Face-to-face time with your doctor is often a matter of minutes. The fast pace of the U.S. health care system leaves patients feeling confused and uncertain about how to participate in their own healing. Physicians feel rushed and overwhelmed by seeing upwards of 25 patients a day. But some say it doesn’t have to be that way. Doctors and researchers are using online tools to open up new lines of communication that improve the doctor-patient relationship and let patients make the most of their brief, but important, time at the doctor’s office.
In Rochester, N.Y., in 2001, Dr. L. Gordon Moore started a nonprofit model for patient care called the Ideal Medical Practice (IMP). One of its main goals is to reduce the number of patients primary care physicians see each day. The IMP model helps physicians afford to see fewer patients by using technology like electronic medical records, Internet scheduling, and email to lower overhead costs. More than 500 physicians across the United States use the IMP model.
“[These physicians] need more time to better engage with people who are coming to them for all sorts of reasons,” Moore said. “They want to get off the treadmill, spend more time with their patients, and make themselves more accessible.”
Dr. Moore said that the emphasis placed on productivity leaves doctors short of time for explaining things or diving into issues that come up during a visit. Poor doctor-patient communication has negative effects, Moore said, including higher medical bills and worse health care outcomes. One of the key components of IMP is an online system that measures how patients feel about the quality of their care. HowsYourHealth.org, developed by Dr. John H. Wasson, provides Moore and other physicians in the IMP network with reports directly from their patients, whom Moore calls the “ultimate arbiters of the practice.”
“Doctors are using this tool to unmask a whole bunch of stuff that gets between people and the outcomes they want,” Moore said, “and then using that information as part of the mix to inform the clinical team on what they can do to help people to get good outcomes.”
Here’s how it works: After their appointments, patients log on to HowsYourHealth.org and respond to questions about access, affordability, clarity, and comfort. The system’s metrics quickly show physicians what matters most to patients and how confident they are in managing their own health problems. According to Wasson, physicians can also customize the HowsYourHealth tool to get concise information from each individual patient and real-time information from their entire clientele.
“The strongest driver of confidence is the quality of information,” Wasson said. “Therefore, as a patient, it is best to obtain information tailored to your needs and have a clinical team that is prepared to augment the information with support for health confidence.”
Dr. Rodney Hornbake, of Essex, Conn., commented on the HowsYourHealth website that he was better able to treat a recent patient because he could identify the patient’s lack of confidence in managing his condition. This led to a discussion of the patient’s concern over his newly implanted defibrillator. Hornbake said the patient left feeling much more confident about his health.
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Jan Walker, R.N., and Tom Delbanco, M.D., would like to see this type of access expanded, giving patients everywhere the ability to see not just their records but also their doctors’ notes. Walker and Delbanco are the principal investigators behind the OpenNotes Project, a one-year experiment in medical record transparency conducted at three major U.S. hospitals in 2010–2011. More than 100 primary care physicians and 200,000 patients participated. Patients were given secure online access to their doctors’ notes. “Even if you have your lab results and your medication list, it’s that note that ties it all together,” Walker said. “If patients can get access to that and read it, it makes them much more knowledgeable about what’s going on. And it also gives them a glimpse into what’s going on in the doctor’s mind.”
Walker described the doctors who participated in the yearlong study as “cautiously optimistic.” They said they could see the benefit in sharing their notes with their patients, but were hesitant because notes can be easily misinterpreted and can contain sensitive information.
But Walker insisted that all patients should be able to access their information, if they wish, to be completely involved in their own healing. She also commented on how helpful access is, as it’s easy to forget what happens during a hospital visit.
“People leave the office and they just don’t remember. And sometimes it’s important stuff, but you forget,” Walker said. “That’s another reason to have access to this note that the doctor writes after the visit. If you get home and you don’t remember, and it’s online, you just look it up.”
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