People think responsibility is hard to bear. It’s not. I think that sometimes it is the absence of responsibility that is harder to bear. You have a great feeling of impotence.
— Henry Kissinger
One common emotion in becoming a “patient” is this feeling of impotence, of giving up the control we exercise all the time in our daily life. There are many stakeholders in healthcare; physicians, hospitals, nurses, pharmacists, insurers, employers and others too numerous to mention but in the final analysis it is the patient who is the ultimate stakeholder in health. This challenge of assuming accountability is foreign to many healthcare providers who have evolved in a world where patients are dependent and do not have the knowledge or experience to make informed choices in their utilization of healthcare services. In this information rich world the ability for patients to become “activated” in their care is possible to an extent never before imagined. The more accountability we bequeath to the patient the more leverage we will apply to quality improvement and perhaps lowering healthcare costs.
The question of accountability in healthcare will become increasingly important in the next few years as the Accountable Care Act of 2010 continues its staged role out of value based purchasing, insurance reform and information technology transformation. Many groups have felt the need to assume quality improvement including the government, the providers, the employers, payers and patient’s advocates. None of these groups in the United States have made a lasting or significant impact in controlling costs and improving overall value. Patients need to take an active role in their own healthcare to clear that hurdle.
I have been encouraged in this regard by the increased use of “Fit Bits”, home blood pressure monitors, iPhone and Apple watch health data, electronic thermometers and finger glucose monitoring in adults and children with diabetes. More and more of my patients come to the office with cell phone photos of what the rash looked like yesterday or send us photos of a wound that may or may not need sutures. This home generated medical technology is now in version two and three and is becoming much more accurate.
What is most exciting is that these links between the patient home and the medical home are becoming more integrated with our office. A key feature of our Rochester Regional electronic record system is the MyCare online patient portal. Most all large health systems now have a patient portal similar to MyCare. All one needs is a personal email address and a computer with access to the internet to enroll. There is no fee for our patients to use the portal. At the close of the visit we give patients an ‘After Visit Summary.’ An activation code is printed on that summary with the discharge instructions. The parent or patient then goes to mycare.rochesterregionalhealth.org and enrolls with that code. You can then access your child’s health information up to age 12 and have limited proxy access to the adolescent records - though we encourage all teens to have their own MyCare account. Most test results are released to MyCare the next day with a few exceptions for sensitive labs, pathology specimens or complex imaging results. The MyCare application can also graphically display health results over time to promote goal setting. You will receive email notification of new results, confirmation of appointments and suggested health maintenance recommendations. You can also request prescription renewals, and communicate with your medical team about non- urgent issues.
In the next few years I anticipate addition linkage which would allow transmission of home measured data such as glucose monitoring results and blood pressure readings, pacemaker status and even electronic tools such as fiber-optic otoscopes and stethoscopes which will support live telemedicine visits. For more information contact the MyCare Service desk at firstname.lastname@example.org or (585) 922-1234
Michael Jordan, MD, MS, FAAP