Improving Community Access to Medical Information and Care

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There was a time when every member of ancient communities understood the basic tenets of medicine, religion, and social order as one interconnected body of shared knowledge.  As civilization progressed, the multiple fields of intelligence became so separated that specialists in these fields: doctors, clergy, civil servants, and others, each conveyed information in different ways, but on their own terms.  Eventually, only scholars in these professions were privy to the state-of-the-art information of their civilizations; the ordinary citizen had virtually no access to bodies of specialized knowledge.

Now, however, society does have the technological tools necessary to bring valuable information back to individuals quickly and easily. No information is more essential to individuals and their community than the basic facts about taking care of one’s health. Being able to understand one’s own body and its reasons for promoting healing and health or causing pain and disease is invaluable.

Approximately 40% of healthcare is simply the exchange of information between healthcare providers and patients.  Therefore, making information readily available offers great potential for today’s medical community. The medical profession is beginning to employ medical information so that the people it was meant to serve are empowered to play a more significant role in their own care.

The Changing Doctor/Patient Relationship

This trend has significant implications for the patient/physician relationship. Physicians are now able to extend their historical hands-on evaluation and emphasize preventative care through distance care or information via telecommunications technology.  Inherent in the new system is increasing responsibility for patients to work with their physicians in making informed healthcare decisions, as well as informed healthcare expenditures.  This requires a greater emphasis on patient education and greater access to information about preventive medicine and healthy lifestyle choices. Both public and private providers and payers are in the best position and have much to gain by bringing this information to patients. It is becoming incumbent upon them to create access to healthcare information, education, and decision based systems.  This imperative is most evident for injuries, acute disease management, management of health events, such as pregnancy, preventative medicine, and management of chronic diseases. 

With these tools at their disposal, physicians are able to interact much more effectively with informed consumers of their services.  A study by Dr. Steven Poole and Dr. Barton Schmitt, of Denver Children’s Hospital demonstrated that as many as 60% of all after-hours calls to physicians can be managed with self-care only, and 25% of after-hours calls to physicians can be managed at home until regular office hours.  As consumers become better educated about healthcare, they tend both to make fewer inappropriate demands on their healthcare system and to seek necessary treatment on a more timely and consistent basis.  When fewer “perceived” emergencies receive attention in the ER or the doctor’s office, the result is more time for doctors to spend with patients providing treatment rather than information and to expand their outreach to the community.   Studies have demonstrated time and again that this factor alone increases patient, community, healthcare personnel, as well as physician satisfaction and overall physician efficiency.

The Changing Structure of the Healthcare Community

The global healthcare community today finds itself facing as never before the combined challenges of reducing costs and expanding access to medical attention. Healthcare delivery systems everywhere are in the process of redefining themselves and their methods. Public and private payers, rather than the traditional patients and providers are driving the process.  The new technology being employed is an attempt to:

• recognize the patient as the center of the system, and therefore, as an important decision maker;

• enhance the effectiveness of the physician and community health care system; and,

• attract patients to the providers that employ the most useful systems.

Together these three elements define “Personal Healthcare Management” which is proving to be the best means available to make inroads into the age-old problem of fundamental lack of access to affordable medical attention.  This issue is especially pertinent in developing countries where shortages of infrastructure, funds, and medical personnel impact on the quantity and quality healthcare for most citizens.  But, the national debates in industrialized nations about how to provide attention to substantial unserved and underserved segments of the population also illustrate the scope of the problem.  In assisting patients in the management of their own and their family’s health the medical profession enhances its productivity by guiding the patient in his choice of the right care at the right time and place.

Community Health Programs Employing Informatics Technology

If patients are to take greater responsibility for their health, they need ready availability of reliable information from a reliable source 24 hours per day. The Internet and informational videos, as well as radio and television programming are all growing as components of community health programs. Direct Satellite TV as well as other satellite technology that is now spreading rapidly in Latin America offers an important new means of spreading health information to remote areas. With over 100 channels of programming public service channels for this purpose are quite feasible. The advent of Direct Broadcast Digital Radio with footprints that reach small hand-held radio receivers throughout the Hemisphere for entertainment and education may be a particularly useful resource at relatively low cost for this purpose. Transmission of still images and computer information over plain telephone lines has proven feasible in a demonstration project in Costa Rica.  This project rightfully demonstrated that doctors at rural health clinics could benefit in being able to consult with national hospitals using transmissions of x-rays and other visual images to improve their diagnosis and treatment.

Medical Call Centers emphasizing preventative health care are quickly proving themselves to be the most efficient, convenient, and interactive sources for medical information. Even in the least developed geographic areas lacking in private telephones, it may be easier to get to a public telephone or to install community information links than to travel to or establish a medical facility. In addition, the information is accessible 24 hours per day, 7 days per week.

Medical Call Centers connect patients by private or public phones, community information centers or directly to the health information they need through medical professionals that offer guidance on how to approach the various medical situations that patients encounter. These centers, offering medical advice, audio text health libraries, physician referral, and health events counseling are playing a leading role in the redefinition of community health programs. Medical professionals aided by sophisticated computer protocols not only provide the community with physician referral, but offer advice about home care, self-treatment, and preventative medicine.

The results are dramatic. In a recent study of calls from all over the U.S., 61% of those requesting emergency care, or indicating they may need it, were redirected to appropriate lower cost alternatives. Similarly, 56% of those seeking immediate contact with their physician were advised they could safely wait for 24 hours before seeking care.  Approximately 20% of these patients were told they could address their healthcare needs through simple home remedies. Equally important, by providing objective and reliable information the Call Center was able to direct patients to appropriate care that they might otherwise have postponed or avoided with resultant medical consequences.

Emerging Applications

Personal Health Management Programs are gaining momentum. Analysts estimate that these programs are growing at better than 25% per year and could grow from some 35 million people served currently. to over 100 million by the year 2000.

We have every reason to expect that over the next decade personal health management services will be the standard means used by communities to gain information about and access to the means for improving their and the community’s health.  This will be especially true in the developing world where the number of medical personnel and hospital beds per capita and resultant morbidity is substantially less favorable than in the US.  We anticipate an explosive growth of this low cost solution.

At the same time that numbers are growing, we also foresee a quantum shift in the nature of services being provided to communities. Education and advice will continue to form the core of community health programs.  Now, however, functionality is expanding and shifting from reactive to proactive outbound services making greater use of interactive video, the Internet and wireless and satellite communications, computer/telephone integration and relational data bases. New applications include the following:

Chronic Disease Management where patients are reminded to practice their preventative care.  It seeks to head off serious problems before they begin by reducing the impact of noncompliance with medical guidance.

Health Event Specific Management where patients can receive in-depth counseling on a particular health topic.  Medical professionals will put together a packet of information, including the most recent research available, and send that information to the caller.  This is followed up with a call from a medical professional. 

Outcomes Measurement where outbound calling facilitates tracking the results of medical procedures and prescriptions.

Public Health Monitoring where real time collection of information about symptoms can both head off an epidemic in the making and pinpoint public health problems.

Computer/Telephone Integration has made it possible for the individual and the community once again to play a knowledgeable role in personal health care management.  The medical call center is becoming the hub from which all members of the care continuum connect, interact, and share their information and resources and are able to act as a team in improving the health of individuals throughout society.

Mr. Bleakley was a speaker at Session AP.9, Applications for Better Living: Tele-Health and Tele-Medicine.  The  participants in Session AP.9 were: