Bringing clinical expertise into patients' everyday lives

CHICAGO—In the future, healthcare and technology needs to reach into the everyday lives of patients to allow providers to deliver better care, said Patricia Flatley Brennan, RN, PhD, speaking Sept. 30 at the Healthcare Leadership Forum. Brennan is the Lillian L. Moehlman Bascom Professor at the School of Nursing and College of Engineering, University of Wisconsin-Madison and national program director of Project HealthDesign.

Data elements from everyday life have just as much need for standardization, support and storage as the healthcare data in use today, she said.

Brennan leads Project HealthDesign which aims to use technology to engage patients in self-care and disease management. “Professionals are experts in clinical care but people are experts in everyday living,” she said. “Our challenge is to leverage both of those.”

The project involved 15 teams around the country who looked at how they could use technology to bring the expertise of clinicians into patients’ lives.

“If we leverage the best skills of everyone on the care team, including the patient, we will get to better care and probably less stress, and maybe even less cost,” she said.

That requires robust network connections because “we’re not going to build individual connections.” Providers and patients need to take advantage of telecommunications companies like Verizon and AT&T, she said, for information pathways that are secure safe and resilient.

Lots of conversations are needed to make sure everyone is on the same page, she said. For example, when talking about pain is everyone talking about the same thing? Self-reported experiences and patient-defined information could change the conversation. “As we bring tools into patients’ lives, the conversations with colleagues and vendors will be essential.”

Brennan also talked about the growing recognition of the importance of social and behavioral determinants of health (SBDH). The goal isn’t to collect more data but the right set. She said an Institute of Medicine report is coming out soon that will recommend the most parsimonious set of SBDH determinants.

The IOM studied “a range of things we might want to know about a patient because they are indicators that have shown a relationship to patient outcomes, mostly morbidity.” Those determinants include racial identity, language and financial resources. For example, studies have shown that the fear of losing one’s house is as stressful as actually losing one’s house. Psychological conditions such as health literacy, stress and behavioral aspects need to be factored into patient care. Social engagement is useful as well, she said, because “we have learned that people are more likely to die from loneliness than from high cholesterol because of the secondary effects of that loneliness.”

Other factors such as exposure to violence, military history and past incarceration also impact health. “We believe a parsimonious set of data would improve immediate care of individuals but also allow us to forecast and plan care.”

Some of these factors have been moved out because while they are important to certain people, they don’t play a role for the majority of individuals. “There is no justification that these need to be assessed on the entire population in any consistent manner.” Capturing more than 8 to 10 indicators is infeasible, she noted. Other considerations, such as who collects this information and how it is stored are still being debated. “There is work being done to help provide guidance to institutions, vendors and clinicians about which are the most critical SBDH to work with.”