Monday, August 12, 2013

Flash follow-up

In my last post, I suggested that patients carry a flash drive that contains their health information.  This drive would contain all medical information, including all labs/procedures/prescriptions that were ordered.  Upon admission to the hospital (or visit to the physician) the staff could review this information and be able to see if the patient had been compliant with the prescribed treatment plan.

I realize that asking the typical patient to keep track of a flash drive is an impossibility.  But with the way technology is evolving it wouldn’t surprise me to see data like this being able to be stored on a chip that is embedded in the patient’s insurance card.

It would be easier to just design a system where all of this data feeds into a central database, but I can’t see how such a system could be secured.  When our government can’t keep national security documents safe I really can’t trust that the medical records of millions of people would be able to be secured.

A few days ago I was talking with an acquaintance who works with health insurance.  We discussed compliance, wellness plans, cost of healthcare.  Pretty much everything that has come up over the past ten years in the world of health care costs.  We came to the same conclusion after our discussion.

People are going to do what they want.  You can only incentivize so much, and some people won’t go for the incentives no matter what. 

With the way the system is currently operating, we are enabling the patients to be non-compliant.  If the patient doesn’t follow the treatment plan that has been developed by their physician/health care facility, it’s the physician/facility that is going to get dinged by not getting reimbursed.  The patient has no skin in the game.

By capturing all of the ordered procedures/tests/medications on a device that the patients must carry with them, compliance with therapy can quickly be determined.  If the patient is not compliant with therapy, the financial responsibility would get shifted from the provider to the patient.  Patients who are chronically non-compliant would, as mean as it sounds, receive a lesser standard of care as providers will be able to see that the patient is not compliant and adjust the treatment to a level with which the patient would be able to comply.

Before jumping down my throat about not giving the best care to all patients, remember that the patients who this would apply to are the patients who have already been given the best care.  They have chosen not to continue with the care plan that has been determined.  The cost for the additional health care expense should not be passed on to the other members of the health care plan or to the taxpayers if the patient is on government-funded insurance.

A provider/facility can only order so many tests, arrange so much home health care, and provide so much medication to a patient.  But when the patient doesn’t have the tests run, cancels the home health care, and doesn’t get their prescriptions filled, is it really the provider/facility’s fault that the patient is readmitted to the hospital twelve days after discharge for the exact same diagnosis?

Maybe a little de-incentivizing is what is needed.  When the patient realizes that they are going to bear a greater portion of their health care expense if they are non-compliant, perhaps they will follow the treatment plan.  For people who want to be compliant, but financial situations prevent them from doing so completely, services such as pharmacist-provided care could help them find alternatives to therapy that help achieve the therapy goals (at a lesser expense).  These services would be reimbursable to the providers, and would be recorded on the device that the patient carries with them as proof that they are attempting to comply with the treatment plan.


Anonymous said...

Do you know how many of my patients DO NOT have their insurance cards ever?

"it's through the county" (luckiy I can find most of that through a VERY slow state database. Give me 10 minutes or so to just get the insurance)
"they done never sent me no card" (double negative would make this a positive, so apparent y you must have it somewhere....)
"I wasn't planning on coming to the ER/pharmacy today" (neither do I, that is why I ALWAYS have my insurance card on me since I can't plan emergencies)
"I didn't have time to grab my purse before I came to the ER due to the emergency" (yet here you are, with an rx for OTC stool softner (ie NOT an emergency) WITH YOUR PURSE IN HAND!!!!!)
"it's for my girlfriend/mom/boyfriend/neighbor/etc" (great, go ask them for their insurance card)

Try about 80% after 6 pm! Not sure how we would update the insurance card. And what about prevent viruses from getting into our software from these cards?

SciFi Pharmacist Guy said...

I like your idea regarding a flash drive for patients' health information. I also work in a critical care hospital where I see the same familiar names printed on medication orders. It feels like we have a revolving door that people enter and stay in until then re-enter the hospital.

You would think the logical thing would be to give the patient the primary responsibility of taking care of himself/herself.