The sharing of patient information in the US is out of whack — we lean far too much toward hoarding information vs. sharing it. While care providers have an explicit duty to protect patient confidentiality and privacy, two things are missing:
the explicit recognition of a corollary duty to share patient information with other providers when doing so is the patient’s interests, and
a recognition that there is potential tension between the duty to protect patient confidentiality/privacy and the duty to share — with minimal guidance on how to resolve the tension.
In this essay we’ll discuss:
1. A recent recognition in the UK
2. The need for an explicit duty to share patient information in the US
Policymakers, researchers, physician-leaders, and patients have all cited the need for care to be tailored to patients’ unique needs and preferences. And there is solid evidence that patient-centered care can help improve care quality and reduce costs. However, in the rush to become more patient-centered, the health care system has misplaced its focus.
Current approaches to patient-centered care are based on aggregated preferences rather than individualized needs. Researchers and health systems deploy focus groups and surveys to assess general patient preferences in an effort to determine “what patients want.” But patients are a diverse group with diverse needs. Characterizing general beliefs and preferences alienates those whose needs and preferences do not align with the majority. The result has been a monolithic view of patients and their needs — a framework that prevents the delivery of truly patient-centered care.
All service industries share the challenge of providing tailored, individualized service. In response, leaders in customer service have developed tools and infrastructure to understand and respond to individual needs and preferences. Health care providers should leverage these approaches.
I am old enough to remember when physicians did not advertise. It was considered a professional ethical issue. Hospital advertising consisted of institutional “We’re here” ads. Anything aggressive by docs or hospitals was considered bad taste… but that was before health care became as competitive as any other type of business.
I have been barraged, as have many of you, by a wave of hospital advertisements as our health care marketplaces consolidate and organizations seek to brand and differentiate themselves. We are subjected to print, radio, and TV ads extolling services, expensive technology, and that fact that each institution cares more than its competitors.
Charlie Rohlfing blogged recently about the worst in hospital advertising techniques, and you will recognize them all. They usually include a Da Vinci Robot and orthopedic surgery that will “get you back in the game.” They claim to be “state-of-the-art,” “leading edge,” or “cutting edge,” with actors playing doctors and nurses in masks.
NPR ran a story recently about how some retailers are retooling efforts to appeal to consumers in light of increased competition, particularly from online vendors.
Many are striving to be more “customer friendly”; Kohl’s department store was mentioned for adopting a “no questions asked” return policy with the idea that customer loyalty could be enhanced as the retailer made itself easier to do business with.
Comparisons between health care and retail abound, and while we say it is ideal for the consumer experience to be the same in both industries, in fact they are much different. The gap between the two industries was well-illustrated in this video of a shopper in a grocery store. We see them at the counter having their items rung up. But they aren’t told the prices and when they are given the receipt at the end, they’re told the final amount due may actually differ from what they see on the receipt.
Let’s take the analogy a step further: what if the customer expected the same “no questions asked” return policy from Kohl’s? Or a money back guarantee? In health care, only recently has the federal government taken steps to impose financial penalties in instances of poor care (which is the health care system’s equivalent of a “return policy” from providers).
When our team was at Subimo we initially focused on cost and quality (outcomes) information on hospitals. It was clear that – for the same procedures – there were both low cost and high quality providers as well as high cost and poor quality providers. Our efforts with transparency were designed to help people sort through the information so they could make more informed decisions and understand what quality outcomes might mean to them. We knew there was much variation in outcomes with certain procedures (e.g. aortic aneurysm repair) and less variation with others (e.g. normal vaginal delivery). Helping people understand when a poor outcome was more likely to occur helped them with their decisions (and presumably made them better shoppers).