Wednesday, February 18, 2009

Personal Physician, Paul Grundy - The Importance of Personal Primary Care-Patient Relationships

Prelude: What follows is the text of a speech Dr. Paul Grundy, Director of Healthcare Transformation at IBM, is giving as he crusades around the country, speaking to legislators, governors, policy makers, physicians and anyone who will listen about the importance of personal primary care physicians for patients, as embodied in the concept of the medical home.

Last year, Dad died in Houston, Texas, at age 87 of congestive failure with complications. He had multiple specialists but no personal primary care physicians. Dad had no personal doctor to whom I could turn to help me and my family understand the totality of what was going on.

As Director of Healthcare Transformation at IBM, Dad’s death brought home to me why I am fighting so hard to change the care we buy for our employees and dependents. That change is the patient centered medical home. The medical home focuses on providing better and more comprehensive primary care. For our employees, this case will serve as a “fence” to reduce the “ambulance fleet” of expensive specialists at the bottom of the expense cliff. Present care costs are unsustainable at IBM and the U.S. as a whole.

In a February 6 New York Times piece “UnitedHeath and IBM Test Health Care Plan “, I called the present care IBM buys as “garbage.” Perhaps “garbage” overstated the case. But the lack of coordination in my father’s case frustrated me.

We have to make healthcare, institutions, and industries smarter. Not just at moments of crisis like we see today, but integrated into our day-to-day reality. Our current healthcare processes are not simply not smart enough to be sustainable.

Think about how many of the medications we prescribe that go untaken or interact badly with other medications anoth er doctorgives you. We lose tens of thousands of lives every year because we do not have the data and systems in place to address the simple issue of medication.

Here’s where technology can help. A computer can provide connection and memory for a doctor’s brain. Just as an x-ray allows the doctor’s vision to expand, it’s health IT that allows his mind to expand and be connected in real time to thousands of other minds and to real data thatmakes a difference.

In truth, the health care system isn’t a “system” at all. It’s antiquated. It doesn’t link diagnosis, drug discovery, healthcare deliverers, insurers, employers, and employrs. Meanwhile, personal expenditures on health now push more than 100 million people worldwide below the poverty line each year.

Smart healthcare can lower therapy costs as much as 90 percent. That’s what ActiveCare Network, based in Columbia, South Carolina, is doing for more than two million patients in 38 states. ActiveCare monitors delivery of people’s injections and vaccines so they can lead active and independent lives.

The single most important part of healing is=2 0the patient-personal physician RELATIONSHIP. It’s healthcare’s backbone. Smart healthcare supports that relationship by improving communication, allows expanded communication with a patient, and empowers the doctor.

Personal doctors tend not forget to ask an important question, be it about the patient’s personal life or a key fact to the healing process. Smart healthcare can send little reminders of care compassion and express a doctor’s investment in a person who needs a healer and healing.

A smart healthcare system can help with compassion by reminding the patient of important things that would otherwise be missed in a busy doctors life like e-reminders of a visit, or that mammogram that was forgotten to be completed.

Smart healthcare makes sure that the right drug is used on the right patient at the right time, taking into account the person’s genetic makeup other medications they are taking. It ensures authenticity of pharmaceuticals and security of patient information. It changes everything from how healthcare organizations do business to how they enable their employees to collaborate and innovate.

In the U.S., we at IBM estimate that smart healthcare will generate lots of new jobs in companies small and large, but most will=2 0be small. In a recent conversation with the Obama administration, IBM’s CEO Sam Palmisano estimated that widespread adoption of personal health records will create 212,000 jobs.

I’m not just referring to large enterprises, but also to smaller and mid-sized companies— engines of economic growth. When we think about systems like healthcare supply chains, healthcare delivery, care management, prevention, we’re really talking how hundreds, even thousands of companies, most of them are small, interact.

In the Mid Hudson valley here in New York, we’re already on the path to deliver integrated health IT to all doctors and hospitals. This has created small companies like Med Allies in Fishkill, whose 40 employees work with doctors’ offices to get them up and running with health IT and keep them connected in a powerful and useful way for the patient. In North Dakota, there is a small company called MDdatacore that provides the register for all the doctors in North Dakota. It now employs 42 folks.

Smart healthcare is giving rise to a new model for primary care, the “medical home.” About three years ago, the people at IBM started talking about all the things that large employers in the U.S. have done to reduce costs and improve quality. We realized we were failing to address a fundamental issue: primary care and the doctor patient relationship.

Shortly after that, I helped found the Patient-Centered Primary Care Collaborative (link PCPCC), a coalition of large employers, consumer organizations and medical providers.

We developed a healthcare model based on the premise that more holistic. Primary care saves money by cutting the incidence of major health problems like heart disease or diabetes later in life. It’s a back-to-the-future approach to the family doctor, enabled by IT.

In the medical home model, a primary care physician acts as a healthcare coach – leading a team that manages a patient’s wellness, preventative and chronic care needs. The doctor spends more time with the patient in person, is available for consultations via email or phone, and has expanded hours and coordinates across an entire care team – nurses, specialists,
pharmacists and hospitals.

A diabetic could give daily blood test readings by phone, email or remote monitoring device and get instructions the moment she needs them, rather than wait for an appointment. Her care team would have a holistic health plan that focuses on diet and exercise as well as monitoring glucose levels.

This is already happening outside the U.S. In the U.K., they have adopted a similar “family doctor” model that makes healthcare more accessible and effective – and makes patients happier.

Electronic health records – central in the U.S. healthcare stimulus bill – are pivotal to making medical homes work. EHRs are the single source of information that can be shared across a network of providers and specialists. There are other IT tools that can help patients and doctors alike – online portals to make appointme nts or look up lab results, or e-prescribing.

Health analytics can look across a patient’s history and pick up trends that provide insight into the treatment of a disease. The list goes on. But it is important and cannot be stressed enough. That technology supports the care and compassion in the doctor patient relationship but will not replace that or even get in the way of it.

Over the next couple of years, there will be winners, and there will be losers. And though it may not be easy to see now, I believe we will see new leaders emerge who win not by surviving the storm, but by changing the game.

The importance of this moment, I believe, is that the key precondition for real change now exists: People want it.


housedoc said...

Another way by which technology can enhance the patient doctor relatioship is by making communications easier, using email instead of the phone. There is already a web site that provides that service at The service is available to everyone, is free, HIPAA compliant, and user friendly.

Anonymous said...

Patient-Doctor relationship is very important. A simple misunderstanding sometimes can lead to more serious matter.
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