Wednesday, December 13, 2006

clinical innovations, what to expect -Twenty Clinical Innovations to Build Patient-Doctor Trust: Second in a Series

Deepening Patient Understanding of What to Expect from Surgery, Procedures, Disease, and Health Care Interactions

Give the matter any thought at all, and you will realize much of what is wrong with the health system can be traced to this simple reality:

Patients don’t understand what to expect from invasive procedures, complications of disease, benefits of complying with medical instructions, an gaps in countless health care interactions.

Nobody’s Fault in Particular

This lack of patient understanding is nobody’s fault in particular. Medicine is a complicated, highly specialized profession. People often visit multiple specialists, each with a slightly different take on their problems. Business dealings of health organizations may be Byzantine, secretive, mysterious, and unfathomable. Disease strikes when you least expect it. Furthermore, with each new health interaction, you may be experiencing something highly personal, health-robbing, and even life-threatening for the first time.

As a patient, you may have asked: Why didn’t someone explain this problem to me and my family clearly in simple language and with graphic drawings or illustrations what to expect? Why wasn’t I more informed of hazards and benefits of my encounter with my doctor and the health system?

Lack of Understanding

Answers to these questions may come down to a lack of understanding. Here is how a company called Emmi Solutions puts it:

“There's a health literacy crisis in this country that, according to the Institute of Medicine, costs as much as $58 billion a year. An estimated 90 million Americans don't understand or act on health information, don't fully understand the consent forms they read, and don't understand or remember what they hear in a clinical setting. Poorly informed patients are more likely to be noncompliant, more apt to suffer complications from medication errors, and are at higher risk for hospitalization."

“Add the stress of the clinical encounter and health worries to the mix, and it's easy to understand the urgent need for a simple, reliable, and powerful healthcare communication solution that manages expectations and calls patients to action.”
Founding of Emmi Solutions (

Doctor David Sobel, a Chicago urologist, and his wife, Michelle, founded Rightfield Solutions, the forerunner if Emmi Solutions in 2001. Emma stands for Expectation Medical Management Information. The basic mission and vision of the company is to educate patients, communicate with them clearly, and manage patient expectations
Sobel shared with Michelle his concerns about limitations of informed consent forms in telling patients what to expect from surgical procedures. As a solution, Michelle suggested an online interactive pictorial voice-guided video “prescribed “ to patients before surgery as an effective means of deepening understanding of patients’ and their families.

Emmi solutions’ video voice explains “This will be pretty simple,” as indeed it is, being expressed in language at the 6th grade level with supporting pictorials.

Everybody “Gets It”

To make a long story short, the idea of simple-to-understand interactive videos has caught on fast. It is a win-win-win-win-win Physicians like the videos because they save time in explaining what to expect – simply, consistently, and comprehensively. Patients and their families like the videos because they understand what’s about to take place. Hospitals and health plans like the videos because they reduce misunderstanding and win patient loyalty. Malpractice carriers like the videos because they document what was explained. Everybody involved likes the videos because they educate patients in a consistent, relevant, and timely fashion that helps compliance with medical instructions. Everybody, in short, “gets it.”

Patient Education at Point of Care Not New, But Timing Is

Patient education using interactive technologies at the point of care is not a new idea. Weinberg and associates at Dartmouth, Bachman at Mayo, and others have pioneered and explored the use of multimedia interactions to educate patients about prostate cancer, chronic diseases, colonoscopies, and other procedures.
What is new are three major developments: 1) the growing ubiquity of the Internet and broad band access in multiple settings – doctors’ offices, hospitals, health plans, consumer websites, Internet cafes, information kiosks, public libraries, 2) increasing ease, simplicity, and functionality of Web use; 3) emphasis of major organizations, such as the Institute of Medicine, on what patients should expect from the system.

Ten Simple Rules for Meeting Patient Expectations

The Institute of Medicine has issued these 10 “simple rules” for meeting patient expectations:

1) Care should be based on continuous relationships.
2) Care should be customized for patient needs and values.
3) Patients should be the source of control.
4) Knowledge should be shared and information should flow freely.
5) Decisions should be based on evidence.
6) Safety should be a given.
7) Transparency is necessary.
8) Patient needs and understanding should be anticipated.
9) Waste and duplications should be continuously decreased.
10) Cooperation among clinicians is a priority.

To these ten points, I would add: For a truly “patient-centered system,” understandable and timely patient education and communication at every point of health care interaction is fundamental if we are to build enduring patient-physician trust.

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