“Healthcare has traditionally not been a consumer oriented industry,” Bill Fox explains. “The doctor knew everything and the patient, the consumer, listened. Other industries don’t have this luxury and long ago figured out that he who hears the customer thrives.”
Fox is the Executive Director of the National Center for Patient Interactive Research (CPIR), a group dedicated to bringing power to the patient through innovative health information technology (HIT). He recently testified before the Federal Coordinating Council on Comparative Effectiveness Research as part of a panel discussing how to spend the $1.1 billion dollars targeted for such research. What CPIR brought to the table was an important realization-that the patient’s voice plays a crucial role in the future CER. The path to this lies in using technology to help create a stronger bond between the patient and the physician, what Fox calls a “therapeutic partnership.” As he puts it, the patient’s “is the only voice which is not being heard on a systematic, standardized, and measurable basis,” in the industry that needs that voice the most.
“It is well established that certain populations: minorities, the old, people with disabilities, do not get the same quality of care and have worse outcomes then other populations. By giving every patient the ability to report on what happened in their encounter with the healthcare system we assure that every voice is heard. Getting the facts on the table is the first step to a transparent, fair healthcare system for all.”
He points out that patient engagement leads, in the long run, to better health as well, tending to choose less costly but equally effective procedures, and requiring fewer surgeries and acute episodes.
Fox believes the days of the physician as the sole decision-making voice in the clinic is over; as access to health information and empowerment online increases, patients can and should play a stronger role in their treatment. What other industry, he asks, plays as intimate a role in the consumer’s well-being, and what other industry, paradoxically, traditionally functions so independently of consumer input?
CPIR’s testimony pins down two points where patient interactivity can be enhanced and energized. The first is in the physician’s office itself, where new strategies on listening and communicating can help the patient set personal self-care goals. Fox points out several cultural shifts that will need to occur to make this possible. Physicians will have to learn how to ask more, and tell less. Patients will have to learn how to ask about and describe symptoms better, and how to set their own goals.
The second is a proposed follow-up system, where patients can use simple and intuitive technologies to “review” his or her experience. Did the physician communicate clearly and sympathetically? Provide the best possible service? Did the patient leave the office feeling good about his or her role in self-care? CPIR proposes that this data be collected and analyzed by an independent third-party and used by health systems, insurance companies, and researchers to look more closely at patient-physician relationships, as well as back to the patients themselves. “By measuring the patients voice at the point of care we set in motion the ability to measure quality more transparently, more fairly and more accurately - and for that measurement to get paid for throughout the healthcare continuum.”
Of course, this is an incredibly broad goal that depends on enthusiastic commitment and participation from both patient and doctor, above and beyond any outside initiative. Fox states that “this is a huge cultural shift, and as I said to the Coordinating Council, culture often eats strategy for lunch. We need to design fairness and transparency into these tools, for both clinicians and patients, and make sure we don’t fatigue doctors any more than they already are. HIT should streamline and focus clinical practice.” Yet Fox stresses that the technology needed for patient input already exists in many forms, and all that remains to be done is implementation.
Above all, Fox’s model for patient empowerment hinges on “dignified accountability.” Asking informed questions, listening and self-monitoring, and taking responsibility for one’s health on a day-to-day basis all contribute to a clinical atmosphere that’s more like a meeting between peers than a lecture. “You energize patients by actually giving them responsibility,” explains Fox. “This needs to be done thoughtfully, but it needs to be done. The patient’s job is to take care of themselves - to work with their caregivers to be as healthy as possible given their conditions. Just like any other job, they need the tools and the knowledge to do this.”