care.  Jossey-­‐Bass  2001.      

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

It  can  be  argued  that  the  largest  yet  most  neglected  health  care  resource,  worldwide,  is  the  pa=ent…  

 

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The  Web  Connects  to  Information,  Caregivers,    and  Each  Other  (and  to  Providers)  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

Changing  Nature  of  Relationship  

Information Asymmetry Information Symmetry

Passive Recipient Active Partner

Patient-Physician Consumer-Provider

Paternalism Participation

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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Conclusions  

ì  Provider,  pa=ent,  and  carer  engagement  are  cri=cal  

ì  Par=cipatory  Medicine  and  an  important  paradigm  shir  ì  “Facilitates  pa=ent  autonomy,  access  to  informa=on,  and  choice”  ì  A  new  dance  that  both  partners  need  to  learn  ì  Transforms  pa=ent  and  clinician  experience  ì  Helps  shir  balance  of  power  

ì  Connected  technology,  including  secure  e-­‐messaging,    PHRs,  and  online  resources  lowers  barriers  to  engagement,  empowering  and  enabling  pa=ents,  carers,  and  providers  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  

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Questions?

Questions  and  e-­‐mail  address  

[email protected]  h?p://www.DrDannySands.com    

@DrDannySands  ©  Copyright  2014  D.  Z.  Sands,  All  Rights  Reserved  -­‐  @DrDannySands