Five Imperatives for Better Patient Outcomes: Implications for Digital Health Technology


As both patient outcome and satisfaction gains more attention because it is becoming a basis for scaling healthcare reimbursement, management struggles to determine what constitutes a good patient experience and how best to achieve it. According to a recent survey, 84% of healthcare leaders identify a good patient experience as one of their top three priorities.  However there is no consensus on how to achieve this.  As an active participant in healthcare as a cardiologist for 20 years, I have my own frame of reference, but would like to inject digital health tech as an important variable in my assessment.

  1. 1.    The patient has a good comfort level with the provider, even it is a new one.  There are many reasons why patients feel uncomfortable with their healthcare.  The erosion of the patient-physician relationship is a fairly recent phenomenon which has as its basis patients changing insurers and subsequently primary care physicians, time pressures of providers, and mutual mistrust. Adding insult to injury, many times (especially at non-routine office visits and during hospitalizations), a patient will see providers never seen before.  This scenario creates anxiety and decreases confidence on the part of the patient.  An EHR which is shared between the provider’s office and the hospital which houses the entire patient’s information is seen as a security blanket by the patient.  My office had an electronic record system accessible in the hospital and on my Palm Pilot mobile device in the 1990s. If I was seeing the patient of one of my partners in the ER and let it be know that I knew everything medically about him from the EMR, the look and feeling of relief was palpable.  EHRs level the playing field if treated with respect and providers pay attention to detail entered and modified appropriately during treatment.
  2. 2.    An educated patient is a better patient.  Patients who ask the right questionsare better patients. Those who take the initiative in both evaluating their providers well and making sure that they participate in shared decision-making increase their chances of having a better outcome. Bedside mobile health patient education tools are here.  Few institutions are aware of their existence let alone utilize them.  They can be placed on a patient or caregiver’s phone or tablet as an app, or transmitted via wifi to a large monitor. Educational videos pertinent to a patient’s condition, test, or procedure in advance of discharge or surgery for example will increase knowledge retention as well as help in risk management and readmission rates.
  3. 3.    An efficient hospital is a safer place.  Institutions which keep track of patients, tests, materials, and have policies in place to ensure patient safety (surgical ‘time outs’, ‘Did you wash your hands?’, 90 minute ‘door to balloon time’ for heart attacks, etc) demonstrate a general commitment to patients. In the same vein, utilization of unique device identifier technologies for materials might avoid not having the right equipment at the right time in an emergency.  Patients who see order and methodologies in place feel more comfortable than one in which chaos reigns.
  4. 4.    Communication must be a priority.  Handing off a patient among nurses and physicians at change of shift is the classic time for the creation of medical errors.  I used to listen as a fly on the wall many times and correct errors in these conversations involving patients I knew.  It was a bone chilling experience.  A mistake at that time could easily lead to a wrong test ordered, a wrong diagnosis, and dangerous middle of the night questions to a third-party healthcare provider who knew nothing about the patient.  Patients must be encouraged to ask questions especially about tests and medications and keep diaries about who sees them in the hospital.  If they are incapable of such, they need to have a caregiver present to do this. Many times this is still might even be done via tape recorder when the sign out nurse has already left and questions cannot be answered.  Telemedicine would be an ideal tool for a face to face electronic exchange of critical information. Patients who have providers who are familiar with their cases well feel better and more secure about the care they are receiving.
  5. 5.    Patient assessment is not just for ‘paperwork.’ Patient assessments are made on admission, every shift, and more frequently according to appropriate clinical protocols. Designing assessments to be incorporated into clinical decision support algorithms and other tools to help healthcare providers at all levels would raise the level of importance and relevance of these assessments. I look forward to this being the case.  This might revive the importance of the physical exam and increase provider-patient interaction because the information gleaned might need to be more detailed or relevant to the patient’s clinical problems, not a standard myriad of check off boxes which are attended to solely for the purpose of ‘paperwork’ requirements by JCAHO.

 

 

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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