Patient-centeredness; the Panacea for CMS? (Pt 2 of CMS series)
Background
In my previous article, I argued that a CMS should be patient-centered and not administrator or clinician-focused. We have patient-centered care, patient-centered communication, why should a CMS be any different?
The problem is administrator or clinician-centric system is that these tend to serve the purposes of one group of service providers. Workflows would be skewed in favour of one group over the others.
Ultimately, we have to ask ourselves if this is to the patients’ benefit. This is not an easy assessment to make because there is a myriad of factors and outcomes that have to be considered.
Do we look at the WHO measurement of Health System Performance? No, it’s too broad and occupies the space above the institutional level (it’s too macro).
Do we look at the health outcomes, which describe the consequences of disease for an individual? No, it’s too narrow and focused on the individual (it’s too micro).
The Agency for healthcare research and quality (AHRQ) has a health care quality indicator framework for organisations that looks like a good fit. It outlines 6 dimensions of quality:
- Safety
- Effectiveness
- Person-Centeredness
- Accessibility
- Affordability
- Efficiency
- Equity
Now that sounds like something we can optimise a CMS for. Let’s look at each domain.
Safety
An obvious one. Of course, patients would benefit from a safe CMS. Such a system would not only prevent errors but also promote a culture of safety.
Error prevention is easy to conceptualise. One obvious example would be in prescribing. The software would prevent users from prescribing dangerous medications such as medications a patient was known to be allergic to, or which were known to interact with existing medications. More subtly, it could also prevent the entry of dangerously high doses.
A CMS could also foster a culture of safety by having inbuilt prompts such as “Has the limb been marked before surgery?” before the patient is portered into the operating theatre. Double sign-offs would be encouraged (if not required) for the administration of therapies. In my experience, one of the biggest reasons why patient safety has been improved, is the time-out system before procedures (right patient, right time, right place etc). But it is also because other clinical staff now will stop Doctors if they have safety concerns. We empowered nurses, physios, let’s empower our CMS to advocate for patient safety.
From a more patient-oriented view, the CMS may even allow communication between Clinicians and Patients, to enable questions or on the fly confirmation of dosing. Perhaps, even some degree of oversight to prevent patients from taking erroneous medications.
Effectiveness
How can a CMS be effective from a patient’s perspective? Easy, it is effective by enabling all the medical services to function seamlessly and in an efficient manner.
An example would be if the patient needed investigations. This ordinarily brings together a clinician (who requests, say a blood test), the receptionist (who receives, processes and accepts the request), the phlebotomist (who draws the blood), the laboratory technician (who processes the sample), back to the clinician (who reviews the results) and finally back to the receptionist (who informs the patient of the next step).
An effective CMS would, in simplistic terms, allow the clinician to accurately and quickly order the test (say through a short form), the receptionist to accept the request rapidly (through a one-click system on the same CMS), the phlebotomist to correctly draw the patient’s blood (by having the CMS display the patient’s identifiers to refer to as well as the tests to quickly determine how much blood and which containers are required) and so on and so forth.
The CMS would have to be vertically integrated between disparate departments as well as horizontally integrated to ensure personnel within the same department work efficiently.
Person-centeredness
How do you create a CMS which is person-centered? Well, just as we are all individuals, with different needs, the CMS should be flexible (or customisable) to be able to meet the needs of patients and staff.
Take, for example, appointments. Some patients need longer than the standard time slot, and the CMS should allow for booking of a double slot or even triple slot. I still am filled with sadness from my past experiences where I know that my double-slotted patient will be cut short because reception has squeezed in an urgent case.
On the flip side, the same appointment system should also allow blocking of slots so clinical staff have enough time to attend to other patients outside of clinic if needed.
Accessibility
This item is where I’ll introduce something a little more contentious. I believe the way forward is to make CMS systems more accessible to patients.
Not to say that they should be able to run wild and order their own tests and medications. But how about a system where the clinician orders a test, sets a required time frame and then allows the patient to book their own appointment, independently?
That would free up more time for receptionists, empower patients and ultimately result in better patient care.
Now, how about patient health records? For many years, there have been vocal advocates and opposition to make health records freely available to patients. It would be well beyond the scope of this article (actually, it’s in part 3 of this CMS series), but suffice to say it would require much consideration and thought.
Affordability
Costs are usually a significant obstacle with CMS implementation. Small institutions are usually most limited, as they lack the resources to develop something in-house but also purchase more complex and well-developed products.
However, it stands to reason that despite the significant investment required, the potential cost savings in terms of safety (and reduction in litigation), efficiency (see below) and patient satisfaction would likely more than offset the costs of a good CMS.
I cannot stress how important it is to have a system that helps the hospital to run smoothly and safely, not making the hospital change it way it works to suit the system.
Efficiency
In terms of patient-centeredness, efficiency can be more or less divided to minimising wastage of materials (such as syringes), money, and time. So the CMS would help patients be seen faster, tests ordered faster, results reported and reviewed faster all with minimal wait, and minimal cost.
Also inside efficiency would be outcomes. Just to add some wood to the fire. So not only would the CMS allow the administration and schedule to work optimally for the patient, but it would also facilitate the optimal outcomes for the patient. Here’s an example, the CMS would be able to show, quickly and efficiently, which are the medications with the best data for a certain patient’s condition.
Equity
Equity is in principal easy; allow all patients regardless of their characteristics equal access to care; that is, appointments, tests, medications.
In practice, it is difficult, as human designers may have unconscious biases or design the CMS in such as way as to inadvertently skew these functions towards certain groups of patients.
Stay tuned for my next article in which I dive into access to Medical Records.
-FIN-
Sketches are done by myself.
Smudges are courtesy of my kids.
ps. I believe medium compresses the photos so my contrast balancing is wiped. Please enjoy the paper texture.
