The visionary Don Berwick came out May 19 with a brilliant new piece in a Health Affairs Web Exclusive, “What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist.” It should be required reading for anybody who cares about making the future health care delivery system better than the current one.

In the article, Berwick offers a profound defintion of what “patient-centered” really should mean, and all I could think about is one of the other most important health care definitional issues of our time: “Meaningful use” of health information technology (HIT). At last week’s first HIT Policy Committee hearing, HHS National Coordinator for HIT David Blumenthal called meaningful use “in some ways a revolutionary concept.” And it could be, particularly if those at HHS who define it do it keeping in mind Berwick’s definition.

Some might think that these two definitions have little to do with one another. After all, isn’t “meaningful use” all about some practical applications of ensuring that adoption of HIT actually results in better, more efficient care? Indeed. In fact, Berwick points out that, “In the more normal [non-health care] world of products and services, excellence is in the eye of the customer.” And, equally importantly, this “is not a moral position; it is a pragmatic one.”

Specifically, Berwick goes on to say, “The business theory underlying modern quality strategies is that producers that meet consumers’ needs, as judged by consumers, will thrive, and those that do not will wither.” That, for example, is something that Toyota became famous for understanding compared to the American auto industry (see here for a previous discussion of how Toyota ties into patient-centered care).

Beyond that, it’s also fair to ask: What is the relationship between these two definitions? Virtually every thinking person in the HIT world has repeated the mantra (something to the effect of): “HIT is not an end; it’s a tool for helping to achieve better, more efficient care…it’s a necessary but not sufficient element of an improved care delivery system.” More importantly, we also know that simply automating existing processes of care will not produce those outcomes. One of the things that we do know will have a substantial impact — particularly in driving better and more efficient chronic care management (where most of our health care dollars are spent) — is engaging the patient in meaningful ways.

Berwick provides several examples of a patient- and family-centered health care system, at least four of which are good examples of what meaningful use of HIT must produce.

• Patients and families would participate in the design of health care processes and services.
• Medical records would belong to patients.
• Shared decision-making technologies would be used universally.
• Patients physically capable of self-care would, in all situations, have the option to do it.

There are many more, but this is a good start. More on “Bringing Patients into the Health IT Conversation About ‘Meaningful Use’” can be found in an excellent post by David Kibbe and Brian Klepper today on the The Health Care Blog. In addition, the IxCenter is working with the Consumer Partnership for eHealth in thinking about how to define a consumer pathway to meaningful use of HIT.

As I wrote a couple of months ago, part of defining “meaningful use” is answering the question, “Meaningful to whom?” If we want the enormous federal investment in HIT to benefit the people who invested the money — consumers a.k.a. American taxpayers –  we had better ask the right question. For my tax dollars, Neil Calman’s query yesterday at a Brookings forum is the root of the question, “How will it benefit patients?” HIT success will require that HIT adoption answers that question in a way that consumers can readily answer it for themselves.

This entry was posted on Thursday, May 21st, 2009 at 8:48 am and is filed under Consumer empowerment, Engaging Consumers, Inside the Beltway, Participatory Medicine, Patient-Clinician Relationship. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.