How Patient-Centric Care Differs from Patient-Centered Care

The NIH defines patient-centered care as follows: “health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs and preferences and solicit patients’ input on the education and support they need to make decisions and participate in their own care.” The patient-centered medical home (PCMH) is a set of guidelines established to reestablish the primary care physician as the predominant point of care, thereby promoting continuity of care. EHRs with connectivity would surely help that, but this is a barrier currently. If one looks at the Am Assoc of Family Physicians’ checklist for what is good practice for PCMH (see,I submit that PCMH is really is about the physician and the practice more than the patient. Certainly the goals are noble, but if the end result is that the patient still has only 15 or 20 minutes for an encounter and needs 30 days to get an appointment, it is not patient-centered.
Patient-centric healthcare differs in that the information and interactions emanate from the patient. Wireless technologies are built around the premise that personalized data and interactions prompted by the patient and managed by both the patient and provider. Personalized medicine will incorporate filtered relevant Big Data with patient specific mined data from EHR and patient portal including genomic data. This data will ultimately result in personalized prescribing of medical apps and other patient management tools. The provider will oversee this algorithmic automation and via interactions with the patient and caregiver, have a better understanding about what is going on with the patient than PCMH. While these ideas are not in use today, I believe they will be. Big Data will rule healthcare and personalized digitized medicine will be mobile. The technology is here, it needs to be synthesized technologically and culturally in mainstream practice. So one can see how patient-centric care differs from patient-centered care. Patient-centered care is retrofitting a noble idea into an antiquated delivery system. It involves thought and workflow processes which are unchanged, just moved around. Part of the patient-centric movement will be changing the mental framework of providers and the public to both transition true focuses on the patient. Patient-centered medicine’s use of technology is provider-focused, with information still emanating from the provider. Patient-centric healthcare creates the information from the patient as source. PCMH was developed years ago and was a good step away from the chaos which has ruled healthcare IT and workflow. However strides made in just the past couple of years mandate that we switch visionary gears.

About davidleescher

David Lee Scher, MD is Founder and Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in advising digital health technology companies, their partners, investors, and clients. As a cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he understood early on the challenges that the culture and landscape of healthcare present to the development and adoption of digital technologies. He is a well-respected thought leader in mobile and other digital health technologies. Scher lectures worldwide on relevant industry topics including the role of tech in Pharma, patient advocacy, standards for development and adoption, and impact on patients and healthcare systems from clinical, risk management, operational and marketing standpoints. He is a Clinical Associate Professor of Medicine at Penn State College of Medicine.
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11 Responses to How Patient-Centric Care Differs from Patient-Centered Care

  1. Sid Brumbach says:

    I absolutely agree with the paradigm switch to patient centric medicine. However, currently the PCMH remains an aberration in healthcare without general adoption let alone universal acceptance. Healthcare is usually a late adopter with any new information technology and the perception of increased liability with increased patient access to medical records. The maxim “A little knowledge is dangerous” is frequently employed, and not without good reason. What are the actionable strategies to move from where most practitioners reside with the physician focused (controlled) care, past where we should be with PCMH, and to the finish line of true patient centric healthcare?

    • You are correct. Patient-centric healthcare will be adopted before the PCMH. Sad commentary on adoption of anything in medicine.

    • @cascadia says:

      When we look at those systems that are already patient centric they are almost all integrated systems – where the providers and insurance are under the same roof. The VA is one example but Group Health Cooperative in the PNW is another.

      Although an EHR is a fundamental tool in this process what was unqiue there is that we gave the patient read write access (via email) to their EHR right at go live with nearly real time access (most are released within 24 hours except for path and AIDS) to their labs, after visit summaries, and as of this summer radiology as well.

      The EHR served as the “spine” of a fundamental shift in care. The patients workflows were taken into account and same day appoints, additional staffing to move to the medical home model (in primary care for 600,000 patients), team based care, 30% to 50% of all “encounters happening online or via the phone, etc etc..

      Although the technology was critical the key was that any up front investments in staffing, workflows or technology were recovered on the back end by improving outcomes for large populations. Sometimes the savings were only $1.50 per patient but that adds up when you have 600000 “members” (it is a co-op owned by its members).

      Now when they build new clinics they are even eliminating much of the waiting room space since they looked at the members (patients) workflow (as well as the providers) and eliminated steps.

      What one thing do you need to do first? Get the payers (large self insured employers) or if shift to the direct pay model for primary care. (Another non-integrated system in Washington charges 50 to 100 a month for primary care with no insurance). The key is changin what we pay for

      • Thanks for the informative and inspiring experience, Sherry. I agree that change is much more easily accomplished with a vertical healthcare system. I do, however, think that significant cost savings may therefore occur with bundled payment systems and not just direct pay models. Certainly the use of online communications is a cost saver which promotes both efficiency and patient satisfaction is long overdue. You do confuse patient-centered care with patient-centric care, which was the point of the article. Patient-centered care has hardly been adopted and is going to be replaced with patient-centric care, which is focused on the patient providing data versus patient-centered care which focuses on a provider-centric process with better interaction with the patient.

  2. Thank you..the message is worth sending.

  3. Actually it is a mistake to equate the meaning of “patient-centeredness” with the outward expression of being patient-centered as applied to medical homes, particularly the HIT aspects of PCMH. I guess what I am trying to say is that there is nothing patient-centered about the first crop of PCMHs. (PCMH 1.0)

    It is important to note that the concept of patient-centered care predates computers going back to the early 1970s. It reflects a spirit or attitude with which providers work with more no less. .

    In Crossing the Quality Chasm, patient-centered is defined as “respecting and responding to patients’ wants, needs, and preferences so that they can make choices in their care that best fit the individual.”

    Don Berwick defines it as:
    1 The needs of the patient come first.
    2 Nothing about me without me.
    3 Every patient is the only patient

    Hope this clarification helps.

    Steve Wilkins

  4. Pingback: Five Imperatives of Patient-Centric Healthcare | The Digital Health Corner

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  7. Patient centric care is the only kind that makes any sense. We operate outside of the healthcare system and self-manage health over 99% of the time every year. What happens during that time matters far more than what a doctor or nurse can learn in the 1% of the time we are in front of them.

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