e-Patient Dave

Power to the Patient!

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“Back to the Future: Doc Tom’s e-patients emerge in shared decision-making” (post on the BMJ blog)

Visit the post on the BMJ blogI was honored (okay, thrilled) to attend last week’s Salzburg Global Seminar on healthcare, titled “The Greatest Untapped Resource? Informing and Involving Patients in Decisions about Their Medical Care.” (I mentioned it last month, writing about a historic Salzburg Seminar in 1998.)

This time more than fifty participants from fifteen countries met for five days to learn about SDM (shared decision-making) and related subjects, and discuss how we can change the culture of healthcare. I got the chance to address the group for 15 minutes one morning (that was fun!), and was invited to contribute thoughts for the blog of the British Medical Journal. “Doc Tom” Ferguson, founder of the e-patient movement, wrote several things for the BMJ, so I decided to tie this event to that precedent. The resulting post is here.
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Abington Memorial already *has* a shared care plan

In How Patient-Provider Engagement Can Transform Patient Safety I proposed a shared care plan, which the patient and family would be able to read. I just learned that Abington Memorial Hospital, outside Philadelphia, already offers a daily one. Click the image to see a PDF.

They have many anecdotes of medical errors that were avoided because the patient and family could see the plan, point out allergies, note things that didn’t get done during the day, etc.

How did they do this? Custom programming? Yes and no: it’s a report they created on their Eclipsys medical record system.

Wonderful! This is one example of the great potential of health IT, to leverage information for better care. Let patients help.

Hospitals, can you do the same? The people at Abington are happy to share.

Read Abington’s press release about the “CARE Plan” (Communication, Access to info, Resources & Education), for which they won a 2008 Magnet Prize.

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How Patient-Provider Engagement Can Transform Patient Safety (new article in PSQH)

I’m honored to be the author of a new article in Patient Safety and Quality Healthcare magazine (PSQH): “How Patient-Provider Engagement Can Transform Patient Safety.”

It’s a companion to a Special Interest Keynote titled “How Patient/Provider Engagement Can Transform Healthcare,” which my primary physician Dr. Danny Sands and I will deliver December 7 at the Institute for Healthcare Improvement (IHI) Forum in Orlando. It’s my cancer story as seen from our two perspectives, as physician and patient, in the age of the internet.

Earlier versions of the talk have been titled “Illness in the Age of ‘e’,” but this event calls for a change – because participatory medicine is now a full-blown movement, with its own medical society, with its Journal of Participatory Medicine as well as the e-patient blog. Plus, significantly, patient and family engagement is now part of Federal policy – it’s one of the “meaningful use” requirements for providers to earn financial incentives in the coming years.

Clearly, the age of participatory medicine – of patient/provider engagement – has arrived.

An early ally of the movement was Susan Carr, editor of PSQH. The patient safety movement clearly sees the value of patients and families being actively engaged in all aspects of care, so we talked this summer about how we really ought to do something together. Then we realized, the subject of our IHI keynote applies perfectly to patient safety, an important part of healthcare.
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Patient & Family Engagement for post-traumatic stress and traumatic brain injury, especially military families

I spoke this morning at an event outside Boston hosted by NAMI NH, the New Hampshire organization of the National Alliance for Mental Illness. The subject was “Best Practices in Mental Health, Prevention and Wellness for Military and their Families,” and to be blunt, a major issue is suicide prevention among veterans.

This video cites that in 2009, more veterans killed themselves than all the active duty soldiers who died in Iraq and Afghanistan combined – and many vets with war-related mental problems aren’t getting any services. Whatever your political views may be about the military actions themselves, this is a human tragedy.

I spoke about the patient engagement movement, starting with citing my own father’s service in World War II and my father-in-law’s – he returned not well, and though we can’t diagnose the dead, his lifelong explosive anger sounds like today it might be called PTSD. (I emphasize that we can’t know.)

Below are my slides. I sure wish my voice recorder wasn’t out of batteries – a lot was said that’s not in the slides. At bottom are the URLs for the resources I talked about.

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How to improve healthcare faster: a TEDMED minute

This past week I was thrilled to attend TEDMED, the medical offshoot of the famous TED conferences. (TED = Technology, Entertainment, Design.) I was invited to be one of the analysts sponsored by the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio, my kinda people: “The Pioneer Portfolio is powering ideas to transform health. We accelerate the trajectory of innovation … supporting exploration and helping great ideas to gain momentum. Pioneer focuses on the future, seeking breakthroughs with the potential to generate significant health and social impact.” Huzzah!

The Pioneer Portfolio funded the creation of the e-Patient White Paper, which blew my mind almost three years ago and set me on this path. (That paper’s at top right of www.e-patients.net.)

At TEDMED RWJF asked the analysts (and anyone else!) to record brief, informal videos on how to improve healthcare fast.  Here’s mine:

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The business of patient engagement: should consumers be regulated?

I edited the top portion at 8:14 pm ET, a few minutes after posting, adding the “key difference” paragraph. Sunday morning, added the Klick Pharma item under Income.

Last month in Cambridge I met Twitter friend Bryan Vartabedian MD (Twitter @Doctor_V) at a meeting at Vertex Pharmaceuticals. We’ll cross paths this fall on the conference speaking circuit. Today on his blog he raised a rowdy, rough, but valid point: as e-patients (obviously including me) get into the business, should they/we be regulated? He said:

  • Will industry be required to publicly list monies used for sponsorship, travel and swag support of high profile patients in the social sphere?
  • Should high visibility patients who serve as stewards and advocates disavow themselves of contact with pharma just as many academic medical centers have begun?

    • As is often the case, I don’t have an answer.  I’m just raising the questions.

Smart questions. My short answer:

  • Fine with me if industry discloses those payments. Nothing to hide.
  • Otoh, I think it’s nuts and counterproductive for consumers in any industry to disconnect.

Academic medical centers have tons of evidence of influence corrupting the academic processes that are at the core of (supposed) science. For patient advocates I don’t see that there’s currently a problem that would justify adding regulators, the ensuing budget impact, etc.

Besides, there’s a key difference: academics are supposed to vet industry. It’s their job in this context. Patients, on the other hand, are the consumers – the ones the industry’s supposed to serve.

As @Doctor_V suggests, healthcare is changing now that industry recognizes patients are worth engaging with. (I presume I’m one of his “high visibility” patients.) And this turned out to be the right time for some thoughts I’ve been meaning to express about my own work.

Introductory principles: [Read more…]