Information services that make patients co-producers of quality health care.

A new era of consumerism is emerging. Increasingly educated consumers are demanding convenience, choice, and self-efficacy or self-mastery. These educated consumers are causing businesses in a variety of service industries, including health care, to change their business design in response to changing consumer preferences. Increased consumer pressures to change health care business designs are evidenced by a flood of state and federal legislation and managed care organizations broadening their networks and product offerings to respond to consumer complaints about lack of choice. These pressures are also evidenced by educated patients, armed with information they have gathered via the Internet and other sources going to their physician and saying, "Together let's figure out how I can do this myself." In addressing the entire scope of illness cost drivers that are causing health care expenditures to spiral upward in this country, providers need not overlook the role that the effective relay of information plays in moving the patient from their traditional roles as resource and customer to more effective roles as co-producer and partner in the transformation process. Health care organizations and professionals must experience a paradigm shift in both their approach to providing health care and in their understanding of the new role of the patient as co-producer.

Medical informatics in healthcare organizations: a survey of healthcare information managers.

OBJECTIVE: To assess the medical informatics needs of healthcare organizations and the work roles for informaticists in those organizations. METHODS: A 128-item survey was developed and administered as a structured interview to thirty-two information managers in eighteen organizations. The survey included items about medical informatics training, prior work experience, skills for informaticists, and programming proficiency. RESULTS: There was a strong preference for informaticists with prior clinical work experience and an understanding of healthcare. Project management and data warehousing were highly rated skills. Informaticists were expected to know about healthcare processes, clinical guidelines, and outcome management. They were not expected to be expert programmers. CONCLUSION: There is a role in healthcare organizations for interdisciplinary workers who understand clinical medicine, healthcare management, information technology, and who can communicate and work effectively across these organizational boundaries.

How consumers evaluate health care quality: Part I.

Information is a critical factor in marketing health care services. Consumers evaluate information according to its source. This report is the first of a three-part series examining the way in which Americans evaluate the quality of consumer information as they make decisions on health care products and services. This report provides an overview of the study. The next two installations will focus, respectively, on health plans, hospital and doctors.

How consumers evaluate health care quality: Part II.

This article is the second in a series which examines the way in which consumers assess information regarding the quality of health care services. In the previous article it was demonstrated that, in the view of health care consumers, three major perceptions held by health care consumers, are: (1) substantial differences in quality exist among health care providers, (2) little information is available that allows for the comparison of health care providers on issues related to quality, and (3) when such information is available it is found to be useful and often serves as the basis for decision regarding the choice of health care providers. We further discussed the short coming of marketing strategies based on complex quality indicators and the difficulties of image advertising in an age of institutional mistrust. The reader is reminded that these findings relate to the subjective assessments of consumers, not to objective facts concerning health care delivery.

How consumers evaluate health care quality: Part III.

This article is the third and final article in a series which examines the way in which consumers assess information regarding the quality of health care services. The previous article focused on consumers' perceptions of health care plans and health insurance companies. This article examines the views of health care consumers regarding hospitals and doctors.

The clinical value of computerized information services. A review of 98 randomized clinical trials.

OBJECTIVE: To review all randomized clinical trials addressing the efficacy of clinical information systems and to determine the clinical settings, types of interventions, and effects studied. DATA SOURCES: Extensive and systematic MEDLINE searches were conducted using a combination of medical subject headings (MeSH) and textword terms to collect trial reports. Manual searches of books and monographs as well as informal contacts were also used. STUDY SELECTION: The eligibility criteria were (1) randomized controlled clinical trial, (2) computerized information intervention in the study group, and (3) effect measured on the process or outcome of care. DATA EXTRACTION: Two research assistants independently abstracted from the selected reports the following structured information: trial sites, computerized interventions, effect variables, and outcomes. Three investigators evaluated the combined list of trial features for setting, intervention, and effect. The statistical analysis included an evaluation of agreement in developing classifications and an analysis of the ratio of positive trial outcomes. DATA SYNTHESIS: Most information services were tested in outpatient care (82%), particularly in primary care (66%). The information intervention targeted the provider in 64% of the trials. The effect was primarily measured for the process of care (76%). Provider prompt/reminder, computer-assisted treatment planner, interactive patient education/therapy, and patient prompt/reminder were significantly successful interventions (sign test, P < .05). CONCLUSIONS: Randomized clinical trials confirm that four generic information interventions are active ingredients of computer systems and can make a significant difference in family medicine (physician and patient reminders, treatment planner, and patient education). To manage care and improve quality, primary care computer systems should incorporate these effective information services.

Integrated pathways for managing rural health services.

Rural providers must redefine their role in the changing health care system to include a more integrated approach to health care delivery. The rural provider must develop integrated pathways to coordinate all medical, behavior, and social services to ensure that appropriate services are available, locally or through linkages with other providers, for the population. The integrated pathway must manage care across the continuum of services and coordinate decisions occurring at the point of service.

New disability rights require organizational change and leadership.

On July 26, 1990, President George Bush signed the Americans with Disabilities Act (ADA). This legislation has been referred to as the "emancipation proclamation for the disabled" because of its great importance to persons with disabilities in our society. The ADA will not be implemented in a substantive way, however, without truly transformative leadership. Because of their traditional role in this area, health care professionals are in a unique position to provide that leadership and to help effect the necessary organizational changes. Passage of the ADA is only the beginning; the true test of its success will be in its implementation.

Spreading the "good news" of total quality management: faith, conversion, and commitment.

In many ways the spread of total quality management (TQM) across this country can be compared to a religious conversion. Both cases are characterized by a philosophical shift with far-reaching changes in responsibilities and incentives for the people involved. This article bridges the disciplines of theology and health services management by elaborating a metaphor in which TQM is compared to various aspects of the Judeo-Christian faiths, such as the role of laws and standards; the importance of miracles, prophets, and evangelists; and the practical applications of living out the faith.

How patients evaluate the quality of ambulatory medical encounters: a marketing perspective.

Quality is becoming an important issue in marketing ambulatory medical services. Based on an empirical study, this article examines how consumers evaluate the quality of medical encounters and how providers can influence patients' perceptions of quality.

Medical group management: a marketing orientation.

This article considers the pragmatic aspects of conducting a situation/marketing audit for group medical practices. This audit is a key component in the formulation of a competitive strategy and the development of a marketing program. Given are a series of questions that may be used by medical groups to guide assessment of the opportunities and threats present in the environment as well as the strengths and weaknesses of the organization in meeting the environmental challenges. Furthermore, the article provides a framework for thinking about strategy and the variables that should be considered and aligned to achieve effective implementation of strategy. Finally, the parameters are outlined for deciding on a marketing program: the mix of marketing tools (service design, distribution channels, pricing and promotion) that should be employed to offensively and/or defensively position the medical group in the competitive marketplace.