Archive for the ‘Donna Cryer’ Category

Guest Blog: A Patient’s Perspective on Improving Care Transitions

Donna Cryer
Friday, October 28th, 2011

Donna Cryer, JD, is Chief Executive Officer of the health care strategy firm CryerHealth in Washington, DC, which guides pharmaceutical, biotech, and diagnostic firms in their alliances with patients and physicians. A liver transplant recipient, Mrs. Cryer has experienced frequent and varied interactions with the health care system, giving her a unique perspective on the patient experience. Mrs. Cryer has been named to a five year term as a Patient Representative to the U.S. Food and Drug Administration, serves as an advisor to the Institute for Patient-Centered Design, and has spoken on the topic of E-patients at the National Institutes of Health and the American Academy of Sciences. She blogs about patient advocacy issues on DCPatient – An Impatient Patient’s Perspective on Health Care Today. To read more from Donna, subscribe to her RSS feed.

Two recent speaking engagements provided me the opportunity to think deeply about the discharge process, an area of healthcare delivery rampant with errors and missed opportunities to support sustained healing and health for patients. This is an area of keen interest to me as I have experienced the discharge/transition process 16 times ( I may have lost count in there somewhere) as a patient and twice as a caregiver to spouse and parent.

On October 20th I delivered Grand Rounds at Montgomery General Hospital. My topic was Patients as Partners in Quality Care Improvement.

On October 13th I had the privilege of being the patient speaker at an event focused on identifying opportunities for technology to improve the transition of patients from acute care settings to home or a rehabilitation or long term care facility.  “Putting the IT in TransITions” was convened by the Office of the National Coordinator for HIT as well as the John A. Hartford Foundation and the Gordon and Betty Moore Foundation in Washington, DC at the Kaiser Permanente Center for Total Health.

The three questions posed were:

1. What are the most important problem statements from the patient’s and caregiver’s perspective that require our attention?

2. Where is IT effectively addressing these challenges now?

3. Where is innovation most needed now?

The invited attendees participated in breakout sessions to brainstorm on the four particular areas of transition:

1. Discharge process

2. Medication reconciliation

3. Information flow and feedback

4. Patient and care-giver activation

 Below are some of the key points from my presentation.  The entire webcast can be seen at http://www.visualwebcaster.com/event.asp?id=82572.  (I start at minute 42)

Successful discharge begins at or before admission.

Reducing readmission is based on addressing the totality of the circumstances that a patient encounters when they leave the hospital.

Opportunity 1: Accurate electronic transmission and appropriate exchange of a patient’s medical history, including known allergies and other alerts can aid and speed diagnosis, avoid unnecessary tests and scans, avoid repeating failed treatments, and laser focus on will work. [Tech Op:  Portable Patient Health Record]

Opportunity 2: Sharing information, including lab values, with patients and caregivers in real time creates trust, and leverages the ability of patients and families to spot errors and omissions.  An EMR is only as good as the information is used. [Tech Op:  EMR]

Opportunity 3: Coordinating, accelerating the integration and conflict resolution of information across specialists is an essential HIT function that power to truly impact care and bend the cost curve in the management of complex patients.  As a liver transplant recipient for underlying autoimmune conditions that manifest in GI and other areas I need to get sign off from all groups before discharge.  This has often taken a full days worth of nurse-hours to procure. [Tech Op: EMR]

Opportunity 4: Beginning the education process – nutrition, self-care, new medication regimens – long before the discharge day would provide an opportunity for patients to begin formulating questions for medical staff in a more timely fashion and start the process of strategizing how to adhere. [Tech Op: Ipads loaded with videos, links to Medline, patient disease state communities]

Opportunity 5: Customized, tailored discharge plans can be populated and continuously updated throughout the hospital stay, triggering communications to long term stay or rehabilitation facilities for certain conditions, orders for medications, equipment, even groceries that meet a prescribed dietary change.  Everything a patient needs to do or have for the immediate post-discharge period needs to be ordered, arranged, scheduled and delivered before they leave the hospital. No exceptions.  Patients are sick, tired, happy to finally be home.  Caregivers and sick, tired, happy to finally be home.  They may not be able to leave the patient to run between pharmacy, grocery store, medical supply once they get home.  Follow up calls to physicians and often not made in the return to home life.  Let’s say good bye to the scribbled sheet of paper with vague generic instructions hastily put together in the final hours of a stay.  [Tech Op: E-prescribing, Peapod/Safeway grocery delivery, RHIE to link to appt scheduling]

Opportunity 6:  Provide resources to fill in the gaps for tasks the patient or caregiver would normally have to do at home instead of resting and healing.  A list of or links to childcare, respite care, lawn service, short- term concierge services, would both give permission to rest and help locate appropriate assistance.  Tools to help patient families organize their own communities for support would also be helpful.  There is a lot left on patient family shoulders even for those who have visiting nurses and other clinical support. [Tech Op:  Foursquare, Groupon, Caring Bridge]

None of these scenarios require anything more than technology we have available today. The reality is that transformation of the discharge/transition process will take a combination of change in workflow and culture in addition to technology.

If you are patient/caregiver who has used a technological solution to help with a care transition or a vendor who has or is working on a solution addressing one of these opportunities, please comment and let us all know.

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Guest Blog: Consumers v Patients

Donna Cryer
Tuesday, November 9th, 2010

Donna Cryer, JD, is Chief Executive Officer of the health care strategy firm CryerHealth in Washington, DC, which guides pharmaceutical, biotech, and diagnostic firms in their alliances with patients and physicians.  A liver transplant recipient, Mrs. Cryer has experienced frequent and varied interactions with the health care system, giving her a unique perspective on the patient experience.   Mrs. Cryer has been named to a five year term as a Patient Representative to the U.S. Food and Drug Administration, serves as an advisor to the Institute for Patient-Centered Design, and has spoken on the topic of E-patients at the National Institutes of Health and the American Academy of Sciences.  She blogs about patient advocacy issues on DCPatient – An Impatient Patient’s Perspective on Health Care Today.  To read more from Donna, subscribe to her RSS feed.

Although often used interchangeably, there are distinctive differences between consumers and patients in the context of health care.  Much is made of what to call those of us actively engaged in pursuing and receiving medical care from health professionals, and this post does not intend to settle that issue.  But after reviewing countless new conferences, pieces of legislation or regulation, coalitions, job titles and  grant opportunities, I’ve discerned a shift towards using consumers as the catch-all term to describe what are actually segments with different experiences, needs, views and behaviors within the health care system. 
Too often, I see the few seats at the table begrudgingly opened to non-physician, non-academician or non-corporate parties are filled by labor unions, general consumer groups and organizations whose average members may not have visited a doctor in years. Organizers, though, feel satisfied in checking off the patient representation box.

Consumers, in my personal dictionary, are members of the general public. Consumers may be perfectly healthy (or think they are) with little contact, or desire to be in contact, with the medical system.  The term consumer is also associated with rational, non-urgent, cost- and feature-comparison activities demonstrated in other industries with more transparent information sharing.

Patients, acute patients for the purposes of this post, are people with some illness or injury necessitating an interaction with the health care system.  They are not electively consuming goods or resources, but trying to secure the more effective treatment with the least amount of pain, time and cost (if there is a choice or information). Their experience with clinical settings and information may be short-lived and soon forgotten.  If there was no error or incidence involved, patients may return to their lives without having been significantly shaped or changed.

Patient Warriors, those patients with chronic diseases, diseases that are potentially terminal or that leave life-changing – and to whatever degree life-defining – marks (visible or invisible), offer something fundamentally different to the conversation.  Experiences over two decades with three conditions at four institutions with five (to the nth power) physicians, nurses, fellows, medical students and techs are quantitatively and qualitatively richer than that of an acute patient or a consumer.  Their cost calculations are too often: Should I buy food or medicine? Should I bankrupt my family to save my life? Should I pay these medical bills or my mortgage?

There is a great need from a population health perspective to reach all three segments, but the approaches and expectations of each should be varied.  Moreover, they cannot be substituted for one another for research, policymaking or other purposes.

Consider these questions:

  • Do consumers want access to their personal health records?
  • What role do patients want to play as part of their health care team?
  • Can patients be experts?
  • What is the consumer perspective on comparative effectiveness research?

These questions are almost meaningless as asked.  Consumers may not care one whit about access to a personal health record, but it may mean life and death to a patient warrior.  Patients (subject to individual preference and temperament) may want to be informed while patient warriors may want to be perceived as full partners or have endured for so long they just want the key decisions while they maintain a positive mindset.  Patients may not be interested in becoming experts. Patient warriors (often E-patients) may spend hundreds or thousands of hours reading, attending medical conferences, and questioning other patients and physicians.  Consumers may consider comparative effectiveness research as commonsensical as having Consumer Reports for other products and look forward to cost-savings.  A patient or patient warrior may be skeptical that a personalized treatment option may be made inaccessible to them.

The extent of interaction with the health care system and impact of health issues on someone’s life are the defining factors in determining these population segments.  If we really are to solve the myriad challenges affecting healthcare we can’t afford to be lazy in our language or our thinking about ensuring that all stakeholders are truly considered and engaged appropriately.

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