Today s Health Care System Self-Care Media Physician Information

Today’s Health Care System Self-Care Media Physician Information Overload Health Insurance The Patient

How to heal a sick healthcare system Dr Aniruddha Malpani, MD Medical Director, HELP Health Education Library for People World’s largest free health library www. healthlibrary. com

What’s wrong with healthcare today? n Remember your last visit to your doctor ?

n Poorly organised patients + rushed doctors = badly performed consultation = poor medical care n How can we improve this ?

The commonest complaints patients have today are: Doctors are too busy – they make me wait too long n I don’t understand what they say – they don’t have time to explain their jargon. They don’t share information or respect my preferences n Care is fragmented amongst specialists n Doctors are not transparent or accountable. How do I know his advise is reliable and trustworthy ? n Too expensive ! n

Doctors are unhappy too ! They are stressed out, because of the large number of patients they need to see, and feel that patients expect too much from them. The feel that patients unfairly blame doctors for all bad outcomes. n They also feel that many patients waste their valuable time by asking stupid and irrelevant questions; because they are too disorganized; and don’t bother to educate themselves or do their homework. n

Result? Breakdown in Doctor-Patient Communication Patients don’t trust doctors as much as they used to in the past n Doctors are getting burnt out n They practice defensive medicine to protect themselves from malpractise suits n Overspecialisation – specialists have tunnel vision n No one to look after the “whole” patient n Doctors have become technicians – lost the n

Major reason for a sick healthcare system n Everything is doctor-centric - the doctor is the center of the medical care system n Healthcare is therefore fragmented and disorganised n Too many specialists , most of whom have tunnel vision

Solution n Need to reform the healthcare ecosystem ! n Put patients at the center – “ patients are the largest untapped healthcare resource “ !

Assumption n Patients ( or their relatives and friends) are : intelligent and capable; and because they have a lot at stake , they are motivated to get good health care, and will be willing to invest time and energy if given the right tools to ensure a good outcome.

Patient centered healthcare n Self-care n Personalization n Transparency n Quality n Control

Information Therapy n “ The right information to the right person at the right time to help make better health decisions” What information do patients want ? n To choose doctors and treatments with good outcomes n To communicate effectively with doctors n To know what the doctor should do

Blended model n Click and mortar n Provide information in the real world n Provide information on the web

Patient information centers n At every point of clinical contact n Clinics n Labs n Diagnostic centers n Chemists n Hospitals

Patients have questions ! We need to answer these proactively n Win-win situation ! n Helps to improve patient satisfaction n Helps to improve patient compliance n Can be answered by all healthcare professionals n Great way of marketing n

Patient education is an untapped area in India today ! n Anyone who provides this will create a USP n Improve brand recognition and market share ! n Works very well in the USA ! n

Our experience with Information Therapy in the real-world HELP – world’s largest free health library n Established in 1998 n Mission - to empower people by providing them with the information they need to promote their health , and prevent and treat medical problems in the family in partnership with their doctor. n We are a registered charitable trust and a nonprofit organisation. n

We help patients save money on medical care 1. Promote Self. Care. Help them to do as much for themselves as they can n 2. Provide Evidence-Based Guidelines , so they can ask for the right medical treatment that they need - no more and no less n 3. Help them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery. n

What we provide Easy to read materials – for patients and by patients n Wide variety of styles – from single page pamphlet to books n Comprehensive – from stress management, exercise, diet, all illnesses, alternative medicine n Over 300 DVDs n

Our focus areas now are: 1. encouraging health insurance companies to invest in patient education n 2. advocating information therapy n 3. setting up a national network of patient education centers n 4. developing patient educational materials in Indian languages for the web n

HELP is growing ! National Network Every hospital should have a Patient Education Resource Center n Win-win situation n Great tool to empower patients n Helps doctors and hospitals too ! n

Patient Information Center Core collection of books n DVDs n PC with internet connection n Printer n Staff member n “Corner” centers – need just about 100 sq ft n

New locations Mini-libraries in pharmacies n Mini-libraries in medical laboratories n Mini-libraries in clinics n

Online Information Therapy Free n 24/7 n Easily accessible n Increased internet penetration n Answer questions free by email ! n

How do we provide the right information to the right patient ? Free floating information is useless n Information Therapy needs to be prescribed to them, tailored to their needs, based on their medical problems n How can we do this ? n n PHR

PHR – Personal Health Record For the Tax Department, you are your tax return n For the Bank, you are your bank statement n For the healthcare system, you are your medical record. n

PHR n n n Technology to help patients to store their medical records on their personal website. Interactive forms and templates so they can fill in the details online. Images, ECGs can be scanned in This is NOT an EMR ! Using CCR information standards , the PHR can exchange data with other databases so that the PHR can be automagically updated ( for example, with lab test results ; with the chemist’s prescription; with the hospital EMR; with health insurance company data)

Yos Technologies ( www. yostechnologies. com) is based in Bangarore and provides a comprehensive "Personal Healthcare System" which includes PHRs, Healthcare tools and applications for Preventive and Continuous Care n I am an angel investor n

Why will patients use the PHR ? n Three players Patients n Doctors n Health insurance companies n

PHR = organised medical information = improved medical care Patients have a lot at stake ! n Keeping this record will help them to get better medical care. n Patients need to manage their own health record. n

Patient benefits n n n Instantly available on your mobile, wherever you are Information is shared amongst all the specialists who participate in your care Available during emergencies Always updated Ensures you don’t forget allergies and drug reactions Automated reminders ( for example, for checkups ) using SMS

Patients own this information. n n n Part can be secure, private, and confidential; part can be public Patients can add a lot of value to the healthcare system using Patient to Patient ( P 2 P) networking. Social networking – an online community , in which patients share information “ Wisdom of the crowds” “Expert patients “ can act as mentors and email buddies. Patients can grade their doctors and hospitals ( using the amazon. com review model ) and compare treatments ( www. askapatient. com).

How do we get patients to sign up ? Reach out to patients directly n Highly motivated patient groups n n Patients with chronic illness, such as cancer, infertility, HIV n Pregnant women n Mothers ( for their children) n Corporates n Employee wellness

PRM – Patient Relationship Management ! PHR can help doctors improve their practise n Because patients are better organized; and the doctor has easy access to all the relevant medical records, the doctor’s productivity will improve n Good medical records reduce medical errors. Important in risk management , thus reducing the doctor’s medicolegal liability. n

More doctors now have their own websites Websites are effective marketing tools for doctors which can help them to promote their practice n As doctors move online, they will want their patients to move with them ! n Email is a much more effective form of communication than a phone call ! n Can also integrate with the doctor’s EMR n

Major player – health insurance companies Initially, health insurance companies can offer the PHR as a value-added service to their clients n Later, the health insurance company could make this compulsory for all their clients n

How the PHR helps health insurance companies n n They could use this for providing health education to their clients, which would help to reduce their medical bills. It would reduce their transaction costs, because the data processing ( collecting premiums, authorizing payments, issuing payments) could all be done electronically, and much more efficiently

How the PHR helps health insurance companies n n They could mine the data these records warehouse, to improve the quality of their services and obtain more accurate actuarial data. Online disease management ( based on the PHR) would help them reduce costs for patients with chronic illnesses (http: //www. lifemasters. com/index. asp)

White-labelled PHRs

Applications being developed 1. Google Earth – to map the nearest doctor; nearest chemist; nearest hospital n 2. Databases of doctors, hospitals, medicines and their prices n n Changing the healthcare ecosystem using Web 2. 0

Why haven’t more hospitals adopted IT ? Bugs in software n Difficult to get skilled IT manpower to run the systems n Difficult to scale up n Connectivity issues n

Better model Software as a Service ! n All the technology is outsourced to Yos n Webware ( Web 2. 0) n No installation or maintenance needed n Always updated n Can be easily scaled n Always available – from anywhere ! n

Risks Need a critical mass of patients to adopt this n Privacy issues n Legal liability issues n

Today’s Health Care System Self-Care Media Physician Information Overload Health Insurance The Patient

The Patient as Integrator Care Information & Feedback The Empowered Patient – with the help of Information Therapy Choice