Our patients have to do everything to get and keep themselves healthy, and I’ve been struck time and time again by how inefficient we are and how slow we are getting these really important things right Ultimately for them.
As providers, we get reports time and time again about the rate of certain screening and health maintenance programs performed for patients in our practice. We understand how many patients are missing recommended colon cancer screenings, breast cancer screenings, vaccines, disease-specific interventions, and more. This even includes health care proxies and living wills – extremely valuable end-of-life tools and tools that can help our patients get the care they need and avoid things they absolutely don’t want.
Build smarter systems
Maybe it’s time, because we’ve been Not being able to make progress on these things for so long (in part because we were overwhelmed and exhausted in the existing system) that we turned things upside down. Not just reminders in electronic medical records, but reminders that patients see when they log in while trying to do something else, or “best practice” alerts that pop up for us telling our patients that something is overdue, Maybe we can build a smarter system.
I know that for almost all of these things, if we had the time (and we knew we didn’t), we would get all of these things; we would have our patients on all of these items Have meaningful and heartfelt discussions and find out what is right for them at this moment, at this stage in their lives. However, during our brief visits with patients, they often have a range of issues to address, and our agendas often conflict with theirs, sometimes for the better, sometimes for the worse. Wouldn’t it be better if we could help design an autonomous system that would run in the background to help patients get the care they need?
I am reminded of the place in Finland, where every woman of a certain age is invited to have regular Pap smears under the national health care scheme. It’s an active process — requiring action from the patient, but much less effort on the medical team’s part to initiate it. Patients clearly appreciate this outreach, understand that it’s an important thing they need to do, and with the help of multiple navigators built into the process, women in Finland complete these screenings at an incredible rate take an exam. This rather simple state intervention has led to a dramatic drop in cervical cancer incidence and cervical cancer deaths in the country.
Wouldn’t it be amazing if we could apply this clever method? Does the system have everything our patients need?
Sometimes I have very dedicated patients who, after logging into the portal and requesting a refill of their cholesterol medication, will “by the way” send me an additional message saying, “I noticed that the system said I’m overdue for the shingles vaccine and tetanus booster. How can I get these things done?” Of course, most of this will probably wait until they come to the office for a visit, but let an intelligent proactive system handle these things with patients and providers May be a better solution. Strike while the iron is hot.
Starting with information to the patient
I can foresee a system where the patient Get a message from their doctor’s office that says, “Looks like you should take (insert screening or healthcare item here). How can we help you do this?” If the patient says they need to know More information, they want more information before making a decision, we can guide them with clear written patient information that will help them make an informed decision about whether to proceed – good information on why this intervention might be appropriate Their reasons, all the risks, benefits and alternatives, maybe even some comments from their personal doctor about why we think it’s great for them to do the job.
Once they decide, they can click “Yes” or “No”. Clicking “No” will cause the item to be flagged in our system as (temporarily) postponed by the patient, and may lead to future discussions during office visits, or maybe even a way for the system to reconnect with them later , if they have further ideas or want to know more. If they click yes, we should have a smooth system to help do the job.
For example, let’s say they decide to get the shingles vaccine. Once they clicked “yes” to the vaccine recommendation, the system sent me a queued order, which I just had to sign. All the correct codes will be entered, the patient will be asked where they want it done, whether it’s the pharmacy or elsewhere – for some reason our hospitals simply don’t carry the shingles vaccine in our practice – and then The system can even coordinate appointment times with pharmacies. The system can then electronically report to us that vaccinations have been taken, satisfying the health maintenance field in the electronic medical record. In doing so, there is no need to send large amounts of electronic messages back and forth between the patient and the radiology department. It should simply lead me to sign a queued task, an order for a screening bilateral mammogram with the correct breast cancer screening diagnostic code, has been sent to their insurance company for approval, and the patient can then coordinate the appointment with the radiology department time. Again, once done, it returns to the system with the result. If normal, the health maintenance modifier in the system is satisfied. If it’s not normal, then maybe we can build complex pathways that allow us to complete the diagnostic imaging and testing needed for the next step.
But let’s not get ahead for now. Much of the necessary follow-up can be done by electronic systems that are smart enough to determine what to do next based on the rules we’ll give it, but some of that may end up requiring humans, navigators, and community-based help with patient coordination to get these things done organizer. However, I do think we already have a robust enough system that should be able to help build these modules on top of what we already have.
Extended Model
I have been doing this for years and I see insurance The reports generated by the company and the practice itself show that we are not getting all of our patients everything they need. Maybe it’s time to accept that the model we’re trying to handle all of this during very brief office visits isn’t enough and never cuts it. It will never overcome the inequalities and access that so often hinder our patients.
But if we can fix this — if we can do vaccines, health maintenance programs, even disease-specific interventions like annual eye exams for people with diabetes, then maybe we This can be expanded and continue to create more and more systems to help patients take control of their medical conditions. Imagine a future where people with high blood pressure start taking their medication in our office and then hand things over to a system that helps them monitor their blood pressure and maybe even increase their dose based on home readings on a path we designed. Diabetics can do it based on what they wear at home Blood glucose readings from a continuous glucose monitor to increase or decrease oral medication or insulin doses that connect back to the system we have.
This will help create a more engaged system, more empowered and informed patients, and help those patients get everything they need to stay healthy, not just It’s simply dumping it all on the overworked and overburdened healthcare system we have right now.
The possibilities are endless, and our time is not.
