Thus, we’re talking about shared information, shared engagement, and shared accountability. It’s a three-legged stool. Those will be the pillars of the new relationship. And it’s difficult, right? Because expert information is what makes a profession. And I didn’t want this to be only about technology. But in the technology realm, this is the Martin Luther moment. With the information of the printing press, you could spread the Bible for everyone to see. That’s what’s happening here, in terms of information being spread. So when your FDA-approved wearable is monitoring you, the information could be as reliable as what your physician does. And so when that kind of expert information is now available without the priest-doctor being involved, that’s going to change the relationship.
One thing that’s clear is that younger healthcare consumers have a vastly different conception of the provider-patient relationship than do their parents, and certainly than do their grandparents. They’re really looking to physician to be expert consultants, but with the consumers themselves directing their care overall.
And there are times when you absolutely can’t understand the complexities of something and you have to trust your doctor—even if you’re another doctor. But to go to your point, in order for you to be able to trust in this new environment, you have to know that the clinician trusts you, in terms engagement and accountability.
And 80 percent of the time, we’re talking about people with well-known chronic diseases.
Yes, and also, the expected diseases of aging. And when you’re dealing with the diseases of aging and with chronic disease, the technology and the economics are both changing. And physicians often underestimate what Web 2.0 is doing—it’s not just web-searching, it’s interactive, personalized, algorithmically driven information that’s not perfect, not infallible, but really pretty good, and much better than you might think. And BTW, the American College of Surgeons has, out on the web, a tool for figuring out the risks of morbidity and mortality for certain conditions. And so we have a multi-polar world. And providers are used to thinking of insurers as insurers, but they’re managing risk by managing medical care in ways they never would have done before. Meanwhile, patient care organizations are taking on financial risk as never before. And so knowledge and technology and everything, they’re all crossing boundaries. And a lot of this can be disguised by simplistic talk about patient-centeredness, etc. And beyond the hype, it’s a true paradigm shift.
And the purpose of the article is really to tell clinicians, you really need to be participatory in this. I did after all write a book called Demanding Accountability. And finally, due to federal incentives, things are moving forward in these areas.
Do you have any specific advice for CIOs and CMIOs of patient care organizations, with regard to strategy around all of this?
I’m a big fan of CIOs and CMIOs. I think the really difficult and important task they face is to look at what I’ve written here and say, how do I prepare my institution for a cultural change being driven by information? And a CMIO or CIO can look at this—they need to ask, how can I look outside my own little insulated world of healthcare, where everything reinforces that I’m at the center of the world, in the healthcare system? How can I understand what’s going on in the world and help my organization to understand some things that are culturally uncomfortable, but are ultimately vital to the success of our mission? And CMIOs especially, as physician informaticists, are unique positioned to break out of the patterns of the past, and adjust, and thrive in the future.
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