Testimony to Health IT Policy Committee on the use of health IT for patient and family engagement

Eric Dishman

Verbal testimony delivered today in Washington DC:

“I am honored to testify today about using health IT to facilitate more patient and family engagement in our own health, wellness, and care.

My social science career has spanned almost 20 years of doing R&D of patient engagement technologies. These past 11 years, I have run Intel’s health research and innovation group… who has lived with and observed more than 1000 patients in 20 different countries…has led more than a dozen pilots of in-home technologies for seniors and chronic disease patients…has created two 300-household cohorts of families in Oregon and Ireland as an evidence-based testbed for these technologies… and has funded almost 100 university grants in this domain.

We have real world, practical experience with IT systems…

· that allowed clinicians to know the actual vital sign trends of CHF and COPD patients and to intervene through a virtual video visit well before an emergency room visit became necessary

· that helped seniors with cognitive decline to continue cooking and calling friends on the phone—with the help of a wireless sensor network—while feeding behavioral markers of changes in daily activity back to neurologists and neighbors on the care team

· that enabled nurses to customize care plans and medication regimens with just-in-time reminders and coaching to their diabetes patients via watches, television sets, PCs, and phones

· that picked up the early signs of the onset of dementia or the increasing risk that a senior may fall…well before those became crisis moments…often even before the clinicians and families were aware of a problem

So professionally, things are great. My career couldn’t be more rewarding as we make small-scale but very meaningful use of health IT with these few patients, families, and providers … to help with prevention, early detection, self-care, and behavior change.

But personally, things aren’t so great.

As a patient with multiple chronic diseases, I can’t get access to my own data—electronic or otherwise—or find one doctor to jockey what’s going on across all of my conditions. As a grandson who cared for a grandmother with Alzheimer’s many years ago, I still can’t go buy technologies that could help someone like her because there is no real marketplace yet. As a son trying to figure out how to care for my aging parents across the country, I can’t even help them with the great prototypes and products Intel has built because there is so little infrastructure or incentive for their doctors to adopt. And as a citizen, I can’t have hope in a clinic-centric health reform effort that, so far, has failed to create a national plan for shifting care from scarce, over-utilized hospitals and clinicians…to abundant, under-utilized homes and consumers in this era of Global Aging.

In my oh-so-longwinded written testimony for today, I laid out more than a dozen recommendations. In the blog for this hearing, I narrowed it to five. In these brief opening comments, I reduce it to three big ideas:

1) Establish what I call a “Y2K+20” commission of top government, non-profit, and industry leaders whose mission is to help our nation prepare for Global Aging by investing in infrastructure that moves 50% of care done in institutions today to the home by 2020!

2) Use stimulus and discretionary funds in the National Institutes to build a national cohort of 10,000 elderly households with next generation broadband to test out promising personal health technologies and care models, thus accelerating their commercialization and best practices!

3) As payment reform pilots at CMS and elsewhere take place around ACOs and Medical Homes, let’s make sure that educated, engaged patients and family members—and the IT to support them—are meaningfully included in Care Coordination teams!

In conclusion, Meaningful use of Health IT is about far more than just having access to an electronic version of our chart. Technology must allow us to do care differently, with different resources, and sometimes in different places: at home, at work, and on-the-go…in addition to traditional clinics and hospitals. I argue that it is unethical for us not to use HIT –that is largely already here—to move care to the home and to the consumer for many health needs, because personal health care will often be better, safer, and cheaper than clinical encounters. In many cases, there is no face-to-face equivalent because these technologies generate new data types, new insights about trends, and new communication channels for personalizing care…that cannot be done in a quick, exam room visit.

Thus, having seen the promise of personal health technologies professionally for the last two decades…and very much needing these kinds of systemspersonally in my own family for the next decades to come… I encourage us not to stop after a day of hearings on this important topic. Let’s weave these ideas and inventions into the fabric of our 21^st century healthcare system for everyone. Thank you.”