“Sooner or later, everything old is new again.” Stephen King fans may recognize the quote from his book Colorado Kid. Although the book and the author have nothing to do with healthcare, the sentiment is applicable to healthcare today.
Medical care in our country in the early 1900s relied very much on a single doctor listening carefully to a patient describe their symptoms. Because the doctor probably treated the patient – and his or her family – for most of their lives, past illnesses, chronic conditions and injuries were known to the doctor. In addition to the medical history, the doctor knew exactly where the patient lived and what the patient’s daily life looked like in terms of family responsibilities and jobs. Each diagnosis and treatment recommendation was made based on the patient’s needs.
As specialized medicine grew, and patients began seeing multiple physicians and ancillary providers who evaluated them from the perspective of their own specialty, patients were no longer at the center of care. Instead, treatments focused on the narrow niche of the specialty rather than on a holistic view of the patient’s quality of life and outcome goals.
When the Centers for Medicare & Medicaid Services (CMS) implemented the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey in 2006 hospital and health systems had been conducting their own patient satisfaction surveys. Although health organizations benchmarked their scores against other healthcare facilities, there was little to no public reporting of scores – unless the reports provided a favorable advantage in the marketplace.
The 2008 advent of public reporting of HCAHPS scores highlighted the importance of patient satisfaction and provided information about healthcare facilities that had not previously been available. The incorporation of HCAHPS scores into Hospital Value-Based Purchasing payment calculations in 2013 further increased the importance of patient-centric care that leads to more engaged, more satisfied patients.
Defining patient engagement and patient centric
Although the terms “patient engagement” and “patient centric” are widely used – sometimes interchangeably – they do not have the same meaning.
Patient engagement is defined as a concept that combines a patient’s knowledge, skills, ability and willingness to manage his own health and care with interventions designed to increase activation and promote positive patient behavior.
According to the Institute of Medicine, patient-centric care is defined as “providing care that is respectful of and responsive to individual patient preferences, needs and values, ensuring that patient values guide all clinical decisions.”
While patient centric focuses on the actions of the healthcare provider to focus on the patient’s individual needs; patient engagement refers to the patient’s response and behavior to treatment recommendations. In both cases, however, it is incumbent on the healthcare provider to ensure that the patient is given the opportunity to participate in decisions and that the patient is given the information and tools needed to comply with treatment recommendations.
The patient-centric model is a focus across all healthcare entities, including life sciences. In fact, a collaborative study to define patient centricity and gauge the impact of patient engagement on life sciences companies identified several patient values that increase engagement. These include access and affordability of medications, and patient access to information.
To become a patient-centric healthcare provider, hospitals and physicians must balance the most appropriate clinical outcomes against a patient’s personal circumstances and life goals. These three factors make up the “Patient Trifecta.” This approach to improve the patient experience addresses factors in a patient’s life, such as finances, caregiver availability and personal goals – seeing a daughter’s wedding or traveling to a favorite city. By evaluating clinical decisions with the patient’s personal goals in mind, the provider can keep the patient’s quality of life at the center of care.
The impact of the patient-centric model and patient engagement in healthcare is complex and constantly evolving, but here are five effects of the focus on patient-centric healthcare:
Greater involvement of patients and family members on advisory councils as well as quality committees or boards of directors
- While many hospitals and physicians rely on patient surveys for feedback, more hospitals are adding community representatives to committees and councils to provide the patient/family perspective.
Enhanced one-on-one communication with patients via bedside rounds and programs to address potential language barriers
- Although some hospitals have initiated hourly rounding by nurses as a patient safety measure, the added benefits of a nurse visiting the patient on a regular basis versus waiting for the patient to push a call button include increased patient satisfaction, improved outcomes and enhanced employee satisfaction.
Use of patient-centered metrics to compensate health system leaders
- Although not widespread, some health systems are integrating outcome and patient satisfaction metrics into algorithms that determine health leaders’ compensation.
Redefinition of quality measurements
- As a patient-centric model of care is adopted in a healthcare organization, there is a need to revisit the metrics used to define quality. Rather than focusing on environment, technical aspects of care and patient reports of satisfaction, healthcare providers will need to define quality from the patient’s perspective – do outcomes match patient’s expectations and goals for quality of life?
Real-time access to patient health information
- In order to support consistent patient-centric healthcare and enhanced patient engagement, access to the longitudinal health record that includes all aspects of a patient’s health and medical history is critical. Physicians and case managers who can review a physical therapist’s notes to confirm that the patient is receiving the prescribed therapies are better equipped to ask a patient why they miss appointments. If it is a transportation problem, solutions that include community transportation or schedule changes that enable a family member to drive the patient can be offered.
- Patients who can see improvements in their health status and associate them with positive changes in their behavior are more likely to remain in compliance with treatment plans.
Data at the center of patient-centric and patient engagement strategies
Throughout all of the impact of the patient-centric model care and patient engagement strategies, data is critical to supporting the transformation of healthcare delivery.
Unfortunately, cost and interoperability challenges inhibit a healthcare organization’s ability to implement patient-centric healthcare. Outdated, legacy systems along with expansion of systems to include other hospitals and physicians – often with technology that doesn’t communicate with other providers – limit development of a longitudinal health record that can be accessed in real-time. Aggregation of data from multiple, siloed systems such as clinical, financial and operational departments also limits the development of new quality metrics, patient satisfaction information and performance measures.
To address these challenges, many healthcare leaders are turning to cloud-based technology and platforms that can support the aggregation, integration and harmonization of data to enable healthcare interoperability.
The growth and sophistication of cloud technology for healthcare supports expanded networks that go beyond specific sites and locations to tie all entities in a health system or health information exchange (HIE) together without a significant investment in new technology.
A cloud-based platform that can collect and translate data from multiple systems and make it available in actionable formats, addresses the data-sharing needs for patient-centric healthcare. By choosing technology that eliminates the need to replace legacy systems and can be managed by experts who are up-to-date on privacy, security and interoperability issues, providers can focus on what they do best – develop a patient-centric model of care with effective patient engagement strategies.