Last week, I was lucky enough to attend a two day workshop/conference at the Institute of Medicine of the National Academy of Medicine (http://www.iom.edu/activities/global/innovationhealthprofeducation.aspx) .
I have to confess after looking at who was attending, I was a bit intimidated wondering what I could contribute. After all, I was there as a patient, and there were health professionals from all over the world. I came away feeling like I had learned a ton I never would have guessed about healthcare and feeling like I had contributed to quite a few of the conversations both from the patient and project management perspectives.
As the second day was ending, I wrote down a few of my take aways:
1) The most surprising stat I heard through two days was 70% of errors in healthcare come in handoffs of care. The reasons are many, but I keep thinking a lot of them could avoided. From an outsider’s vantage, it seems a lot of these errors could be avoided if there was an easily accessible way for healthcare providers to see the rest of what was going on with the patient’s medical care. Of course, there are probably some structural problems within our system making it harder. For example, if we had a single coding/billing system for all medical procedures, maybe it would help.
I know the Census codes businesses using an 8 digit code with the first couple of digits expressing the sector and each subsequent digit getting more descriptive. Could a similar system allow for quick browsing of a medical record to quickly see current treatments? Of course this improvement would be most useful if the record were portable and/or available for the entire healthcare team of patients
2) When it comes to considering changes in healthcare and healthcare education, insurance companies should probably be at the table because they probably have the most inclusive view of the system. The funny part of thinking this during the forum was talking with a representative from United Healthcare over the weekend. It turns out they are in the process of trying to come up with a coding system to account for all healthcare procedures, even in areas they do not cover like dentistry. I was happy to hear this as I was about to propose “somebody” needs to come up with a system.
3) In a related thought, I think insurance companies need to come up with a way to reimburse healthcare providers for services provided outside the traditional office/hospital visit model. I know how important it is to me to have a neurologist willing to answer emails. When I’ve asked him about how it is billed, he’s told me he is OK because his is a salaried position. Still, from a billing standpoint, isn’t our email a more efficient way to handle every day questions medical problems? How many more healthcare situations could be handled with less overhead? Many of the best doctors are providing their services outside the standard models. They need to be encouraged to continue.
4) These non-standard ways to provide healthcare speak to a need to better integrate patients’ needs and experience into the shaping of healthcare policy. Patients are ever more connected. We read more about our conditions and healthcare. While this can give us vital information allowing us to track more of our condition, it can also lead us down many dead ends. Quite simply, we often don’t know what we don’t know and often what we don’t know is the all important context.
(continued on next page)
5) This thought leads to how knowledge should be gained, and it is not a question limited to patients. The session going over changes taking place in health education were some of my favorites. The traditional model of advanced education is based on people in seats, but it is under attack from various on-line services. If Stanford is teaching on-line high school, and many colleges are offering ever more on-line course work why should anyone assume medical school will always be taught in class rooms?
When I think of my job and all of the people we have hired out of college, I know we always have months before they are up to speed. I know many of the healthcare professionals at the forum were expressing similar experiences. The schools are all there to teach towards the exams. I know we all expect a broad base of knowledge from our doctors, but does the discrepancy between what is encountered with real patients and what is on the exams speak to a fundamental flaw in our healthcare education model.
I tend toward the “no” camp, but I recognize my own bias having graduated from a traditional college. While I use little of what I learned there, I think the value of traditional education is learning how to learn and more importantly how to question. The base knowledge is the important launch point, and it’s my hope medical schools still provide the base for our nurses, doctors and other health professionals to make informed readings of new information. They need the context we patients lack. What is less clear to me is whether the class room is the best medium for conveying the information in all situations.
6) All of this lead to what seemed a general consensus there should be some general metrics to assess how current healthcare providers, their teachers, and institutions in general are in terms of their knowledge of current best practices. These metrics might better inform us which methods are most efficient.
7) I was struck in a few of the break out sessions by the frequency people expressed a view that health care systems in the U.S. and elsewhere are becoming more “community based” and less hospital system based. This drove me back to the 70% of errors stat I heard on day one. If 70% of errors in healthcare come from hand offs in care, won’t a decentralized healthcare system exasperate this problem? I hope not, but I don’t know how to avoid it without other structural changes in our system.
Finally, I can not say how thankful I am to Patientslikeme.com for suggesting my name and getting me invited. I was planning on taking a couple of days off to go, but it turned out to be an incredibly stimulating way to spend a couple of furlough days. I would also like to thank all the people who invited me to the forum.