Making Patient-Centric Care a Priority: Action, Access, Attitudes
One of the key priorities in healthcare today, stressed Ms. Murphy, is “keeping the patient at the center of all we do.” Methodologies for facilitating interoperability between EHR systems and health information exchange are critical for meeting this goal. So is the development of strategies that increase patient engagement and make the patient a “partner” in health IT, Ms. Murphy said. In fact, she noted, the concept that patients share the responsibility for their own health care is incorporated into the American Medical Association’s current code of medical ethics, and when it comes to communication with their healthcare providers, “patients increasingly expect engagement via IT, as in many other aspects of their lives.”
In this newer patient-centric world of healthcare, with patient-as-consumer, Ms. Murphy said it’s helpful to consider “the three As approach” to consumer engagement: Access, Action, and Attitudes. “Access” refers to programs and strategies aimed at increasing consumers’ access to their healthcare information. “Action” represents efforts to enable consumers to take action with their health information. “Attitudes” addresses the need to shift consumer and healthcare provider attitudes to better support a patient-provider partnership. “We nurses own this space,” Ms. Murphy said during her keynote presentation, “and Health IT is the hook to promote patient engagement.”
There are a number of ways that patient access can be improved, said Ms. Murphy, such as providing reminders for preventive or follow-up care; identifying and distributing educational resources; enabling patients to have online access to their health and treatment information, through patient portals or personal health records (PHRs); giving patients visit summaries; and providing patients with information that is downloadable/transmittable to a third party.
The HHS’s ONC, she added, has led the way on Access through a consumer e-health pledge program on its website (healthIT.gov), with more than 400 organizations pledging to provide access to personal health information for one-third of Americans. On the US General Services Administration’s website, challenge.gov (whose motto is “Government Challenges, Your Solutions”), explained Ms. Murphy, there is a link that invites designers and developers to redesign the patient health record (see healthdesign.challenge.gov). The US Surgeon General’s Healthy Apps Challenge (available at sghealthyapps.challenge.gov) notes that “[t]he Surgeon General is challenging developers to create apps that provide tailored health information and empower users to engage in and enjoy healthy behavior.” The website provides links to winners of the challenge, with background information on their apps.
Among nursing organizations, the American Nurses Association and the Alliance for Nursing Informatics have asked their members to obtain their personal health records from their healthcare providers, develop or maintain them online, and use these records to make decisions about their own health, to gain first-hand experience of patient-centered care—and promote it more widely among their patients.
There have been a variety of creative Action strategies that aim to make it easier for patients to use health IT, including not only Challenge.gov’s medical record “Design Challenge” but also the “Blue Button Mash-Up Challenge” to create an app that integrates personal and general health-related data and information.
Importantly, said Ms. Murphy, in May 2012 Leon Rodriguez, HHS’s Director of the Office of Civil Rights, posted a letter to consumers encouraging them to educate themselves about their right to access their personal health information (and correct it if necessary) under the HIPAA (the Health Insurance Portability and Accountability Act of 1996; information available at hhs.gov/ocr). The letter provides links to additional helpful educational videos and pamphlets about health information and privacy. It encourages the use of EHRs/PHRs by stating that “[I]mportant tools like Electronic Health Records (EHRs) and Personal Health Records (PHRs) will make it easier, safer, and faster for you to get access to your health information and stay engaged. These tools help you become a true partner in your healthcare and wellness.”
In terms of shifting consumer and healthcare provider Attitudes to be more accepting of the patient-provider relationship as a partnership, the ONC’s healthIT.gov website offers 1-minute and 3-minute animations that healthcare providers can use to educate patients about accessing their medical records. “I encourage you to use it,” said Ms. Murphy, “in your waiting room or closed-circuit TV systems.” The challenge.gov website offers a consumer video challenge called “What’s in Your Health Record?” that invites consumers to share their stories of why they think the ability to access and review their health records can improve the quality of healthcare they receive, as well as similar video challenges, including one that empowers patients to take on a greater role in achieving blood pressure control. An important resource for nurses, Ms. Murphy said, is the September 2013 Institute of Medicine report, “Best Care at Lower Cost: The Path to Continuously Learning Health.” which “does a wonderful job of explaining what we need to do” to improve healthcare in America, with automation and health IT essential to the effort.
The Three-Part Goal of Healthcare IT
Echoing the sentiments of HHS’s previous National Coordinator of Health IT, Dr. David Blumenthal, Ms. Murphy emphasized that health IT should be viewed as “the means, not the end” in terms of improving healthcare. The ultimate three-part goal, she said, is to provide better healthcare within the Institute of Medicine’s six domains of quality (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity); to increase the overall health of populations (eg, by addressing behavioral risk factors and focusing on prevention); and to deliver higher-quality care at a lower cost (eg, reducing Medicare, Medicaid, and CHIP [Medicaid’s Children’s Health Insurance Program] expenditures).
“Nurses are the most trusted health professionals,” said Ms. Murphy. “We have had the patient advocacy role forever, and patients look to us to see what they should be doing,” when it comes to taking more responsibility in managing their own health. Through patient engagement using health IT, she told the audience, nurses can help their patients “get that extra ‘oomph!’ in quality care.”