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Health system renewal relies on empowered patients

By Dr. Ahmad Zbib

Information is power. Over the course of history, information has helped underdogs break free from their dependencies on those who controlled the masses. At times, it has even contributed to the toppling of regimes and the elimination of famine.

This reminds me of a story my dad told me about a famous regional political leader, a mid-century feudal lord. One day, the farmers protested the lack of access to postsecondary education for their kids. His response? “Why would you want to send your kids to university when I am sending my son so he can learn and bring back his knowledge to help you all?”

Does that sound familiar? While there is no doubt that healthcare providers do truly have the patient’s best interests at heart, paternalism is still prevalent in our healthcare system.

In trying to understand some of the factors that are likely to shape the future, a couple of questions come to mind:

To what degree are new medical devices and information technologies empowering patients?

How might this evolve over time?

There is no doubt; we are in the middle of a health information revolution. What was once reserved for a relatively small group of professionals is suddenly accessible by all. While the informed/empowered patient movement started before medical information became available online, the internet has facilitated the dissemination on a far broader scale.

This has been so impactful that we had to coin a term (cyberchondria) for people who have “unfounded escalated concerns” about serious illnesses based on their reviews of online medical and health literature.

While this “diagnosis” is reserved for a few, modern day healthcare practitioners are learning to deal with the phenomenon of empowered patients and in some cases, they are encouraging it. Why wouldn’t they, if it can ultimately help them be more efficient? After all, patient education and self-management, when done right, can lead to positive outcomes.

The Internet is not the only factor at play. Most current smartphones feature immensely powerful chips with great processing power. Add cloud hosting and computing to that, and consumers today have access to ever increasing computational power. As well, we now have access to medical grade smartphone enabled devices and sensors, such as smartphone-compatible ECG leads, respirometers, pulse oximeters, brain-wave measuring headbands and the list is growing.

Furthermore, novel home genetic testing kits and modern approaches to laboratory medicine, as Theranos is doing in the United States, for example, is putting information in the hands of patients, sometimes even before their health providers receive it!

Soon, the patient will not only get the actual lab reading, but they will be receiving accurate interpretations and recommendations made possible by sophisticated algorithms that can interpret massive amount of data virtually instantaneously.

Austere global economic conditions and skyrocketing healthcare spending will also drive the transformation.

In Ontario, for example, government spending on healthcare will exceed 50 percent of the provincial budget in the not so distant future. The current archaic model of a provider- or hospital-centred system is not sustainable.

There is an economic need to leverage the most important stakeholder, the patient. In the United States, through the Affordable Care Act, where healthcare organizations and providers are rewarded for positive outcomes or penalized otherwise, there has been a realization that the new model of care needs to include, if not rely heavily on the patient.

Luckily, technology has the potential to facilitate this by helping to connect patients with their healthcare organizations and providers and by raising their awareness, boosting their motivation and enabling their self-efficacy.

While I certainly do not see the role of healthcare providers vanishing in the future, I can see healthcare delivery becoming more efficient and focused on addressing urgent matters while passing some of the treatment adjustment accountability along to the patient. For physicians, the time-savings can be re-invested back into treatment.

Finally, I would like to restructure the questions I started with and instead of asking whether new medical devices and information technologies are empowering patients, I would like to leave you with this question to ponder:

To what extent will empowered patients impact the creation of a new generation of medical devices and information technologies?

Ahmad Zbib, MD, is Director, Digital Health and Innovation at the Heart and Stroke Foundation of Canada.

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