And please, never believe HIT has a standard – HL7 – it doesn’t. HL7 is a to standards as gerrymandering is to politics.

Technology\standards aside, the other revolution that needs to come is to move away from seeing healthcare as being episodic and to see it as a longer continuum, not a cycle, but a thread that beings at life and ends at death, with an educated patient involved with their own care.

There’s a LOT of smart, willing doctors, nurses and patients, they’ve only got THEMSELVES to blame for not banding against the idiocy of the healthcare marketplace and insisting, demanding on processes and solutions that are patient empowering.

“But, we must be mindful that while the technology considerations and solutions will arm patients with the information they need to navigate the system, to effectively engage with their Health Care Providers, and help them achieve the best Patient Experience and treatment possible, with technology we are primarily addressing the Medical Information management issues.”

Am I ever lovin’ this discussion. I can invision an app for the iPhone, iTouch, any smartphone, etc., which will allow a patient to view her EMR/EHR/PHR and to which she may respond.

We must get rid of this “us vs. them” attitude on both sides of the fence. There should be no fence, actually. When the only empowerment is in bureaucracy and VRM, then we’ve reached the bottom. I like Dave’s statement:

I want brilliant freakin’ motivated smart doctors empowered to do brilliant freakin’ things for me.

Me, too. I don’t want to disempower anyone (well, ‘cept maybe some bureaucrats and such…ahem…) who is working toward my health. I just want to be a part of the team.

Vendors CAN change any proprietary platform so that it integrates with a common interface. They are going to be driven to it anyhow as cloud computing becomes more prevalent. (Microsoft and Google are already there.) With the increasing use of smartphones (which some vendors actually call a type of “netbook”!), everyone will have the capability of accessing PHR’s. Ok, some say not “everyone”, but when even the homeless are using cell phones (which will soon all become smartphones or more), I beg to differ.

Along these same lines, @SusannahFox, @jayparkinson and I (@staticnrg) had a twittersation about rating doctors/medical care. Jay tweeted a link and said: “yep. next minor revision of hh will have this built in: http://bit.ly/R4ZzR their dashboards are awesome.” I believe that with an easy response/survey system like Jay linked, patients can give valuable feedback instantly which benefits all concerned. It does not have to be a negative system. Ranking/rating systems that we have now are used mainly by disgruntled patients and aren’t valuable. I believe they do more if a disservice than a service most of the time.

Most of all, if we don’t consider the role of the physician in all this, we are going to lose valuable, front-line PCP’s, pediatricians, and family doctors. It is already happening, and we need to keep that in mind as we work towards participatory healthcare.

as you know I am never talking about confrontation as a means to modify the mindset of clinicians. Instead, I see myself as a constant irritant because someone needs to tell them repeatedly that the system has changed.

It is indeed very sad that the changes have taken place almost entirely without clinicians input, first because they denied the reality of the changes and now because they have to deal with issues of bigger financial/psychological importance to them.

As senior irritant, I would be tempted to say that clinicians, in general, do carry a significant responsibility for their original lack of involvement in the transformation of the medical system, from paternalistic to participatory. But it is never too late to join the movement and be an equal partner in the formulation of the necessary changes. None of us should ever think that we are advocating any type of “us vs. them” kind of interaction. I can only quote an ACOR user who said a few days ago: “The oncologists and all the oncology nurses and the researchers are the ones battling cancer. I’m just the battlefield.”

Susannah is both polite and effective and will probably formulate this much better.

Gilles says:

“I understand that doctors are not happy with their work environment but this is NOT something we can have a real impact on. OTOH we can definitely have an impact on how doctors are going to interact with patients and view them as equals in the patient-doctor relationship.”

The unhappiness and lack of control that clinicians of all stripes feel in the present workspace is not something we can ignore. If we do, we simply add another way they lose control and yet are still held accountable, further deepening the “learned helplessness” already part of our problem. While you may think you know all about the state of learned helplessness, refresh your memory. A key point is that not all people respond to the same situation with depression and feelings of futility. We can engage those who still feel good about clinical practice, and partner with them to show it’s actually more fun to work together. But a consistently confrontational approach (OK, I’m one of the worst offenders, I confess) will not move participatory medicine forward.

For years I’ve heard doctors talk about having their recommended treatments rejected by insurance office staff who have no medical training at all and aren’t even able to discuss the indications for this case being outside the norm. That’s powerlessness.

I don’t know – this wouldn’t be the first time your experience and instincts have out”smart”ed mine. I do know, though, that if I’m going to be in charge of my care, I want my chosen doctors to be authorized to do their job – to exercise their best judgment.

I understand that doctors are not happy with their work environment but this is NOT something we can have a real impact on. OTOH we can definitely have an impact on how doctors are going to interact with patients and view them as equals in the patient-doctor relationship. That is already a lofty goal and as Susannah wrote earlier:

I think participatory medicine is what Eric Raymond calls a “plausible promise”: something big enough to inspire interest yet achievable enough to inspire confidence.

Reforming health care is too big for most people to grasp; creating spaces for participatory medicine is not.

Dan,

> We’ve spent a lot of time in this blog
> talking about the patients, and not enough
> about the new roles of nurses, doctors
> and other clinicians.

Well, dude, let’s get on with it!

On Ted Eytan’s blog, as he was working on a definition of Health 2.0, Consumer-Focused Healthcare blogger Vijay Gopal MD said

I’m curious as to why when everyone talks about participatory health care, the physicians and other care providers aren’t seen as empowered participants.

You know what I want? I want brilliant freakin’ motivated smart doctors empowered to do brilliant freakin’ things for me.

Patients may be at the center (hey, as a firstborn I’ve been that way all my life) but I want every single doctor, nurse and floorscrubber (and administrator) I encounter to go home that night correctly feeling that they just did something amazing that day.

So let’s get to work on that too.