View source for Role of informatics in promoting patient-centered care

This a [[Category::Paper]] discussed in Social Media Analysis 10-802 in Fall 2012. 

== Citation ==

C. F. Snyder, A. W. Wu, R. S. Miller, R. E. Jensen, E. T. Bantug, and A. C. Wolff, "The role of informatics in promoting patient-centered care," Cancer J, vol. 17, pp. 211-8, Jul-Aug 2011.

== Online version ==

[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146983/pdf/nihms307041.pdf The Role of Informatics in Promoting Patient-Centered Care]

== Summary ==

Patient-centered care is a vital part of improving the quality of healthcare and ensuring that the patient’s best interest is always kept in mind. In the modern era, medical informatics may either be the boon or bane of this consistent improvement of healthcare quality. It can provide a means for patients and physicians to share information and communicate regularly. This will allow both the patients and their caregivers to take a more active role in their own care. Clinicians have become accustomed to using electronic health record (EHR) systems to enter, organize and analyze the medical information for their patients. However, with the rise of “big data”, both clinicians and patients should be cautioned against poor quality, inaccurate and irrelevant information. The greatest challenge will be the identification of high-quality information that will actually improve their quality of care, rather than impede it.
 
== Background ==

In 2001, the Institute of Medicine (IOM) came out with the report titled “Crossing the Quality Chasm”, which was the initial push towards a concept of truly patient-centered care. The study created a new framework for health care quality and described six values to focus on: 

* Safety
* Effectiveness
* Efficiency
* Patient-centeredness
* Timeliness
* Equitability 

The formal definition of patient-centered care is: “care that is respectful of and responsive to individual patient preferences, needs and values” (Institute of Medicine. Crossing the Quality Chasm. Washington, DC: National Academies Press; 2001). Ultimately, it should ensure that the relationship between patients and their providers is respectful, coordinated and efficient. Informatics has been and will continue to play a major role in this field as it is being used for data acquisition, storage, dissemination and analysis. Social networking and EHR portals were mentioned to be one way of increasing communication between patients and physicians and patients and their family/caregivers. On the other hand, social networks can also house low-quality information such as un-moderated discussion boards. 

== Discussion ==

'''Informatics Assisted Patient Management to Provide Quality, Safe, Patient-Centered Care'''

The delivery of cancer care has largely benefited from and relied on EHR system to help manage the vast amount of data for their cancer patients. Since many of the therapies have high morbidity and mortality, the oncology EHR is used to help analyze past data and improve upon future patients. Unfortunately, there are still an alarming number or hospitals and practices that use paper-based health records and thus are prone to lost files, illegible documents as well as other mishaps. Some tools for mediating the risk of error include decision support tools to notify users of allergies, drug interactions and needed dose adjustments. Cancer patients largely benefit from a patient-portal component of an EHR system so that they can readily access and view their medical information and test results. The authors even propose using EHR interfaces more effectively as a point of care approach in the exam room to educate patients, to engage them in co-creating their visit notes and to ensure that the data entered is accurate. One example could be viewing imaging studies together. 

'''Patients Providing Information to Their Clinicians'''

There is also the idea of a personal health record (PHR) that would be controlled and stored by the patients, possibly by a cloud-based system or integrated with the hospital EHR system. These have been slow to adopt as their effectiveness for improving patient care has not been proven. One concern would be if patient anxiety would increase if they were to look at raw medical data or images without the dictated thoughts or interpretation of their physician. There is also the idea of a web portal to enable patients to communicate with their physicians, request prescription refills and make appointments as well as access some of their lab test results or other exam results. 
Electronic patient reported outcomes (ePRO) assessments can potentially help with health related quality of life studies (HRQOL). The electronic nature of the assessments provides the benefit of automating both the administration and the scoring task once all the data is collected.  The ePRO systems can provide flexibility in terms of where data is collected and how it is disseminated, such as the use of tablet-based computing, mobile technology such as internet-based patient portal web sites,  text messages and computerized telephone surveys. 

'''Tools for Care Coordination'''

In 2006, the [http://www.pewinternet.org/Reports/2006/Online-Health-Search-2006.aspx Pew Internet and American Life Project] found that 80% of internet users in the US have performed health related information searchers using their computers. As patients learn more about their health issues and treatment plans, they tend to play a more active role in the decision-making process. There are desktop applications and recently [http://www.jmir.org/2012/5/e128/ mobile phone apps] being developed to allow patients to plan their treatment regimens and stay informed about their conditions. 

'''Informatics at the Intersection of Clinicians and Empowered Patients'''

The second generation of medicine is often referred to as [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626430/ Medicine 2.0] and is moving away from hospital-based care and instead towards home care and preventative medicine to keep people out of hospitals or reducing the number of readmissions. It is interesting to think that the internet has essentially ‘leveled the playing field’ as the control of the medical information flow is shifting away from the physician and more towards the patient. The patients are able to learn more about their needs, independent from their physician and thus take a more active role in the medical decisions made for their healthcare. Although this article (like the [http://malt.ml.cmu.edu/mw/index.php/Reviewing_social_media_use_by_clinicians von Muhlen and Ohno-Machado article]) expressed concern with the misuse of social media when applied to medicine and healthcare, there were still numerous instances where social media played a very positive and vital role in improving HRQOL. One study showed that content analysis of information on the internet can identify important topics that are under-represented [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550657/]. There was also a study about how patient’s posting their stories on YouTube could help other patients coup with their illness [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221357/].

==Conclusion==

This was a very interesting review of how informatics and the general trend towards added connectedness between patient and physician is changing the dynamics of healthcare. As social media, social networking and information on internet increases and is freely available to everyone, the relationship of physicians and patients is experiencing some changes in power. Patients are able to look up information about their illness and treatment plan and as a result, are able to play a more active role during their treatment plan. Physicians must respect this and allow patients and their caregivers to educate themselves. 

There are a number of ways that medical informatics can help promote a patient-centered care in oncology care as well as other departments. This article discusses many of the potential benefits including improved access to health information, improved patient safety, increased coordination of care and more informed patients. 

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