Today’s Health Care Today’s Health Care SystemSystem

Physician

Health Insurance

Self-Care

Information Overload

Media

The Patient

How to heal a sick How to heal a sick healthcare systemhealthcare system

Dr Aniruddha Malpani, MDDr Aniruddha Malpani, MD

Medical Director, HELPMedical Director, HELP

Health Education Library for PeopleHealth Education Library for People

World’s largest free health libraryWorld’s largest free health library

www.healthlibrary.comwww.healthlibrary.com

What’s wrong with What’s wrong with healthcare today?healthcare today?

Remember your last visit Remember your last visit to your doctor ?to your doctor ?

Poorly organised patients + Poorly organised patients + rushed doctors = badly rushed doctors = badly performed consultation = performed consultation = poor medical carepoor medical care

How can we improve this ?How can we improve this ?

The commonest complaints The commonest complaints patients have today are:patients have today are:

Doctors are too busy – they make me wait Doctors are too busy – they make me wait too longtoo long

I don’t understand what they say – they don’t I don’t understand what they say – they don’t have time to explain their jargon. They don’t have time to explain their jargon. They don’t share information or respect my preferencesshare information or respect my preferences

Care is fragmented amongst specialistsCare is fragmented amongst specialists Doctors are not transparent or accountable. Doctors are not transparent or accountable.

How do I know his advise is reliable and How do I know his advise is reliable and trustworthy ?trustworthy ?

Too expensive !Too expensive !

Doctors are unhappy Doctors are unhappy too !too !

They are stressed out, because of the They are stressed out, because of the large number of patients they need to see, large number of patients they need to see, and feel that patients expect too much and feel that patients expect too much from them. The feel that patients unfairly from them. The feel that patients unfairly blame doctors for all bad outcomes. blame doctors for all bad outcomes.

They also feel that many patients waste They also feel that many patients waste their valuable time by asking stupid and their valuable time by asking stupid and irrelevant questions; because they are too irrelevant questions; because they are too disorganized; and don’t bother to educate disorganized; and don’t bother to educate themselves or do their homework. themselves or do their homework.

Result? Result? Breakdown in Doctor-Breakdown in Doctor-

Patient CommunicationPatient Communication Patients don’t trust doctors as much as they Patients don’t trust doctors as much as they

used to in the pastused to in the past Doctors are getting burnt outDoctors are getting burnt out They practice defensive medicine to protect They practice defensive medicine to protect

themselves from malpractise suitsthemselves from malpractise suits Overspecialisation – specialists have tunnel Overspecialisation – specialists have tunnel

visionvision No one to look after the “whole” patientNo one to look after the “whole” patient Doctors have become technicians – lost the Doctors have become technicians – lost the

human touchhuman touch

Major reason for a sick Major reason for a sick healthcare system healthcare system

Everything is doctor-centric - Everything is doctor-centric - the doctor is the center of the the doctor is the center of the medical care systemmedical care system

Healthcare is therefore Healthcare is therefore fragmented and disorganisedfragmented and disorganised

Too many specialists , most Too many specialists , most of whom have tunnel visionof whom have tunnel vision

Solution Solution

Need to reform the Need to reform the healthcare ecosystem !healthcare ecosystem !

Put patients at the center – “ Put patients at the center – “ patients are the largest patients are the largest untapped healthcare untapped healthcare resource “ !resource “ !

AssumptionAssumption

Patients ( or their relatives and Patients ( or their relatives and friends) are : intelligent and friends) are : intelligent and capable; and because they have a capable; and because they have a lot at stake , they are motivated lot at stake , they are motivated to get good health care, and will to get good health care, and will be willing to invest time and be willing to invest time and energy if given the right tools to energy if given the right tools to ensure a good outcome.ensure a good outcome.

Patient centered Patient centered healthcarehealthcare

Self-careSelf-care PersonalizationPersonalization TransparencyTransparency QualityQuality ControlControl

Information TherapyInformation Therapy

“ “ The right The right information to the right information to the right person at the right time to help person at the right time to help make better health decisions”make better health decisions”

What information do patients want ?What information do patients want ? To choose doctors and treatments with To choose doctors and treatments with

good outcomes good outcomes To communicate effectively with To communicate effectively with

doctors doctors To know what the doctor To know what the doctor shouldshould do do

Blended modelBlended model

Click and mortarClick and mortarProvide information in the Provide information in the

real world real world Provide information on the Provide information on the

webweb

Patient information Patient information centers centers

At every point of clinical At every point of clinical contactcontactClinicsClinicsLabsLabsDiagnostic centersDiagnostic centersChemistsChemistsHospitalsHospitals

Patients have questions !Patients have questions !

We need to answer these proactivelyWe need to answer these proactively Win-win situation !Win-win situation ! Helps to improve patient satisfactionHelps to improve patient satisfaction Helps to improve patient complianceHelps to improve patient compliance Can be answered by all healthcare Can be answered by all healthcare

professionalsprofessionals Great way of marketingGreat way of marketing

Patient education is an untapped Patient education is an untapped area in India today !area in India today !

Anyone who provides this will create Anyone who provides this will create a USP a USP

Improve brand recognition and Improve brand recognition and market share !market share !

Works very well in the USA !Works very well in the USA !

Our experience with Our experience with Information Therapy in Information Therapy in

the real-worldthe real-world HELP – world’s largest free health libraryHELP – world’s largest free health library Established in 1998Established in 1998 Mission - to empower people by providing Mission - to empower people by providing

them with  the  information they  need to them with  the  information they  need to promote their health , and prevent and promote their health , and prevent and treat   medical problems in the family in treat   medical problems in the family in partnership with their doctor. partnership with their doctor.

We are a registered charitable trust and We are a registered charitable trust and a non-profit organisation. a non-profit organisation.

We help patients save We help patients save money on medical care money on medical care

1. Promote SelfCare . Help them to do as 1. Promote SelfCare . Help them to do as much for themselves as they canmuch for themselves as they can

2. Provide Evidence-Based Guidelines , so 2. Provide Evidence-Based Guidelines , so they can ask for the right medical they can ask for the right medical treatment that they need - no more and no treatment that they need - no more and no lessless

3. Help them with Veto Power, so they can 3. Help them with Veto Power, so they can say No to medical care they don’t need, say No to medical care they don’t need, thus preventing overtesting and thus preventing overtesting and unnecessary surgery .unnecessary surgery .

What we provideWhat we provide

Easy to read materials – for patients Easy to read materials – for patients and by patientsand by patients

Wide variety of styles – from single Wide variety of styles – from single page pamphlet to bookspage pamphlet to books

Comprehensive – from stress Comprehensive – from stress management, exercise, diet, all management, exercise, diet, all illnesses, alternative medicineillnesses, alternative medicine

Over 300 DVDs Over 300 DVDs

Our focus areas now are:Our focus areas now are:

1. encouraging health insurance 1. encouraging health insurance companies to invest in patient companies to invest in patient educationeducation

2. advocating information therapy2. advocating information therapy 3. setting up a national network of 3. setting up a national network of

patient education centerspatient education centers 4. developing patient educational 4. developing patient educational

materials in Indian languages for the materials in Indian languages for the webweb

HELP is growing !HELP is growing ! National Network National Network

Every hospital should have a Patient Every hospital should have a Patient Education Resource CenterEducation Resource Center

Win-win situationWin-win situation Great tool to empower patientsGreat tool to empower patients Helps doctors and hospitals too !Helps doctors and hospitals too !

Patient Information Patient Information CenterCenter

Core collection of booksCore collection of books DVDsDVDs PC with internet connectionPC with internet connection PrinterPrinter Staff member Staff member ““Corner” centers – need just about Corner” centers – need just about

100 sq ft100 sq ft

New locationsNew locations

Mini-libraries in pharmaciesMini-libraries in pharmacies Mini-libraries in medical laboratoriesMini-libraries in medical laboratories Mini-libraries in clinicsMini-libraries in clinics

Online Information Online Information TherapyTherapy

FreeFree 24/724/7 Easily accessibleEasily accessible Increased internet penetrationIncreased internet penetration Answer questions free by email !Answer questions free by email !

How do we provide the How do we provide the right information to the right information to the

right patient ?right patient ? Free floating information is uselessFree floating information is useless Information Therapy needs to be Information Therapy needs to be

prescribed to them, tailored to their prescribed to them, tailored to their needs, based on their medical needs, based on their medical problemsproblems

How can we do this ?How can we do this ?

PHRPHR

PHR – Personal Health PHR – Personal Health RecordRecord

For the Tax Department, you are For the Tax Department, you are your tax returnyour tax return

For the Bank, you are your bank For the Bank, you are your bank statementstatement

For the healthcare system, you are For the healthcare system, you are your medical record .your medical record .

PHRPHR Technology to help patients to store their Technology to help patients to store their

medical records on their personal website. medical records on their personal website. Interactive forms and templates so they can fill in Interactive forms and templates so they can fill in the details online. Images, ECGs can be scanned the details online. Images, ECGs can be scanned in in

This is NOT an EMR !This is NOT an EMR ! Using CCR information standards , the PHR can Using CCR information standards , the PHR can

exchange data with other databases so that the exchange data with other databases so that the PHR can be automagically updated ( for example, PHR can be automagically updated ( for example, with lab test results ; with the chemist’s with lab test results ; with the chemist’s prescription; with the hospital EMR; with health prescription; with the hospital EMR; with health insurance company data)insurance company data)

Yos TechnologiesYos Technologies

Yos Technologies Yos Technologies ( www.yostechnologies.com) is ( www.yostechnologies.com) is based in Bangarore and provides a based in Bangarore and provides a comprehensive "Personal Healthcare comprehensive "Personal Healthcare System" which includes PHRs, System" which includes PHRs, Healthcare tools and applications for Healthcare tools and applications for Preventive and Continuous CarePreventive and Continuous Care

I am an angel investorI am an angel investor

Why will patients use the Why will patients use the PHR ?PHR ?

Three playersThree players

PatientsPatients DoctorsDoctors Health insurance companiesHealth insurance companies

PHR PHR = organised medical = organised medical

information information = improved medical care= improved medical care

Patients have a lot at stake ! Patients have a lot at stake ! Keeping this record will help them to Keeping this record will help them to

get better medical care. get better medical care. Patients need to manage their own Patients need to manage their own

health record. health record.

Patient benefitsPatient benefits Instantly available on your mobile, Instantly available on your mobile,

wherever you arewherever you are Information is shared amongst all the Information is shared amongst all the

specialists who participate in your carespecialists who participate in your care Available during emergenciesAvailable during emergencies Always updatedAlways updated Ensures you don’t forget allergies and Ensures you don’t forget allergies and

drug reactionsdrug reactions Automated reminders ( for example, for Automated reminders ( for example, for

checkups ) using SMScheckups ) using SMS

Patients own this Patients own this information.information.

Part can be secure, private, and confidential; Part can be secure, private, and confidential; part can be public part can be public

Patients can add a lot of value to the Patients can add a lot of value to the healthcare system using Patient to Patient healthcare system using Patient to Patient ( P2P) networking. ( P2P) networking.

Social networking – an online community , in Social networking – an online community , in which patients share informationwhich patients share information

“ “ Wisdom of the crowds” Wisdom of the crowds” ““Expert patients “ can act as mentors and Expert patients “ can act as mentors and

email buddies.email buddies. Patients can grade their doctors and hospitals Patients can grade their doctors and hospitals

( using the amazon.com review model ) and ( using the amazon.com review model ) and compare treatments ( compare treatments ( www.askapatient.com). ).

How do we get patients to How do we get patients to sign up ?sign up ?

Reach out to patients directlyReach out to patients directly Highly motivated patient groupsHighly motivated patient groups

Patients with chronic illness, such as Patients with chronic illness, such as cancer, infertility, HIVcancer, infertility, HIV

Pregnant womenPregnant women Mothers ( for their children)Mothers ( for their children)

Corporates Corporates Employee wellnessEmployee wellness

PRM – Patient Relationship PRM – Patient Relationship Management ! Management !

PHR can help doctors improve their PHR can help doctors improve their practisepractise

Because patients are better organized; and Because patients are better organized; and the doctor has easy access to all the the doctor has easy access to all the relevant medical records, the doctor’s relevant medical records, the doctor’s productivity will improveproductivity will improve

Good medical records reduce medical Good medical records reduce medical errors. Important in risk management , thus errors. Important in risk management , thus reducing the doctor’s medicolegal liability . reducing the doctor’s medicolegal liability .

More doctors now have More doctors now have their own websitestheir own websites

Websites are effective marketing tools Websites are effective marketing tools for doctors which can help them to for doctors which can help them to promote their practicepromote their practice

As doctors move online, they will want As doctors move online, they will want their patients to move with them !their patients to move with them !

Email is a much more effective form of Email is a much more effective form of communication than a phone call !communication than a phone call !

Can also integrate with the doctor’s Can also integrate with the doctor’s EMR EMR

Major player – health Major player – health insurance companiesinsurance companies

Initially, health insurance companies Initially, health insurance companies can offer the PHR as a value-added can offer the PHR as a value-added service to their clientsservice to their clients

Later, the health insurance company Later, the health insurance company could make this compulsory for all could make this compulsory for all their clientstheir clients

How the PHR helps health How the PHR helps health insurance companiesinsurance companies

They could use this for providing They could use this for providing health education to their clients, health education to their clients, which would help to reduce their which would help to reduce their medical bills. medical bills.

It would reduce their transaction It would reduce their transaction costs, because the data costs, because the data processing ( collecting premiums, processing ( collecting premiums, authorizing payments, issuing authorizing payments, issuing payments) could all be done payments) could all be done electronically, and much more electronically, and much more efficientlyefficiently

How the PHR helps health How the PHR helps health insurance companiesinsurance companies

They could mine the data these They could mine the data these records warehouse, to improve records warehouse, to improve the quality of their services and the quality of their services and obtain more accurate actuarial obtain more accurate actuarial data .data .

Online disease management Online disease management ( based on the PHR) would help ( based on the PHR) would help them reduce costs for patients them reduce costs for patients with chronic illnesses (with chronic illnesses (http://www.lifemasters.com/index.asp))

White-labelled PHRsWhite-labelled PHRs

Applications being Applications being developeddeveloped

1. Google Earth – to map the nearest 1. Google Earth – to map the nearest doctor; nearest chemist; nearest doctor; nearest chemist; nearest hospitalhospital

2. Databases of doctors, hospitals, 2. Databases of doctors, hospitals, medicines and their pricesmedicines and their prices

Changing the healthcare ecosystem Changing the healthcare ecosystem using Web 2.0using Web 2.0

Why haven’t more Why haven’t more hospitals adopted IT ?hospitals adopted IT ?

Bugs in softwareBugs in software Difficult to get skilled IT manpower Difficult to get skilled IT manpower

to run the systemsto run the systems Difficult to scale upDifficult to scale up Connectivity issuesConnectivity issues

Better modelBetter model

Software as a Service !Software as a Service ! All the technology is outsourced to Yos All the technology is outsourced to Yos Webware ( Web 2.0)Webware ( Web 2.0) No installation or maintenance neededNo installation or maintenance needed Always updatedAlways updated Can be easily scaledCan be easily scaled Always available – from anywhere !Always available – from anywhere !

RisksRisks

Need a critical mass of patients to Need a critical mass of patients to adopt thisadopt this

Privacy issuesPrivacy issues Legal liability issuesLegal liability issues

Today’s Health Care Today’s Health Care SystemSystem

Physician

Health Insurance

Self-Care

Information Overload

Media

The Patient

The Patient as IntegratorThe Patient as Integrator

Care

Choice

Information & Feedback

The Empowered Patient – with the help of Information

Therapy