I have been involved throughout most of my medical career in trying to understand the role that information plays in the delivery of healthcare. I have been primarily interested in how to improve patient/provider communication – regardless of whether the provider is represented by a single physician or an entire healthcare organization. I started this endeavor long before the Internet had become a public space – enamored with the capabilities of the computer to deliver multimedia information. Most of the delivery methods available at the time were utilizing stand alone computer systems combined with some type of video device – such as the lazerdisc. These early attempts were cumbersome at best.
Time flies….
As the saying goes: “This changes everything” – This being the Internet.
The Internet has clearly revolutionized the paradigms for both creating and delivering information in every way imaginable. Anyone who has participated in this revolution can not help but be dumfounded by the shear magnitude of the changes that the Internet has wrought. Perhaps it is more blatant to those of us that still can remember the challenges presented by information management, information distribution and search in the “pre-Internet days”. An information “search” was actually a physical event – actually going to the library and walking through the stacks of hard bound journals… The paradigm shift that the Internet represents has occurred not in the simple, incremental way that we initially thought, but has resulted in a seismic shift in the core assumptions that we make when we conceive of the role of information.
The healthcare “system” has yet to grapple with this new reality.
One of those core assumptions that the Internet has brought into clear view is the fact that every product or service can be dissected into two components – a physical product or technical service component and a knowledge component. The knowledge component represents the information necessary to effectively utilize the product or service.
For example, a product such as a television may have an owner’s manual that provides instructions and tips for getting the most out of the product. It may have a marketing component that creates consumer awareness of the product and allows the potential customer to execute a search and analysis of the comparable benefits of this product versus the competition in order to make a buying decision. All of these bits of information represent the knowledge component and make the actual product more valuable.
A service such as knee surgery has a knowledge component as well. That component includes preoperative education and instructions, informed consent, and postoperative rehab protocols that are critical to the optimal outcome of the surgery. It includes a marketing component that allows the potential patient to seek out and select that specific surgeon and that organization as the preferred choice to perform the service (even if that component is currently more likely distributed via “word of mouth”). It includes the outcomes data of the specific surgeon and organization that provides that service.
Similarly, the lifelong task of managing a chronic disease has a large knowledge component that dramatically affects any individual’s ability to optimally manage their disease state. The knowledge an individual needs to successfully manage a chronic disease state includes knowledge about the disease itself, and knowledge about how to find and navigate the necessary and appropriate services from the healthcare system. Information about the disease may be generic, but information about how to find and navigate the appropriate service is more often region-specific — depending on where the individual pursues their care.
It is one of my core assumptions that part of the answer in improving communication between provider and patient lies in coordinating and strengthening the link between the information and service components of healthcare delivery.
In order to increase the efficiency of the process, the knowledge component of a healthcare transaction must be extracted and made available to the consumer through a “self service” or “on demand” basis. The healthcare organization must learn to more effectively articulate both “disease specific” and “system specific” information necessary for the healthcare consumer to more effectively participate in their ongoing care, and manage their relationship with the healthcare organization and provider.
We need to learn how to do this better – and create sustainable systems and processes within our organizations that are tasked with the responsibility to effectively communicate with the public.
