Encouraging patient empowerment in a general hospital using e-Health

Abstract

Contribution and responsibility of patients in the area of patient safety is encouraged by the Dutch government.Technology has provided the means to give the patient better access to health care information. The role of the patient is changing. In the past health care providers had a more paternal approach (the patient does exactly what(ever) the doctor says), whereas nowadays the doctor and patient make decisions together. Furthermore, people are starting to organize their own health care. Health care providers offer expertise and support instead of making decisions for the patients. (VWS,2014)As an answer to this different approach, the Jeroen Bosch Hospital has developed several actions.Joost van de Mortel (2013) made it clear with a qualitative research (N=13) the hospital (community) is open to the application of patient empowerment and already applies it, consciously or subconsciously. Despite the good intentions, there are misconceptions regarding patient empowerment that obstruct proper application. In the organization the structure, applied systems and the lack of a management model in which patient empowerment is central, prevent full implementation of patient empowerment.In a consecutive study Jean Marc Reinold (2014) made an inventory which functionalities in a patient portal (“An online gateway that gives the patient control in gathering and sharing information about their health through multiple websites and / or functionalities”) would contribute to ‘patient empowerment’.Besides an extensive literature review, the researcher has gathered information by means of a questionnaire (168 patients, a 95% reliable sample), focus group discussion with 7 patients and the result of a Digi panel inquiry (50% of the 150 panel members i.c. patients responded) of the Jeroen Bosch Hospital (JBZ).The research made clear the patients want to have direct access to their complete medical record, including lab results, research results and imagery. The function ‘inspection of medical records’ makes it possible to take more control of their own treatment (patient empowerment). Besides seeing their medical records the patients of the JBZ want to be able to make several (combined) appointments themselves and to have the possibility of email correspondence with their own doctor. The real empowering ability of a patient portal has to do with the attitude of the doctor and his patient to move towards dialogue and cooperation.This means that in addition to the practical development and implementation of the portal, now in progress after the deployment of the Electronic Patient File (EPF), the strategic reasons for the use of the portal need to be promoted and spread within the organization.To implement the portal successfully within the organization some misunderstandings among the staff has to be resolved:- the abilities of the patients regarding eHealth are sufficient in general and still developing,- the exact content of the patient portal (test-results, images, diagnosis/reports, treatment plan) by using a demo,- the influence on the work processes and financial consequences .Further staff training and a helpdesk should facilitate the implementation.Direct active involvement in the development and implementation of the patient portal of motivated patients will contribute to increasing support and will have a positive marketing effect.Use of e-Health and patient empowerment is a powerful combination. Technology and most patients are ready, a lot of professionals in health care in the Netherlands are positive on patient empowerment and are using e-Health fragmented.Barriers to implement are merely the absence of a clear policy of the organization, the organizational structure, the systems, the skills and attitude of a minority of the professionals and the adjustment of the system of financial compensation (a negotiation with the insurance companies is necessary to compensate digital interaction with the patient).In a presentation the impact and outcomes of several actions to improve patient empowerment and e-Health (project Digital Working) within the Jeroen Bosch Hospital and developments on the implementation of eHealth in the Netherlands can be shared.