Well-being wish list for the future of health care

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The health care system is filled with dreamers, from compassionate nurses and doctors to technology experts and researchers in the lab. After reaching out to experts in the field, the Post-Gazette shares this unscientific wish list for the future of health care:

Medical homes

There are high hopes for the medical homes model for patient-centered care, which takes the emphasis away from doctors and moves health care out of hospitals and doctors' offices when the alternative can provide the best care. The cultural change has begun in Pittsburgh's health systems and in the Geisinger Health System, in northern Pennsylvania.

Patients become active partners in their care, said Geisinger's Thomas Graf, associate chief medical officer of population health, explaining that medical homes provide "standardized care in a customized fashion." That includes a focus on prevention, treating chronic disease effectively and giving patients the resources and help they need at the earliest point possible.

Cliff Brubaker, dean of University of Pittsburgh's School of Health and Rehabilitation Sciences, said this practice is developing rapidly. "It is noteworthy that this evolving system will be utilizing [nonphysician health care] practitioners extensively -- including nurses, physician assistants, physical therapists, occupational therapists, rehabilitation counselors, speech-language pathologists, audiologists, pharmacists, nutritionist and other health professionals."

It's a part of the larger dream, described by Paula Milone-Nuzzo, dean and professor at Penn State College of Nursing: "a health care system in which patients get the right health care, at the right time by the right provider to facilitate the best outcomes."

COMING SUNDAY
Vitals: "What is the future of health care?" Part two of our exploration of key issues reshaping our health care.

Check out Part One: "Rethinking the way we pay for care" with video from a public forum on the topic.

Electronic records

Electronic medical records of the future will be more than just converting a patient's paper chart to a computer.

"We're making data in such a way so we can analyze and use it to improve the care and safety of patients," said C. Martin Harris, chief information officer of the Cleveland Clinic, using the example of an elderly patient on multiple medications.

"Remembering the interactions is impossible from a human point of view; a computer can do that in seconds, identify any potential harmful medication interactions," Dr. Harris said. "The physician is still responsible for the decision, but you want to prevent the oversight error."

Communication between doctors and patients has already moved into the 24/7 world through what is called a patient portal, a secure online website containing the patient's records.

Patients "can look at lab tests, testing reports, ask questions, order refills, do virtual visits in some cases," Dr. Graf said. "They get the same kind of reports that our physicians do, they can schedule their own appointments, self-schedule their flu shot, self-schedule a radiology appointment. They can be in charge of their own health care."

Patient involvement

The next step may be having patients themselves add data to their medical record.

Patricia Kroboth, dean, and Randall B. Smith, senior associate dean, of the Pitt School of Pharmacy said they see a future where patient-centered technology will expand to where patients -- while wearing devices that monitor vital health information -- will be collecting important data on their own.

In the future, patients may be able to see their doctor's office notes. A recent Geisinger study gave patients that access, and it was a success.

"Patients showed they were paying attention; they were engaged with their care," Dr. Graf said. "And that leads to better outcomes."

ALSO FROM SUNDAY: The hospital of the future

Telemedicine

Rapidly developing electronic communications technology is pushing telemedicine forward to improve the clinical care of patients, and not just in the remote areas where it was first practiced.

Pitt's Mr. Brubaker sees telemedicine, or telehealth, as a way to "substantially increase quality service at a lower cost per unit of care delivered." He said it's been successful in military health care and the Veterans Administration health services, but civilian providers have been "hampered by political limitations and potential cost."

Medical research

Individual researchers have their specific dreams, their part in the larger piece of a cure or vaccine for disease, a biomarker to detect disease, a surgical method that is less invasive, a new device or a new way of sharing the latest evidence-based medical knowledge.

At the Cleveland Clinic, researchers are pinning their hopes on a human lung lab, new biomarkers, a transcatheter surgical method to replace a heart valve, an artificial heart, a breast cancer vaccine and breath testing for disease.

Genetic medicine

Genetic testing has expanded from identifying congenital and inherited disorders to personalizing medical treatment for patients -- identifying cancer drugs that will be most effective, for example -- and it's expected to go further. Geisinger Health System this year entered a partnership with Regeneron Pharmaceuticals to study how disease can be linked to a person's genes.

"They're going to do 100,000 patients' genome sequencing ... link that to their phenotype [physical/behavioral attributes of a person] ... and look to connect genes and outcomes," Dr. Graf said.

Prevention

Perhaps the most challenging health initiative of the future is in prevention, but that work lies with the person, not a health professional.

"I would like to see our entire health system in Allegheny County shift its focus from treatment to prevention," said Donald Burke, dean of Pitt's Graduate School of Public Health.

Dr. Burke described a hard truth of the Pittsburgh region: "Although our hospitals are international leaders in modern curative medicine, our region still has the sixth-highest rate of early death out of 34 other largest metropolitan areas in the USA. Most of these early deaths occur among our poorest neighbors here in Allegheny County.

"Eighty percent of prevention takes place outside the hospital, in the form of health education, nutrition and behaviors," he said.

Dr. Burke called for people in the region to support efforts to cut that early death rate "so that we become the healthiest in the nation, not the bottom."

Big data

Many health professionals see hope in the future through big data -- the accumulation of information about people, their health, their lifestyles, their medical treatments.

"We're heading toward managing large populations of patients," Dr. Harris said, explaining that data, for example, can help doctors better care for the segment of their patients who have diabetes.

Out of 100 patients, he can sort the data on a computer to determine the top five things that should be done for them and then sort patients' information to see which 10 patients still need to have some of those things done -- such as blood sugar or blood pressure tests, weight check, feet check and medications.

Big data on patients also can help test a new drug, for example. When designing a clinical trial, researchers can use accurate information on patients to recruit the best qualifying patients to test the drug.


Jill Daly: jdaly@post-gazette.com or 412-263-1596.

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