Putting the Patient at the Center of Care

As the concept of healthcare consumerism gains currency, patients will expect (and be expected) to play an even greater role in their care. Patients’ awareness of treatment options and level of involvement in determining treatment plans is increasing. Payors are also starting to shift more payment responsibilities to patients. More than ever, patients are at the center of cancer care. The cancer patient’s journey is more complex and emotionally demanding than in almost any other area of medicine.

Unfortunately, much of the care they receive is still very disjointed and geographically dispersed. Many providers are in separate entities that do not have business-to-business IT tools for exchanging information with other providers; multi-specialty care is the standard today. From initial screening and diagnosis through the long path of surgery, radiation, and chemotherapy—enormous amounts of information are generated. All of this information needs to be shared in a coordinated fashion so that optimal decisions can be made on behalf of patients. Th e “focused factories” model holds the promise of taking the care of individual cancers such as breast cancer, lung cancer, colon cancer, and prostate cancer to the next level. We must build the support infrastructure to pull the care together.

The core focus in building this infrastructure should be engaging the patient (customer). Wal-Mart’s view of healthcare is to provide healthcare customers with more control, enabling them to own their healthcare data much like they control their finances today. Their initial focus is to drive down the cost to drive up value. In the longer term, the goal is to provide both cost and quality data as a justification for value provided. Wal-Mart has already dramatically lowered the cost of many generic drugs to less than $10 for a three-month supply. They plan to add convenient care clinics that will be driven by EHRs that will provide data for a personal health record (PHR) that will be available across all the Wal-Mart stores. As the patient finishes a clinical visit, an e-prescription will be filled and ready at the pharmacy. All the clinical events will be recorded and accessible in some form by the patients. Google Health and Microsoft’s HealthVault online projects are also placing an emphasis on health information being owned and controlled in the future by patients. These organizations have developed a core model that involves a hard aggressive push to engage the customers (patients).

Who are our patients? What do they want? Where are they going? Are our organizations falling behind our customers? Perhaps in the future the patient will truly drive the healthcare experience and we as providers will help them navigate. Expert providers enabled by systems that support navigation will be key for providing value to our customers. How will we demonstrate value to our customers? How good is the cancer care that we provide? How does it compare to care provided elsewhere? What are the tools we will use to engage patients?

As we evolve our organizations, the above models are excellent case studies for helping us build our vision for the future. I believe EHR adoption and measuring outcomes are essential activities for cancer care organizations today. Measuring outcomes is essential for improving patient safety and the quality of cancer care. Some fi nancing for EHR adoption is emerging. In the professional sector, provider organizations like ASCO are starting to certify IT products in the marketplace. In the public sector, CMS has funded the EHR demo project with $150 million bonus payments in 12 regions for adopting, measuring, and performing with certifi ed products. A Stark exception for donation of up to 85% of the cost of certifi ed EHRs has been created. In the private sector in some regions, up to 9% of payers off er EHR adoption incentives and physician liability insurance premium discounts of 3—5% are available for implementation of certifi ed EHRs. The online banking industry has clearly demonstrated that the lay public can do very complex things when given the right tools. Healthcare will be no exception. In oncology, the need for the proper tools is even greater because consumers believe that participating in decisions about their own care will not only improve their chances of doing well but may actually save their life.

Jivesh Sharma, MD, is CEO of Texas Cancer Associates, a midsize oncology practice based in Dallas/Fort Worth, TX. He is also CEO of HealthIT, an Internet services company that supports the patient/ provider network with technology solutions, and founder of NextGen Oncology, which works to provide next-generation solutions for the diagnosis, management, and treatment of cancer. E-mail Dr. Sharma at JSharma@MyCancerCenter.com.