Gabriel Miller; Richard Schilsky, MD


June 25, 2014

Another aspect that I think is important is that patients have more and more access to their own medical records, and increasingly many healthcare facilities have a patient portal that allows the patient to see various elements of their own medical history. Sometimes it's just administrative information, like when is your next appointment, but some practices allow the patient to see their complete medical record. Of course, what that does in some cases is to actually improve the overall quality of the medical record because the patient can correct mistakes that are often pervasive in medical records. The patient may not be able to correct it directly, but they can call up their nurse or their healthcare providers and say, "Hey, look, my chart says that I have a history of prostate cancer, but I'm a 58-year-old woman with breast cancer. There's something wrong in the record there."

Medscape: What are some aspects of cancer care that seem most ripe for increased patient engagement?

Dr. Schilsky: The ability for the patient to actually help improve the overall quality of medical records is important. I think patients will increasingly help to improve the overall quality of care because, as there is a bigger push from Medicare and other payers to relate physician reimbursement to quality metrics, patients are going to start demanding to see those quality metrics. That's going to enable them to push doctors toward improvement because the doctors will realize that not only are the payers looking at their quality metrics, not only are their colleagues potentially knowing something about their quality metrics, but their patients may know something about their quality metrics going forward.

The final thing I would say on this point is that I think patients can also, as they get more engaged in their care, play a very important role in the whole discussion about the value of care. This is an important emerging issue in cancer care. I'm sure you've heard a lot of discussion at the ASCO meeting about value in care. What physicians value, what researchers value, what society values, and what patients value -- they'll all be slightly different. As the engaged patient is able to sit with their physician, review what their options are in terms of the benefit of the treatment, the side effects of the treatment, and again, the cost of the treatment to them and their family, they will use that information to make their own value judgment as to what treatment they want. In some cases, that may help to reduce the cost of care. I think all of these forces are coming into play the more that patients are directly involved in their own healthcare.

Medscape: Are there any specific examples of programs or initiatives that exemplify the potential of more engaged patients?

Dr. Schilsky: A lot of this is, to some extent, driving the concept of the patient-centered medical home, which we're seeing developed in many areas of medicine, including oncology.

If you look at what are the key elements of the patient-centered medical home, in most models and most examples of that, what it really boils down to is better communication and engagement with patients, because most of the features of the patient-centered medical home are that the patient has easier access to their healthcare team. The healthcare team is available to them 24/7; all members of the healthcare team have access to the same electronic health record; everyone has access to the necessary information about the patient; and the patient, by virtue of better education regarding their disease, the treatment of their disease, their desired outcomes, and so on, not only can improve the quality of the care that they get, but can also help to reduce the cost of care.

For example, if they're having a complication of treatment and it's a complication that they've been educated about and maybe have come to expect as a possible complication, they can be told ahead of time that they don't need to run to the emergency department but that they can call the nurse practitioner and actually get somebody to answer the phone after hours and help them manage whatever the issue is. Those are all sort of features of the patient-centered medical home. But the concept is that the patient will also have to be engaged in this whole process.


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