In this unprecedented age of technology and communication, many wonder why the healthcare industry has traditionally not been on the cutting edge. Some attribute the medical world’s notoriously sluggish adaptation of modern technology to the massive paradigm shift that would be required at all ends of the spectrum, from back-end clinical trials all the way to physician administration and patient management. But the recent success of medical technology in healthcare management, on the side of administrative and record-keeping, has inspired many to direct efforts to improving patient-physician communication, most intriguingly, in the waiting room.
Dr. Cynthia Haines is a Renaissance woman of health communication. A practicing family physician, she is also Chief Medical Officer of HealthDay, a published author and a well-respected speaker about the space. Her book “The New Prescription” pulls no punches: healthcare is broken, she says, and it’s up to the individual (not insurance companies, Congress, or any other entity) to fix it. Dr.Haines believes proper patient education is at the center of this fight. The internet and mobile technology, with the ability to bring targeted, interactive information to the patient is of utmost importance in circumventing the red tape and unnecessary healthcare costs. Soon, she says, tablets will be as common in the waiting room as two-week-old golfing magazines. But today, it could be a revolutionary financial opportunity. OneMedRadio Editor, Matt Margolis interviews Dr. Haines below.
Click below to hear full audio interview and see transcript to follow.
Matt Margolis: Greetings. This is Matthew Margolis with OneMed Radio. I’m with Dr. Cynthia Hanes, author of “The New Prescription: How to Get the Best Health Care in a Broken System” and as well chief medical officer of HealthDay, a leading health, news and information provider. Dr. Haines is also managing editor of HealthDay’s Physician’s Briefing, an adjunct assistant professor at St. Louis University School of Medicine, and a diplomat of the American Academy of Family Physicians. Thank you so much for joining us, Dr. Haines. How are you?
Dr. Cynthia Haines: I’m very well. Thank you so much for having me.
MM: Absolutely. Well, I was hoping that we could begin with the inspiration for writing this book.
CH: Sure. Well, I am a family doctor on the frontlines of providing primary care to folks in this great nation. It’s basically my way of boiling down all of the things that I would tell you if you were one of my patients sitting there across from me in the exam room telling you how to get the most of this visit and all of your other visits into the healthcare system. But also how to need me and others like me as far as healthcare providers less because you’re doing a better job of taking care of yourself and being healthier.
MM: So you would say that your target audience is basically your patients and the people who are interested in getting the healthcare?
CH: Exactly. So my target audience for this book is the patient in all of us. So we’re all patients at one time or another, it’s going to happen. So it’s for all of us in the sense of a tool to help us get more empowered in that process. A way of pulling back the curtain if you will saying, hey guys, this is what’s going on behind the scenes, things that you may not realize that things that are having a direct impact on you and your health outcomes and your health. So if you can take that information and be able to use it in a way that helps you navigate the current healthcare system in a much more efficient way and get what you really want out of it, which is better health at a much more reasonable cost then you’re my target.
MM: Sure. So what about the healthcare provider? What do you think the healthcare provider can get from your book?
CH: So the healthcare provider in a couple of ways, number one, we’re all patients ourselves and number two, to figure out how to use these tools as presented in my book to improve their side of communication because it’s a team approach and that’s really the model of the future. That we’ve been transitioning into this team approach from more of the paternalistic approach of days past, which needs to go away. So a provider being able to utilize that communication to know how to better partner with the patient as a team rather than instructing them in a more unilateral fashion.
MM: Absolutely. So, I was hoping we could talk a little bit about the subtitle of your book. It mentions that we’re sort of living in this broken system and I was wondering if you could just discuss what particular parts you think are broken, how we got here, how we can actually get around it?
CH: So the system is broken in a lot of different ways and one of the main ways that I talk about all the time is the fact that we practice medicine backwards in this country. We focus a lot of energy and resources on curing disease and very little on preventing disease and illness in the first place. So we see that a lot with the economic crisis that there are studies that tell us that people seeking healthcare services in times of economic crisis have gone down and we think, oh, well that’s a good thing because we’re using less right and that’s part of the goal. We want to use less. Not so fast.
It’s part of the problem because a lot of what’s going by the wayside in times of economic crisis are preventive services, routine checkups, annual physicals, screenings that have shown benefit, things of that nature. So what happens is that when you’re not getting that preventive screening and you’re not being proactive about the prevention of disease and illness and you’re only coming in later when there’s a problem, the train is very far down the tracks as far as it’s going to be more expensive to treat something. A lot of times you’re going to be dealing in things in much later stages where if you could head things off at the pass. Not only are you going to lower cost taking the long-range view but you’re also going to enjoy better health outcomes and better health and that’s the goal. So the goal is not to stay out of the healthcare system, end of story. It’s to use it more efficiently so that you need to use it less overall and you’re enjoying better health outcomes and better health as a result. So, the system being broken is that we’re practicing it backwards, as I mentioned, but also it seems like all forces are conspiring to make it difficult to do what I just described.
So historically, we’ve made it difficult to be able to get a primary care provider that you connect with and get in there for routine preventive visits. We haven’t placed a lot of importance on the communication of that. We place a lot of importance on the doing. So as an example of that, you get paid as a physician a lot more for doing a procedure than you do for just talking with a patient for 30 minutes about how to quit smoking and helping them construct an effective strategy to actually get them off of their tobacco dependence.
So those are a couple of big ways that the system is broken. Another big factor in that is there’s been an erosion of the relationship between provider and patient. This is very multifactorial and I don’t want to point any fingers at any one entity but a lot of things going into this, you know, lawyers getting into the mix, third party payers getting into the mix where there’s a real disconnect. Where patients and physicians from both sides, the trust there is being eroded and it’s unnecessary in a lot of ways. A lot of these things that came into the mix really are unnecessary and very damaging. So those are just a few of the ways that the system is broken to date not to mention the fact that a lot of people who really do need healthcare simply can’t afford it.
MM: So why is it financially advantageous for physicians to begin to promote this idea of preventive healthcare, and sort of like you said before, the train gets way too far down the tracks? Why is it financially advantageous for healthcare providers in general, insurance companies, and etc.?
CH: Well, there is a lot of financial incentive for people who are paying the healthcare bills to do this because again prevention is the key. Prevention is where we need to be focusing our efforts. If we can prevent illness and disease and particularly the very expensive chronic diseases most of which are largely preventable, we can save huge dollars from our annual healthcare tab.
Now of course, you know, we’re seeing that that’s very advantageous from a financial perspective for the third party payers, the large insurers, healthcare organizations, healthcare entities, and also patients that are shouldering the burden of these bills as well. How is this financially advantageous to the providers? So let’s just take the example of why would a doctor want to help you in prevention efforts when they’re going to get more money by doing more to you when you come in later sicker and with more issues. The answer is that that’s inherently what healthcare providers want to do. They want to help you optimize your health.
Now the disconnect from the financial perspective is that historically there hasn’t been a lot of compensation provided for preventive efforts, but that’s changing. So we are seeing positive change with people being able to come in and get their wellness screenings, get certain screening tests that have demonstrated benefit and all of that is going to provide compensation for the provider. So there is the financial incentive for the provider as well.
Now taking that one step further. We are in a primary care crisis where there simply are not enough primary care providers to go around. That’s a perfect storm brewing with the other increasing numbers of baby boomers aging and needing more and more care. So who’s going to be available to provide all of this care? So you can see that we’ve really got this perfect storm brewing where we’ve got larger numbers plus with people who have been uninsured and unable to get healthcare services now being able to get them under terms of healthcare reform. So we’ve got all of these increasing numbers of those in need of healthcare services and decreasing numbers of those able to provide them. So it behooves healthcare providers to help empower patients to take better care of themselves and focus more on the preventive arm because they’re going to have more than enough and way more than a full plate of patients in need of chronic care services and even urgent care issues that need addressing and need the doing. So bringing that together with providing the preventive care services for the other patients who aren’t in acute need or in need of services at that moment is going to financially benefit them as well.
MM: So it seems like there’s an underlying issue here of patients needing to take a lot more responsibility for how they view their own healthcare. I was curious if you could speak a little bit about how patients are becoming engaged efficiently and effectively both in the waiting room as well as outside of the waiting room.
CH: Sure. So I’ve started my journey into medicine several years ago and this was actually in the early days of email and internet was just really taking on the world by storm and it doesn’t seem like that’s going to be fading. But back in those days, it was the early days of seeing patients going online for health information. And there was a lot of grumbling from the healthcare professional side of, oh, you know, what now, do we have to spend time going over this list of things you found from the internet and what are these sites that you’re finding. You know, what is the validity of these sites, how reliable is the information and I don’t want you going to those sites to get information. I want you to just listen to what I’m telling you and then we’re good. So of course from those early days, you know, it takes us to where we are today in 2012 where that’s very commonplace. Where patients the majority of the time are getting some kind of medical information online and now we have even more new technology on top of that where we’re basically connected to the web 24/7 with all of the mobile technology that we have at our disposal.
So healthcare professionals I think have largely embraced this and of course now we’re in the age of electronic health records where everything is really available at the ready whenever you need it. That’s being rolled out for healthcare professionals in waves and so some are more fluent with that at this point than others. But as far as how this affects patients being more empowered, I say we’ve got to use this smart technology to help us get smarter. So we have all of this information at our disposal, not all of it is good. So it is our job as healthcare providers and healthcare communicators to help educate our patients in where they should be going to truly get empowered. It’s not empowering if you go to online information that’s just scaring you and creating more health and anxiety or sending you down the wrong pathway. You know, that’s just wasting everybody’s time and energy.
But is empowering if you can get to the right sources of information and get to the right wellness tools that have great use of this mobile technology that does make things so much easier. You know, there’s a lot of new technology that enables people to learn things in a more interactive way using your smart phone or a tablet where it engages you in that process. It is much more empowering than the days of old where it’s just your doctor telling you to do something and you’ve got to remember what they said and you don’t always remember everything. Nobody does. Nobody remembers everything said during a doctor’s visit and furthermore, they’re not remembering all of that correctly so even what they take a way may not be exactly what the doctor or nurse actually said. So using all of these technological advances and all of this information overload in a smart targeted way is how we can help better empower our patients.
MM: So how does HealthDay as well as the similar entities distinguish their authoritative voice from these amateur blogs that you’ve been describing these not necessarily objective or informative voices that maybe out there? And what is the medical community doing to embrace very authoritative and informative websites?
CH: Well that is a great question because there is so much out there how does on effectively vet the source? The answer for HealthDay is that we have several different divisions. So we have traditional news divisions where we focus our news to the consumer, otherwise known as the patient, and then we also have newswires that are directed at the professional audience, doctors, nurses, pharmacists, and other healthcare professionals. Then we also have a custom content arm where we work with a lot of the other health information providers as sort of the ghost and the machine to produce reliable and many times accredited information.
So patients can look to the information and look at where it’s coming from. So I say a lot of these government sources as well as academic sources are wonderful sources of information. So for example, the National Institutes of Health or the American Cancer Society or Mayo Clinic or the Cleveland Clinic, all of these places have streams of information that are very reliable and great sources to direct patients to. HealthDay partners with a lot of similar organizations and provides content out to these other sites. So HealthDay in and of itself is not a health information destination. We are a provider of health news and information to streams of other health information providers.
So the answer to that question is how do we differentiate ourselves from the amateur blogs and a lot of the information that’s out there that maybe people are selling things or they have another agenda, is we don’t have that agenda. We don’t accept sponsorship. We don’t partner with big pharma or medical device to run stories on anything that they ask us to run. It’s old fashioned traditional clean journalism. As far as the custom content creation, we have a multilayered approach to creating that content most of which includes review by a board certified physician in whatever appropriate specialty the content is covering.
MM: So one of the news hooks that inspired this interview was that many different companies both small and large are beginning to roll out these tablets into the waiting room. I’m just curious as a physician and as a healthcare provider, what do you want to see in these tablets? There are a variety of different programs and advertisements and interactive models to get the patient informed, but what do you want to see as a doctor?
CH: What would be ideal in that scenario is to have the tablet program be customized per patient visit. So if there was a way to connect to the details of that visit for that particular patient, it could bring up information about what they’re coming in to see the doctor about. It is also very important for this to be affordable for the healthcare provider to be able to actually have it available within their office and the functionality needs to be there. So what is each healthcare provider trying to accomplish? Do they want the patient to be thinking about what they’re there for at that exact visit or do they want to be accessing reminders about what screening tests might be appropriate and bringing that up? Do they want the patient to be interacting with the program to update their medications before they even get back to speak with the nurse or the medical assistant? Things like that.
So there’s a lot of variables that go into what would make it ideal for any given provider. But I think tablet use in the waiting room is genius and I think it’s another example of how we really need to be figuring out how to access this smart technology to actually get smarter. So the last thing that we need is more clutter and more information overload. So the last thing that we would want is to have patients getting online before the visit and being distracted from the point of their visit, from the focus of where they are in their lives. So for example, you know, I’m 40 years old, mom of two, I’ve got my own issues of what I would be going in to go see the doctor about. I wouldn’t want to be in there talking about or reading something about osteoporosis and getting ads directed at me for bone health medications as one example. You know, I would want something that’s more in my field of vision.
MM: Sure, sure. And so moving sort of to the back end of the doctor’s office, what particular types of technology has been there for the healthcare provider to make their lives easier and to be able to more efficiently provide the treatment?
CH: Well in the past, it was really essentially about scheduling programs and then came prescribing programs and then came some smart phone applications like Hippocrates and then UpToDate came along and then we’ve got DynaMed and other things like that. Then, the burst of EMRs or EHRs brought a whole new access. So you can do a lot within these electronic medical records or electronic health records to manage everything from one central port. But there’s a lot of frustration with that as well because one of the biggest problems is they don’t talk to each other. So unless your EMR is hooked up with the other doctor’s EMRs that your patients are seeing at all times, you’re still having a clouded, imperfect, incomplete picture of what’s going on with your patient.
So there are new advances that are starting to fix some of these problems and another one was that patient wasn’t really involved. Like for example with SLU School of Medicine we have something called My Chart which brings the patient into the conversation and they don’t have access to everything the providers have access to, but they don’t have access to quite a bit and they are able to ask the providers questions. They can look at, get direct access to some of their lab results, ask for prescription refills, things like that that we didn’t have before that can help streamline. But a lot of times, the learning curve for providers is so steep that that can be a barrier to implementing the process. So getting past that initial barrier and learning how to operate each individual system in the most efficient way could be very helpful.
Multiple studies have been done about E-prescribing for example of how E-prescribing can have positive impact on reducing medication errors but, you know, there’s human errors still and there’s computer errors still and there’s patient error. So there’s all of these things that come into play that it is still very imperfect, but we need to still keep working to, again, I keep saying it, try to use the smart technology in a way that actually makes us smarter. Not just giving us more stuff to do and distract.
MM: So do you think that, I guess in your professional opinion, will we see tablets make it to the mainstream and eventually be in every single doctor’s office? Will I never use a clipboard and pieces of paper again when I’m registering at the doctor’s office?
CH: I do think that that’s the way of the future and the same thing in hospitals. You know, like to have tablets in the emergency room or just in the admission departments in the general sense. I do think that that’s where we’re headed because we need to get away from this paper model where it’s more connected. But there are issues that need to be addressed. Affordability and functionality and interoperability, those are all very key factors that need to be addressed and the challenges need to be optimized.
MM: Sure, sure. Well thank you for this interview. I wanted to ask one more question. You’ve had such an impressive career moving to very many different areas of healthcare information, what’s in store for you and what projects are you working on in the future?
CH: Well I’m this funny sort of hybrid of what my editor-in-chief likes to call a communicator who just happens to be a doctor and I think he’s right. I just think it’s a funny way to put it. That’s what I do. I communicate and my sweet spot is empowering people to live healthier, happier lives. Communication is the best way I know how to do that. Where I’m going in the future is to work with all of the smart technology and do just what I’ve been saying and beating the drum for. Use it to actually become smarter and get what we really want.
MM: That was analysis, advice, and musings from Dr. Cynthia Haines, chief medical officer of HealthDay and author of, “The New Prescription: How to Get the Best Health Care in a Broken System.” Dr. Haines, thank you so much for joining us.
CH: Thank you so much. It’s my pleasure.
MM: And this is Matthew Margolis with OneMed Radio signing off.