Although we're calling this section Policy: Other Models, it really is a little bit about the threats of health IT and informatics in this era of new models. So, let's see how this all plays out. So, we have, we talked about ACOs, there are patient-centered medical homes, there is care management, and you can read the definitions on the slides, they certainly want to be patient-centered. So, what matters to patients, you can see on this left-hand side: feeling informed, they want staff who listen, they want to be treated like a person, they want to be involved, they want efficiency. The clinicians, well we saw before they see an illness, and the personas of the patient is really implicit in the clinician's view, but these are clearly two lists that are at odds with each other. This issue about, are you a patient or a person is important. The way these other models work is that they have to look at managing populations. Now, the way they manage a populations is you take a bunch of people, you put them through care, you put them through your algorithms, and you see who the high users are and the low users are. Then you say okay," I'm going to pay attention to the high users, I'm not going to pay that much attention to low users." So, is this person-centric, is this poor patient hood or not? Sorry, does this support personhood or not? To be honest, it could go either way, if it's viewed solely as population health management for the sake of saving money, it's probably not person-centered. If on the other hand it's helping to relocate and to make sure that the persons who need care are gaining the higher touch care that they need, I would argue that it is person-centered. It's not just the algorithms that you're using, it's what you do with them. So, very often we talked about risk stratification, trying to figure out who's the most needy, we talked about the social determinants of health. The reason I put these with a little sarcasm is that the risk stratification goes back to what I was just saying that well, am I chopping you up to help you or am I chopping you up just to manage you? The first one is person-centered, the second is widget-centered. Social determinants, certainly true that things like poverty and homelessness will make you health worse. But to be honest, most people think of homelessness as its own very bad outcome separate from whatever their health is, and the same thing with poverty. Probably, a lot of people would tolerate illness yet to be wealthier than they are. So, we have to worry about this health-centered way of thinking when we try to be person-centered. To bring this home a bit, there's this graphic I got from Stewards of Change an organization that has been very concerned about, probably would basically call social service informatics, which is how can and how should IT be used to improve the social services and social needs of people, patients or not? This particular graphic comes from an exercise about a use case named Harriet Cooper, who was O2 dependent as you can kinda of see on the screen, and it's kind of home bound. We were asked in a breakout session to articulate what her needs were and what the information system will need to provide in order to supply those needs. So on the left-hand side, you see the needs, and the right hand side you see the information system, is it errata? Though is it's not doing anything with this what you'd want this system to be able to accomplish. So, you see issues like mobile applications, you see things like single point of contact. How these things are going to be put into practice, don't know yet, but it's important to see that social services should be supported as much if not more than medical. It's been shown that, if you can fix social service needs, you can improve health outcomes by 20 percent which is huge. Now, there is a danger, as the data become available, as they become interoperable, some public health or public agencies use this data to limit the services that people get. So, here I have shown you a number of covers of recent textbooks till today of how IT and information sharing can be bad for the person. So, we've spent a couple of sessions on models of care and macro, and all these things done to "cut costs", we have to hope that it's not just all about the money, and then in the middle of all this good patient that comes due result. So, there are issues with this meme that both more information will lead to better health outcomes, that a third of health care costs is waste, that we can figure out what the waste is, and I won't read the whole list to you, but you can see that they're divided into separate regions. The main point here is that we all talk this game, it's not clear that it's all true, which means that IT that's designed to support this meme as it were, might cause some harm, if in fact these memes were true. In closing, I think you could say yes, we've seen the upper level of the stack, but now the further down, we do see has some of these errata between the patient and the providers, and the patient and society, between society and health, they don't all have the same desires and the same goals, and therefore they can be some conflict, not only at the top levels of the stack, but even down below where the data are captured, stored, and reasoned about.
