Role of the patient-information-communication-manager PICM in a tertiary care hospital, community, quality improvement, integrative medicine and the business of healthcare

Needed to clarify the role of a 'patient information communication manager' PICM that may have been missed in past blogs. 

Perhaps it would be easier to clarify what it is not first? :-)

S/He is not to be used as a vehicle to get patients to a 'tertiary care hospital' and then leave the patients to fend for themselves hoping that the doctors will be able to do the job from that point (this may be currently happening in many hospitals and may be boosting their short term gains but doesn't go a long way toward sustainable returns?).  

The PICM's role is to help patients by delivering 'Quality-improvement' QI and we believe the return on investment ROI for their work will be in terms of a long-term collective inflow of patients (and money) built up gradually over months to years and this will be directly proportional to the quality of care that we are able to provide as a result of our 'intervention.'

Now let me elaborate again on our 'intervention/tool' that we need to use for QI in your tertiary care set up. One of the commonest problems in tertiary care (and perhaps healthcare in general due to which quality suffers) is the lack of information and communication. 

The PICM will be able to address this gap that will lead to better sharing of clinical information through creation of accessible 'electronic health records' for every patient. Think of the relief to pathologists and radiologists when they are able to access the entire details of the history of a patient in a neatly typed format (instead of trying to figure it out from cryptic one liners in a paper based request form)? Similarly think of the value to clinicians (residents and consultants) who can spend more time in talking to patients rather than maintaining information in files and request forms. Imagine the value to medical student learning as these records can become valuable learning repositories of clinical problems for them (as each record would also contain the biochemistry, pathology, radiology of the patient). 

Interestingly EHRs are not popular with physicians even in US but that is because they have to create these EHRs themselves and are not yet blessed with the concept of having 'patient-information-managers.' I am sure they will get there soon. :-) 

Having a better information and communication workflow will lead to better transparency and accountable decision making that will improve the quality of care. The initial role of well-trained PICM would be more of a trainer for all the existing staff in a tertiary care organization   (obviously even though well trained, one PICM  alone cannot manage all the records and departments in a hospital but if s/he can train even one from each department that should scale very well). 

These staffs that are trained can find an incentive in learning this new tool and utilizing this knowledge to work in the evenings from their homes (E-health centers carrying the name of the tertiary hospital with no additional expense to it's management) and create similar online-health-records in their community at a small fee that they can charge directly from the patient (and provide a receipt in the tertiary-center's letter head for their service). 

A few PICMs are already doing this in one location in West Bengal (although they may be doing it on faith and not providing a receipt of any organization to their patients). Once patients are engaged in this detailed manner (that automatically happens during the process of creating the online-record) and if/when they receive an online feedback from the doctor who can deal with their mentioned problem) they are more amenable toward subsequent adherence to quality care. 

In summary one can utilize online-patient-record creation as an important tool/intervention to improve quality of healthcare both in the tertiary set up as well as the community and help our medical students and staff learn in a patient centered manner from all the valuable patient data that otherwise goes undocumented and wasted in paper files (fit for dead-letter-offices?). This quality improvement QI in terms of learning will translate into earning for the tertiary-hospital-owners with time (but yes this may not be reflected through short term gains but only through long term sustainable returns).