The Learning Healthcare System Workshop Summary (2007) / Chapter Skim
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6 The Patient as a Catalyst for Change
6 The Patient as a Catalyst for Change
Pages 243-266
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From page 243... ...
The era of the Internet and the personal health record greatly expands the types of information and evidence available to patients, but in a truly learning healthcare system, learning is bidirectional such that it works not only to better inform patients but also to ensure that patient preference is incorporated into "best care." These contributions only introduce the complexities and possibilities of a truly patient-centered healthcare system, but they represent important shifts towards a system that seeks to learn from patients and provide the means for their collaboration in the delivery of care. In the first essay, Janet Marchibroda reviews a number of recent public and private initiatives promoting the use of health information technology and health information exchange and widespread adoption of the electronic health record (EHR)
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From page 244... ...
THE INTERNET, eHEALTH, AND PATIENT EMPOWERMENT Janet M Marchibroda eHealth Initiatie Over the last five years, there has been a growing consensus among recognized experts, including many of the nation's leading providers, employers, health plans, and patient groups; members of both the House and the Senate; leaders in nearly every federal agency involved in health care; and state and local policy makers, that healthcare information technology, and specifically mobilizing health information exchange electronically, will contribute to significant improvements in the quality, safety, and efficiency of health care.
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From page 245... ...
Interoperable health information technology (HIT) and health information exchange -- or the mobilization of clinical information electronically -- facilitates access to and retrieval of clinical data, privately and securely, by different entities involved in the care delivery system, to provide safer, more timely, efficient, effective, equitable, patient-centered care.
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From page 246... ...
Despite considerable momentum, talks were suspended and this issue will be taken up in the 110th Congress as part of the Democratic agenda of economic, foreign policy, and healthcare reforms. A number of states are also moving forward -- in parallel with federal efforts -- to develop and adopt policies for improving health and health care through HIT and electronic health information exchange.
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: . Connecting the system: Every medical provider has some system for health records.
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From page 248... ...
Among other things, the bill creates a quality reporting system for the voluntary reporting by eligible professionals of data on quality measures specified by the HHS secretary starting in July 2007. Beginning in 2008, quality measures used for data reporting will be measures adopted or endorsed by a consensus organization (such as the National Quality Forum or the AQA [Ambulatory Care Quality Alliance]
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From page 249... ...
. When asked about perceived benefits, the research indicates that for the most part, consumers believe a great deal of value emerges from the use of electronic health records, HIT, or health information exchange.
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JOINT PATIENT-PROVIDER MANAGEMENT OF THE ELECTRONIC HEALTH RECORD Andrew Barbash, M.D. Apractis Solutions The increasing adoption of the electronic health record across a variety of settings will bring new roles and responsibilities to all those involved.
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From page 251... ...
Many organizations are involved in getting consumers engaged through portals, products, software, and communication processes, such as the Veterans Health Administration, Kaiser Permanente, Regional Health Information Organizations, and the Centers for Medicare and Medicaid Services (CMS) , as well as commercial vendors and small practices.
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From page 252... ...
There is a lot of work being done on interactive patient portals where patients can manage personal health records. This will require a better understanding of how patients view their own condition relative to how a health professional would characterize them, but nonetheless has significant opportunity to benefit the patient, make disease states more understandable to the provider, and provide a means to generate information for the healthcare system.
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patients, patients will have access to their personal health information. If they see errors, what is their role, their responsibility, and who do they communicate with on these issues?
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1 Dr. Weinstein has in the past served as a consultant to the Foundation of Informed Medical Decision-Making which develops the content for the shared decision-making videos (proceeds directed to the Center for the Evaluative Clinical Sciences (CECS)
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and altruistic clinical trials (Weinstein 2006)
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The Learning Healthcare System The United States is lagging behind in providing meaningful support for clinical excellence. The British National Health Service (NHS)
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. With one mighty leap, the NHS has vaulted over anything being attempted in the US, the previous leader in quality improvement initiatives" (Roland 2004)
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2 THE LEARNING HEALTHCARE SYSTEM Validated measurement tools are used at Dartmouth to give a snapshot of how each patient is doing in comparison to the last visit, so that care plans can be tailored by taking into account self-ratings and treatment preferences. Planning for DHMC institution-wide use of patient self-reported intake questionnaires for all patients at all points of care is well under way.
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2 THE PATIENT AS A CATALYST FOR CHANGE worth considering, and the valuing of risks and benefits becomes individual and personal (Weinstein et al. 2006b; Weinstein et al.
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From page 260... ...
20 THE LEARNING HEALTHCARE SYSTEM • Lowering decisional conflict; • Reducing uncertainty about what to choose; • Enhancing active participation in decision making; • Decreasing the proportion of people who are undecided; and • Improving agreement between values and choices (O'Connor et al.
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From page 261... ...
In addition to resistance on the part of clinicians, there are barriers to implementing these strategies at other levels: health plans, health systems, even patients, some of whom just want the doctor to decide. Current practice incentives (e.g., fee-for-service model)
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From page 262... ...
It also took advantage of the computer as a technology partner in healthcare delivery (Birkmeyer et al. 2002; Arega et al.
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From page 263... ...
What we are talking about is not new; patients and doctors have always been part of the same system. We need to shift from an independent doctorpatient relationship to a relationship where we are on the same team, shifting our roles so we are coaching each other and helping each other to improve health care for each individual patient.
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From page 264... ...
. States Getting Connected: State Policy Makers Drie Im proements in Healthcare Quality and Safety Through IT.
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From page 265... ...
. National Surey on Electronic Personal Health Records.
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