Creative Disruption in Healthcare

Creative
Disruption
in
Medicine Healthcare
Dr Rowan Molnar
MBBS (Melb)
FANZCA MSHPEd (Mass.Gen. Hosp.Inst.) MAICD


Copyright ©2016 by Dr Rowan Molnar
ISBN: 978-0-646-94839-3
All rights reserved. This book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping
or by any information storage retrieval system. Quotations embodied in critical articles and reviews are welcome with due acknowledgment of the author and online link to the book. The publisher reserves the right to amend reproduction permission at anytime without notice.
Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.
To order hard copies of this book, contact
T: +613 9824 0420 (Australia) E: [email protected]
IGI Publishing is a member of IGI Worldwide


Table Of Contents
Preface 7
Chapter #1: Creating a Better Healthcare Delivery System 8
Providing Time, Cost and Location Efficient High-Quality Medical Services . . . . . . .
Use of Modern Technology. . . . . . . . . . The Use of Electronic Health Records . . . .
Other Approaches for Reforming
the Healthcare System . . . . . . . . . . . .
. . 9 . . 8 . . 8 . . 9
. .9 ..9
. 10 . 10 . 11 . 11
. 11 . 12
Chapter #2: Healthcare
Innovation 15
Six Characteristics of Quality Care Outlined by Institute of Medicine (IOM). . . . . . . . . . . . . 15 HighQualityCareShouldbeSafe. . . . . . . . . . . .15 HighQualityCareisEffectiveandReliable. . . . . . .15 CareshouldbePatientCentered . . . . . . . . . . . .16 QualityCareisTimely. . . . . . . . . . . . . . . . . . .16 HealthCaremustbeEquitable. . . . . . . . . . . . . .16 CareshouldbeEfficient .................16
Factors that Influence the Healthcare Industry .
Advances in Technology . . . . . . . . . . . The Increase in Life Expectancy . . . . . . . The Cost of Medical Care . . . . . . . . . .
The Rise of Alternative or Complementary Therapies . . . . . . . . . . . . . . . . . . . Why People Use Complementary Therapies . .
. . . . . .
. . ..
. 18
Challenges Faced by the Healthcare Industry .
. 20 . 21 . 23 . 23
24
Poor Quality of Care . . . . . . . . . . . . .
High Costs . . . . . . . . . . . . . . . . . . .
Lack of Coordination . . . . . . . . . . . . .
Embrace Innovation for a Well Coordinated Healthcare System . . . . . . . . . . . . . .
The Advantage of the Integrated Unit . . . .
Measure Care Outcome and Cost for
Every Patient . . . . . . . . . . . . . . . . .
. . . . . .
. . . .
..
.24 .24 . 25
.12 Countries ......................14
Biggest Obstacles to Healthcare in Developing
. . . . . .
Chapter #3: The End of Medical Paternalism 19
. . EvaluatingMedicalEducationProgramsintheUS. . .18
The Right and Wrong of Paternalism . . . . . . When is Medical Paternalism Justified? . . . . . Patient Autonomy vs. Paternalism . . . . . . . . Conclusion – Is Medical Paternalism Justified?.
Chapter #4: Empowering the Patient – Patients as Managers of Their Personal Medical Care
What is Patient Autonomy? . . . . . . . . . . . .
Patient Consent: Why It Is Important. . . . . . .
The Problem with Patient Autonomy . . . . . . Doctorvs.Autonomy ...................26
Legal Complications of Patient Autonomy . . . . 27 Patient’sRighttoRefuseorDemandMedicalTreatment. . 27
Other Important Aspects of Patient Autonomy . . 28 PatientConfidentiality ..................28 Why Maintaining Confidentiality is Difficult?. . . . . . 28
Telling Truth to the Patients . . . . . . . . . . . . 29 Is it Essential for Physicians to Disclose the Truth Completely. . . . . . . . . . . . . . . . . . . . . . . . .29 PatientsWanttoKnowMore ...............30
AreThereAnyExceptionstoTruthTelling . . . . . . . .30
. 17 . 17 . 17
Disclaimer
© 2016 – Dr Rowan Molnar. All Rights Reserved. The information presented in the pages of Creative Disruption in Medicine No part of this publication may be reproduced, stored is o ered solely for informational and educational purposes. It cannot be or transmitted in any form, or by any means, electronic, used as a substitute for professional medical advice or business advice. mechanical, scanning, recording or photocopying You should consult with your personal physician or healthcare provider without prior written permission of the author. regarding your personal medical care. You should consult with your
professional business advisor regarding your business a airs.


Table Of Contents
Should Patients Be Given More Options
to Manage Their Healthcare?. . . . . . . . . ...31 Different Perspectives on Patient Involvement . ....31 Different Forms of Patient Involvement . . . . . ....32
The Final Recommendations. . . . . . . . . ...34
Smartphones In Healthcare –
What are the Barriers . . . . . . . . . . . . . . . . 42
NotAllMedicalAppsareDiscoverable. . . . . . . . .42 NotAllAppsareCredible ................42 The Use of a Smartphone Doesn’t Make
YouaDoctor!. . . . . . . . . . . . . . . . . . . . . . . .42 ThePresenceofFDA ...................42 Should Smartphones be used in the Healthcare
Chapter #5: The Use of Technology in Healthcare Sector
35
Sector? . . . . . . . . . . . . . . . . . . . . . . .
Looking at the Future . . . . . . . . . . . . .
What is Watson? . . . . . . . . . . . . . . . . TheArtificialIntelligencebehindWatson. . . . WatsonastheWorld’sBestDoctor. . . . . . . . HowDoesWatsonWork? . . . . . . . . . . . . . HowWatsonCanBeaGameChanger. . . . . .
. . . .43
. . . 43
. . . 44 . . . .44 . . . .44 . . . .44 . . . .45
The Internet, Social Media
and Global Networking. . . . . . . . . . . . .
. . 35
How Technology is Improving Healthcare . . . . . MoreAccessibleCare,Anytime,Anywhere. . . . . RealTimeAccesstoPatientMedicalRecords . . . Healthcare Websites and Facilities are Reaching PatientsthroughSocialMedia . . . . . . . . . . . . NewTechnologyHelpssaveLives. . . . . . . . . . Technology Has Made Healthcare Sector ProductiveandEfficient. . . . . . . . . . . . . . . .
Chapter #6: How Smartphones Can Change the Future
of Healthcare
. .35 . .35 . .36
. .36 . .37
. .37
38
Chapter #7: Effective Ways
to Predict and Pre-empt Disease 47
Patients Want Good Care . . . . . . . . . . . . . . 47
Predictive Analysis (PA) . . . . . . . . . . . . . . 47 AdvantagesofPredictiveAnalysis. . . . . . . . . . . .47
Chapter #8: Conclusion 49
Smartphones Can be An Important Tool
for Managing Health . . . . . . . . . . . . . . . . 38
Clinical Adoption of Smartphones. . . . . . . . . 38 MedicalReferenceTools . . . . . . . . . . . . . . . . .39 DiagnosticApps. . . . . . . . . . . . . . . . . . . . . .39 ImagingandLaboratoryResults. . . . . . . . . . . . .39 Obstetrics .........................39 Ongoing Patient Support . . . . . . . . . . . . . . . . . 39 TopMedicalAppsThatareCreatingWaves . . . . . .40
4


Dedication
To all people who love innovation and creativity to move our communities forward.
Our patients for placing their trust in us as carers and to my colleagues who work day and night to make their lives better.
5


Acknowledgement
This book is dedicated to my mentors and teachers, Professor Clayton Christensen of the Harvard Business School and Professor Elizabeth Armstrong of the Harvard Medical School. As the two greatest minds and thinkers of the modern era they have created the Harvard Macy Institute where the theory and development of disruptive innovation in healthcare has been created and disseminated. Since the early 1990s, both Professor Christensen and Armstrong have accurately predicted the impact and evolution of disruptive technology, a phenomenon that has only recently become a major force in developing healthcare services for the
future and in the process the inspiration for my works.
6


Over the past two decades, issues related to general healthcare, quality of medical services, patient safety, medical practice efficiency, medical treatment effectiveness and the integrity of physicians have been widely discussed. The purpose of this eBook is to create a common understanding of the healthcare practices and approaches for quality improvement. It is expected that this eBook will be of help to physicians, healthcare specialists, healthcare groups and organizations as well as individual patients.
This eBook discusses all aspects of healthcare including quality of care, access to healthcare services, scientific knowledge, patient confidentiality and honesty with patients, distribution of resources, as well as responsibilities of physicians. In addition, there is a section on the need for transparency regarding healthcare quality and price. Patients deserve to know how much their health care costs, how good it is and more importantly, what choices are available to them.
It is important that we remind ourselves that improvement in quality of medical services and patient safety is crucial to both physicians and their
Preface
patients. Sole emphasis on physician performance is not enough. As patients’ expectations rise, healthcare becomes more complex and resources begin to shrink. More and more physicians and healthcare organizations are becoming convinced that improving quality requires a lot more than traditional approaches.
Quality – the most important term used in this eBook is challenging to define precisely. The Institute of Medicine defines healthcare quality as the degree
to which healthcare services increase the chances
of desired (health) outcomes for patients and are consistent with professional knowledge. The six major characteristics of high-quality patient care will be discussed later in this book. What is important to note here is that patients as well as their families have the right to information that will help them make more informed choices.
Our healthcare system in general faces a number of challenges that clearly indicate the need to reform. Let’s have a closer look at the changes that can bring about an improvement in quality and value of healthcare.
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Creating a Better Healthcare Delivery System
The healthcare industry has undergone a number of major improvements in the recent years. In fact, healthcare industry has evolved into one of the largest industries and requires careful financial management, operational control and strategic planning in order to function properly.
NIOSH Healthcare worker information states that the healthcare sector has over 18 million employees (2014) and this number is going to increase further in the coming years. The increase in demand of skilled and qualified workers is due to the increased growth and ever increasing challenges in the health care industry.
Chapter
#1
Factors that In uence the Healthcare Industry
Major factors that have an impact on the growth of the healthcare industry include technological advances, cost of medical care, increase in
the aging population and the availability of complementary therapies.
Advances in Technology
Advances in technology have contributed to improved patient care. Moreover, the availability of the latest medical technology assists medical diagnosis, so healthcare providers are now in a better position to make more precise and accurate ‘therapeutic’ decisions.
Patient care is now more efficient with the development of electronic devices and the subsequent advances in mobile technology. Now physicians can view multiple patient records
from mobile locations, so improving the speed of patient care. The effective use of technology will be discussed in detail in the forthcoming chapters.
The Increase in Life Expectancy
According to the National Center for Health Statistics, the life expectancy for an American citizen is about 77.9 years. As the life expectancy of the population increases, the number of elderly, the largest group of medical care users, also grows.
This increase in the aging population also increases the demand of medical care because the elderly are prone to acquiring chronic and systemic medical conditions such as kidney failure, diabetes and
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hypertension. The natural functioning of the body decreases with age and it is important that efficient healthcare services are present to support the elderly through the tough times. Most chronic and systemic diseases require prolonged treatments; therefore
the need for qualified, trained medical specialists becomes more important.
The Cost of Medical Care
Health care costs have increased considerably in the past few years and patients are looking for more cost-effective options. There is a significant increase in the number of outpatient visits while the number of inpatient stays is decreasing. This alarming increase in the cost of healthcare costs is one of the strongest reasons for the increasing demand of alternative or complementary therapies.
From 1981 to 2007, the inflation rate measured
by the Consumer Price Index for healthcare increased more than the rate for all items. Among the workers employed in the healthcare sector excluding doctors and dentists, pharmacists had the highest average annual wages.
The Rise of Alternative or Complementary Therapies
The use of alternative or complementary therapies
is becoming more accepted. Popular alternative therapies like acupuncture and massage therapy incorporate a holistic approach to patient care. Most therapies address the physical and emotional as well as spiritual needs of the person.
Why People Use Complementary Therapies
Patients usually have more than one reason for choosing complementary therapies.
1Some patients believe that reducing stress and boosting relaxation can improve their health and help their body recover.
2Certain therapies such as acupuncture can help control the side effects of preexisting medical conditions. Patients use acupuncture to relieve symptoms of chemotherapy drugs.
3Complementary therapy seems non-toxic and 100% natural to patients. Patients also believe that alternative therapies are more responsive and provide better results.
4People prefer to choose alternative therapies because they feel more connected to their complementary therapist.
Acupuncture:
This popular ancient Chinese therapy was used
in eastern countries for thousands of years before becoming accepted in the west. Increasing numbers of westerners are now using acupuncture to treat common medical conditions like lower back pain, sciatica, arthritis, migraine, allergies, asthma, digestive problems, depression, anxiety, menopausal symptoms and muscle pain and weakness. Fine needles are inserted at specific points into the individual to treat the underlying illness or medical condition.
The number of patients seeking acupuncture care is likely to increase in the coming years.
Massage Therapy:
Massage therapy is also known to provide the body with a number of health benefits. Massage therapy is often used commercially for relaxation, but it is also used medicinally.
Patients use massages to treat a variety of medical conditions, including stress, depression, insomnia, pain, arthritis, muscle pain and strain, and gastrointestinal problems as well as lower back pain.
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Challenges Faced by the Healthcare Industry
Although the healthcare industry in most parts
of the globe is experiencing rapid growth, there are several key challenges that require attention. One of the key challenges experienced by the US healthcare industry is a lack of quality medical care.
Poor Quality of Care
The quality of healthcare services offered to patients varies widely. Thousands of patients do not have access to basic care which then leads to increased medical complications. It is also seen that people without insurance coverage have worse access to care than people who have an insurance plan. Almost 27% of uninsured adults in 2014 went without needed medical care due to high costs.
Lack of medical care causes an increase in
patient mortality. However, patient deaths may be preventable with better recognition of the medical condition and early treatment.
Patients die because they do not receive medical care when they need it the most. Here’s an abstract quoted directly from ‘The Washington Post” website to help you understand better.
Maternal deaths from pregnancy-related sepsis are uncommon in the United States, but the few that do occur may be preventable according to Medscape Medical News.
“A review of maternal deaths from sepsis in Michigan during an 8-year period showed that sepsis was identified as the cause of death in 22 of 151 women who died from pregnancy-related causes. The available hospital records for 15 cases showed
that for 11 patients, there was a delay in starting antibiotics, and in eight cases, there was a delay in escalation of care, report Melissa E Bauer, DO, assistant professor of anesthesiology at the University of Michigan Medical Center in Ann Arbor, and colleagues.”
Cancer patients died waiting for care at troubled veterans’ hospital, probe finds.
Some patients with bladder and prostate cancer died waiting for care, and medical treatment for almost 1,500 others was delayed because of short-staffing and mismanagement of urology care at the Veterans Affairs hospital in Phoenix, a new investigation has found.
Senior officials at the medical center, the center of a national scandal last year over fudged wait times, did little to respond to a severe staffing shortage as recently as April 2015, investigators for the Department of Veterans Affairs inspector general found.
10
The Washington Post
Medscape Medical News


On the other hand, every year thousands of Americans receive healthcare services that are unnecessary. This overuse of services not only increases the national cost of medical treatment, but also endangers patient’s health.
Lack of Coordination
Another major barrier to the improvement
of healthcare systems has been the lack
of coordination. There is no harmony or synchronization between the state governments, hospitals, physician organizations, and insurance companies. Without coordination, it is highly unlikely that the healthcare costs will be reduced.
Unfortunately, most healthcare system around the world are struggling despite the hard work of highly trained doctors and other professionals. The healthcare industry will become more productive by knowing what needs to be
done, and this can only be achieved through restructuring and better management systems.
The first step in any restructuring process is
to define the proper goals and objectives of
the health system. Creating a better healthcare delivery system is not about reducing medical costs at the expense of quality. Every stakeholder including healthcare providers, employers and medical insurance companies, must provide value to patients, meaning the health outcomes the patients receive relative to the costs that have been spent. Failure to improve patient value means that the healthcare system is failing.
Embrace Innovation for a Well Coordinated Healthcare System
A well coordinated health care system will
look very different to the current flawed model. Physicians, hospitals, insurance companies and
other stakeholders must work in teams to improve coordination. More importantly, all healthcare centers should monitor the quality of patient care in addition to providing medical care for the patients.
The healthcare industry can be transformed by changing the way medical facilities are organized to deliver care.
High Costs
Together, state and federal governments annually spend around $300 billion on healthcare, equaling nearly one third of the total budget. This high level
of medical spending, combined with the economic recession and reduced revenue generation, is creating economical difficulties for the governments. It is crucial that governments improve quality of the care they provide as well as lowering healthcare costs
For example, healthcare facilities spend millions of dollars to employ people to handle billing operations. However, a large part of the healthcare budget currently spent on administrative expenses can easily be lessened.
For example, a hospital with 600 beds might have 1,200 billing clerks to take care of the billing process. These people are paid to ensure that the hospital forms are correctly documented. Insurance companies too, employ hundreds of people to ensure that all claims are fully documented and more importantly, are correct.
In order to lower administrative costs, electronic systems must be used to streamline documentation and payment processes, establish online insurance claims processes and to document and reward employees that consistently provide high quality medical care.
11


Every facility should be organized around the patients and their special needs. This calls for a dedicated team made up of both physicians and non-clinical personnel to provide full care for the patient’s condition.
When all stakeholders of the healthcare industry work together as a team, the patient’s overall outcomes will be maximized. An efficient electronic system can help the stakeholders coordinate easily and minimize the wastage of time and resources.
The Advantage
of the Integrated Unit
Surprisingly, lower back pain is one of the most expensive medical conditions for which patients seek medical care. Typically, the patients receive their care from various healthcare providers who function more as individual units than a collective team.
One patient might visit a GP first and then visit
a specialized physician such as an orthopedist
or rheumatologist who might be in a different location. The patient may then be referred to several physicians and physical therapists during the treatment process, thus lengthening the time of treatment.
Physicians, hospitals or insurance companies do little or nothing to coordinate the care required. There is duplication of effort, waste of time, and unnecessary delays that complicate the situation further. If there is no system to measure and record patient outcomes or the time the treatment took or the ultimate cost, the value of healthcare will never improve.
Measure Care Outcome and Cost for Every Patient
Like any other field, rapid improvement in a healthcare delivery system is possible only when
the results are measured. Ideally, healthcare
teams would improve if they were able to track their progress over time as well as compare
their performance to that of peers outside their organization. Competitive markets in health care can offer patients greater quality, more options, and lower costs – you can read more here.
The reality is that the great majority of healthcare providers fail to track the outcomes and costs of medical conditions for their patients. However things have started to improve.
M.D. Anderson Cancer Center, the Cleveland Clinic and the Mayo Clinic use a new technology called time-driven activity-based costing. TDABC involves monitoring every step involved in delivering a healthcare service – this includes a simple blood test as well as a complex surgery.
Experts determine personnel and equipment that
are needed for the service, their costs per minute as well as amount of time or number of minutes that are involved. The costs for each step are added along with a share of overhead expenses and profit margins to determine the true cost.
Dr. Feeley, who heads M.D. Anderson’s Institute for Cancer Care Innovation along with this colleagues identified and calculated the cost of delivering 160 different services to patients during the course
of their treatment (one year in this case) and the revelations were shocking.
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It was seen that patient’s first visit cost M.D. Anderson more than what is charged mainly due to extended discussions and testing involved. Second, some hospital staffers were performing tasks that could
be done by others for much less. By reducing such inefficiencies M.D. Anderson was able to increase the number of patients assessed by 19% and lower cost by 46% without changing the quality of care.
Most healthcare outcome measurements are restricted to areas such as mortality and safety
of treatment procedure. Diabetic patients for example, only go for routine hemoglobin A1C and cholesterol checks. These patients in fact need to be given information about how fluctuating blood sugar levels may affect them in the future, i.e. how diabetes will affect their vision and their kidneys or if they are more likely to suffer from a heart attack or stroke.
Simply put, the outcomes should assess whether or not healthcare providers are improving the health
of patients. Outcomes can be classified into several categories including mortality, pain, functional status, satisfaction, and costs. You can measure short-term outcomes (for example mortality rates
for hospitalized myocardial infarction patients), intermediate outcome (for example functional ability of patients 6–12 months after knee replacement surgery) or long-term outcomes (for example 10 year survival status for patients treated for breast cancer.)
Remember, patients are concerned about their safety, treatment costs and mortality, but they are more concerned about their functional status.
Frequent visits to the emergency department and high readmission rates are expensive and frustrating both for the healthcare provider and patients. Moreover, delays and discomfort during medical care also cause unnecessary anxiety to patients.
Healthcare providers now are improving their understanding of what patient outcomes to measure and how they must collect, analyze and most importantly, report patient outcome data. They are also testing the use of innovative technology such as online portals, interactive technology and tablet computers for improving quality of care.
Healthcare is one field in which high costs are a
huge problem. Only a few healthcare providers have knowledge about what each individual component of care costs. The best way of tracking costs is tracking patient expenses over the full cycle of care. This includes tracking resources used in patient care, i.e. equipment, medical facilities and personnel as well
as support costs associated with medical care, such as administration and IT.
Tracking patient expenses over the full cycle of care can be made more cost effective by developing
a central electronic monitoring system. With a powerful electronic system in place, health care providers can utilize medical staff, equipment, facilities, and administrative resources far more efficiently. In addition, healthcare providers can streamline the path of patients through the system,
13


and select treatment methods that are necessary as well as eliminate services that are not required.
Healthcare providers can reduce the cost of medical care by selecting the best suited personnel for the task as well as the most cost effective type of medical facility.
Creating a high-value health care delivery system
is possible when all stakeholders like physicians
and provider organizations take the lead. Every stakeholder in the health care system has an important role to play when it comes to improving the overall quality of healthcare.
Biggest Obstacles to Healthcare in Developing Countries
The World Health Organization looks at health issues around the world. In many developing countries,
public spending on health services is minimal and often benefits the rich more than the poor.
Millions of people in developing countries live below the poverty line and do not have access to basic healthcare needs. They have to pay for their own healthcare which only increases their problems further.
Lack of healthcare resources and poor system design leads to high rates of hospital acquired infections in the developing world. There are also high incidences of medical errors which lead to death and ill-health among patients. A large number of deaths related to medical errors and lack of medical resources could be easily avoided with better hygiene, more efficient systems and good management.
The right to quality care is the right of every person and it is important that developing countries take strong measures to improve the healthcare system they already have.
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Healthcare Innovation
The Institute of Medicine calls on healthcare stakeholders to improve the health and functioning of patients. The IOM has also laid down six characteristics of high-quality care which have been adopted by various healthcare organizations actively involved in improving the quality of healthcare.
Chapter
#2
Six Characteristics of Quality Care Outlined by Institute of Medicine (IOM)
High Quality Care Should be Safe
The most fundamental aspect of high-quality healthcare is patient safety. The first IOM report released in December 1999 was titled ‘To Err is Human’ and most healthcare providers were shocked to know the findings. Not many healthcare providers could believe that millions of patients were actually harmed because of errors in medical practice and that 44,000 to 98,000 patients died nationwide
as a result of these medical errors every year in hospitals.
This Medscape article abstract (quoted directly) explains how the figures were obtained.
“The IOM figures regarding injuries and deaths are estimates, but they are reasonable estimates. It is important to understand how they were obtained. The higher estimate, that nationwide 98,000 people die annually as
the result of errors in medical management, is a 1998 extrapolation from the findings of the medical record review study conducted using 1984 data and released by the Harvard Medical Practice Study (MPS) in 1991. The lower figure of 44,000 is based on a study conducted in Colorado and Utah hospitals about 8 years later.”
Patients need to be confident that they will not be harmed by medical care that is primarily intended to help them. If care is not safe or the patients don’t feel safe, there is no point in arguing over high-quality healthcare characteristics.
Close examination of the existing system and process of care gives patients assurance that their medical care is safe. Points of failure need to be identified and rectified as quickly as possible. It is also important that the changes and improvements in the healthcare system are documented.
High Quality Care is E ective and Reliable
Effective medical care means that patients only receive care that will help them and/or the benefits of care outweigh the risks associated with care. Unfortunately, patients do receive unnecessary care for a range of conditions which causes a number
of medical complications. Perhaps, the biggest example is scheduling non-medically indicated labor inductions or cesarean sections before 39 weeks.
Reliable healthcare means that the patients receive the same standard of medical facilities and care regardless of how, when, where and from whom
they receive care. Sadly, as mentioned earlier, there continues to be a wide variation in the quality of care that patients receive.
15
Medscape article


Care should be Patient Centered
Patient Centered Care now is the buzzword in the healthcare industry. Patient centered care means that the healthcare system should focus on individual patient’s needs. Moreover, healthcare providers should respect patient’s values, expressed needs, as well as preferences.
It is crucial that patients are given clear, concise
and accurate information about their personal medical condition in easy to understand language. Furthermore, health care should provide relief from physical pain and discomfort as well as offering emotional support to help patients cope with anxiety of injury and illness.
documentation not only consume time and energy, but make the healthcare system less efficient.
Like any other high-quality process, the process of medical care should flow smoothly and more importantly, in a timely manner.
Health Care must be Equitable
Equity in medical or health care operates at two different levels, i.e. at the population level and at the individual patient’s level.
When it comes to the population level, the goal of the healthcare system is to reduce disparities among the different population groups. At the individual patient level, high-quality care must not discriminate where gender, age, education, sexual orientation, ethnicity, income, home address or race are concerned.
Care should be E cient
An efficient healthcare system is one that uses all its resources to get the best value for money. The present system is characterized by a great deal of wastage which does not provide any benefit to the patient.
All levels of the healthcare system, i.e. the solo physician practice office, regional healthcare systems as well as national healthcare programs can be made more efficient.
Healthcare providers can use a number of strategies to eliminate wastage. Care can be made more efficient by:
1Matching supply of care to demand 2Managing the flow of information through the
system
3Eliminating diagnostic tests and treatment procedures that are not necessary
Quality Care is Timely
In addition to being safe, efficient and patient centered, quality care needs to be timely. Long delays and waits in emergency rooms, testing laboratories or physicians’ offices not only result in emotional stress, but they can also cause physical harm.
Delays are equally annoying for the providers of health care. Often surgeries and other treatments
are delayed because the staff is still trying to track missing patient information. These delays in receiving
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4Making patient records accessible to concerned parties
5Avoiding duplication of diagnosis and treatment
6Recycling resources and making more efficient substitutions. The most promising scope for efficiency improvement might lie in changing funding mechanisms and monitoring healthcare accountability.
Healthcare products and services must be made more accessible and affordable so more people can purchase and use healthcare services that are time and cost efficient. Let’s now briefly review how it can be done.
Changing the way healthcare is delivered requires extensive process redesigns. We need processes that will improve the quality of care and limit cost growth, thereby making healthcare system more efficient.
Use of Modern Technology
Most medical conditions are a combination
of different physical symptoms. This can be confusing when you consider that a particular symptom can be triggered by a number of distinctly different disorders.
The use of modern technology in healthcare can enable precise diagnosis of the patient. Healthcare providers can determine the exact cause of the disease through the use of technology directly rather than by examining the physical symptoms. As a result of healthcare technologies such as diagnostic imaging and molecular diagnosis, doctors can now provide specialized and timely care for a number of different infectious diseases and other complicated medical conditions such as cancer, type II diabetes and asthma.
The Use of Electronic Health Records
A large number of healthcare providers have found that the use of electronic health records can increase the efficiency and lower the cost of healthcare services. In addition to increased efficiency, the use of electronic records also helps physicians receive lab results quickly and send prescriptions more quickly. Hospitals now can also ensure improved patient data confidentiality with the use of electronic records.
Providing Time, Cost and Location E cient High-Quality Medical Services
The problems faced by the healthcare industry aren’t surprising. Like most products and services offered in other industries, high-quality healthcare is more accessible to the wealthy. It is very expensive to receive quality care from highly trained experts. Moreover, not every person has access to timely care.
Wide variations in quality and safety further affect
the standard of healthcare. This is why patients,
policy makers, physicians and other stakeholders are looking for ways to reduce the waste of resources and improve the efficiency of health care delivery.
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Going paperless is also beneficial for the hospitals and insurance companies. The documentation process is less time consuming and the reimbursement process can also be made more accurate. Since medical records are electronic, it reduces the chances of medical errors caused by misinterpretation or inaccurate understanding of written notes. Paper prescriptions and diagnosis have high chances of getting lost or being misread.
Electronic enabled medical records will help lab technicians, physicians, hospitals and insurance companies because patient histories can be accessed from anywhere. Lab tests, diagnostic images and other patient related data can be shared easily between physicians, which will reduce wasted
time and resources. This will in return reduce the cost of billing and lost charges related to medical procedures performed without Advance Beneficiary notices.
Administrative tasks such as billing requests and filling out medical documentation make up a large percentage of healthcare costs. Moreover, paper documentation and patient medical records kept in several places are more likely to result
in unnecessary or duplicated medical tests and procedures. Electronic exchange of information can reduce this problem, as well as increasing time and cost efficiency.
Other Approaches for Reforming the Healthcare System
One of the major challenges facing the healthcare industry is that the failure of quality is invisible. In other industries, failure of quality is quite obvious. Food will be noticeably tainted, the computer won’t start or the car won’t stop when the brakes are applied.
However, in the healthcare industry, the failure of quality is mostly invisible to both the patient and the healthcare provider. The doctor may write the wrong dose or prescribe the wrong medication. The patient on the other hand may fail to comply with the dietary warning given by the doctor.
Monitoring and tracking performance and
failure of the resources can be a crucial step to improving the efficiency and safety of healthcare. Hospitals can easily control disease relapse and patient readmission by eliminating inefficiency. Healthcare can be improved if physicians are offered incentives to increase productivity. Research and experience suggest that financial incentives such as higher salaries and bonuses can improve performance and help physicians render quality services to the patients.
Evaluating Medical Education Programs in the US
Periodic evaluation of medical education programs in the United States and its territories is also crucial for the development of the healthcare sector. Accrediting bodies need to have strict requirements and action should be taken against institutions that are not compliant.
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Chapter
The End of Medical Paternalism
#3
Medical school students are taught to be good to their patients. ‘Do no harm’ generally is the first principle doctors are required to learn and this dates back to Hippocrates. Over the past 50 years or so, doctors not only are taught to protect the patients, but are asked
to make the right decisions for them. Many healthcare providers do not include the patient in the conversation or decision making for a number of reasons, including a wish to protect them from undue worry.
The concept of paternalism has interested doctors for quite some time. Supporters of paternalism believe that certain health decisions (such as care in cancer or terminally ill patients or extensive surgery) are best left in the hands of those providing the care or the doctors. The doctors proceed with the treatment they think is best for the good of the patient.
There are different types of doctor-patient relationship.
The autocratic doctor is one that has little/no regard for the opinions of the patient. The practitioners
have strict rules to which they adhere regardless of what the patient thinks. Such doctors may feel that the patient is being ungrateful for not accepting the
proposed solution and that the patients are fortunate to get expert advice from them.
A paternalistic doctor will listen to the patient and guide them through the decision making process. However, paternalistic doctors want the patients to follow their suggestions as they feel patients might not know what’s best for them.
For example, if a paternalistic doctor is treating a hypertensive patient, he would be willing to make
a number of changes in therapy for the good of the patient. However, if the patient rejects these changes, the doctor would exaggerate the possibilities of damage caused by this action. ‘Stroke is almost certain’ he would tell the patient even though chances of it happening are minimal. Doctors feel that the long term interests of the patient are better served this way.
In a paternalistic relationship, the doctor always sees himself/herself in the superior position. They think they are justified in ignoring the patient’s wishes.
As mentioned earlier, doctors feel that the patients cannot make good decisions because they are too
ill or they are not capable of making all the good decisions themselves.
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The Right and Wrong of Paternalism
Medical paternalism is said to be a concept where healthcare decisions are best left to professionals providing the care. This issue is quite controversial as the decision making process does not involve the patient.
Paternalistic doctors have a parent-child kind of relationship with their patients. They decide to conceal the truth if they think it is in the patient’s best interest. Moreover, doctors dictate the treatment and don’t feel the need to justify their treatment choices to the patient.
Patients are expected to follow the therapy without questioning as doctors think they are the experts
and know what’s best for the patient. This behavior is quite similar to what parents do. Kids are made to eat certain foods or sleep at a particular time because their parents think it is right for them.
With the passage of time, the autocratic or paternalistic doctor-patient relationship has evolved into a new kind of relationship. Doctors now are willing to share their expert knowledge and opinion with the patient. In fact, they encourage a dialogue before any treatment plan is decided. Patient autonomy has now become paramount and the treatment proceeds only if the patient has given informed consent.
Generally it is accepted that medical paternalism is bad, but is it really? While patient autonomy seems to be a core component of good medical care, things are not that simple.
Patients are frequently asked to make crucial medical decisions when they’re not at their best. They may be stressed, frightened by the diagnosis and proposed treatment or too sick to think clearly and come to a conclusion. What’s even worse is that the stakes are high and patients sometimes are pressed to make
immediate decisions which can have disastrous consequences.
Things become even more complicated when the autonomy of the patient clashes with the supposed authority of the physician. For example, if the doctor and patient have different opinions, which is the best possible way to serve the interests of the patient as well as providing highest quality care?
Simply put, patients cannot make rational decisions without the specialized knowledge of the physicians when they incapable of thinking clearly. Patients might be incapable of making a decision that is in their best interests if they are emotionally disturbed. On the other hand, who should be held responsible if the patient refuses life saving treatment? This
is another question that needs to be answered before medical paternalism is deemed cruel or inappropriate.
The statement that ‘with treatment 50% of patients survive’ definitely sounds much better than ‘without treatment 50% of patients die a painful death.’ The patient may not fully understand the benefits and side effects of a particular therapy, which is the reason they can inflict harm upon themselves. Some patients might decide against chemotherapy because a friend
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or family member had a horrible experience.
Some might not be willing to go under the knife because of their beliefs. Whatever the reason, it will be the patient who suffers the consequences of a bad decision.
As mentioned earlier, dialogue with the patient is extremely important before the doctor decides to proceed with a medical treatment. It’s always crucial for the patient to be as informed and involved in
the discussion as possible. The best way is to strike the right balance between patient autonomy and physician intervention.
treatment because they believe that the long term interest of the patient would be served by it. This is especially important considering the fact that medical treatments can have entirely different outcomes than what were originally perceived.
One of the biggest arguments against medical paternalism is that first, someone’s belief (doctor) about what is good for the other person may be wrong. There are three elements involved – the patient, the doctor and the medical condition or illness. Doctors might be wrong in predicting the outcome of the treatment which may cause more harm to the patient.
Of course, physicians are humans. They are normal people who make mistakes; however they have the specialized training and medical expertise required to make a medical decision than the patient who has no such experience or credible expertise.
Just as a lawyer is qualified to make the toughest legal decisions for clients, and a certified accountant is qualified to make monetary decisions for a business, a doctor or healthcare provider
has the necessary professional ability to help patients make the right decision for their health and wellbeing.
Sometimes, patients are keen to exercise autonomy; however, on other occasions, they want to be guided. Some patients even want to be told what to do. They ask the doctor to prescribe what’s best for them. Some of them even ask the doctors to make the decision. They say ‘you’re the doctor; so you decide.’
Informed consent or planned discussions are often used to endorse physician decisions that have already been made. Doctors encourage patients to go with their advice, thinking that patients are not equipped to make the tough medical decisions. If patients don’t agree with the healthcare providers, doctors assume that they’re not in their ‘right mind.’
When is Medical Paternalism Justi ed?
Paternalism in medicine can be defined as interference with the patient’s liberty or autonomy for their own good. Doctors decide to go with their own decision to prevent harm to the patient without acknowledging the preference of the person whose autonomy is being compromised.
The major debate about paternalism is whether or not doctors are truly justified in making decisions
for patients if they know patients would object if they were properly informed. In addition, there’s a debate about whether or not a doctor should perform the
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Doctors without a doubt need to have a strong sense of responsibility to use their knowledge, expertise and hard-earned experience to help patients make the best decision regarding their health, i.e. the ability to live a fully functional and healthy life. Isn’t that what most patients really want? Maybe a little cautious approach(paternalism) is not such a bad thing after all. It’s something a healthcare provider and patient need to think about and discuss.
Medical paternalism can be100% justifiable if the patient lacks the capacity to look after his or her health interests. There needs to be some form
of partial or complete paternalism when people cannot make decisions for themselves. Paternalism also becomes obligatory if patients are suffering from incapacitating illnesses. Doctors are not left with many options when a patient resorts to self- destructive behavior or makesunsuitable choices when allowed to establish their autonomy.
Interference from the side of physicians and healthcare providers seems 100% justified in the presence of patient’s self-destructive behavior or when their preferred choice of treatment is irrational, unreasonable, or harmful.
Thus, it can be said that paternalism is acceptable
in medicine to a certain degree, and doctors have
to decide how, when and where they should act like good parents and look after patients who cannot care or make decisions for themselves.
In order for a person to be able to make a sound medical decision, they must have the capability to
be rational. Obvious exceptions to autonomy include children who cannot decide what’s best for them
and adults who cannot make decisions in order to preserve their health. In these circumstances the decision of a healthcare provider or more importantly, a paternalistic figure would be better suited for the patient’s interest.
The modern relationship between physicians and their patients is somewhat unique. Most patients are easily influenced by the expert opinion of the doctor and prefer that the doctors make decisions for them. This is not such a bad thing overall.
Patients go to a physician for help. In fact, they trust the doctors and believe that they will be able to help them. Therefore, it is not surprising that the majority of patients are influenced by medical expertise, and trust the decisions doctors are making. However, patients want the doctors to make decisions for them only after they have heard all of the questions and concerns that a patient may have.
Complete banishment of paternalism might not work. However, there must be strong communication between the patient and the healthcare provider
or physician. Patients have the right to receive information about their medical condition and their progress. More importantly, they have the right to be a part of the decision making process. If the doctor, for example, suggests two ways in which he believes the patient will benefit, the patient should be able to choose which is more desirable for them.
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Patient Autonomy vs. Paternalism
What is best for the patient – paternalism or patient autonomy? Which of the two approaches can result in the best of medical outcomes? These two questions are not easy to answer.
Often doctors or healthcare providers use medical terms (jargon) that leave the patient and caretakers wondering what they should do next. Patients may not fully understand what they are being told so it is less likely that they are in the position to make a suitable medical decision.
Sometimes doctors may present the proposed ‘plan of action’ or treatment from a totally paternalistic approach. Simply put, doctors might make all the decisions for the patient without consultation. As a result, the patient may feel helpless and possibly confused about the success of the treatment.
The approach that healthcare providers and doctors use sometimes leaves patients in a confused state
Conclusion – Is Medical Paternalism Justi ed?
of mind. Patients might be lacking the complete information they need to make informed decisions about the treatment plan. Some patients may want to discuss other treatment options that could be available to them, but might be reluctant to talk to their doctor.
Our paternalistic healthcare system only manages the patient’s condition the same way ‘old school’ parents deal with their children. What effect does this paternalism have on the patients?
Patient autonomy may be defined as the right to make decisions about one’s health. Every patient has the right to exercise his or her autonomy; however, it is important to understand that a large part of the population seeking medical care is ‘medically illiterate.’ Therefore, it is crucial that healthcare providers give patients support and guidance. Doctors can help patients make decisions for achieving medical health
and wellness by giving them the necessary knowledge.
The degree to which doctors can consult patients depends on the personality of the patient (their ability to think, comprehend information and make
Medical paternalism can be justified if it involves input from the patient’s side. Doctors must help the patients make a decision to improve their health and wellbeing. However, there needs to be a constructive dialogue.
decisions), the type of problem (seriousness of
the medical condition) and the time available for consultation. Needless to say, doctors must explain their decision in the most concise, easiest way and make patients feel as though they are an important part of the consultation.
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Chapter
Empowering the Patient – Patients as Managers of Their Personal Medical Care
#4
What is Patient Autonomy?
Patient autonomy can be defined as the right of patients to make decisions about their medical care. Patient autonomy in medicine allows healthcare providers to guide and educate the patient, but the doctors cannot influence or make the decision for the patient. Respect for patient autonomy is one of the fundamental guidelines of clinical ethics. However, patient autonomy in medicine is still a hot topic for debate.
As mentioned earlier, physicians have an obligation to help the patient make the right decision as well as create the conditions necessary for autonomous choice. Patients
in general look up to the doctor for medical guidance because they do not have the necessary medical information or background to make
the right choice. It is the doctor’s responsibility to help the patient understand the situation adequately. Moreover, healthcare providers also need to work to calm the patient and address fears and emotions that might interfere with the patient’s ability to make the right decision.
Doctors sometimes have to counsel patients when their choices are destructive to their health and well-being. Respect for patient autonomy also includes patient confidentiality, maintaining patient privacy and seeking patient consent for medical treatment and procedures.
Patient Consent: Why It Is Important
Informed consent from the patient’s side is required for all medical treatments, investigations and procedures. This section looks at the ethical and legal principles related to patient consent. Furthermore, the legal exceptions and practical implications of consent are also discussed.
Patient consent to medical investigation and treatment is a cornerstone of the patient doctor relationship. Consent basically means that the patient has given permission for something to happen or has agreed
to do something. Historic evidence reveals that Plato and Hippocrates also used consent in their practice.
Hippocrates, ancient Greek physician is regarded as the Father of Medicine. He is also revered for his
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strong ethical standards in the practice of medicine. Plato is also one of the best known classical Greek philosophers. Both Hippocrates and Plato recognized the purpose of ethics in medicine and stressed the importance of obtaining a patient’s consent before starting a treatment.
The concept of informed patient consent however
is new in the field of medicine. Informed consent basically means that the patient has granted permission for an investigation or treatment with an understanding of possible consequences. Patients rely on the information provided by the doctors for informed consent, therefore honesty and truthfulness from the side of the healthcare provider is of utmost importance.
The debate whether patient autonomy is absolute involves both ethical and legal aspects. Giving patient
the freedom to make a medical decision can be risky. Problems arise when the patient lacks information and experience required to make the right decision.
Generally, patients have to be guided about their diagnosis, treatment and other medical procedures. Doctors also help the patients understand uncertainties about their diagnosis as well as other treatment options that are available. Patients need to be informed about the advantages, disadvantages and achievable outcomes of every available option before selecting the most appropriate one.
The Problem with Patient Autonomy
Patient autonomy is a cornerstone of medical ethics, but the situation sometimes is very complicated. Every patient has different intellectual capabilities. Moreover, every person has a different understanding of their illness. Considering the differences in individual intellectual capabilities and understanding of the medical condition, doctors feel that it’s mandatory to guide the patients and tailor medical information provided
to the individual patient based on the current situation.
Sometimes, it is also difficult to understand and
judge whether a patient has really understood all information that has been provided. This leaves
the healthcare providers in doubt whether or not
the patient will be able to make a truly informed decision. Physicians are more concerned with the wellbeing of the patient as decisions based on partial or misinterpreted medical information can have disastrous consequences.
An overemphasis on patient autonomy can do more harm than good. Some patients feel abandoned when they are asked to make a decision on their own. Doctors on the other hand, feel increasingly frustrated if they are not allowed to help the patient.
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Doctor vs. Autonomy
As mentioned earlier, the practice of medicine has evolved a great deal. In addition, it has also been affected by changes in demographics, technology, and economics and most importantly, by changes in the patient doctor relationship.
There is a huge transformation in the way doctors and patients perceive each other. Over the past five decades or so, the patient doctor relationship has changed from a strongly medical paternalistic one to one that relies strongly on patient autonomy.
Practically, it is important that the physicians show respect for the decision making ability of competent adults. Autonomy makes perfect sense when the patient is an informed adult with a sound mind and the situation is not an emergency. But often healthcare providers are confronted with patients whose mental capacity is in question.
Shared decision making or guidance may not be appropriate in cases of acute myocardial infarction
or when the patient has cognitive impairment, is mentally ill or is intoxicated. In such cases, physicians prefer to make decisions that are in the best interests of the patient.
Healthcare providers are expected not to force their decisions, but they also have an added obligation of helping their patients. The primary goal of healthcare providers is to prevent and remove harm. Healthcare workers, particularly doctors, also need to weigh
and balance the possible benefits of a treatment or medical procedure against the possible risks of the same action.
Some of the most complicated ethical issues arise when the patient’s decision conflicts with the doctor’s decision. For example, a patient who recently had
had bypass surgery may want to continue eating saturated fats or to continue smoking. In this situation, the patient’s decision can cause more harm and it is
critical that the doctor tries to convince the patient to change his or her decision.
Problems can also arise when the patients
don’t trust the doctors. Patients may object to a paternalistic approach. In such situations, patients try to make their own decisions, and often don’t respond well.
Since physicians are held more responsible for medical decisions and outcomes, they should be given more opportunity to practice beneficence
or to do the most good for the patient in every situation. Doctors do help shift the burden of making difficult decisions from the patients onto their own shoulders. This is especially important when a patient needs to be told about a fatal diagnosis or when ineffective care needs to be withdrawn or when the treatment plan needs to be changed.
The practice of beneficence is needed to connect physicians and patients in a more personal way. The physician-patient relationship based solely on autonomy is incomplete and may not give the best results.
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Legal Complications of Patient Autonomy
Any medical intervention such as diagnosis, treatment or procedure without consent of the patient is a serious criminal offense in many countries and the physician can be charged for it.
Examples of situations where physicians could
face legal action include treatment against the patient’s will, proceeding with a medical treatment
or procedure other than what was communicated
to the patient and providing wrong information to
the patient. Sometimes, doctors are required to get consent from the patient’s family or caregivers before starting any therapy or treatment.
Children Younger Than 16 Years
Children younger than 16 years may not understand the medical information completely; therefore, they should be treated only with consent from the parent or guardian.
Patients lacking Mental Capacity
Patients lacking understanding due to loss of consciousness after an accident, or patients on mechanical ventilation, or those with chronic illness such as dementia, cannot make the best treatment decisions themselves. Hence, in this situation, it is the healthcare provider’s duty to make decisions based on the best interest of the patient after a thorough discussion with the family members. If a patient had clearly given his decision while still competent, the doctor is bound to respect the earlier choice made by the patient.
To sum up, patients need to have the mental capacity, and more importantly, the ability to communicate their choice to the physician to give informed consent. The doctor needs to first evaluate and weigh the medical information that is relevant to the patient before proceeding with medical assessment or treatment.
Patient’s Right to Refuse or Demand Medical Treatment
Medical ethics clearly give competent patients the right to refuse any treatment. This has caused doctors and medical authorities to modify or withdraw medical treatments that are against the wishes of the patients or their family members.
Again, the patient’s right to refuse treatment is a heated debate. Ethically, every person has the right to refuse to undergo any medical treatment. However, this right can only be denied when the doctors believe that the patient is not competent to make a decision.
Any patient who refuses medical treatment must
be well-informed and in a strong position to make the decision. The patient needs to understand the consequences of refusal. Also he or she needs to make the decision without manipulation by outsiders.
Generally, patients can refuse a treatment if:
1It fails to achieve its desired objective either therapeutically or in a palliative way.
2The treatment is too burdensome for the patient and there’s no reason the patient should bear it.
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Similarly, the family members or caregivers of a terminally ill patient can refuse to continue with the treatment if it does not deliver the desired results. They can also back out if the treatment is excessively damaging to future possibilities.
For example, a cancer patient may refuse chemotherapy for its likely effect on sexual health. The patient might be worried about the effects of chemotherapy on bodily functions, particularly the reproductive system if he or she is married and wants a child.
Are there any other exceptions to accepting patient’s refusal?
Yes, physicians can proceed with treatment or quarantine the patient if a patient with an infectious disease refuses treatment. Doctors can also proceed with the treatment to protect patients from child abuse, or domestic violence. It is also permissible
to treat the patient in order to protect third parties (family, public) who are in some way endangered by the patient. Patient’s refusal can also be challenged to protect the patient from harm.
Other Important Aspects of Patient Autonomy
Patient Con dentiality
Respect for patient autonomy also includes respect for patient confidentiality. This means that the
doctor or physician is responsible to keep medical information that a patient reveals to himself or herself.
Patients might reveal sensitive medical information to their physician as a part of doctor-patient relationship. This can include medical history and other emotional problems such as drug, alcohol withdrawal, sexual abuse and other personal details. Patients are more willing to seek medical care if
they know that their medical information will be kept confidential.
Respecting patient confidentiality can avoid harmful consequences to patients in some cases. This is particularly important in cases of HIV infection or other medical conditions where patients are subject to stigmatization and discrimination.
Why Maintaining Con dentiality is Di cult?
Maintaining patient confidentiality is more difficult than what it seems. In fact, physicians may breach patient confidentiality without even knowing about
Some patients decide not to continue with the treatment if it is excessively costly or painful. There is a limit to how much pain and financial pressure an individual can withstand.
Patients can refuse medical decisions on religious grounds and this is commonly accepted as a valid reason; however, it is important to establish that the patient held the same religious beliefs before the treatment was proposed.
Doctors have the right to seek court orders in case parents refuse treatment for their children on religious grounds.
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Telling Truth to the Patients
it. The what maintenance of confidentiality can be complicated by several factors:
1The use of computerized patient records.
People not directly related to the patient can have access to patient records in hospitals and other medical settings. While certain people have the ability to view records, it does not mean they have the right to view sensitive patient information.
2Revealing information to other physicians
Doctors may be tempted to have discussions regarding their patients in public places like the hospital cafeteria, elevators, hallways and medical conferences. While discussing patient data and treatments at medical conferences might be appropriate, doctors should never disclose the names and other identification information related to the patient.
3Discussing information with family members
Physicians can reveal a patient’s medical information and condition to family members without clear
consent of the patient. This is generally acceptable in emergencies or when the patient is not competent. However, if relationships between family members are strained, this revelation could become a sensitive issue.
Telling truth to the patients basically is the same as avoiding deception, lying or non-disclosure while interacting with the patients or in matters related to patient care. Being honest with the patients seems like a good thing, but why is it such a big deal?
Truth telling or being honest with the patients is
a new addition to healthcare ethics. Until a few decades ago, healthcare providers and physicians often avoided revealing the full extent of a serious heartbreaking diagnosis to the patient. Non disclosure was more common, particularly if the diagnosis had limited treatment options.
In some circumstances physicians believe that it is morally correct to hide a serious diagnosis from the patient. They fear patients may get depressed or lose hope or even worse, harm themselves after becoming demoralized by the negative information.
Most medical ethicists argue that physicians might wrongly use non disclosure to hide the truth about medical errors. They believe that the primary healthcare provider and the healthcare team in general need to report medical errors to oversight committees as well as the patient directly affected. This may not be the easiest thing to do, particularly when patients or families are severely affected as a result, i.e. due to medical errors.
Physicians also avoid disclosing the facts if they believe that telling the patient will not improve the situation or when the stakes for admitting errors are high. However, physicians should report errors to
the concerned authority so that they may develop an efficient system for avoiding problems in the future.
Is it Essential for Physicians to Disclose the Truth Completely
Non disclosure and lying are always considered unethical. It is never appropriate for a physician to
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lie in order to prevent the patient from making an informed decision. Even if the patient has insufficient medical information, doctors cannot simply trample a patient’s autonomy.
Physicians have the obligation to provide sufficient medical information to help the patient make the most meaningful decision. Lying to the patient can have disastrous consequences if the patient finds out about the betrayal later.
If the doctor lies to the patient at the initial stage and the patient later finds out, the patient naturally will be less likely to trust any doctor or healthcare provider in the future. In addition to being morally wrong,
this betrayal will also destroy the foundation of an effective patient-physician relationship.
Shaky patient-physician relationships never work especially if there is inappropriate or insufficient exchange of information regarding the diagnosis, prognosis, and treatment. Furthermore, if one
patient tells another patient about his or her bad experiences, other patients may also start mistrusting their physician.
they assume that their patients don’t want to hear the bad news.
Like any other wrongdoing, non disclosure, misinterpretation or lying to the patient creates a vicious cycle of betrayal and deceit. Patients/family members may decide to back out of the treatment having not received the diagnosis and treatment options directly from the doctor beforehand.
Are There Any Exceptions to Truth Telling
What happens if a family member wants to protect the patient from receiving the bad news? In such cases,
it is the physician’s responsibility to ensure that the family member’s wishes reflect those of the patient. Healthcare providers may ask the patient to decide how he or she wishes to receive medical information. Often patients choose to receive the information regardless of what their family members want.
Another exception is when the patient directly tells the doctor that he or she does not want to receive any information regarding the diagnosis or medical treatment. If this is the case, healthcare providers can withhold information ethically because they have given the patient the free will to decide.
It is important that the healthcare providers have direct personal conversation with the patient before opting for non-disclosure. Both the patient and doctor can decide how they want medical information, diagnosis and treatment to be handled. As mentioned earlier, doctors should not assume patient preferences. Instead, they should plan their moves after discussion with the patient.
Doctors may withhold information if they are dealing with a mentally unstable patient. Sometimes, patients may harm themselves or people around them after receiving the bad news. In such cases, doctors and healthcare providers are justified in delaying the disclosure of information. Medical information can be given if the patient’s mental health improves or if there is appropriate psychiatric backup.
Patients Want to Know More
Most patients want to know everything about their medical condition, even if it is harsh and heartbreaking. Simply put, doctors are mistaken if
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Should Patients Be Given More Options to Manage Their Healthcare?
Before banks introduced the online banking system, customers used to seek help from personal bankers. With the introduction of a fast, efficient online banking system, more and more customers preferred to take control of their banking
needs. However, unlike personalized banking, personalized healthcare is something that doesn’t really exist.
Putting patients first has recently become a favored mantra in healthcare industry. A lot of effort is
being put in to help patients self manage their healthcare services and information such as physician appointments and prescription filling.
The aim of putting patients first is that people should have a stronger voice in making decisions about their health and medical care. When patients are more actively involved in healthcare decisions, the result will be better patient health, better health outcomes and more importantly, medical resources will be allocated more efficiently.
Despite strong evidence in favor, why is there a
lack of systematic progress in the area of active involvement by the patient? There are several reasons why patients are not involved in making decisions about their health.
First, stakeholders and decision makers (healthcare sector) are unsure about what needs to be done There is a great deal of confusion as
to how patients should be engaged or involved.
In addition, there is no information about sharing medical decisions and personalizing healthcare.
Second, involving patients in healthcare is challenging because it challenges the traditional way things used to be done by the stakeholders. If patients are to be involved in health decisions,
the system needs to become more human and responsive. And not all stakeholders in the healthcare industry are willing to do things differently.
The practice of patient involvement can be traced back to the 1990s – the root of the NHS in the UK. Patients were given the ability to choose general practitioners and medical services as well as access medical treatment privately.
Recent years have seen increasing involvement of patients in making healthcare decisions. Patient involvement here is seen as effective means to improve quality.
Di erent Perspectives on Patient Involvement
1The industry should respond to patient preferences in order to improve quality of care provided.
2People have social, economic and political rights as citizens of a democratic country and they have certain rights regarding what they receive from public service industries such as healthcare.
3Involving the patients and letting them decide the treatment is an ethical thing to do. However, physicians need to assess the risks and benefits of involving the patients in decision making.
4All patients deserve to get the best of the healthcare system, hence it is important that the system knows and responds to what people need and want. Simply put, healthcare delivery should be patient centered.
5By involving people in managing their medical health, the healthcare sector can make the use of scarce, expensive resources more efficient.
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Di erent Forms of Patient Involvement
2Involving Patients in Shared Decision The following are different ways patients can be Making
managers of their own healthcare.
1Engaging People In Keeping Healthy
Our lifestyles in general play an important
role in determining our overall health. Sadly,
high incidence of diabetes, hypertension and
other chronic medical conditions in the present population is closely linked to smoking, lack of physical activity, alcohol abuse, inadequate nutrition and obesity.
The healthcare sector needs to involve the patients in tackling the controllable risk factors. For example, doctors can use appropriate training and support to help people change their lifestyle.
Patients with high levels of medical and health literacy may only require an initial conversation. On the other hand, some patients may require a personalized coaching approach. They need to be provided with medical information in different formats to help them understand and use the information.
Hospitals in collaboration with local communities can set up training centers where health trainers can offer tailored advice, motivation and practical support to people who want to change their lifestyle. Not only is this method is cost effective, but it will also help the healthcare industry make good use of scarce medical resources.
Shared decision making is where physicians and patients work together to make decisions about medical care and treatment. The idea of shared decision making is that doctors and patients bring different, but equally important expertise to the decision making process.
Doctors’ expertise is related to diagnosis, disease prognosis and treatment options and outcome possibilities. Patients’ knowledge on the other hand
is related to personal preferences, willingness to take risks and most importantly, their experience of illness.
Shared decision making is more about information exchange – doctors share theoretical information, outline treatment options, their outcomes and likely risks and the patient shares his or her knowledge of the medical condition and personal preference that may impact a decision.
The Right Way to Share Decision Making
Not all patients want an upper hand in deciding their care and treatment; however, they expect their doctor to have a supportive consulting style. Doctors can provide coaching and consultation to help patients think about what different treatment options would mean to them.
Shared decision making is best in any situation where there is no single best option. Most health conditions have more than one best course of action.
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3Supported Self Management
Supported self management is more relevant to patients with chronic or long-term health conditions. Most patients can cope with chronic conditions like diabetes, arthritis and hypertension when they know what to do and more importantly, are confident in taking ‘medical’ action without the support of a medical professional.
Again, healthcare providers have an important role in helping patients gain the necessary skills, medical knowledge and confidence. The crucial elements of self management include:
1Personalized care plans – helping patients manage their illness for example adhering to special diet or taking prescription medication
2Access to structured medical information and education when needed
3Access to physicians, healthcare professionals when needed
4Emotional and practical support from family, friends and caregivers
Self management will not only improve the
patient’s quality of life, but it will also help prevent deterioration of the condition. Education programs can help patients gain the necessary skills and knowledge to self-manage their condition. However, self care plans should be holistic and need to offer every advice to keep patients as healthy as possible.
Self management training tends to work better when integrated into the healthcare system. Physicians can guide the patient through the self management process and this includes increasing knowledge
and understanding of the medical condition, coping behavior, following treatment recommendations
and more importantly, giving unbiased feedback on quality of care.
Patients can only play a distinct role in managing their healthcare when they are aware of the causes of the disease and other factors that influence their health. It is also important that patients learn to manage the symptoms of chronic disease and adopt healthy behavior to prevent or delay deterioration of health.
Policy makers in most countries work on patient self-management programs to take the load off the expensive healthcare resources.
4Involving Family and Caregivers
Family members and caregivers are an essential part of good patient care – they can provide the much needed emotional, financial and social support. Family members can also provide doctors with important information about the patient. This is especially important if monitoring the health and wellbeing of the patient is highly critical.
Family members and caregivers look after patients with chronic, debilitating conditions and disabilities. Hence, it is important that they are involved at all stages of care planning, care delivery and decision making with the same attention as the patient.
Doctors and healthcare providers need to identify primary caregivers and keep their information updated in medical records. However, the extent of involvement of caregivers and family members is subject to the agreement of the patient they are caring for. Finally, it is important that caregivers receive adequate support and help from the physician’s side to assess the needs of the patient.
The involvement of family members and healthcare providers may increase a patient’s confidence and understanding in dealing with the health condition. It is crucial that caregivers are proactive in order to develop effective relationships with medical professionals.
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5Allowing Patients to Choose Where They Want to Go for Care or Treatment
Patients can make their own decision on the following occasions:
1Deciding on a GP
2Going for a first appointment as an outpatient
3Deciding who should carry out the specialist tests
4Deciding on maternity services
5Requesting change of hospital or to see a specialist
The Final Recommendations
Occasionally, all patients have to make important decisions that affect health outcomes. Effective strategies to improve patient education and understanding of medical conditions can empower patients to have greater control over their healthcare. Effective patient engagement interventions include:
1Training healthcare providers in communication skills.
making where patients are actively involved with the physicians to make healthcare decisions.
When patients become more actively involved with their healthcare providers, their knowledge improves and they feel more satisfied with the decision.
Well-designed communication courses can improve communication skills of doctors, pharmacists and nurses. This is especially useful in shared decision
education programs 4Improving patient health literacy.
Patients should be trained to read, understand, evaluate and use medical information to make best decisions about their healthcare. Computer based, interactive education material may be more effective than paper based information. The reason is that interactive videos, audio, podcasts, slideshows and websites can be easily tailored to deliver medical information.
Health literacy is fundamental to patient engagement. This is because patients cannot be made managers of their healthcare if they cannot understand basic health information or look after themselves or make good health decisions.
Regardless of medical knowledge and level of understanding, all patients need practical information to support healthcare decisions as well as to reduce anxiety. There is now substantial evidence that involving patients in healthcare decisions can lead to better health outcomes.
All strategies to improve patient literacy and engagement should be put into play. Also, shared decision making and self management are patient empowering approaches that should be given high importance.
Giving patients timely, easy access to health information is the right thing to do, because it is the best way to enhance their health. The growth of technology is improving healthcare.
2
3Arranging patient coaching and self-management
Offering written material such as brochures, flyers that supplement clinical consultations
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Chapter #5
The Use of Technology in Healthcare Sector
The Internet, Social Media and Global Networking
Medical information in electronic formats such as websites, interactive videos, podcasts and apps can help improve a patient’s understanding and ability
to be involved in a medical decision. Most patients prefer to see health information that is reliable, timely, relevant and appropriate.
If patients are to play more active roles in decisions related to their care, it is important that they become involved with medical information. Various patient empowering resources have been developed and promoted on the internet and social media.
There are medical websites that encourage patients to ask questions regarding their conditions. Discussion forums have topic lists that help people with chronic conditions, like depression, arthritis, hypertension
and eating disorders, to benefit from reading the experiences of other people with the same condition.
Active education on the internet,through the use of social media or mobile apps, can be more effective
than traditional ‘paper based’ education. This section looks at different ways technology is improving healthcare.
How Technology is Improving Healthcare
Technology improvements are constantly infiltrating our lives, whether it’s the way we communicate, work, travel or even shop for our favorite products. Continuous developments in technology are also transforming the way healthcare is delivered.
There have been major breakthroughs in medical research and treatments as well as how patient information is collected. Healthcare providers now have exciting new tools to work with , leading to major improvements in the healthcare sector.
More Accessible Care, Anytime, Anywhere
An internet search enables anyone to access information anytime, anywhere. Laptops and other ‘smart’ mobile devices have become an integral part of our lives and it’s reasonable to expect that people are using the internet to access information related to healthcare.
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The majority of patients take advantage of medical websites that offer disease diagnosis, symptom checkers and valuable ‘coping’ suggestions. Also, patients can take part in online discussions over the web and social media. Some patients also decide to explore online tools and apps that help them find doctors in their area and request prescription refills. The majority of patients prefer to book, cancel or change their appointments online.
Real Time Access to Patient Medical Records
Each minute of a doctor’s visit is valuable for patients so even a short delay can sometimes have disastrous health consequences for the patient.
A typical visit to the doctor’s office involves checking vital information. There are questions that must be answered and notes taken. While all this is unlikely to require more than a few minutes, delays in manually accessing patient records can fill the time allowed for consultation.
Healthcare providers prefer to have online access to patient records. This way there is no time lag and
doctors can access important patient information in real time. Most patients and some physicians may not be comfortable with the idea of ‘open medical records’ that can be accessed by anyone. However, technology improvements now allow for appropriate security mechanisms to be put into place.
Patient records can be made accessible to related healthcare providers in real time. This will reduce costs related to healthcare systems. Since healthcare stakeholders are looking for ways to make the delivery of healthcare more cost effective and time efficient, embracing technology is the best answer to all their problems.
Healthcare Websites and Facilities are Reaching Patients through Social Media
Medical websites, doctors, hospitals and research facilities these days commonly use social media tools to reach wider populations. Hospitals and health regulating bodies in particular use social media websites to launch public awareness campaigns and answer medical related questions patients might have.
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Some dedicated medical websites even allow patients to chat with doctors about the medical issues they are facing. These websites also send email reminders for people to get routine tests done on time.
New Technology Helps save Lives
Perhaps the most obvious way technology has changed healthcare is by providing advanced diagnostic machines, medicines and life saving treatments. Sophisticated machines and innovative drugs improve the chances of patient survival. They also save lives as healthcare providers are now able to make more efficient healthcare decisions. More importantly, these decisions are made without wasting a great deal of time.
Technology Has Made Healthcare Sector Productive and E cient
treatment. As more and more sophisticated diagnostic tools and innovative drugs make their way into the healthcare sector, doctors also can better study the exact cause of ailments and come up with better treatment methods.
It is interesting to note that healthcare providers
now can access loads of medical data with a simple click on their computer or mobile device. There
are thousands of text books and other medical case studies that can help doctors serve the patient better.
The increasing use of advanced technology in hospitals and other medical facilities also helps doctors connect with their colleagues working around the globe. They can routinely use emails, audio and video conferencing to diagnose, treat and research medical conditions.
Video conferencing is especially useful for doctors
Doctors and other healthcare providers can now use computers to record the patient’s medical history and check whether or not they are providing the right
working in rural or under developed areas. This way, quality health care can be offered to patients without having to move them to a sophisticated hospital.
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How Smartphones Can Change the Future
of Healthcare
Smartphones have made a special place for themselves in our lives. More than eighty percent of Americans use some kind of mobile device and more than 2/3rds of the people use their smartphones to access the internet.
Closely related to smartphones and mobile internet technology are tablet computers. More than 75 percent of physicians use tablets to access electronic health records. Interestingly, that is the second most frequent use of tablets after sending emails.
Chapter
#6
Smartphones Can be An Important Tool for Managing Health
There are a number of software applications and peripheral devices that can be attached to tablets
or smartphones. In fact, medical devices that are compatible with smartphones and tablets are already making way into patients’ homes.
Most medical devices connect easily with mobile devices and provide healthcare information and instructions in a user-friendly interface. This perfect sync of mobile technology and mobile devices has empowered patients to take a more active role in their own health.
Other mobile innovations that are under test could also drastically change how patients receive healthcare.
A phone-based health system that can track all of a person’s medical data, health apps and sophisticated devices is currently being researched. This system will even allow patients to test their own urine, blood and DNA. Simply put, people can have a clinic at home.
The next generation of mobile technology is also taking multiple device integration into account. Patients can keep track of their medical history from different devices. For example, a blood pressure
monitor may be linked to apps monitoring health and fitness activities.
Clinical Adoption of Smartphones
Primary healthcare providers may also find value in using mobile technology and smart devices. Some of the widely used mobile applications
by doctors and nurses are drugs and clinical references. Doctors and pharmacists prefer to use clinical tools such as dosage calculators to reduce the chances of medical errors.
Electronic prescriptions and real-time decision support (to clarify diagnosis, treatment) are the next most popular uses of smartphones by physicians.
Surprisingly, doctors in Japan use iPads to clarify their diagnosis. Instead of wasting valuable
paper, patients in Japan use their mobile device
to fill out answers to health questionnaires prior
to consultations. These answers help physicians stay current on patient condition. In addition, doctors can also be warned when a health crisis is coming.
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Medical Reference Tools
Smartphones can easily be configured to show alerts or notifications. Most healthcare providers will know about the latest clinical advice, guidelines and breakthrough medical news almost instantly if they are communicated via mobile devices.
Because healthcare is information intensive, it is important that health information goes mobile to make the physician’s life easier. Well-known online medical reference companies offer medical reference products for all the major mobile operating systems including Android, iOS, Blackberry and Windows mobile.
Like physicians, customers also prefer to access medical information via mobile devices. Most patients use medical apps to look for the best over the counter drugs for their particular symptoms.
Diagnostic Apps
Applications related to differential diagnosis are also becoming popular. The IDdx is one such example. This app covers the basic of infectious disease diagnosis based on the Control of Communicable Disease Manual.
Imaging and Laboratory Results
Smartphones can help doctors and healthcare providers access laboratory results as soon as they are completed. If test values are abnormal, the doctor can immediately contact the patient for follow-up. There are many digital imaging apps that can help healthcare providers determine the most appropriate exams for a patient.
Obstetrics
The Apple app store features an application that provides obstetricians remote access to patient’s vital signs, fetal heart rate, and labor contraction patterns.
Ongoing Patient Support
Tablet computers, smartphones and the internet
play an important role in continuing patient support. Some smart phone apps focus on a single medical condition to help the patients deal with the condition. Dedicated mobile apps dramatically improve medical adherence and compliance in patients suffering from chronic conditions.
These apps feature user friendly interfaces, and help improve patients’ understanding of their condition.
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Patients become more aware of the complex treatment plans and learn to deal with painful symptoms of the condition as well as the side effects of treatment plans.
Mobile apps are available for the most common chronic conditions including asthma, COPD (chronic obstructive pulmonary disease), diabetes, hypertension, migraine, anorexia, Crohn’s disease, multiple sclerosis and cancers. Though disease specific apps were primarily aimed at doctors, they can now be downloaded and used by anyone.
A number of mobile health monitoring apps
also help patients connect with care givers and clinicians real-time. Doctors can track the health
of the patient using sensor technology and advanced mobile communication systems. People with diabetes have access to a wide variety of mobile monitoring devices that can be connected to smartphones. Roche Diabetes Care’s blood glucose meter can be integrated with a mobile app that calculates the impact of the patient’s meals, activities and other actions on blood glucose levels.
Top Medical Apps That are Creating Waves
A large number of apps geared specifically towards healthcare are now available. Impressive new mobile medical apps are popping up every day. Health, fitness and wellness apps have made their way into Google Play and Apple App Store. Some of them are free, while others are available for a subscription fee. Here’s a quick look at medical apps that really stand out from the crowd.
1Mayo Clinic Patient App
Mayo Clinic launched its iPhone app in December 2009. This free Apple app gives patients secure access to medical records, appointment schedules, as well as lab results. It has undergone a number of improvements since its launch.
Patients can also use digital maps provided by the app to become familiar with the medical facilities offered
by the clinic. The patient app also gives directions to patients’ appointment venues and other related facilities.
The Mayo Clinic patient app also allows people stay in touch with Mayo staff. Patients can use the app to make appointments. They also access health management tips from Mayo’s online resources, as well as other appropriate medical information.
Mayo Clinic launched its free symptom checker app in 2010. The app was based on its popular desktop website version.
2Visible Health’s DrawMD
This free Apple app helps physicians show patients what exactly will happen during their surgery or other medical procedure. The app is created by surgical oncologists and covers nine medicine specialties including cardiology, female pelvic
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surgery, obstetrics/gynecology, orthopedics, critical care, otolaryngology, anesthesiology, general surgery, vascular surgery, and urology.
Doctors can use visual tools available in the app to explain complex surgical procedures to patients. These images and notes can also be used by the patients to enable doctors to answer their specific questions.
3 VaxNation
VaxNation is an online vaccination tracker. People need to enter basic information such as birth date, vaccinations that they’ve had, date of immunization. VaxNation then provides appropriate vaccine recommendations based on the Center for Disease Control and Prevention’s guidelines.
This app is really useful for families with young children. The app account can be linked to Facebook and Twitter so that immunization information is easily shared. Families can also set up joint accounts for easy sharing of information.
VaxNation also offers clinic locator service, email reminders and other information related to immunization.
4EZ Derm
EZ Derm is specially designed iPad app for dermatology. The app provides physicians with accurate 3D body maps on which they can make notes using touch technology. Doctors can also use videoconferencing and texting features offered
by the app to connect with their patients, staff and colleagues.
5iSonea’s AsthmaSense
This asthma monitoring tool runs on Apple and Android devices. AsthmaSense allows patients to track their breathing as well as manage their
medications. The app has an in-built medication reminder system that can be turned on and off. Patients also receive alerts if the system (app) determines that their asthma is not properly controlled. AsthmaSense uses the National Institute of Health guidelines to determine whether asthma is well-controlled or poorly-controlled.
iSonea’s AsthmaSense has an online journal to help patients record asthma symptoms, breathing function meter readings and medication history. Patients can maintain records of medications they usually take
as well as in emergency situations. Monthly data is available for review and can also be shared with physicians. Patients can also use the app to call for emergency help.
6Emmi® Solutions Programs
Emmi Solutions Programs are geared towards
patient education. Originally available as web based products, these programs can now be downloaded on Apple and Android devices.
Physicians can use Emmi’s programs to follow up with their patients after scheduled office visits. Doctors can provide information on preventative or treatment options as well as help with patients medical decisions. The information can be viewed or read by the patient when and where they want to.
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7Castlight Health
This app uses a patient’s healthcare plan (insurance) information and helps locate doctors and hospitals available under the plan. Patients are also given advice about how to make the most of their insurance plan.
Smartphones In Healthcare – What are the Barriers
How can patients efficiently locate an application that answers all their needs? The number of smartphones apps available in the market is overwhelming. However, sometimes patients are unable to discover apps specifically related to their condition.
Not All Medical Apps are Discoverable
Discoverability of apps is not the only issue that is bothering clinicians and patients. Another barrier to using smartphones in the healthcare sector is the difficulty of distinguishing safe, credible apps and devices from ones that are not safe.
Not All Apps are Credible
Patients who are technology friendly may download the app on their device, but they may not know the right way to use them. The fact that anyone can create a medical app and put it in the app store is even more concerning.
Simply put, apps from untrustworthy or unknown sources can put patients’ health at risk. Therefore, patients should be advised to download and use only credible apps from government agencies such as FDA, NIH or CDC. Apps from trusted academic institutions and reliable medical websites such as John Hopkins, WEBMD, Mayo Clinic, Cleveland Clinic and University of Maryland can also downloaded for personal use.
The Use of a Smartphone Doesn’t Make You a Doctor!
Tech-savvy patients may choose to download medical apps especially designed for professionals and they might even use it correctly. However, the app is not a replacement for physician consultation. Furthermore, using the app doesn’t make patients as qualified as a doctor.
The Presence of FDA
It is not clear whether or not health and medical apps are included under FDA’s definition of ‘medical devices.’ According to FDA, if a software or application is intended to provide cure, prevention, mitigation or cure of a disease, it may be considered a medical device.
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In January 2010, the FDA advised MIMVISTA (software developer) to get pre-market approval for its imaging app. The pre-market approval (FDA) requires
clinical trials and the process is time consuming
and expensive. It will be some time before software companies become willing to invest their money into clinical trials.
Should Smartphones be used in the Healthcare Sector?
The bottom line is that mobile health solutions can help healthcare providers manage patient care
in lower cost settings. The healthcare sector can make the best possible use of already scarce health resources; however, this is possible only when the staff are used to innovative mobile technology.
One of the biggest challenges is how senior physicians will integrate smartphones into their workflow or practice. Newer doctors are unlikely to have problems as most medical students are familiar with using smartphones.
Looking at the Future
Mobile technology is changing quickly. New hardware platforms, software and advanced internet connectivity makes the use of mobile devices easier and cheaper than in the past. Keeping patient personal information secure is also less challenging with the advent of strong encryption and strong authentication technology. Lack of privacy now is much less of a concern to physicians as well as patients.
Since the use of wireless devices is on the rise in most industries, smartphones and medical apps do not have many barriers to entry in the healthcare industry. Healthcare providers can easily adopt devices and apps if they are valuable. Conversely, devices and apps can be discontinued if they don’t prove to be useful.
The attractive thing about smartphones and tablet computers is their size. Smartphones in particular have the same size and shape as the prescription pad commonly used by doctors. Doctors have a great deal of experience in pulling out small writing pads from their pockets, so similarly-sized smartphones are a superior alternative for viewing and recording information.
Smartphones can make life easier for patients managing chronic health conditions. Especially designed medical apps can help patients make good decisions from nutritional choices to tracking disease progression and adherence to treatment.
Smartphones have a bright future in the healthcare sector since they are mobile, agile and easy
to use. Over the past decade, smartphones
have changed every aspect of our life from entertainment to communication to shopping
and medicine probably is next. An increasingly powerful set of tools and devices is about to enter the medical world.
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IBM’s Watson
What is Watson?
Watson is a supercomputer created by IBM that combines artificial intelligence (AI) and complex analytical software. This computer was designed to compete on a popular American television quiz show. Interestingly, Watson challenged two top-ranked players on ‘Jeopardy’ and beat champions Brad
Rutter and Ken Jennings. During the quiz, Watson had no internet access like the other contestants.
Most people know Watson as IBM’s response
to Jeopardy’s winner Ken Jennings, but this supercomputer now is more of a medical genius, not just an ordinary quiz show champion.
The Arti cial Intelligence behind Watson
Watson supercomputer is named after IBM’s founder, Thomas J. Watson. After becoming the World Jeopardy Champion, Watson ‘studied’ medicine to become the world’s best doctor.
Watson features IBM’s DeepQA software. The software is especially designed for seamless information retrieval and incorporates natural language processing and machine learning.
Watson has access to 90 servers and 200 million pages of information in total. The supercomputer
is capable of storing far more medical information than any doctor or healthcare professional and this is not all.
Unlike human doctors, Watson’s decision is evidence based and more importantly, free of biases and overconfidence. What makes Watson special is that
it can find meaning in the medical information and does more than just storing data.
Watson as the World’s Best Doctor
IBM wanted Watson to be full of medical knowledge – one of the toughest knowledge areas in the world.
According to a report released by Forbes in 2013, Watson was pumped with dozens of medical textbooks, all of PubMed and Medline databases* and thousands of patient records from Memorial Sloan Kettering Cancer Center, New York. In addition, Watson had also analyzed 2 million pages of text, 605,000 pieces of medical evidence and 25,000 training cases.
How Does Watson Work?
The doctor or physician describes the symptoms to the system. Watson then identifies and matches key pieces of patient data, including symptoms, family history, existing medical conditions as well as current medication with a variety of data sources.
Watson compares the latest patient information with existing electronic medical record data, treatment guidelines, clinical studies, medical research as well as notes added by doctors and nurses.
Once Watson completes analyzing patient data, it will provide all possible treatment options that will work for the patient. Furthermore, Watson will also provide its confidence rating for each treatment suggestion.
* PubMed and Medline presently are the largest sources of biomedical literature from around the world.
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Oncology is the first specialty that uses Watson. Presently, 14 cancer institutes in Canada and US
use IBM’s Watson to choose cancer treatments and therapies as the latest step in bringing personalized medical care to cancer patients.
Watson for Oncology has a special ability to analyze data in clinical reports and notes. It can also easily interpret the meaning and context of patient information contained in doctor’s notes and medical reports. The information written in plain English will be analyzed by Watson before a cancer treatment pathway is selected.
By comparing patient information with medical research and other pieces of clinical information, Watson will identify potential treatment plans for a patient. The doctors can then consider each suggestion provided by Watson when making decisions for individual patients.
What’s interesting is that Watson provides rankings for each identified treatment option. It also provides supporting evidence to help oncologists weigh
the pros and cons of each treatment. Drug profiles provided by Watson include administration and dosage information, as well as warnings and toxicities.
As stated earlier, Watson for Oncology has access
to an impressive store of data. Itoffers treatment suggestions only after analyzing more than 290 medical journals, over 200 textbooks, and 12 million pages of medical literature.
While Watson has a remarkable ability to learn, analyze, and apply medical knowledge, there is
still a long way to go before it can truly match the versatility of human diagnosis. Considering Watson’s performance over the years, IBM believes that eventually it will get there.
How Watson Can Be a Game Changer
Thousands of patients are misdiagnosed by doctors around the world, so Watson can surely give doctors an inspiration for improvement. Here’s how Watson can take healthcare to a completely different level.
1Watson has access to all available medical knowledge 24/7
While the human brain is impressive, it cannot store the same amount of information as Watson. In addition, human doctors do have problems keeping up with the changing medical information and latest clinical research. Watson knows all available information and it never forgets anything!
2Watson’s analysis is accurate
Since Watson provides supporting evidence with each
suggestion, it is an accurate diagnostician.
3Watson’s diagnosis is consistent
Watson is unbiased and more importantly, it is never upset, nervous, sick, scared, sleep deprived
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or anxious. This means Watson’s diagnosis
will be free of common flaws among medical professionals. Since Watson is always working, doctors can get accurate diagnoses whenever, wherever they want.
4Watson can go anywhere in the world
If a doctor has access to a computer or mobile device, he or she can ask Watson for help.
5Watson’s diagnoses are cheap
While Watson is expensive to build and train, obtaining a diagnosis is practically free once it is up and running. A few cloud connected computers could provide quick, accurate and essential diagnostics to patients in hard to reach areas or with limited, or no doctors.
Watson is still in the research phase and we need to wait before it can be used in other healthcare areas.
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E ective Ways #7 to Predict and
Pre-empt Disease
Over the past few decades, there has been a reduction in the number of deaths caused by coronary artery diseases, stroke and other life threatening conditions such as AIDS. This is largely due to extraordinary biomedical research. The goal of specialized medical research is to detect each of
the diseases in the earliest stage and then intervene quickly to preempt later stages. Healthcare organizations all over the world spend millions of dollars annually to come up with better diagnosis and treatment methods.
The simple concept of detecting heart attacks and strokes as early as possible has yielded better outcomes than treating the later stages of the diseases. Simply put, physicians believe that the future of healthcare lies in predicting diseases before they can even happen. If a disease can be predicted accurately, doctors can tailor the treatment plan according to the patient’s genetic makeup.
Chapter
Patients Want Good Care
All patients regardless of their medical condition want good medical care. They expect doctors to understand their condition and then follow up with an effective treatment plan.
Physicians are well-trained professionals and they do try their best to stay updated with the latest medical research. However, doctors need time
to come up with effective treatment methods for
all the different kinds of diseases they encounter. Sometimes even the smallest errors in diagnosis or treatment can result in devastating consequences for both the patient and the doctor. And this is the exact reason why the healthcare industry is now considering Predictive Analysis (PA).
Predictive Analysis (PA)
More and more physicians these days are using predictive analysis to predict disease outcomes for
patients. PA uses statistical methods and innovative technology to search through massive amounts of medical research, past (patient) treatment methods and the patient’s history. The results help physicians predict the likelihood of the disease, the possible patient response
to medical treatment as well as the future wellness of
the patient. It is important to understand that Predictive Analysis focuses on the individual patient, not groups.
Advantages of Predictive Analysis
1 PA can increase the accuracy of diagnosis
Physicians can use algorithms to make accurate diagnosis. For example, if a patient with chest pain comes to the ER, doctors can assess the patient’s condition (with accurate algorithms) and decide whether or not she or he should be hospitalized. Doctors can also decide what treatment plan is likely to work best in that patient’s case.
PA can also help doctors predict whether or not the patient should be sent home. PA is never used to
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replace a physician’s judgment: it is only used to assist the doctor, i.e. to offer a better, more informed decision.
2 It will allow doctors to successfully identify ‘at risk’ patients
Many medical conditions can be prevented or at least delayed with early intervention. Doctors can identify high risk patients with the help of predictive analysis and educate them so that the patients can make the necessary medicinal and lifestyle changes to lower their risk.
The prediction of high-risk patients is especially important in cases of neuron degenerative diseases such as Alzheimer’s disease and Multiple Sclerosis. For example, if a doctor predicts a gene marker for early onset of Alzheimer’s disease in the patient’s genome, the patient can be educated about helpful lifestyle changes that might prevent the medical condition.
The physician can guide the patient about good nutrition and healthy brain exercises which will indirectly affect the progression of Alzheimer’s disease. Doctors can upload results of memory tests and brain game apps to the patient record to monitor how well he or she is performing.
Since brain activity, brain exercises, and other variables such as patient diet and sleeping patterns are included in the electronic medical records, physicians can make changes to patient’s medical treatment as and when needed.
3 PA gives physicians the answers they are looking for individual patients
The solutions that work best for a group of patients in a clinical study might not work best for an individual seeking treatment for the same condition. Predictive analysis helps the doctor give more targeted treatments to the patient. Since PA also helps with better diagnosis, the result will be a better patient outcome with the use of fewer medical resources. Predictive analysis also saves the doctor’s time.
Moreover, treatments that are not needed or that won’t work specifically for the patient are taken out of the picture immediately.
4 Insurance companies and employers can obtain predictions of future medical costs
Employers and insurance companies providing healthcare benefits can use predictive analytic algorithm to estimate future medical costs. More accurate cost predictions will assist insurance companies in providing better health coverage to the patients.
5 PA can produce great results for pharmaceutical companies as well.
Predictive analysis can serve as an incentive for pharmaceutical industries to develop medication for specialized or smaller groups of patients. The reason is that drug companies will find specialized medication research and development to be economically feasible.
Predictive analysis has a number of benefits for patients as well. Patients will only receive treatment that works for them, which means they no longer have to deal with unwanted side effects of unnecessary medications or needless diagnostic tests.
PA also gives doctors a chance to work closely with their patients to achieve better outcomes. Since doctors will be aware of the possible health risks to the patient, they can make more informed decisions about their health and future wellbeing.
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Chapter
Conclusion
#8
Creative disruption is the next big thing in medicine. It can bring about a significant change in the way healthcare sector functions. More importantly, it can change the doctor-patient relationship for the better.
Creative disruption in medicine will make patients better informed about their health and they can assume more responsibility for their own medical treatment. On the other hand, doctors are also likely to become more of a consultant than a dictator. Physicians can now advise patients and help them make better health decisions. This perhaps will be a game changer – doctors and
patients can once again form a truly positive and lasting relationship.
Last, all major stakeholders in the healthcare sector, such as hospitals, insurance companies, and pharmaceutical companies, will be able to make more efficient use of their resources with the help of creative disruption. Once the use of resources is more meaningful, there will be a significant improvement in the quality of care.
All in all, we can hope that better times are coming. The healthcare industry is ready to transform itself so let us anticipate great results and prepare ourselves for the good days.
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About Dr Rowan Molnar
Dr. Rowan Molnar is recognised as one of Australasia's leading commentators on "Creative Disruption in Medicine and Healthcare".
Rowan loves his vocation. Ask him to comment about his work in anaesthesiology and his face lights up.
A senior specialist anaesthetist with extensive clinical experience in anaesthesia at a tertiary referral hospital level, both in Australia and internationally, he has clinical specialisation in cardiac surgery, orthopaedic surgery, tumour surgery, plastic and reconstructive surgery.
Dedicated to medical education at all levels, particularly in establishment, deployment and implementation of simulation based teaching. Rowan is lecturer at Harvard Macy's program on "Leading Innovations in Healthcare and Education" in Boston, USA.
In his spare time Rowan enjoys flying the Australian designed Jabiru which has earned him the title – ‘The Flying Doctor’.
- Author -
Accomplished award winning author with comprehensive representation in numerous prestigious medical journals around the world.
- Professional Speaker & Consultant -
“If you want to influence, you must speak up”, says Dr Molnar. An experienced professional speaker that has inspired thousands with his presentations on health and the human condition.
- International Links -
With over 25 years experience worldwide, Dr. Molnar’s reach stretches beyond the borders of Australasia to the U.S.A including Harvard University, Massachusetts General Hospital, Boston and John Hopkins Medical Centre, Baltimore, and University of California.
Contact Dr Molnar:
LinkedIn: https://au.linkedin.com/in/dr-rowan-molnar-770a6986
Media & Speaking Engagement Patricia Bosa
Communications Director
IGI Worldwide
T: +613 9824 0420 (Australia) E: [email protected]
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