What is Patient 3.0, and what does it suggest about how the doctor-patient relationship can be made better? This was the theme of the keynote address delivered last week by Paul Tang, M.D., a practicing internist and chief innovation and technology officer at the Palo Alto Medical Foundation (PAMF), at the Health IT Summit in New York City, sponsored by the Institute for Health Technology Transformation, also known as iHT2. (Since December 2013, iHT2 has been in partnership with Healthcare Informatics through its acquisition by the Vendome Group LLC, the parent company of Healthcare Informatics.)
In his view, what he terms Patient 3.0 (and its counterpart, Provider 3.0), can improve care by allowing the doctor and patient to share knowledge and share decision making. He said the patient-centered care model has fallen short of its goals of using care coordination and communication to improve primary care. He sees a gap, or a need for doctors to communicate with their patients as people—using the term “person-centered” care.
Using the example of a diabetic patient named Brian, Dr. Tang said the patient is coping with his disease by sticking to rigid routines and a restricted diet, which thrown up walls between his relationship with the other members of his family. While he is supported by his primary-care physician, who tells him what he needs to do: lose weight, stop smoking, check his sugar level, take his meds, and get blood tests before his next doctor visit, Tang termed this type of interaction as Patient 1.0—which he described as essentially a doctor yelling at the patient or telling him what to do—an approach that he said has not been very successful in changing patient behavior.
Tang said that in focus groups at PAMF, patients talked about doctors “yelling” at them instead of communicating with them on their own terms. Those goals may not be expressed in terms of, for example, controlling blood sugar levels, but in rather terms of what is really important to the patient, such as living a longer and healthier life. He gave a few examples, one of which was, “I want to live to 90.”
In his view, patient goals such as these should be incorporated into a personalized patient record. “In my mind and in the patient’s mind, let’s maximize the chance of living to 90,” he said. “This is a person-centered view of how we are a partner in helping you meet your life goals, which is this case is helping him to live to 90.”
Technology plays a key role as an enabler of Patient 3.0, in Tang’s view. For care of diabetes patients, PAMF offers patents a glucometer with a wireless adaptor, which allows patients with diabetes to take sugar level readings and transmit the information directly to the physician. This makes the communication between the physician and patient more seamless, bypassing the need for the patent to record the reading manually on paper and schedule an office visit.
“That’s why we created this feedback where you can receive the information directly and get the tools you need,” he said. One of those tools is just plotting of data, which can point to correlations with lifestyle changes that result in “teachable moments” that change behavior. In a group of patients at PAMF, the approach has led patients to adopt changes that have made a difference in their diabetes management.
“Basically they were learning things that we may have said in words, but they were learning from their own bodies,” Tang said—that is, the difference between Patient 1.0 and Patient 3.0. The wireless glucometer he cited in his presentation is more than merely a device to read blood sugar readings; its real purpose is to achieve data, which will improve care across disease settings, he said. “We have transformed the way they [the patients] can control information if we give them the data, the knowledge and the tools to do so,” empowering the patient.
In fact, the name of the online disease management program Tang described is just that: EMPOWER-D, the acronym for Engaging and Motivating Patients Online with Enhanced Resources for Diabetes, which was initiated in 2007. Since then, platforms such as HealthKit, which allows sharing of health and fitness data, and Bluetooth have made seamless sharing of data much easier.
PAMF has since extended the concept for the treatment of hypertension (EMPOWER-H). That program incorporates a blood-pressure monitor, a pedometer and a weight scale, which can be uploaded into their personal health record; and it created a population management tool for use on the clinician side.
Technology as made major strides since 2007, when EMPOWER-D was first initiated (in his presentation, Tang showed the picture of a Palm Trio, noting that neither the company nor the device are around today). Those strides are transforming the doctor-patient relationship into a partnership in managing chronic disease.
“With patient 3.0, if we focus on the job of the person, with their holistic health goals, we will be far better in terms of engagement and in terms of partners,” Tang said. Placing the right tools in the hands of patients is not only more efficient but also is more practical, because it can be applied to all diseases, not just one disease. It provides for a partnership between doctor and patient that “will enable this new world that can affect the health status of the entire population or the entire community,” he said.