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In the second part of a two-part Q&A, Nick van Terheyden, M.D., chief medical officer of Dell's healthcare and life sciences services division, discusses patient engagement and the democratization of delivering healthcare information. Read part one, in which van Terheyden talks about health consumerism's benefits for patients and providers.
Could you talk about the democratization of delivering healthcare, greater access to healthcare information and other factors that empower patients?
Nick van Terheyden: I think the biggest driver, or one of the biggest drivers, of this is mobile technology. It's not that long ago that the iPhone arrived on the scene. And it's now all pervasive. And I know that's widely variable, certainly in the international setting. It's not quite the same accessibility. But even in poorer parts of the world, in Africa, mobile technology remains one of the mainstays of access and distribution.
So, in our world, a great example of that: I remember I had a friend who was just a goldmine, a Google for movies. You'd know the movie or you'd know somebody who was in the movie who you were trying to think of, and you could call her and say, 'Hey, it's ...' And I'd describe what I knew and she would help me get to the movie I was trying to think of. That's been entirely replaced by access to [film website] IMDb. I can always get to the movie I'm trying to think of.
The same is true with all this healthcare information. Even when you go to Africa, where their access to the technology is limited quite often to text-based phones, even with the simple process of text-based messaging, they've got systems that allow them to expand the reach and accessibility of healthcare information for their community. They have a much less dense availability of physicians. So, where there are fewer physicians per person ... they use paraclinical resources. They support them with text messaging. We've seen work on outbreak information. Everybody knows about Ebola. But there are many other diseases that have a transmission effect and the ability to communicate that so that you can bring the resources and support and also quarantine appropriately.
One of my favorite examples, because it has this really compelling message at the end, [is] the ultrasounds that are carried out on pregnant moms that were stored and forwarded using a minimal amount of data. They were done by people who were trained to do them, but couldn't read them. They weren't typically physicians, but rather, more often than not, a midwife or somebody like that in these remote villages. This is about access and democratization of delivering healthcare information, and pushing it out to the people and making the people [who] are experts more available.
You've referred to patient engagement as the 'drug of the century.' Could you elaborate on that and also talk about some of the best ways to create patient engagement in delivering healthcare?
van Terheyden: So, first off, I want to be sure that I give credit to [health IT theorist] Leonard Kish, who originally coined that phrase. I reference it a lot. What he did was essentially make a comparison of patient engagement to treatment with a drug. And if you could take patient engagement, put it into a pill and offer it for sale, people would fall over themselves to buy the patient engagement drug because it's so effective at improving the overall quality of health for patients.
In a Kaiser study in 2009 of coordinated cardiac care, the folks [who] were enrolled in this coordinated, engaged group had an 88% reduction in the risk of dying of cardiac-related causes. That's an astounding result. The clinical care teams in that engagement reduced overall mortality by a hard number of 76%. So, as a tool, I think patient engagement [has] been proven to really deliver value. I also think it makes sense. I talk a lot about democratization of healthcare and the accessibility of healthcare information. One of my other great leaders in this space that I look to a lot is Eric Topol, [M.D.], whose original book, The Creative Destruction of Medicine, and then subsequently, The Patient Will See You Now, have been really important.
Those books really emphasized this change and move away from this paternalistic system that I grew up in. When I went to medical school, I was essentially imbued with these huge amounts of knowledge. It wasn't that long before I got into medical school that medical textbooks were off-limits, and you couldn't get into a medical library if you couldn't prove you are clinician. That's all obviously changed appropriately, and being the holder of information is no longer the expertise. And we, as physicians, are not the ultimate experts.
How can patients benefit most from participating in delivering healthcare and patient engagement?
van Terheyden: This patient engagement demands that people get involved. Obviously, their capacity to understand all the details is highly variable. And that's really one of the functions for the clinical teams is to help guide them through that challenging terminology, challenging science and understanding to explain it in ways to allow them to make informed decisions. And that's really the sort of key to this process. It's not just physicians engaging, but patients engaging.
And I think there is much to blame, certainly, in my parents' generation. You know, the idea that you would ever challenge your physician. If he said X was true, X was true. You would never question that or ask why even. That was just what they did. And I think we have to move away from that. Younger generations are better at it, but still not as good as we need to [be]. And we need to encourage that so that they become fully engaged participants in the care process, and spending as much time on their own healthcare as they do when they go and buy a toaster on Amazon and review all the data about toasters and decide which is the best one for them. We should be doing the same thing with delivering healthcare.
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