Putting Patients at the Center of Their Health Care
Posted Nov 14 2011 10:32am
Those of us working on health information technology (health IT) and health reform talk frequently about how health IT can lead to better coordination of care and better outcomes for patients. I strongly believe this is true. There are regular conversations about health IT promoting “patient-centered care.” But what does that really mean?
Often, people use the term “patient centered care” when discussing how to assure health care professionals have all the necessary information about their patient’s other health care services. This is important…very important! From a health care professional’s perspective, he or she can provide better treatment to a patient if they have more comprehensive information and can see a more complete picture of the patient. Electronic health records (EHR) and electronic health information exchange (HIE) efforts have helped health care providers have the right information, about the right patient, at the right time. This is a key focus of the work of ONC and is central to Centers for Medicare & Medicaid Services’ incentive programs promoting adoption and meaningful use of EHRs.
However, patient-centered care is—or should be—much more. If people really want patient-centered care, care needs to be viewed from the patient’s perspective.
What would a patient think?
Patients want and expect health care providers to have all relevant information about his or her personal health and health care services (consistent with privacy preferences) in order to treat them. Patients have other expectations and needs and have relevant information that may not be in the hands of their health care providers.
Patients are sometimes the only source for particular information that affects their health, their diagnoses, and the best treatment alternatives. The bottom line is – patients know best. They know how they feel, they know their symptoms, they know their priorities.
Know their ability to follow or not follow complex and/or costly medications or treatment regimens and what might help them.
Have preferences about what outcomes they want, whether they value quality of life or length of life and what “quality of life” means to them.
Have information about external factors that impact their health, such as their home and work environments, daily stresses, lifestyle issues, etc.
Are in the best position to explain what they do and don’t understand.
There are tools that can help patients keep track of some of this information, including their symptoms or preferences, such as personal health records (PHRs).
If we want to move toward patient-centered care, we need to not just put patient information in the center, we need to put the patient at the center. The patient is a partner, not just an object of care.
But really, I think we should be talking about “individual”-centered care, not just “patient”-centered care since day-to-day management of health or care for a condition is often provided by the patient and those outside the health care system. Many times, it is the caregivers—the moms and dads of small children and the daughters and sons of elderly parents—that are really focused on individuals and their health every day.
To focus on individual-centered care:
We need to support individuals and the people they want involved in their care, outside the health care delivery system. Health IT tools can make it easier for individuals and caregivers to get information they need and support to manage their conditions.
We need to enable individuals to get information more easily—this includes getting access to their own health information, and information on what it means to get efficient, good quality care. Health IT tools, such as PHRs and portals, can provide ways to store and manage health information.
We need to help individuals connect with communities that support their health and care. Health IT can do this through social media and other disease-specific sites.
We need to enable more efficient ways for individuals to access professional advice without taking a day off of work to go to a physician’s office. Health IT can support on-line visits and secure messaging with health care providers.
To focus on individual-centered care, there needs to be a shift in our thinking to focus on the individual who is trying to maintain health and how health care professionals and the health care system contribute to that goal. Health IT is central to support this objective.
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