Pushing for Partnership in Digital Health

October 16, 2017

by Michael L. Millenson, President, Health Quality Advisors 

CHICAGO, IL – Could OpenNotes help push predictive analytics from paternalism to partnership?

As new payment incentives make it profitable to prevent illness as well as treat it, new technology is offering the tantalizing prospect of accurately targeting pre-emptive interventions.

At the recent Health 2.0 Annual Fall Conference, for example, companies like Cardinal Analytx Solutions and Base Health spoke of using machine learning to find those individuals among a client’s population who haven’t yet been expensively sick, but are likely to be so soon. Companies seeking to make that information actionable touted their use of behavioral theory to “optimize patient motivation and engagement” via bots, texting and other technological tools.

Being able to stave off a significant amount of sickness would constitute extraordinary medical progress. Along the way, however, there’s a danger that an allegiance to algorithms will reinforce a paternalism we’ve only recently begun to shed. A thin line can separate engagement from enforcement, motivation from manipulation, and, sometimes, “This is for your own good” from “This is for my bottom line.” It is here where OpenNotes could play a critical role.

In a recent article for The BMJ, I proposed a concept called “collaborative health” to describe a shifting constellation of relationships for maintaining wellbeing and for sickness care. Shaped by each individual’s life circumstances, these will sometimes involve the traditional care system, as “patient-centered care” does, but not always.

Algorithmic alerts may go directly to a vendor’s employed nurse, for example, and not be automatically shared with a primary care physician. Doctors, I suggested, can retain their role as patients’ trusted allies only if they embrace shared information, shared engagement and shared accountability.

Shared information in the form of OpenNotes could well be the most important step towards establishing a balance of informational power. With access to complete electronic information from any and all entities involved in care management, individuals can judge for themselves whether “engagement” is mutual or just marketing. They can also start to make accountability a two-way street.

Appropriately using information to support clinicians and citizens alike in the search for better health “is one of the most important responsibilities and opportunities we have,” Hal Wolf, about to become HIMSS’s new chief executive officer, told the Health 2.0 meeting. That’s a noble sentiment, but corporate entities like health plans and tech companies are unlikely to lead the way.

Modeling a relationship of transparency and trust is first and foremost a physician obligation. The collaborative health pillars of shared information, engagement and accountability symbolize a commitment to ensuring that digital health’s potentially transformational improvements in wellbeing and sickness care never weaken the foundational bond of patient trust. Physicians must lead so that accreditors, regulators and ethically responsible corporate entities will follow.

Michael L. Millenson, President of Health Quality Advisors, LLC, is a nationally recognized expert on making American health care better, safer and more patient-centered. Follow him on Twitter at @MLMillenson.