Workshop C4 MF has nothing to disclose JK discloses that he is part-time SEA at Booz&Co and director of MijnZorgnet Health 2.0: Patients as Team Members Jan A.M. Kremer Marjan J. Faber @JKNL @MJFaber #IHI_PHC Radboud University Nijmegen, The Netherlands December 11, 2012 1:30 PM 2:45 PM Session Objectives P2 Understand the disruptive and innovative possibilities of personal health communities (PHC s) Explore the main barriers and facilitators for the implementation of PHC s in routine clinical practice Assess the most promising interventions to overcome these barriers Get inspired to start or implement your own patientcentered innovations 1
Inspiration: epatient Dave P3 Interaction P4 Online access to your own EMR? Online contact with your doctor? 2
Session program P5 Personal Health Communities Implementation science Group exercise, part 1 Group exercise, part 2 Closing remarks Personal Health Community P6 3
Gynaecologist Radboud IVF team P7 Patients are our best teachers The world is changing P8 The new doctor: from god to guide from host to guest (Don Berwick) The new patient: from passive object to active subject from patient to person (TIFKAP) The Individual Formerly Known As Patient The new healthcare organization: from better/expensive to simple/affordable from physical building to virtual networks 4
Digital IVF clinic (2003) P9 General information 1.0 interviews, education leaflets Personal Health Record (PHR) test results, pictures, letters, reports Communication chat and forum (P2D & P2P) MijnZorgnet (MyHealthNet) P10 Personal Health Community Platform for online health communities: Digital Clinic Personal Health Community (community of the patient) Digital Clinic (community of the provider) 5
MijnZorgnet: the meeting place for patients, doctors and nurses Activities Personal Health Activities Files Diary Consultations Apps Problem list Team members Relations Olga de Haes Communities Digital fertility clinic Fertility community Herniated disk community Enter search term. 6
Files Personal Health Activities Files Diary Consultations Apps Problem list Team members Relations Olga de Haes Communities Digital fertility clinic Fertility community Herniated disk community Diary Personal Health Activities Files Diary Consultations Apps Problem list Team members Relations Olga de Haes Communities Digital fertility clinic Fertility community Herniated disk community 7
Consultations Personal Health Activities Files Diary Consultations Apps Problem list Team members Relations Olga de Haes Communities Digital fertility clinic Fertility community Herniated disk community Apps Personal Health Activities Files Diary Consultations Apps Problem list Team members Relations Olga de Haes Communities Digital fertility clinic Fertility community Herniated disk community 8
Problem list Personal Health Activities Files Diary Consultations Apps Problem list Team members Relations Olga de Haes Communities Digital fertility clinic Fertility community Herniated disk community Team Personal Health Activities Files Diary Consultations Apps Problem list Team members Relations Olga de Haes Communities Digital fertility clinic Fertility community Herniated disk community 9
Implementation P19 >12,000 people with an account > 500 people with a PHC Parkinson patients in The Netherlands Pregnant women in Nijmegen Infertile women in Nijmegen Herniated disk patients Patient with health illiteracy Complex patients with their general practitioners We are quite disappointed in your website: no blogs, no wikis, no twitter, no PHR, no HC, no PHC how static & top-down. As modern care consumers, we want more than just being treated! 10
Session program P21 Personal Health Communities Implementation science Group exercise, part 1 Group exercise, part 2 Closing remarks How can we improve healthcare? P22 Clinical professionals: (interactive) education, accreditation Clinical researchers: EBM, guidelines, decision aids Policy makers, authorities, financers: regulations, contracts, budgets, transparency, audits, public reporting Social scientists: improving culture, team climate, modeling best practices, enhance leadership Managers: changing systems, redesigning care processes, managed care, changing culture in organization Patient representatives: increasing rights and autonomy of patients, patient empowerment 11
Implementation Science P23 Innovation / new evidence Barriers & facilitators Implementation strategy Adoption into routine clinical practice Methods P24 1. Individual interview methods 2. Group interview methods 3. Theory-based methods 4. Literature studies 5. Questionnaire survey methods 6. Studies of practice variation 12
Types of theories P25 Process theories How implementation should be planned, organized, and scheduled Impact theories What factors are associated with change, and why interventions are effective: - Individual professionals - Individual patients - Social context - Organizational context - Political and economic context Grol et al, Milbank Q 2007;85(1):93-138 Framework linking barriers to change Fleuren et al. Int J Qual Health Care 2004;16:107-123 P26 13
PHC of a person with Parkinson s disease P27 Created value (n=18) P28 A. Patient centeredness Emotional support Coordination and integration Continuity Personalized care Accessibility Autonomy B. Efficiency C. Timely Aarts. Thesis, Radboud University Nijmegen, 2012 14
Session program P29 Personal Health Communities Implementation science Group exercise, part 1 Group exercise, part 2 Closing remarks Exercise 1 P30 Make triplets: Payer, Provider and Patient Question: What are the most important barriers and facilitators for the implementation of PHC s? Answers in 10 minutes! 15
Answers P31 Socio political context Organizational context User characteristics Professionals Patients Intervention itself Session program P32 Personal Health Communities Implementation science Group exercise, part 1 Group exercise, part 2 Closing remarks 16
Excercise 2 P33 Make triplets: Payer, Provider and Patient Question: How to overcome the most important barriers and facilitators for the implementation of PHC s? Answers in 10 minutes! Answers P34 Socio political context Organizational context User characteristics Professionals Patients Intervention itself 17
Session program P35 Personal Health Communities Implementation science Group exercise, part 1 Group exercise, part 2 Closing remarks 18