Thursday, February 19, 2009

The Competent Healthcare Consumer

What does it take for a consumer of healthcare products and services to be a competent consumer?

Well, let's start with the definition of "competence;" here's one I like: "The individual's demonstrated capacity to perform, i.e., the possession of knowledge, skills and personal characteristics needed to satisfy the special demands or requirements of a particular situation is referred to as competence." [Italics added - Reference]

OK, so what kind of knowledge, skills, and characteristics do competent healthcare consumers need?

The knowledge needed emerges (grows, develops) from understandable, useful, "actionable" information (i.e., it can be acted on). This information helps consumers act responsibly and effectively by making good decisions and behaving wisely. This knowledge spurs the development of crucial skills that promote good physical and psychological (body and mind) health.

These skills focus on: (a) self-improvement (developing one's potential), (b) self-maintenance (self-care), and (c) continually improving coping abilities (problem-solving strategies and methods for accepting the unchangeable).

In addition, certain personality characteristics are required. I've discussed these characteristics in previous post starting at this link. They include:

  • Positive attitudes about managing one's health (e.g., a joy of living and willingness to take constructive action)
  • Confidence, motivation, awareness, rational thinking, and assertiveness
  • A desire to learn (gain knowledge about) about one's physical and mental health status and risks, and to understand how to (a) avoid health problems, (b) self-manage chronic conditions, and (c) treat existing problems in the safest and most cost-effective way
  • A tendency to use their knowledge and understanding wisely through healthy living
  • Proactive coping strategies focused on solving problems, learning lessons, and minimizing one's emotional distress by rationally accepting when a problem cannot be solved.

When dealing with existing and potential health problems, competent consumers, therefore, actively seek to acquire and utilize valid knowledge and guidance to help them (a) understand the pros & cons of different treatment and prevention options, (b) select the options best suited to their particular situation and preferences, and (c) develop skills necessary to implement those options effectively.

I'd like to return to the knowledge requirement since it's at the core of competent healthcare consumerism. Since knowledge comes from information, let's examine the kinds of information consumers need in order to generate valuable knowledge.

First of all, good information requires comprehensive, valid, reliable (complete, accurate, and dependable) data. These data are facts and figures, collected on multiple occasions (over time), which include:

  • Internal biological measures (biometrics) such as height, weight, blood pressure and other vital signs, cholesterol level, blood glucose and other blood component levels, imaging studies and lab tests, illnesses, allergies, genetics, etc.
  • Psychological measures of mood and emotions, cognitions (thoughts and beliefs), behaviors (e.g., exercise, eating, sleeping, smoking, substance and alcohol use), social relationships, learning styles and (dis)abilities, significant past experiences (e.g., memories, traumas), etc.
  • Healthcare treatments, including medications taken, procedures received, and their outcomes
  • Preventive actions, such as inoculations, wellness coaching, and health education
  • Demographics, which include age, gender, finances, ethnicity, etc.
  • Environmental conditions, past and present, including neighborhood crime levels, pollution, etc.

All these data then have to be analyzed using valid computational models to generate high-value information that helps consumers and their make valid predictions, build useful knowledge and skills, make sound decisions, increase positive motivation, improve physical health, and have greater peace of mind (e.g., reducing mental stress and emotional distress). This information can be grouped into at least five categories:

  1. Trends. Knowing changes in a person's health data over time can reveal trends and tendencies, which give insights into what is likely to happen in the future by studying what has been happening in the past and in the present. For example, if your blood pressure has been rising over the years into dangerous levels, then you have a risk factor that may lead to heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis/arteriosclerosis), stroke (brain damage), and eye/vision problems. This is actionable information since you can do many things to decrease your blood pressure, including medication, lifestyle changes, and more.
  2. Tendencies. Knowing your tendencies is also important. These tendencies include your habits, typical behaviors/reactions in particular situations, mind-sets, etc. The field of psychoneuroimmunology is demonstrating that people who tend to have difficulty handling stressful life events can have an impaired immune system. Other researchers are identifying "coronary-prone behaviors," such as feelings of insecurity and a perceived lack of self-efficacy, which can increase the likelihood of coronary heart disease. Potentially high-cost, medically dangerous behaviors — such as excessive consumption of alcohol, use of illicit drugs, violence, and unsafe sex — also find their roots in negative behavioral tendencies (see this link for more).
  3. Associations (relationships, connections, interactions). Knowing how different things are associated is also important, including the connection between body, mind and behavior. For example, let's say you have high blood pressure/hypertension (a body problem), as well as the tendency to feel helplessness and stressed-out (a "mind" problem), as well as a tendency to eat high-salt foods and avoid regular exercise (a behavior problem). The interaction between these things can disastrous. Taking action to control you stress (e.g., with stress management training and counseling), modifying your diet, and engaging in healthy exercise can prevent these a serious medical condition. Having genetic markers or family history related to certain inheritable illnesses is also crucial knowledge.
  4. Warnings and alerts. It is obviously important to know when you are due for a medical check-up, when it's time for inoculation. Equally important, you ought to know if there are possible serious drug-drug interactions between medications you are taking, if you may be experiencing adverse side-effects of your medications, if your lab tests indicate a health problem, etc. These are some of the kinds of information warning and alerts convey.
  5. Guidelines and instructions. Up to this point, the information I discussed becomes knowledge that helps identify risk factors, make predictions, and make a person aware when some action is required. A fifth form of knowledge concerns what to do about a risk factor or health problems, and how to do it, i.e., having the awareness and skill to take good care of oneself. This is the role of evidence-based guidelines and instruction/education. I've written much about this topic. In a recent blog post, I discussed it in terms of Consumer-Centered Cognitive Support through Clinical Decision Support, which is at this link. I also discussed diabetes health education programs at this link.

So, being a competent healthcare consumer requires a great deal. You need:

  • Substantial knowledge about your current health status and risks, as well as the options for handling them
  • The training, guidance, and skills required to manage existing and potential health problems effectively
  • Personality characteristics that promote positive motivation, attitudes and behavior.

Obtaining the requisite knowledge, skills, and characteristics, in turn, requires access to:

Please realize that I am not dismissing the importance of consumers consulting their healthcare professionals and gaining from their knowledge. However, many times patients come out of a doctor’s office without fully understanding what the doctor said. That’s why the information presented to consumers (patients) must be interpreted and explained in ways they understand, and why evidence-based guidelines should be presented to help direct them.

I’m convinced that next-generation personal health records will be able to do much of this, but no one should bypass/ignore one's healthcare professionals. After all, when it concerns one’s health, it would be foolish for a patient to rely only on software, or even on the word of a single doctor when multiple options exist.

Anyway, developing and refining these interpretations, explanations and guidelines require international collaborations with a focus on continually evolving and improving them, as well as huge amount of intricate body and mind health data and validated models for analyzing those data.

Tuesday, February 10, 2009

Personal Health Profiler – Beta testing has begun

I'd like to announce that our Personal Health Profiler (PHPro) beta has just begun formal field testing. I expect to release it for public examination later this month. Here's what the PHPro beta currently includes:
  • Interactive reports provide an integrated view of a person's biomedical and psychological (body-mind) information, which improves decision-making by addressing the needs of the "whole person."
  • Medication assessment tool that identifies possible drug-drug interactions and adverse side effects, as well as offering recommendations for oneself and one's healthcare provider
  • Personalized desktop portal providing easy access to relevant information on the Internet and elsewhere.
  • Problem-management guides providing coping and problem-solving tools that include gateways to focused information related to troubling issues a person is facing; this process helps avoid overload by supplying information and interpretations in the context of real-life situations.
  • A diabetes data collection and reporting module, which provides a convenient way to input data about blood glucose and hemoglobin A1c levels, insulin use, exercise, blood pressure, cholesterol, and mental stress. It also calculates your body mass index (BMI) and generates a series of charts and graphs showing changes over time. Note that we will be building other specialized modules for other chronic conditions.
  • A way to give the individual complete control over the data by enabling him/her to determine whom (if anyone) has permission to view each particular piece of information, which allows data sharing in a very protective manner.
  • The ability to generate "composite reports" containing information from multiple sources. To demonstrate this, several additional files are included with the beta version. One is an XML-based Continuity of Care Document (CCD) and the other is a data file from a diabetes health education program that was generated by a web-based database. The software automatically retrieves data from both files and includes them in a demo Profile report, along with data that has been manually entered using the PHPro data entry forms.
  • A method for indexing and categorizing every conceivable piece of health-related information using a convenient numeric classification system similar to Dewey Decimal, which libraries use to organize books.
  • A comprehensive, ever-evolving, self-assessment questionnaire that speeds knowledge-building through a patented process that uses sophisticated branching logic to administer to an individual only the assessment items relevant to him/her.
  • The ability to enter time-sensitive data in any order and have it appear chronologically.
  • An innovative, secure, low-cost patented system for sharing health information in peer-to-peer (decentralized) networks.
I will announce on this blog when the beta is ready for public review.