By Jeff Liddell, Harmony Healthcare IT Consultant, Licensed Social Worker, Emergency Psychiatric Services High Reliability Organization Coach
The buzz and excitement surrounding last month’s NCAA Basketball Tournament provided another example of how the Road to the Final Four has become an annual community ritual encompassing people of all ages and backgrounds. Everyone, it seems, follows the action with brackets in hand as the field is whittled down from 68 to one National Champion – this year North Carolina.
The enormity of the event can be overwhelming, but as I followed the action I was most inspired by the individual stories of these college players - some of them beginning in faraway places like Poland, Africa, and Germany. While the victorious Tarheels cut down the nets amid a shower of blue and white confetti, many of the player stories had already begun to fade away.
Something similar is happening in the healthcare industry. The exhilaration surrounding the innovations in healthcare technology has taken center stage – sometimes at the expense of the stories of the patients the technology is meant to help. As industry leaders, we can’t be dazzled to the point where the patient story is lost beneath the waves of technology sweeping healthcare today. In an environment of mergers and acquisitions, consolidations and the tsunami of new technology and challenges to deliver care, we must be vigilant in ensuring that the patient remains the focus.
Patient-centered means not letting the patient story be lost to Big Data or technology innovation. The admonition of Dr. Compton-Phillips, Executive Vice President and Chief Clinical Officer at Providence St. Joseph Health, “No data without stories and no stories without data,” should become a governing principle when it comes to patient care. Without connecting to the patient story, we risk losing the narrative that enables patient engagement and helps drive better outcomes.
Patient-Centered Care vs. Tech-Centered Care
The new technology landing on the desktops and mobile devices of caregivers must be less like a “close encounter of the third kind” and more like a butterfly breaking free from the cocoon. All innovation must begin with inclusion. In the same way that healthcare must stay laser focused on the patient, technology must remain focused on how it serves those who deliver care. Simply upgrading without considering the effects on the patient adds a level of stress and frustration that can impact the connection with the patient.
Improving Patient Engagement
Advancing technology should not come at the expense of leaving providers behind. If innovation does not lead to enhancing patient engagement, those who provide care run the risk of, in the words of internationally renowned priest and author Henri Nouwen, “becoming distant technicians.” Understanding of the patient’s story provides a base to promote necessary engagement. The resulting patient/provider connection leads to better communication and greater patient participation.
This is the formula I use when approaching patients and their family members. Ultimately when providers are engaged with patients, outcomes of care can improve resulting in decreased re-hospitalizations and enhanced patient safety.
Legacy Data is the Legacy Story
A key ingredient of the patient story is contained in the data that has been collected on the patient over the years. There are reasons beyond record retention requirements to preserve and protect historical PHI. A patient’s legacy data is crucial in the design of a value-based approach for delivering care. Initiatives like population health and the principles of Triple Aim – improved health outcomes, enhanced patient experience, and reduced cost – rely on having complete data sets of all patients.
Organizations must not only create a governance team to preserve patient information it must also ensure that the data is accessible. Too often obtaining this information for providers is akin to plucking blackberries – you will need to work hard to get “the fruit” but you will not come out of the search unscathed. If Tolstoy is right, “there is more in the search than the discovery,” than the search must be available in a timely fashion to providers and ultimately the patients they serve.
Providers and clinicians are often left behind when transitioning to a new EMR. Legacy data can fall prey to the expedience of not converting or migrating data to the go-forward EMR. At Harmony Healthcare IT, we have made it a cornerstone of our mission to be innovative to “improve lives by preserving vital information.” Data loss or corruption leads to reduced access to care and poorer quality care outcomes because of incomplete understanding of the patient’s lifelong story.
Importance of the Patient Story
The story gives the provider context and insight on which to base the treatment and care of the patient. The provider is then better able to partner with the patient to create a level of engagement that promotes two-way communication and understanding – a key element in providing care.
In the behavioral health arena where I have been privileged to operate over the past 25 years, knowing the patient story provides insights into key history including previous diagnosis, traumatic brain injuries, substance abuse and co-and morbid illness. Helping a mentally ill patient navigate through a complicated system requires careful attention to his or her unique challenges. Knowing the story is key to building the relationship that will often provide access to care and reduce the burden of fragmented treatment in emergency departments and primary care offices.
HIMSS has emphasized the importance of the patient story by starting the Health Story Project in 2006. The initiative has a vision of creating comprehensive electronic records that tell a patient’s complete health story. The project has produced Health Level Seven (HL7) data standards to integrate the flow of information among common types of healthcare documentation and EMR systems.2
Costs of Losing the Patient Story
Credibility costs. Patients who develop an adversarial relationship and are at odds with their providers due to misunderstanding become frustrated and disenchanted with treatment. This can create further chaos in a high stress environment and result in duplication of services and ineffective interventions.
Quality costs. The patient story provides an opportunity to explore the need. When providers better understand patient needs, they can more precisely match the right care. A discussion at a conference I attended several years ago centered on a woman in her 50’s with a history of mental illness. Her trips to the ED were increasing and during one visit a staff member asked why she was coming in more often. She responded, “I am hungry, my son lost his job and I have to share my food with him.” The story revealed this patient’s primary need.
Risks. Missing the patient’s story can result in creating an unsafe experience for both the patients and caregivers. For example, working with a patient who has an unknown history of a traumatic brain injury can result in tragic outcomes.
Lost opportunities. Often the patient story provides an opportunity to help guide the patient in a more constructive direction. While this opportunity cost is intangible, potential improved outcomes have tangible financial consequences for both patients and their families.
Each day caregivers are involved in thousands of encounters like delivering a patient tray, injecting a life-saving medication, supplying a blanket, or offering the news of a new birth. Amid the multiple alarms and overhead calls to respond to critical needs, there exists many what Erie Chapman, former CEO of the Baptist Health System, calls sacred encounters. In an industry where the stakes are high, combining technology and innovation with the patient story can play a fundamental role to guide and transform these encounters to benefit the patient.
Preserving the patient story helps build a legacy of lasting care. The two eyes of healthcare -clinical and technological - must create one vision that advances patient-centered care.
For more information on healthcare IT advice, download our roadmap, Maintaining the Health of Your IT System: 6 Proven Steps.
2HIMSS Health Story Project: http://www.himss.org/library/health-story-project