Patient-centric

Full Title or Meme

Patient-centric solutions start from the Identity Modeling Introduction as a detailed extension of User-centric design.

Context

• Patient-centric design starts at the beginning of the patient User Experience and follows the user through their attempt to navigate the healthcare jungle, where they have limited knowledge but still must the part of all decisions about their healthcare plan.

Patient Journeys

As in all journeys this one starts at the beginning. The patient has no primary care physician (PCP) and no electronic health record (EHR).

1. Public Health Centers - click to see that part of the journey, but the broad outline is the same as below.
2. The patient presents themselves at a private care provider .
   1. Private health care the patient must go through an Identity Proofing process that typically includes a driver's license and also a Payment Proofing process to understand the payer and any conditions.
   2. The patient must establish a means to contact them, which we will define here as a cell phone of some type.
      1. In 80% of the cases the patient will have a Smartphone and will be provisioned with a app to enable the Phone as Personal Identifier Provider
      2. in 10% of the cases the patient will have a simpler cell phone which will be enrolled in SMS messaging.
      3. in the remaining 10% of the cases, and perhaps even in the simple cell phone case, the care provider may decide to provision the patient with a Smartphone to reduce overall system costs.
   3. The patient is given the means for stipulations including end-of-life conditions to amend the care plan.
   4. The patient meets the physician and then receives a care plan which may include prescriptions for medicines or other care devices and a follow up plan for tracking the patient's progress against the care plan.
3. The patient presents themselves to the druggist or other alternate device or care provider.
   1. The patient records are made available to the other provider with their Smartphone acting as either (1) the source of a proofed identifier, or (2) the the repository of the patient's PHI and scripts.
   2. Note that this only works for medications from a pharmacy. The problem of injections or other pharmacy provided care has not been address in the US.
4. The patient at home with their laptop - i.e. Tele-medicine.
5. The patient wants to move their PHI from one provider to another (either at home or at the new provider)
6. The patient away with their Smartphone. - there is the potential for a similar journey with simple cell phones that would not have as rich an experience and is not elaborated here.
7. The patient is referred to a specialist for follow-on care operating under a different EHR. (A simpler version is available if the EHR is the same.)
8. The patient (or the state) designates a guardian with certain stipulated areas of control. Now the guardian needs to prove who they are as well as their grant of access to patient data. (Note that the grant may have have been bound to the guardian during a previous encounter and continue in effect.

In State Jurisdictions

• Minnesota e-Health Patient Engagement: Health Care Providers Empowering Patients to Improve Health.

Outcomes

1. The patient has a medical record locator for their Private Health Information (PHI) at the EHR used by the PCP.

References

• A Patient's Identity Experience We Can Do Better Catherine Shulten at Identiverse 2020-07-02