Text messaging intervention for patient-centered healthcare delivery

Health IT and Patient-Centeredness Introduction With the growing need for universal care in nations, the 21st century face of healthcare is rapidly shifting from the traditional hospital and doctor centeredness to focus on patient care, satisfaction, prevention of ill-health, increase interests in self, and improve quality of health – which means patient-centeredness (Snyder et al., 2011). The shift to patient-centered healthcare is supported more through the use of Health Information Technology (HIT). In the past decade, IT has gained a prominent position in the delivery of healthcare especially through the collection of health-related data. This research, therefore, proposes the adoption and utilization of HIT in advancing patient-centered healthcare delivery in the communities. Specifically, the paper will seek to establish how text messaging will be used as a way of reminding patients to submit their proposed agenda for their upcoming physician visit. The information submitted by the patient will then form an electronic medical record that will be used as the primary location for storing this information. Specifics of the technology One of the key features of the patient-centered healthcare system is its target to the community and home-based care delivery. Community and home-based healthcare delivery pose challenges specific to each patient with specificity to the care environment and healthcare issues that might arise as a result to compromise in the environment. Moreover, the mere fact that that care is focused on the patient means doctor visits will no longer be doctor-originating, but to a larger part, patient-originating. To this end, a HIT solution would be utilized to enhance communication between the patient and the doctor (Rey-Bellet et al., 2017). A text messaging service is therefore proposed as the best-suited medium for enhancing communication between the patient and the doctor, and in particular, in setting the agenda for the next doctor visit. A well-designed SMS text-based intervention will be used for this challenge. The intervention will be designed based on a conceptual framework that is created from preliminary survey and review of literature materials of clinical patients. The purpose of the preliminary survey and review of material will be to establish and understand the challenges and barriers faced by patients in home-care settings (Siedner, Haberer & Bangsberg, 2015). For this research, the problem is that many patients under home-care do not have doctor adequately address their challenges. Secondly, under the objective of patient-centered healthcare, it is vital that patient input is made to the agenda during the doctor’s visit. The designed intervention will, therefore, allow patients to log into the system, and for the first login, with the help of a skilled hospital-staff, fill in their medical data, without any personal identifying information. Subsequent logins will be done through the card number issued to the patient. The text messaging IT solution will be used by the hospital/doctor to notify patients of their next doctor’s visitation and require patients to text the health issues they would want the doctor to address. During the design of the text messaging intervention, various stakeholders will be involved including a doctor, programmers, clinicians, and hospital management. The involvement of the multidisciplinary team will be to ensure a balance between ease of use, sufficiency in meeting the set goals, clarity and patient privacy, optimization of frequency and timing of message. The information sent by a patient or a patient’s family member will be accessed using the patient\\\\\\\'s identifier number/code. This information can be accessed by anyone with the patient number, but patient private information will not be included. This information will be stored in the health electronic records. Suitably timed auto notification will be sent to patients to remind them to submit their agenda if not submitted as the doctor’s visit nears. In addition, the information submitted by an individual patient will be available to the wider professional healthcare system to allow for better future health care service delivery to patients will similar health conditions and environments. In addition, the intervention will be carried out in a pilot study setting to determine operation under field settings. Adoption and use of the text messaging intervention The text messaging intervention will typically be in the form of an App, with website alternatives. In addition, the intervention will be designed to incorporate the use of phone-based text message service. The starting point for the implementation of the patient-centered HIT solution will be to first determine where hospitals stand in terms of HIT solution to promote patient-centered care (Cliff, 2012). Specifically, the status check will be done to establish how hospitals, those which have, have integrated HIT and how they promote the exchange of health information so as to improve care delivery, the quality of care, to reduce costs, to optimize revenue generated, and most importantly, to promote and personalize a patient healthcare experience (Cliff, 2012; Bailey-Davis et al., 2018). This status audit should inform the implementation process in terms of the capabilities needed to meet patient’s needs and how hospitals can promote the realization of patient-centered care within their operations. Generally, the implementation plan for the HIT text messaging service will primarily target the healthcare professionals to promote the adoption and use of the service in the healthcare system. The introduction phase of the plan will involve training seminars and conferences done by the design team. The seminar and conferences will be incorporated into online video tutorials (Snyder et al., 2011; Anderson et al., 2017). The online tutorial will be available for those interests in learning how to use the IT solution. Based on research findings by Anderson et al. (2017), both patients (79%) and clinicians (74%) agree that the use of HIT for the purpose of agenda setting helps to improve communication between patients and clinicians. In addition, 73% of patients and 82% of clinicians wanted to continue using agenda-setting tools in the future (Anderson et al., 2017). Based on these findings, it is expected that the text messaging solution will not only be used by health professionals, but also the patients. i. Agenda setting The text messaging intervention will be primarily used to allow the patient to set the agenda for the next doctor’s visit. The text messaging intervention will be introduced to the patient by the health professional, and with the preliminary patient information entered by the clinician in conjunction with the patient or patient’s family member, the patient will be required to set the agenda. This will be done by the health professional asking the patient to complete a pre-consultation form (Saha, Beach & Cooper, 2008). The form will guide patients to articulate the main pressing health problems they are having in relation to their daily life. The patient will also be asked to identify three issues that he/she would want to be discussed during the next visit. This not only ensures a patient is in the driving seat in the healthcare services they receive, but it also has psychological benefits in that it helps patient’s self-management of their symptoms and in so doing improve their coping strategies (Saha et al., 2008). In addition to agenda setting, part of patient-centered healthcare is to gauge patient satisfaction with the healthcare services received (Saha et al., 2008). The patient will also be asked by the clinician to set an overall goal that they would like to realize by the end of each session based on their health condition. When filling a pre-visit form, patients will also be required to rate their experience for the previous session. Stakeholders in the implementation plan i. Patients For the successful adoption and implementation of the text messaging solution, various stakeholders have to play an active role. The primary and the most important stakeholders for the realization of the intended goals are the patients. The goal of this particular HIT solution is to promote patient-centered healthcare, and therefore patients are at the center of implementing the intervention. Patients’ role is to provide the vital data required to drive healthcare delivery and to ensure the services on offer by the health system are satisfactory and meet the set national healthcare goals. Various factors and features of the patient population are important to ensure the success of the HIT intervention. The first is health literacy of the general population. It is important that health literacy of the population be sufficiently high to allow for the conceptualization of the need for the health data, and the objective of patient-centered care (Corrigan, Swift & Hurtado, 2001). Easy conceptualization of the concept of the entire initiative will result to easy functioning through; prompt data entry by patients, provision of relevant data, and minimum effort by a health professional to ensure patients remember to provide the required information. Essentially, sufficiently high health literacy is a vital requirement for the success of the entire agenda-setting initiative. Second, cultural competence of the target population should be adequately factored in for the success of the patient-centered healthcare delivery system. Culture plays a crucial role in healthcare delivery ranging from language, beliefs and traditions, health practices, and gender roles among others (Costas et al., 2017). Generally, the unconventional cultural setup of the American society, commonly referred to as ‘western’ and refers to equality and absence of restrictive traditions across gender, education, ethnicity, and the race will play a crucial role in promoting this HIT solution. Nevertheless, the solution will be designed to cater for the indigenous minority traditions and belief. ii. Healthcare professionals The second important stakeholders are healthcare professionals. These include clinicians, medical doctors, surgeons, dentists, etc. this group will play a crucial role in the adoption and implementation of the proposed HIT solution. Healthcare professionals will be tasked with the role of ensuring that patients understand the purpose of the intervention, the details required and that they make an informed consent. Additionally, healthcare professionals will foresee the initial login of the patient into the HIT system and ensure that data is filed up prior to after each hospital visitation as required. It is also the responsibility of the healthcare professionals to ensure the objective of the entire patient-centered initiative is ran by making use of the information provided by patients to make healthcare services better, satisfactory, and patient-oriented. The starting point is to ensure that the agenda identified by the patient forms part of the discussion during the visit, even though the caregiver can also include other agenda (Finkelstein et al., 2012). In addition to healthcare professionals, the hospital management team will also play a crucial role. Hospital management team include among others, hospital administrators. Note: the only identifiable detail which will be used by a patient in the system is the card number issued by the hospital. As a result, hospital administrators play a crucial role in ensuring that only unique numbers are issued and there are no repeat or multiple allocations of the same number. The primary requirement for both the healthcare professionals and hospital management is to understand the need for the solution and its purpose and knowledge on how to use the solution (Bates & Bitton, 2010). These will both be addressed through training seminar and conferences, and the online tutorials. iii. Programmers/coder (IT Professionals) These are essentially the professional who will be required to create an IT programme that meets the set objective and provides users with the expected functionalities. The programmers and coder will work closely with the principal researcher to ensure that the programme is designed to allow for the collection of patient data from the front-end, to ensure healthcare professionals are able to interact with patient-data in the back-end, and that after a patient is discharged, the information is safely transmitted to the electronic records database to further add to the pool of health data available (Bates & Bitton, 2010). In addition, the programmers will be required to bring on board the various features needed to make the solution easy to use, clear, and a patient-friendly interface. The IT professionals used to design the solution will be contracted from online freelancing platforms mainly from upwork.com. To ensure that the IT professionals contracted is qualified for the job, they will be required to be certified and with an established job success of more than 90% (Popiel, 2017). After launching the tool, the programmers will still be useful for the periodic maintenance and optimization of the tool to ensure effective functioning as required. iv. Legislators For the HIT solution to work; there is need to ensure that a relevant and supportive legal framework is also in place least it is struck down in the courts. The job of policy formulation rests with the lawmakers. Currently, as argued by Epstein et al. (2010), there are no sufficient policies in the American law to support the patient-centered healthcare and in particular, the use of HIT solutions. The Patient Protection Affordable Care Act (popularly known as the Affordable Care Act or “Obamacare”) which has been the main law governing health care in the United States certainly has some important provision for the promotion and utilization of informatics in healthcare delivery (Koh et al., 2012). However, with the recent destabilization of the Affordable Care Act (ACA) by the Trump administration, it is obvious that there is a clear need to have a sufficient and clear law that supports the use of HIT solutions to promote and advance healthcare delivery. To ensure that the lawmakers draft an adequately supportive bill, there is need to ensure that the lawmakers are informed on the purpose and benefits of patient-centered care in promoting healthcare delivery. As the GOP health bill seeks to repeal and replace the ACA is still being drafted, it is important that clear provisions are made to accommodate, support, and promote the use of HIT in bridging the communication-related gaps that have curtailed healthcare delivery. Patient protection and data security Patient protection and safety of the information provided is of uttermost importance for the success of the agenda-setting HIT intervention. Patient protection will be achieved by employing various strategies. First, before a patient signs up into the system, a healthcare professional will explain to them the purpose of the system, the right accorded to the patient, the type of information to be collected, how that information will be used, and for how long the data will be collected (Epstein et al., 2010; Koh et al., 2012). The proposed HIT intervention will also comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The law provides a minimum standard which should be adhered to at the federal level with relation to medical privacy, the disclosure of patient’s protected health information, and penalties applicable on violation of the law (Public law 104-191 AUG. 21, 1996). The areas that are covered by the HIPAA include health plans, healthcare providers transmitting protected health information through electronic media, and healthcare clearinghouses. Specifically, this research will protect patient information by using only the issued card number to identify patient’s information on the HIT platform. There will be no names or any other personal identifying information used (Wang & Jin, 2011). In addition, after the treatment, the data collected will be transmitted to the electronic records databases to enrich the data pool available. Before this data is transmitted, the hospital issued card number will also be eliminated thus making it literary impossible to backtrack the data to the source patient. Ethical concerns and expected limitations One of the ethical concerns concerned with patient-centered care is the fact that, during health law formulation process, patients are absent in shaping the law. The majority of what is known as health law is common law (Shepherd & Hall, 2010) and it has been shaped by the arguments of litigant and judges understanding. It is expected that legislators will have a rather difficult task in creating laws that are adequate to monitor, regulate, and punish violators factoring in the abstractness and at times, the vagueness of IT tools (Sine & Sharpe, 2011). Moreover, the objectives of medical care and public health are different thus; it is wise to consider the law required for patient-centered healthcare to be different as it embraces both public health and medical care. If all population health considerations are wrapped into the patient-centered health concept, then there would be the need to establish subcategories that are population focused and not patient focused so as to determine how to accommodate, trade-off, balance, or choose between the two. In the patient-centered topic, it is important to also determine who the patient is. The typical assumption is that the patient is adequately self-aware and independently physically capable. However, this is not always the case as some patients will be unable to make decisions of their own or act on their own. Moreover, some patients will also be minors and unable to legally make decisions of their own (Sine & Sharpe, 2011), in such cases, a surrogate or a guardian as to act on behalf of the patient. Even though this is legally sound, it ultimately erodes the entire concept of patient-centered care. Moreover, patients who need emergency medical care e.g. accident victims, are without their right to refuse or determine which medical or health issues to be prioritized. It is a common experience that, patient-centered care has often been misconstrued by patients who might consider it to be a friendly relationship with the healthcare professional. Ordinarily, it is required that the relationship between a health professional and the patient should be professional and courteous, but patient-centered care can open the door for a breach of this boundary with patients opening themselves too much in an effort by the healthcare professional to understand the patient better so as to improve healthcare delivery (Braddock et al., 2013). Conclusion Patient-centered care focuses on patient care, satisfaction, prevention of ill-health, increase interests in self, and improve quality of health. One of the crucial elements for patient-centered care is communication and for this case, a text messaging intervention is proposed. The intervention will be designed based on a conceptual framework that is created from preliminary survey and review of literature materials of clinical patients. Patient information during treatment will be stored in the electronic records and accessed using the patient’s identifier number/code. The HIT solution will be used for agenda setting and to gauge patient satisfaction with healthcare services offered. To ensure success of the suggested solution, various stakeholders will have to play an active role among them, health literate patients, well-informed legislators, and knowledgeable programmers and designer to ensure continued optimization of the solution. Ultimately, a wide scale adoption of patient-centered care will need an overhaul of the entire healthcare system as it would impact on healthcare service delivery, the operations of both in-patient and out-patient services, and payment models for healthcare. At the same time, it is also the ripe time to start determining the specific areas of health-related law that need to be changed, erased, or new law to support patient-centered health care.