Sunday, May 1, 2016

A Modest Proposal to Boost Clinical Efficiency and Patient Health
The Megapolitics of the Information Age: The Triumph of Efficiency over Power.
Title of chapter in The Sovereign Individual: Mastering the Transition to the Information Age, Simon and Schuster, 1999
Everybody knows the American health system and the health law to reform it have been inefficient at lowering costs and promoting health of the general population.  
Everybody knows we live in the information age – the internet, computer networks, databases, modems, apps, iphones, social media, and electronic health records.  
Everybody knows a nation’s health depends not so much on a nation’s health system but more on its culture and its citizens’ life styles, poverty, family coherence,  and economic prosperity.    
Everybody knows that the United States exceeds other industrialized nations in its high rates of obesity, diabetes, prescription drug use, premature drug deaths.
Everybody knows we  trail most other countries in  longevity. 
Everybody knows the path to good health is proper diet, physical activity, and  everything in moderation. 
Lastly,  everybody knows that physicians and their effective interaction with patients are key in transmitting health information and in making any sound health system work more efficiently and effectively.
But how to integrate this information in an effective way, that is the question.
Patient Preparation Before Physician Visits (PPV)
I have a modest proposal, which I  call  “ Patient Preparation before  Physician  Visits (PPPV).  
After all,  all of us, soon or late, visit a physician,  for minor or major ailments, or  to see how sick or how well we are.   Most of us are now online and have access to online health information.    Most physicians have electronic health records, capable of receiving, transmitting, and storing  health information.  
There is now an obsession with one’s personal health  and how to preserve and maintain it.   
And there is a widespread  movement towards Patient Engagement, which includes  sharing health information with patients,  transferring monetary risks to them,  and initiating and   giving them more control over health decisions by allowing them to order and interpret health care tests on their health,  monitor their vital signs,   and control their own health destinies.    
That is the basis for  Medicare’s  periodic  wellness exams,   corporate  health and wellness programs, the renewed emphasis on long-term prevention rather than  treatment after the disease  horse has left the barn,  the obsession to monitor fitness using  wearable devices,  and the Theranos company’s attempt to allow patients to order 200 tests on a finger-tip drop of blood on their own without a physician’s orders.  The Theranos venture generated $9 billion value for the company, a vivid testament to the venture capital industry's interest in innovative patient engagements.
My Proposal
My proposal  is  straightforward and based on patient autonomy, and   patient preparation for a physician office visit using  existing information technologies.
One,  have  patients  prepare for a physicians visit by having them  record  on their own computers their vital signs (blood pressure, weight, height,  waist circumference, and so forth) using reliable and available devices.

Two.  have physicians re-order a panel of relevant clinical tests - such as glucose, total cholesterol and its components, creatinine, and renal and liver function tests.
Three,  have patients enter their  health information ( gender, age, state of health ,  family history,   chief complaint,  signs and symptoms using  computer interview  technologies  such as existing  the  tried and tested Instant Medical History. 

Four,  integrate vital sign and body measurement information, with Instant Medical History.
Five,  give health consumers the ability to generate  a report for themselves with  this type of HQ information on their health status –  0-50,  health problems exist, consult a physician immediately ,   60-75,  below normal health,  consult a physician,  75-125, within range of  normal health,  but could be improved,  125 or greater,  excellent health.
 This pre-visit preparation should  include   the patient’s  health status  compared to persons of their age and gender (a health IQ with a normal range of  75 to 125 is a useful marker) which can improved with better health habits;   and a brief  differential diagnosis of possible  health problems based on the demographic information and medical history with suggestions  before visiting a doctor.
This proposal promotes clinical  efficiency.  It saves physicians’ time in evaluating patient’s health, gives patients objective evidence of their health and disease status,  employs and integrates  the latest technologies,  and helps put patient in control of their health with physician input when appropriate and necessary.

On the other hand, the proposal raises certain questions -   Can patients  be trusted to enter their own demographic , vital signs, and body measurement data?  Can patients handle the objective results?   Can patients and doctors protect this highly personal data against hackers and now and future employers?  What would such an approach cost patients and the health system?  How would physicians and patients react to such a proposal?

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