Sunday, June 7, 2015

Dynamic Case Report model of 'user driven healthcare' UDHC

The UDHC model is based on a 'Case Reports' model where every Online patient record is actually treated as a case-report and as in a case-report the patient's de-identified information is shared with a wider community of physicians. However unlike current 'case-reports' journals this is done with an aim to benefit the patient who is being reported. More here: In current 'case-reports journals' the aim is to benefit future patients by accumulating similar case-data in a data base that can be mined and matched with the case at hand (and this feature incidentally is also incorporated in UDHC).

If we trace the historical evolution of 'case-reports,' the original purpose of 'case-reporting' was actually to share patient information by physicians to find out solutions for their patients using a wider network of other physician brains. Initially they did it in synchronous forums such as lecture halls etc but once they moved to 'asynchronous' forums with the invention of the printing press a change occurred where physicians got into a 'race' to associate their unique 'case-reports' with their 'own-names' depending on who 'documented' it first. Think Parkinson's and various others diseases named after their case-reporters as recently as 1992 after Brugada and HOCM reported for the first time in 1950s could also have been called Morrow-Braunwald's disease in spite of its having become the commonest genetic cardiovascular disease in the next 40 years after the first report! Now that the 'race' to associate one's name with a 'new' disease has reduced momentum, UDHC is currently trying to restore the original intention of 'case-reports' and add more value to it by bringing multi-stakeholder perspectives instead of the traditional doctor-centric viewpoint around a case

In traditional health care models the patient gets the benefit of a one-to-one doctor-patient relationship (and this is interpreted as accountability) whereas in UDHC patient gets the benefit of a local doctor (who bears the brunt of legal-accountability). In addition UDHC provides the patient and the local doctor a potential to benefit from a wider network of global doctors (this is from the personal experience of being a directly accountable local doctor to many patients where i benefit daily from the plurality of multiple inputs from our global network toward helping my patients).

Other online patient query answering sites globally are also not one-to-one traditional doctor patient relationships as the patients here benefit from multiple doctor inputs but they do have significant differences from UDHC in that they do not de-identify their patient's information and leave it on their patients to decide what or how much they would like to share about themselves. In other sites the patient data may not be completely open (unlike in UDHC which is completely open but de-identified as a typical case-report).

I am also not very sure about the accountability being very different in other online forums than UDHC as the doctors here appear to be accountable only for the information they are posting online and do not appear to have any legal one-to-one bonding with the patient (unless a patient depending on the inputs of various physicians chooses to select one 'apparently best of the lot' and proceeds to meet him/her face to face).

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