Innovation-Driven Health Care, the Patient as the Centeor of the Universe, Copernicus, Patient-Centered Care, and Me

A Devastatingly Brief Tale about the Discovery of the Patient-Centered Universe, i.e., That The Health Care System Rotates around the Patient, Rather Than the Patient around the Health Care System

Finally we shall place the Sun himself at the Center of the Universe. All this is suggested by the systematic procession of events and the harmony of the whole Universe, if only we face the facts, as they say, “with both eyes open.”

Nicholas Copernicus, 1473-1543
De Revolutionibus Orbium Coelestium, 1543

I was speaking recently to Allen Wenner, MD, a family physician in Columbia, South Carolina.

Allen had just received a copy of my book Innovation-Driven Health Care. In it is a case study based on his founding and his work with the Instant Medical History, Inc. The Instant Medical History allows patients to electronically create their own history over the Internet before seeing the doctor by going to PatientCenter.com or by completing the Instant Medical History algorithm in his reception room.

Allen says 70% of patients complete the history before seeing him in the exam room (another 10% never show up at the office. They do not need to be seen for minor problems, so instead they do an e-visit.)

Allen’s collaborator in developing, using, and promoting the Instant Medical History is Dr. John Bachman, professor of primary care at Mayo in Rochester, Minnesota. Out of Bachman’s work has come Bachman’s Patient-Centered Law: No patient leaves the office without an electronic record containing details of their visit – history, exam results, and treatment plan.

But I digress. After reviewing Innovation-Driven Care, Allen commented, “Before you know it, you’ll be another Copernicus.” Nicholas Corpernicus, for those of you not in the know, was a Polish clergyman and astronomer, who spent the last 30 years of his life convincing the world that the Earth rotated around the sun rather than the other way around. His book, De Revolutionibus Orbium Coelestium, documenting his belief, was printed just before his death in 1543. Rumor has it, Copernicus carried it with him to his deathbed.

Well, Allen, I’m flattered. But I’m no Copernicus. I'm not even close. In health care, the belief that the health system rotates around the patient rather than the other way, around belongs to a galaxy of people.

• The Developers of WebMD, who believed and still believe the Web is the lever that will make patients the center of health care. WebMD, whose history dates back to 1995, describes itself this way:

WebMD is the leading provider of health information services, serving consumers, physicians, other healthcare professionals, employers and health plans. The online healthcare information, decision-support applications and communications services that we provide:

- Help consumers take an active role in managing their health by providing objective healthcare information and lifestyle information.

- Make it easier for physicians and healthcare professionals to access clinical reference sources, stay abreast of the latest clinical information, learn about new treatment options, earn continuing medical education credits and communicate with peers.

- Enable employers and health plans to provide their employees and plan members with access to personalized heath and benefit information and decision support technology that helps them make informed benefit, provider and treatment choices.

• Regina Herzlinger, PhD, professor of business administration at Harvard, who has steadfastly maintained and convinced the health care world that patients are perfectly capable of making intelligence health care decisions (see Consumer-Driven Health Care: Implications for Providers, Payers, and Policy Makers, Jossey-Bass, 2004). Her message is:

Consumer-driven health care is fundamentally about empowering health care consumers—all of us –with control, choice, and information. Consumer control will reward innovative insurers and providers for creating the higher-quality, lower-cost services we want and deserve. In this consumer-driven system, government will protect us with financial assistance and oversight, not micromanagement.

• Daniel Berwick, MD, of Harvard Medical School, founder of the Institute of Healthcare Improvement in Boston, where he preaches this gospel:

You might not think our health care system needs to be reminded to center its efforts on the patient But as the system has grown more complex and fragmented, and as providers feel more pressure to see more patients in less time, care has become centered not on the needs of patients, but around the needs of the system itself.
Care that is truly patient-centered considers patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient and their loved ones an integral part of the care team who collaborate with health care professionals in making clinical decisions. Patient-centered puts responsibility for important aspects of self-care and monitoring in patients’ hands — along with the tools and support they need to carry out that responsibility. Patient-centered care ensures that transitions between providers, departments, and health care settings are respectful, coordinated, and efficient. When care is patient , unneeded and unwanted services can be reduced.

• Steve Case, founder of AOL, who has sunk $100 million of his own money, into the Revolution Health Group, one manifestation of which is the revolutionhealth.com, a health care portal, created to revolutionize health care by putting the consumer at the center of health care. Revolutionhealth.com characterizes itself as:

Revolution Health is a health related portal site and social network. Users are urged to ask questions and answer other users’ questions, rate their doctors, participate in online discussions and otherwise contribute content. The site also has a number of tools to help people become healthier, such as a calculator that shows how long you need to do a given activity to lose a pound of weight, and a tool for showing you how much money an individual will save if he quits smoking. Every user has a profile page where they can link up to other users, set personal goals and aggregate content they’ve contributed to the site.

Allen and his friend, John Bachman,are part of this patient-centered galaxy, but I am not. I am a mere messenger. What amazes me is that the Copernicus-like message that health care rotates around the patient is that it took us so long to figure out that the patient – not providers, insurers, or policy makers -- is the center of the solar health system.