Renowned industry leader Paul Tang, M.D., vice president and chief innovation and technology officer at the Palo Alto (Calif.) Medical Foundation and consulting associate and professor of medicine at Stanford University, and director of the David Druker Center for Health Systems Innovation, gave a keynote address on Jan. 20 at the Health IT Summit in San Diego entitled “Patients 3.0: What’s the Job of a Patient?” In it, Tang clarified what he believes are the key differences separating the emerging landscape of care management from the past and current states, as part of the conference being held this week at the Omni San Diego Hotel and sponsored by the Institute for Health Technology Transformation, or iHT2, a sister organization of Healthcare Informatics.
Paul Tang, M.D. speaking on January 21
Tang told his audience that while the “Patient 1.0” landscape was all about patients “complying” with and “adhering” to physician orders; and the “Patient 2.0” landscape has been about patients becoming better-informed, as through web searches and other means; “Patient 3.0” will be about patients—soon to be known as people—moving forward to co-create plans for improving their health, in true partnership with their physicians and other providers, rather than following anyone’s orders.
“The danger of being ‘patient-centered,’” Tang said, “is that we’re still focusing on being in control” as providers, on giving patients the opportunity for more convenient appointments with their caregivers, for example, but still maintaining the physician and clinical team as the center of the universe.
He gave an example of a real-life patient Brian, a middle-aged man living with diabetes. As Tang noted, a provider-centric perspective on someone like Brian would be to set goals around “compliance,” “adherence,” and similar other top-down concepts of care management, with Brian conceived as a patient. “What do we do for diabetic patients? We try to get them to stop smoking, to adhere to protocols, and so on. We even call it max-packing, when we’re talking about physician-patient communication during patient visits, referring to trying to get the maximum amount of information across to a patient in a short period of time.”
But, he asked, what would a patient like Brian offer as his goals as a person? He would focus on health and living. Brian would say, “I want to live, and this health condition is getting in the way,” Tang said. “So what if we all of a sudden focused on these patients as humans? What if we created a personalized diabetes dashboard, tailored for each person? What would that look like? You’d begin by asking, what are your goals? One might be to live to the age of 90. And what are you afraid of? It might be having a skin condition breakdown, having to go on dialysis, or experiencing a heart attack or stroke. So that means we will focus on your glucose and your [hemoglobin] a1c and your blood pressure, because those all involve issues that can get in the way of getting to 90. And we’ll ask you to undergo certain exams in order to move forward” towards the age of 90.
And in the new world of the true person-centered healthcare, with a person’s physician and other clinicians as her/his partners in health, everything would naturally proceed logically from such person-driven goals and perspectives. Supporting the person in his/her testing of his blood sugars, for example, weighing herself, etc., would all emanate naturally from the person-centered perspective.
Fortunately, the technologies available to support person-centered health are leaps and bounds ahead of what they were even six or seven years ago when he and his colleagues first attempted to move forward in this area, Tang noted. He and his colleagues attempted to create some automated process for uploading diabetics’ glucometer data, but at the time, mobile phones had not yet become smart phones, so they had had to improvise a connective device between a flip phone and a glucometer. Things are more sophisticated now, he noted.
But the bottom line, he said, is that “We should be helping people with the tools to change their behavior, not yelling at them to follow instructions. And the new model of care requires, first, ‘patients 3.0,’ and for us to position ourselves as partners to people, not patients. Personalizing care,” he added, “is not only more effective, it’s longer-lasting, because it changes patient behavior for life. And so you need ‘providers 3.0’ [to make all this work], too.”