A P2P Revolution in Healthcare?

Insulin-dependent diabetics, for example, quickly learn how to manage their blood glucose levels at home by matching their insulin dosage to changes in their diet and physical activity. Many diabetics have also joined online communities to share information and advice, sometimes viewing each other as more trusted advisors than their own doctors. Diabetics who take their health in hand in this way find that the cost of care decreases dramatically, while the quality increases: it’s far more effective than relying on experts whom they may see only every few months.

In The Atlantic, Clayton M. Christensen and Jason Hwang call for more ‘patient power’ in medical care, citing three priorities (excerpt):

“One area where patients could become more involved is in the management of their own medical records. Health records have long been considered holy scripture—to be modified and interpreted by nobody less than a health care professional. But patients could be valuable contributors to their health records if only they were allowed access. Understandably, the notion of health records becoming fully accessible to and modifiable by patients – as well as portable across different health systems—raises concerns among some providers about accuracy and privacy. But patients ought to be viewed as partners in managing and keeping track of this information. After all, it’s in their own interest to ensure that their records are accurate and complete. And if implemented properly, patient-controlled records could relieve providers of many of the administrative headaches related to maintaining and securing health data.

Another opportunity for patient empowerment lies in online patient communities. Some professionals regard interactive medical web sites with suspicion, fearing that they enable the spread of misinformation among laypeople. This worry is not unfounded, but the simple fact is that patients are already drawing upon user-generated content, like Wikipedia and online discussion boards, to gather health information. Rather than trying to shut these sites down or ignore them, physicians could actively participate, thereby offering correctives to any misperceptions. Clearly there’s a market for it: patients have been creating these communities precisely because they’re clamoring for information that they’re not getting from their physicians. And in the event of a pandemic or other widespread health emergency, accurate information could more efficiently be dispensed in this way than by speaking with one patient at a time.

Finally, implementing a ratings system for health care providers would empower not only patients (who could make more informed choices about whom they want to see) but also doctors, who could fine-tune their services in response to feedback. Most physicians have so far resisted any type of consumer ratings system because they believe that patients aren’t qualified to judge them. But while that may be true in some respects, there are plenty of service-oriented aspects of the clinical experience that are important to patients, but which are too often ignored by providers. Other industries ignore service flaws at their peril. Health care should be no different.”

3 Comments A P2P Revolution in Healthcare?

  1. AvatarStan Rhodes

    Jay Parkinson (http://jayparkinsonmd.com/) has been developing tools that would complement this. I am automatically uncomfortable with proprietary, so I hope we will see increasing trends toward transparency and accountability, culminating with open, social enterprise. It’s the only way to stay honest over the long haul. Also, there is increasing interest in harnessing the power of citizen science in medicine: http://fora.tv/2009/07/28/Making_the_Web_Work_for_Science

    I recently obtained Christensen, Hwang, and Grossman’s book, but have not had a chance to read it. I have been thinking a lot in these areas, as I have been working on my research into the behavioral sciences and the emerging peer commons revolution.

    This includes health care, as well, but I suspect it will come in many versions, including some bottom-up systems. Forgive my pessimism, but ultimately, these are the only way for real reform, rather than the shell games on Capitol Hill, because they allow patients to vote with their voices and dollars, which will undermine existing power structures (not without a fight, I’m sure). In addition to the points mentioned in the blog post:
    1) Fact-finding and wellness / preventive care programs that do not require licensing and can employ cheaper labor, but are informational. Based on information, the patient decides whether to “escalate” the problem immediately, and the information is there to pass on to a physician or specialist immediately.
    2) Quick-consult along the lines of Jay Parkinson’s work, enabled in part by technology, and in part by “lean thinking” that goes outside the box we’re all used to.
    3) Involve tech and medical students in solving common problems shared by many clinics, using other peer methods, including open source software, and open design.

    Seattle + Portland + San Francisco is certainly a great place to try to seed such things. We 3 are the “techbasket” of the West Coast. I suspect the early adopters of putting medical records online will be the young and tech-savvy (they’re more open, so it’s not a big deal), and those with chronic diseases, particularly rare ones (by consolidating information, they can make the biggest gains in quality of care).

    Andrew, I was not aware of your site, but I am very impressed, and very glad to make its acquaintance. I’m very glad you stopped by and commented.

    Perhaps it would be possible to create an “open, peer medical” small conference on the west coast? Perhaps Portland as a midway point (lot of open source here, and OHSU of course)?

    On the pure tech side, there have been BarCamp HealthCamps, but I don’t know what they’ve resulted in. Perhaps, a “winter of code,” (like Google’s “Summer of Code”) or a “winter of open health startups” would give the students and freshly unemployed some challenging problems to tackle.

    — Stan

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