Why caregiversThe woman was sitting on a gurney in the emergency room, and I was facing her, typing. I had just written about her abdominal pain when she posed a question I'd never been asked before: "May I take a look at what you're writing?"
At the time, I was a fourth-year medical resident in Boston. In our ER, doctors routinely typed visit notes, placed orders and checked past records while we were in patients' rooms. To maintain at least some eye contact, we faced our patients, with the computer between us.
But there was no reason why we couldn't be on the same side of the computer screen. I sat down next to her and showed her what I was typing. She began pointing out changes. She'd said that her pain had started three weeks ago, not last week. Her chart mentioned alcohol abuse in the past; she admitted that she was under a lot of stress and had returned to heavy drinking a couple of months ago.
As we talked, her diagnosis — inflammation of the pancreas from alcohol use — became clear, and I wondered why I'd never shown patients their records before. In medical school, we learn that medical records exist so that doctors can communicate with other doctors. No one told us about the benefits they could bring when shared with patients.
In fact, before the Health Insurance Portability and Accountability Act, a federal law enacted in 1996, patients generally had to sue to see their records. HIPAA, as that mouthful is abbreviated, affirmed that patients have a right to their medical information. But the process for obtaining records was often so cumbersome that few patients tried to access them.
In 2010, Tom Delbanco, an internist, and Jan Walker, a nurse and researcher, started anexperiment called OpenNotes that let patients read what their primary care providers write about them. They hypothesized that giving patients access to notes would allow them to become more engaged in their care.
Many doctors resisted the idea. Wouldn't open medical records inhibit what they wrote about sensitive issues, such as substance abuse? What if patients misunderstood the notes? Would that lead to more lawsuits? And what would patients do with all the information anyway?
After the first year, the results were striking: 80 percent of patients who saw their records reported better understanding of their medical condition and said they were in better control of their health. Two-thirds reported that they were better at sticking with their prescriptions. Ninety-nine percent of the patients wanted OpenNotes to continue, and no doctor withdrew from the pilot. Instead, they shared anecdotes like mine. When patients see their records, there's more trust and more accuracy.
That day in the Boston ER was a turning point for me. Since I started sharing notes with my patients, they have made dozens of valuable corrections and changes, such as adding medication allergies and telling me when a previous medical problem has been resolved. We come up with treatment plans together. And when patients leave, they receive a copy of my detailed instructions. The medical record becomes a collaborative tool for patients, not just a record of what we doctors do to patients.
The OpenNotes experiment has become something of a movement, spreading to hospitals, health systems and doctors' offices across the country. The Mayo Clinic, Geisinger Health System and Veterans Affairs are among the adopters so far. (The OpenNotes project has received funding from the Robert Wood Johnson Foundation, which also provides financial support to NPR.)
But there are new controversies arising. Should patients receiving mental health servicesobtain full access to therapy records, or should there be limits to open records? What happens if patients want to share their records on social media? Will such "crowdsourcing" harm the doctor-patient relationship? What if patients want to develop their own record andvideotape their medical encounter? Are doctors obligated to comply?
Delbanco tells me that he considers OpenNotes to be "like a new medication." Just like any new treatment, it will come with unexpected side effects. In the meantime, patients and doctors don't need to wait for the formal OpenNotes program to come to town. Patients can ask their doctors directly to look at their records. Doctors can try sharing them with patients, in real time, as I do now. It's changed my practice, and fundamentally transformed my understanding of whom the medical record ultimately belongs to: the patient.
Wen is an attending physician and director of patient-centered care research in the Department of Emergency Medicine at George Washington University. She is the author of"When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Care," and founder of Who's My Doctor, a project to encourage transparency in medicine. On Twitter:
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Some healthcare providers have figured out the best set of IT tools to get patients more involved in their own care.
Patient engagement may have started as a Meaningful Use rule that providers had to follow to obtain electronic health record (EHR) financial incentives, but it has taken on a life of its own in several forward-thinking health systems.
The Cleveland Clinic, for instance, has done some impressive work in this arena. Many providers are offering patients the ability to make appointments on their websites, but Cleveland Clinic's family health centers now put their clinician's entireschedule up so that patients can make their own appointments. That's customer service.
They are also opening up their medical records in ways that most providers have been reluctant to do. They're putting lab results and medical imaging results online and eventually plan to post physicians' notes after each patient's visit. They also have a pilot project in the works that allows patients to enter data into their own records, which may help clinicians monitor patients' progress in controlling blood pressure, blood glucose and other measurable parameters.
Mayo Clinic, not wanting to be left behind in the race to get patients more involved in their own care, has developed a popular app that originally started as a mobile map to help patients find their way around its huge campus. It has evolved to include appointment calendars, access to radiology and lab reports, even suggestions on where to eat when they come to the Rochester, Minn., facility. Patients can also see a portion of their electronic medical record, their medication lists and patient summaries.
The consumerization of healthcare isn’t a passing fad, according to PwC’s U.S. health industries leader, Kelly Barnes.
“Healthcare organizations are increasingly operating in a world in which the voice of the consumer impacts the bottom line, and where customer experience is now a matter of dollars and cents.”
“As consumerism in healthcare gains steam, customer feedback has become a determining factor in the success of health organizations. Ratings connect consumers’ experience to quality, and quality connects to financial performance, market share and reputation.”
And if that doesn’t impress you, then this might:
68% of people who’ve read healthcare reviews use that information to select their next physician, hospital, health plan, pharmacy, and drug or medical device, according to a recent survey from PwC’s Health Research Institute.
The writing is on the wall.
Patients can and will shop around when they have to use more of their own money to pay for healthcare, and there are better channels of communication and information available to make those decisions.
Which means the way you reach them, engage them, and retain them has to evolve as well.
But is Social Media in Healthcare Good for Physicians Too?
Last year, a study in the Journal of Medical Internet Research surveyed 485 oncologists and primary care physicians.
60% of those physicians surveyed reported that social media improves the quality of patient care they deliver on a daily basis. It helps with receive new information, and engage with colleagues or patients.
One of the authors on that paper, Brian McGowan, also does a great job summarizing a few other key studies on his blog, #SocialQI.
Technology and social media are playing a big role how patients choose new physiciansThis trend is legitimate and growing according to industry experts, andThe majority of other physician’s surveyed rate social media as beneficial
Then… what are you waiting for?
There are a few common reasons (or excuses). And some are very real.
Take patient confidentiality for starters. A recent research paper from the American College of Physicians and the Federation of State Medical Boards identifies a few major points in regards to physicians using online media technology (that I’ve taken the liberty of summarizing for clarity below):
Be mindful of ethical principles in regards to confidentiality, privacy, respectTry to keep professional and personal social spheres separateDocument patient communication and stick to email (when there’s consent)“Self-audit” your own online presence to make sure the information is factual and accurateBe aware that these online postings will be around a long time (and could have future implications)
All of these points are important to keep in mind. But they’re also pretty straight-forward and obvious.
Which could mean a lot of physicians hold back on using social media because they’re not sure where to get started, they don’t have a mental framework for how it fits in their life, and they don’t understand the impact it has.
So here are three simple questions you can work through below, that will help you adopt new online media technologies into your daily routine and practices.
Question #1. Why Would You Use It?
Most lackluster social media results can be directly attributable to a disconnect between the (a) purpose and (b) execution.
If you can’t define success before you begin, then it will never make a positive dent in your daily routine (no matter how many times you update a Facebook page or send out a Tweet).
This simple decision affects everything else. For example, what platform should you choose to focus on? (Because in most cases, you can’t excel at all of them.)
So do you want to…
Stay informed and on top of the latest news? → TwitterKeep up with colleagues, associates and opportunities? → LinkedInEngage with patients and provide support? → FacebookIncrease your organization’s “reach” and “awareness”? → Yelp
Start here, and then you’ll have a framework for guiding the next few decisions.
Question #2. How Are You Going to Manage It?
Now that you know why, let’s talk about how.
What’s your role in the process?
Are you going to be a hands-on patient advocate, or would you rather outsource and let someone else worry about it?
Doesn’t matter which one you choose — you just need to prepare accordingly.
If you want to be heavily involved, then pick up some “time hacks” to speed up your social media productivity.
And if you want someone else to manage it, then what’s the relationship (e.g. a resident, independent vendor, etc.), and what are the checks and balances?
A simple policy might help, but you’ll also need to think about your purpose (#1), and what are the concrete steps that will get you closer to achieving it.
Question #3. What’s the Feedback Loop?
If you (a) know the purpose behind an activity, and (b) can see who’s responsible, then you’ll know exactly how to measure the performance over time.
And you’ll be able to see how it contributes to your thought leadership, patient care, or the bottom line.
If your goal is thought leadership, then identify some simple simple actionable metrics, like articles published, interviews given, and colleagues contacted.
If you want to improve patient care, then how easily can they reach you, how often do you respond, which channels should you have a presence (like Yelp), and how many reviews per month can you incentivize?
And if you want to improve your bottom line, then you can even use an old copywriting framework — AIDA — which stands for:
AttentionInterestDesire (or trust)Action
Now plot a few simple metrics like so:
And link your activities to each of these stages, which will help you rationalize (or justify) the time, money and energy it takes.
But take caution with this approach, because unrealistic expectations can also be damaging to your progress.
Social media hasn’t changed communication or marketing — it’s just changed the delivery and distribution.
So if you want social media to build your practice and improve your bottom line, then like most brand-building marketing activities, you can’t sell directly with it (at least, not all the time). It’s hard to pinpoint a direct ROI like there is with direct mail or Google AdWords.
And correlation doesn’t always equal causation.
So… how are you supposed to use social media to improve the bottom line?
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