Save the Patients, Save the Providers — Save the System
We all seem to be able to tell a story about how the health care system has failed us, or someone we love. We all know our country spends more money on health care, by far, than any other nation in the world and provides the lion’s share of innovation in drug, procedure and device development. We know our system saves lives. We know our system has people working in it, and for it, who care more and do more and try harder every single day. Yet, Americans’ health outcomes are less than stellar compared to other developed nations— particularly the outcomes of the most vulnerable members of our society.
Not only does our spending on health care outpace our GDP growth on the regular, our providers face long hours, exorbitant college debt, spurious lawsuits and high suicide rates. Our nurses face ever-increasing responsibilities, record levels of burnout and low pay. And our patients face mounting insurance premiums, surprise medical bills, practices that aren’t evidence-based, and more mistakes and missing care than ever before. Meanwhile, law-makers do nothing to reform the system; caught between a mounting public outcry for change and more financial pressure than ever from lobbyists and special interest groups.
The media and other information providers usually do little to empower us. Our information is siloed and audience-specific, for one thing. Providers read their journals and articles, while we nurses read ours. Patients try to make sense of their insurance policies on the way to the ED or urgent care. There is the occasional laudable attempt made to inform the general public with regard to the truth about the system’s complex inner workings, such as Steven Brill’s opus “The Bitter Pill” (2013), but for the most part, no matter how hard we all try to be good doctors, good nurses or good patients — we find ourselves coming up short.
How can providers read all the articles pertinent to their decision-making, especially when they face long hours in the hospital? How can nurses stay up to date on evidence-based nursing practice, when they are pushing administrative demands, working double shifts, and exhausting themselves trying to be there for the patients and families who need them? And patients and families — how can they stay on top of the management of their (or their loved ones’) complex chronic conditions, making good decisions ten times a day when they have jobs, children, grandchildren and little daily input from their health care team(s)?
The answers to these questions exist, and they involve two major changes — creating good health data, and placing the patient firmly at the center of decision-making about both their data and their health care. We have the technology to turn the system around right now, but so far — we haven’t used it.
A lot more of us need to start asking why this is, because the financial, physical, emotional and moral pressures on the system are clearly reaching critical mass. If we don’t demand changes, we will continue to get what we’ve always gotten — an overall system that, at best, just doesn’t get better and a public system that continues to narrowly avoid bankruptcy.
Truthful and honest reflection by administrators, providers and nurses is integral to this. We all traipse into work every day and do the very best that we can. Patients acknowledge this, and they thank us. Their families thank us. The community thanks us. Some things we do very well, but are we really achieving our goals? Truly practicing evidence-based medicine and nursing? Making the best decisions possible? Really doing everything we’re responsible for? And if we aren’t, don’t we need to try to address that? It often seems impossible to step back, when we’re caught in the daily fray, but in our heart of hearts we know we could do so much better — just not with the system we currently have.
Where are our leaders? The heads of our IT and HIMS departments? Our risk managers, quality and corporate compliance experts? Our CEOs and visionaries? Our law and policy makers and our economic experts? Didn’t they study far into the night in order to lead us into the health care future? If not now, when?
Unleashing data, at our patients’ behest, will change the face of the health care future. Providers and nurses will monitor patients’ progress remotely, conferring with patients regularly via electronic devices and through telehealth. Hospital stays will continue to shorten. Visits will become more and more planned. With access to streams of secure good data, physicians and researchers will be able to learn in hours, days or weeks what used to take years or months. These clinical leaders will provide analytics systems with rules, and the systems will use these rules to sample population data, model it, and feed useful results back to health system leaders, who can choose what to integrate into their decision-making.
Some have cynically claimed that these changes would create a system based on robot caregivers; that we won’t need doctors or nurses any more. However, the truly brilliant minds at the forefront of machine learning and AI are now saying the opposite. These technologies will enable us to make better decisions faster, but they won’t make decisions for us. Healing involves a human connection, a human touch and a human heart. Technology changes but this reality, and its moral implications, cannot.
The most important thing about our data-driven future? Patients will have access to information and tools that empower their health care and health maintenance journeys. They’ll get daily information specific to their plan of care, receive reminders for fluid monitoring, blood glucose checks, medication times, exercise periods, and shopping and meal planning all based on preferences specific to them. As their health improves, the system will be forced to change in all the ways we may be able to imagine — lower costs, fewer visits, reduced demand for drugs. For some, the sick care system is a cash cow; their hearts aren’t in the right place. For those of us who truly love our patients, the time to demand the changes necessary to empower them — and ourselves — is now.
