Patient-Centered Computing: Are the patients ready? Are we?

1
Patient-Centered ComputingAre the patients
ready? Are we?

• Patti Brennan, RN, PhD
• University of Wisconsin-Madison
• Preparation of these remarks was supported by
  grants from the Agency for Health Care Policy and
  Research, the National Library of Medicine,
  Intel Corporation and the Moehlman Bascom
  Professorship

2
Consumer Health Informatics

• What it is, and what it is not!

3
Consumer Health Informatics Delivering
informative, relevant Information directly to the
individual
4
Consumer Health Informatics Innovations

• Patient Portals
• PatCIS (CPMC)
• Patient Gateway (Partners)
• MyAurora.com (Aurora Health Systems)
• Health-related Web Sites
• Remote sensing and monitoring
• Device-based assessment coaching (beepers,
  telephones)
• Planning analysis and decision support tools

5
CHI version 1.0 Push information into the
lives of patients
6
CHI version 2.0 Information, communication
companionship
7
Critical Questions

1. How does consumer health information facilitate
   and/or interfere with the clinical health care
   process?
2. Are informatics professionals adequately trained
   in the patient perspective or is systems
   development training overly grounded in the
   provider perspective?

8
How does consumer health information facilitate
and/or interfere with the clinical health care
process?
9

• First, one must define the clinical care process

10
How does consumer health information facilitate
and/or interfere with the clinical health care
process?

• The view from the industry

11
When and where doeshealth care happen?
The Patients view
12
The Contexts of Care

• Living Environment
• Homes
• Communities
• Social Environments
• Families
• Cultural Groups
• Psychological Environments
• Illness representations
• Human Information Processing
• Technological Environments
• Broadband, Telecom, household
• Health Services Environments
• Care delivery

13
How does consumer health information facilitate
and/or interfere with the clinical health care
process?

• Cognitive
• Provides content
• Behavioral
• Builds skills
• Motivational/attitudinal
• Promotes peer support
• Logistics
• Storage and organization of content
• Management of contacts
• Reminders Schedulers

14
A short view on the reality of logistics

• The typical lay person in our study
• Views their health better than that of their
  household members
• Receives health information from about 10 sources
• Manages information for the household

15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Are informatics professionals adequately trained
in the patient perspective, or is systems
development training overly grounded in the
provider perspective?
20
Challenges in CHI design

• Who really is the user?
• Patient vs. carepartner
• How does the designer know the user?
• The reflexive user
• users are just like designers
• The configured user
• design encourages some forms of use, not others
• The projected user
• design based on users with specific tastes,
  competencies, motives, aspirations, political
  prejudices, roles
• What is the role of the user?

21
Current views on patients

• Flat and silent
• Provider-centric
• Institutional accountability
• Professional responsibility
• Systems orientation
• Task focused

22
Readiness assessment

• Patients
• Almost!
• Existing skills and workable strategies
• Technology assessment
• Expectation of empowerment

• Medical Informaticts
• NO!
• Incentives to optimize the clinical enterprise
• Models and design strategies do not scale beyond
  organizations
• Philosophical alignment with clinical disciplines

23
Contact us! pbrennan_at_engr.wisc.edu healthsystems.
engr.wisc.edu
24
Most Important Nurse Caring Behaviors

• Know what they are doing
• Make me feel someone is there
• Know how to take care of me
• Know how to handle equipment
• Know when to call MD
• Do what they say they will do

25
Patients (and Nurses) Ratings
26
Nurses (and Patients) Ratings
27
Top Patients Preferences(Rank Order)

• Compassionate
• Being Kind
• Maintain Confidentiality
• Trust
• Get Answers to Questions
• Being concerned for total wellbeing

28
Top Nurses Preferences(Rank Order)

• Make patient feel as an individual, not a room
  number
• Confidence
• Non-judgmental
• Trust

29
What do patients want from nurses?

• Motivate, monitor, mentor and mend
• Information broker
• Service referral
• Care!

30
The contemporary context of health care