In an earlier blog post, I described my dream for a patient-centered, technology-driven healthcare system that I am hoping will become a reality someday in the not-too-distant future. In this first of several healthcare scenarios, a simple sick care case is described to give you an idea of how this future health delivery system would function. In particular, this simple sick care case will highlight how the application of information technology and patient-engagement could greatly enhance the functioning of all aspects of our health care system. In this future health care delivery system, the successful engagement of the consumer both before sickness health and after sickness care takes center stage.
Jack—A simple sick care case
Jack has spent the night throwing up and experiencing stomach cramps and vomiting. Although his vomiting has stopped, Jack feels sick enough to seek medical care. Jack has the ability to go online to his local healthcare facility’s website to pre-register for an appointment, but chooses not to take advantage of it because the last time he went to the healthcare facility, he was seen pretty quickly. Online pre-registration would have given Jack advice based on his symptoms, and sometimes instead of booking an appointment, he might have been given educational information, suggested home remedies to try, and/or told to wait one more day before seeking one-to-one care. Often if given sufficient information and education, the healthcare consumer can learn to recognize when a simple sick care case calls for seeking professional medical care immediately or when it can wait to see if it improves with time and effort within the healthcare consumer’s resources.
Jack goes to his local community healthcare facility (open 24 hours a day/7 days a week) to check out his health problem. He pays a nominal copay. Local healthcare facilities are scattered across communities (much like police and fire facilities). Jack is greeted by a trained healthcare employee (Kelly), who is one of the facility’s “medical traffic cops”. This job is very important and requires good listening, observational, and “people” skills. Jack’s interactions with Kelly have always been pleasant and as usual, she eases some of his feelings of distress.
Checking In for A Simple Sick Care Case
Kelly scans the Jack’s health identification card and asks him why he is seeking service at the healthcare facility. He chooses to have Kelly input his symptom information instead of inputting it into the computer’s consumer-friendly symptom program. Kelly handles healthcare customers who are unable to do the registration on their own. In this technology-driven healthcare system, the non-emergency patients (or their patient advocates) have the obligation to describe their medical complaint as completely as possible. If they are not very good with words, the computer symptom program (with pictures) is designed to help. While Jack is put to work inputting the information about his newest symptoms into his Electronic Health Record (EHR), Kelly has placed him into the “after sickness” care (and not “before sickness” or emergency care) queue. The computer evaluates all health situations currently at the health facility and ranks them from the least urgent, simple care case requiring minimum healthcare professional care to the most urgent complicated care case requiring multiple, coordinated care.
With the graphic-based symptom system, Jack records his symptoms quickly. The computer asks Jack about the last meal (including drugs and alcohol) he consumed. As the computer brings up a list of Jack’s most recent healthcare visits, his allergies, and his pre-existing conditions. Jack views his list of current medications for verification. Jack lets the computer know that one of his prescription drugs listed is no longer in use. There is no need to verify health insurance coverage because everyone is covered under a single- payer universal healthcare system. Kelly notes the patient’s discomfort but with the help of the computer resources, determines that care does not require emergency care.
Jack’s weight, temperature, blood pressure, and pulse rate are taken and the information is directly transferred into Jack’s Electronic Health Record (EHR) file. Within a very short time, the supercomputer is capable of analyzing large amounts of medical data (Jack’s medical history, drug interactions, evidence-based clinical guidelines, and symptom databases) and will present Kelly with a healthcare plan of action for his care. This plan of action determines which healthcare personnel Jack will see next. In Jack’s case, the most probable diagnosis obtained by the computer is that Jack has food poisoning (95% confidence) because Jack is the third person with the same symptoms seeking medical care after eating at one particular local restaurant.
While waiting to be seen by the appropriate healthcare professional, Jack can choose to view a short educational (and entertaining) online video or interactive game that is targeted to his particular health situation. For Jack, he might view a video about what to do if you suspect food poisoning or play a game that reinforces nutritional eating.
Seeing the “Doctor” in A Simple Care Case
Given the guidance from the computer, Jack is seen by Tom, a non-physician healthcare professional. In the healthcare facility, the computer determines the level of expertise needed to treat Jack’s problem in the most cost-effective way. Jack is taken into an examination room where Tom is already viewing Jack’s likely diagnosis and other computer-generated summary on the computer screen. Jack is told that he likely experienced the symptoms of food poisoning, what he needs to do over the next couple of days, and what he should watch out for if his symptoms do not improve or others develop. Tom tells him to drink plenty of liquids over the next several days to make sure that he doesn’t become dehydrated. Tom waits for Jack’s response and listens if he has any other concerns.
Tom notes that the Jack had lost 10 pounds in the past three months and had been attending recommended nutritional and exercise classes. Tom asks about the weight loss to make sure it was not related to his newest medical condition. Jack tells him that at his past yearly checkup he was “incentivized” to lose weight and the weight loss was the result of better life style choices and not attributed to any stomach problems. As part of the before sickness health care emphasis, Tom congratulates Jack on his successful program of weight loss and tells him to keep up the good work (and jokingly, to stay away from that restaurant). In this future healthcare system, obesity prevention has taken center-stage in federal health policy.
Jack is invited to view a short video describing how food poisoning is treated. This information will be reinforced with text messages over the next couple of days giving Jack an option to come in again for more testing if his symptoms have not improved. Jack can also review all the information at home on his home computer. Before he leaves, Jack answers several questions about the care he received. The information is collected to assess the quality of care delivered by the particular healthcare professionals and is used to evaluate personnel and improve care in the future.
Summary and Disclaimer
The medical scenario (a simple care case) described above is not to be taken as medical advice but rather as an example of how a patient-centered, technology-driven healthcare system of the future might function. I am not a medical professional and all details from this simple sick care case may not be exactly what constitutes the “best” care. The focus in such a system would put the well-being of the healthcare consumer over the financial interests of healthcare businesses. This future healthcare system would use healthcare resources to deliver maximum healthcare value, use healthcare resources in the most coordinated way, and treat healthcare consumers as essential stakeholders in their own health care.