Healthcare moving toward a model of 'information symmetry'

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 - Danny Sands
Dr. Danny Sands

BOSTON—The fundamental nature of the relationship between physician and patient is inevitably changing, and healthcare providers need to get on board with that change, because the “train is leaving the station,” said Danny Sands, MD, MPH, during a session on “Informatics and the Patient-Provider Partnership” at the 2014 AMDIS Fall Symposium.

Sands, who currently serves as chief medical officer at both Conversa Health and Kinergy Health, and is an assistant professor at Harvard Medical School, maintained that healthcare is moving from a model of information asymmetry to information symmetry in the sense that doctors no longer have a monopoly on healthcare information.

There are several reasons why this is happening. Traditionally, Sands pointed out, healthcare information has been “locked up” away from the prying eyes of patients. But today we are bombarded with information related to health on a daily basis, he said, “and our patients are reading it and we have to understand this information is out there and available to our patients.”

Sands has long partnered with patient engagement activist Dave deBronkart, who also is known as "e-patient Dave." deBronkart came to Sands with stage 4 kidney cancer, researched his disease, sought out other patients in similar situations, and showed how informed and engaged in their own healthcare patients can be.

This is definitely a good thing, Sands pointed out, since it allows the physician to get away from the idea that he or she “has to know everything.”

“We are acculturated to know everything—it’s the way we were taught,” he said. “But that’s a burden, because we all know that we can’t know everything.” Physicians should welcome a move towards information symmetry because it is “liberating,” Sands said, and allows them to focus on the things that got them into healthcare in the first place, like helping and healing their patients.

Not only are we moving from this model of information symmetry, Sands said, but we also are seeing a shift from patients being passive recipients of information to being active partners in their healthcare, from paternalism to participation, and from something that is more than a simple patient/physician relationship, but is a consumer/provider relationship as well.

“These are important transformations,” Sands said, “and we need to understand them.”

All of this really means that physicians and patients are becoming collaborators, with each bringing something to the table. Patients have expertise in being patients and know themselves better than physicians do, Sands pointed out, while physicians obviously have expertise in healthcare.

“Physicians and patients have to respect what each brings to the table,” he said. This is not just about ‘the patient is always right’ and the 'patient can be his own doctor.’ This is about a collaboration. Patients can and must help, and we must let them.”

Which means there has to be transparency. If patients are going to be involved in managing their own healthcare, they need the tools to do it. “Consumer-facing technologies really make all the difference,” he said. “It’s secure messaging, it’s portals . . . they are engaging, they lower barriers and they are empowering to all stakeholders.”

Participatory medicine is a new paradigm and will take getting used to, he said. “It’s a dance, and we have to learn how to do it, and we’re going to step on each others’ toes sometimes, but that’s how we learn.” It will end up transforming both the patient and clinical experience, he argued, and promises to improve quality, reduce costs and increase satisfaction.

“My call to action to all of you as healthcare information technology [advocates] is that we can make this happen,” he told his audience. “This is the group that can lower these barriers. This is the group that can introduce these consumer-facing technologies.”