By Patricia Flatley Brennan.
A comment on my last post, Is it really so easy to bring ODLs into the clinical workflow?, asked us to address the “What's in it for me" question doctors will inevitably be asking. I am surely unqualified (but no less reluctant!) to discuss what value ODLs in PHRs hold for doctors. I invite all physicians reading this to weigh in.
However, let's step back a little to bring both ODLs and a patient's clinical care team into better focus. ODLs, observations in daily living, are the cues people use to let them know how they are doing. ODLs may be behaviors, thoughts, feelings, actions, even environmental indicators like pollen levels and humidity. The issue is more about what stimulates people to take, or not take, health action. Some ODLs map directly to underlying physiology (e.g. a damp and smelly t-shirt results from sweat produced during exercise and may signal that the effort was worthy) or provide hints of related processes (indigestion may signal marital discord). Each of these may be a call to action for the person, and it is likely that such calls to action may also be informative to the clinician.
ODLs: Useful to various care team members
In most encounters with the health care system, contemporary patients "see" many clinicians, even in solo physician practice there may be a medical assistant, health educator, nurse, etc. I suspect that ODLs may be more or less relevant to the practitioner depending on the purpose of the visit and the reason that the ODLs are discussed. ODLs may be most relevant to case managers, community workers, family practitioners and pharmacists. We saw this play out in the most recent design workshop involving the five Project HealthDesign grantee teams where the involved clinicians included social workers, nurse practitioners, and community outreach specialists, in addition to physicians.
Finally, ODLs hold the clues to interpreting the outcomes of therapeutics that even physicians need. Certainly a physician, discovering that what drives a patient to action is in fact misleading, will take the time to clarify the misconception and coach the person towards more appropriate responses. ODLs might help explain why prescribed therapies are not working, as in a patient who skips an anti-hypertensive because they have wrongly determined that the frequency of urinating indicated a problem with the medication rather than an expected consequence. By shedding light on everyday health experiences, ODLs might be just the thing to ensure that prescribed therapies are followed.
It would be interesting to explore how ODL usage/collection models would work in the many cases in which a lay caregiver is active in support of a patient (e.g. an adult child of an elderly patient). There are over 47 million such lay caregivers of adults plus the parents of the US's 60 million children. This implies that most people are involved in some sort of lay caregiving relationship. So, some focus on how the lay caregiver can be a front line monitor of ODLs and can be better supported as an advocate for the patient with the clinical team would aid in finding how to get most advantage from ODLs.
Posted by: Dave Kirby | April 04, 2010 at 08:16 AM