By e-PATIENT DAVE DEBRONKART
Caution: This post is not a prediction. It’s just a tutorial about the concept of herd immunity, with an eye to why it’s probably not an approach the US wants to take in solving the complex problems we’ve gotten ourselves into with COVID-19.
Click this graphic to go see a six second animation of these images, created in 2017 by Reddit user TheOtherEdmund. You many need to watch a few times. Get a feel for the differences in what happens in the different blocks, and come back to discuss:
This weekend I’ve labored to understand this concept, which first came to my ears regarding coronavirus in March, when British prime minister Boris Johnson proposed it as a possible approach for Britain to take: let the virus take its course, and they’d end up with “herd immunity,” and that would be the end of that.
In my unsophisticated knowledge “herd immunity” meant “you let the weak cows die, and the rest of the herd will be fine.” And in fact in April a Tennessee protestor held up a sign saying “Sacrifice the Weak – Reopen TN.” (It’s not clear whether the sign was mocking or real (Snopes), but it illustrates the point.)
In it’s broadest definition, a portal is a doorway from one place to another. On the internet, a portal is a site that has links to other sites. In health care IT, the term refers to a feature of an electronic medical record that gives patients the ability to see parts of their medical record.
In each of these definitions there are two important things that are consistent:
1. To access what’s on the other side, a person must find the portal.
2. What is on the other side of the portal is not controlled by the person using it.
This is very important in the area of my concern: health care IT. Our old friend “Meaningful Use” includes the requirement that the EMR system must “Provide patients the ability to view online, download, and transmit their health information.”
In case you’ve forgotten (deliberately or not), “Meaningful Use” is a program to encourage use of EMR by doctors, paying them real cash money if they meet the prescribed requirements. The main way EMR vendors accomplish this provision is through the use of a “patient portal.”
So are portals the answer to patient engagement via online tools? Are they the answer to e-Patient Dave’s demand to “Gimme My Damn Data?” I don’t think so. They may be a step in the right direction, giving people some of the information they need, but there is still a wide gulf between giving someone a cup of water and ending a drought.
Over the past decade, I’ve seen a number of studies asking people whom they trust among various health care stakeholders. Nurses, pharmacists, and doctors always come out at the top. Beyond that:
·Trust of hospitals tends to be high (60–80%)
·Trust of health plans is at the bottom of the heap (10–20%)
Is this written in stone for the future? I don’t think so…and the dynamics for change are in motion. Please read on.
Here’s the emerging picture I’m seeing:
·Hospitals are dragging their feet in connecting you with your electronic health information.
·Health plans are highly motivated to connect you with your health information.
Hospitals Keeping You from Your Health Records
Yesterday the American Hospital Association released a 68 page letter commenting on proposed regs for Meaningful Use Stage 2. Putting aside my usual analytic tendencies, I’ll simply describe the letter as whiny, snivelly, “can’t do”, mean, and thick-headed.