Recently, I’ve become involved in the design and creation of decision support tools for both clinical and non-clinical applications.  While there have been decades of research supporting the concept of integrating shared decision-making practices and decision support technology in our healthcare system, adoption has been slow.  I’d like to add my voice to the chorus of those talking about and pushing for the transition from a healthcare system to a well-being system.

According to Melchiorre et al, there are numerous potential barriers to adopting a well-being system.  What I found surprising was that patient demand or reticence was not near the top.  According to their 2017 study the top three potential barriers to adoption are:

1. Inadequate funding
2. Compatibility between eHealth tools
3. Inadequate technical support for clinicians

While the Melchiorre study touched only tangentially on patient demand, another study from 2017 published in the BMJ (British Medical Journal) dug in on the subject.  They found that many patients felt unable rather the unwilling to participate in their own care for fear of not being seen as a “good patient”.

What can be done?

Changes are already underway.  Around the world, people are shifting their views on healthcare, well-being, and population health.  Yesterday, CNN reported that hundreds of doctors protested a recent raise in their pay, preferring instead to redistribute the monies towards patient care.  Physician’s willingness to change and adopt a new model of care is the first step.

Individuals, whether they wanted to or not, are becoming more engaged in their healthcare in the U.S.  With the rise of high-deductible-health-plans, individuals and families are required to shoulder more and more of their personal healthcare costs.  An engaged consumer becomes an educated consumer which translate into a “good patient”.

Once the caregivers and the care-receivers are equally engaged, the need for cost-effective and efficient technology will be paramount.  We’ve already seen an increase in the use of electronic health records (EHRs) and legislation/regulation around the interoperability of these systems is trending in the right direction.  The next steps are to solve for the potential barriers highlighted in Melchiorre et al.  We need:

1. More funding for systemic technology solution development and their implementation
2. Additional focus on enabling technologies like healthcare data companies to democratize supporting data
3. Increased attention to both the technical education of and technical support for our physicians, nurses and other caregivers.

Let’s keep the conversation going – as always, I look forward to your thoughts, comments or criticism.

Citations

1. eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project – Melchiorre, Maria Gabriella et al. – Health Policy, Volume 122, Issue 1, 53 – 63

2. Joseph Williams Natalie, Lloyd Amy, Edwards Adrian, Stobbart Lynne, Tomson David, Macphail Sheila et al. Implementing shared decision making in the NHS: lessons from the MAGIC programme BMJ 2017; 357 :j1744

3. CNN Report “Hundreds of doctors in Canada are protesting. They say they make too much” https://www.cnn.com/2018/03/08/health/canada-doctor-raises-trnd/index.html