would you like an office with that visit?
TRANSCRIPT
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ì
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
Would You Like An Office With That Visit?: Changing Our Thinking About Health Care Delivery
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 -‐ @DrDannySands
I will not be discussing products or services of any of these companies in my presenta8on.
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Source: ReachMail.net and DZ Sands
▶ 1969: Internet born as ARPAnet at UCLA.
◀ 1998: First guide-lines for e-mail w/ patients (AMIA)
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
History Lesson
Boston’s Beth Israel introduces e-mail
1991: Danny e-‐mailing pa=ents
“Sorry, Dr. Sands no longer sees people. He e-‐mails them.” © Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Dr. Sands not seeing patients
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ì Includes encrypted e-‐mail or, more commonly, secure web messaging
ì Enables efficient communica=on because it is asynchronous
ì Is cost-‐effec=ve and benefits both pa=ents and physicians
ì Enhances rela=onships
ì Is a channel for care-‐at-‐a-‐distance
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
What Have We Learned About e-‐Messaging?
Sources: Kane B, Sands DZ, JAMIA 1998. Delbanco T, Sands DZ, NEJM 2004.
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
The Consumerization of Health and the Virtualization of Care
Diagnose and Treat
Prevent and
Maintain
Physical Resources
Virtual Resources
Drivers: • Burden of chronic illness • Ageing popula=on • Resource maldistribu=on • Cost-‐containment • Consumer demand
Health Treatment
Hospital
Home
Anywhere
Built on ideas from Michael Gill
$$$$$
$
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Care Delivery Costly in Traditional Settings
Yet There is Relentless Demand for Services
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
And Our Systems Are Optimized for Managing Acute Care
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
So We Must Focus More on Chronic Disease Prevention and Treatment
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Also Have Maldistribution of Resources
~40% Fewer Clinicians Outside
Major Ci=es
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Therefore, We Must Adopt New Care Models
More care op=ons for pa=ents § Bring care to pa=ent rather than pa=ent to care § Care and services when and where is needed § Pervasive care availability: formal to informal secngs à beder service, sa=sfac=on, outcomes, value
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
… Eventually Providing Care Anywhere
Online Population Rising…
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
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…And Health Info Seeking Popular
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
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 -‐ @DrDannySands
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Patient-‐Generated Health Information
Many Patients Want To Be Engaged
Involvement in
Care
Communica=on
Convenience Informa=on
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
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hBps://www.paEentsite.org
Bringing It All Together: Patient Portals
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Services: § Prescrip=on refills § Appointment requests § Referrals § View bill
EducaEon: § 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
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Feedback from Dave, a 56 yo M consultant
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. (Seriously.)
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Ideally, What Is Patient Care?
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Health Care Is a Collaboration …
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
… But Collaboration ≠ In Person
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Many Tools Can Be Used for Collaboration, From Simple…
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
… To Sophisticated
Source: Philips, American Well, Cisco, InTouch
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
E-‐messaging Is Just the Start
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Attributes of Collaboration Channels
Technology Synchronous? InformaEon 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 -‐ @DrDannySands
Attributes of Personnel
PaEent Self-‐care
Counselor/ Educator
Clinical Nurse
NP/PA Physician
§ Different personnel can provide care § Each has adributes § Each should prac=ce at “top of his/her license” § Can add others to this list, even perhaps, Watson…
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
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Optimizing Channel and Personnel
PaEent Self-‐care
Counselor/ Educator
Clinical Nurse
NP/PA Physician
Telephone
E-‐messaging
Text messaging/IM
Remote monitoring
Telemedicine
Advanced Telemedicine
Face-‐to-‐face visit
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Because of the Web, Patients Can Connect to Information and Each Other (and to Health Care)
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
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We Have The Tools We Need
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Self-‐Care, Transparency, and Pa=ent-‐Provider Collabora=on Can Save Healthcare
Conclusions
ì Good pa=ent care is a collabora=on
ì Technology can facilitate remote collabora=on
ì The drive to offer telehealth services comes from: ì Need to manage chronic disease effec=vely ì The over-‐extended health care system ì Pa=ent demand for convenience
ì We must op=mize technologies and personnel for each encounter to both meet our customer’s needs and to scale our health care systems
© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
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© Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands
Questions?
Questions and e-‐mail address
[email protected] hBp://www.DrDannySands.com
@DrDannySands © Copyright 2014 D. Z. Sands, All Rights Reserved -‐ @DrDannySands