Table 3.
Comparison of key parameters of diagnosis-centered and person-centered healthcare models relevant for design of AHMS.
| Parameter | The “old, reactive,” diagnosis-centered model | The “new, proactive,” patient-centered model |
|---|---|---|
| The part of health continuum where major measures of health management take place | Acute disease or chronic disease with significant clinical representation (=a prerequisite for diagnosis) | Same as in the “old” model + patients with early premorbid health conditions and generally healthy people (with risk factors) |
| How the strategy of health management considers the root causes of NCD onset and progression | Almost fail to consider in everyday practice | Health is determined by factors that influence a person daily over a long term |
| Correlation with continuum of care | Fragmented care: 1. Emergency care 2. Hi-tech hospital care for complications of an NCD 3. Medical rehabilitation (short-term, hi-tech) 4. Outpatient follow-up for certain patient categories |
Integrated care that is involved in addition to the fragments of the “old” model (pp. 1–4): - early premorbid prevention; - long-term rehabilitation in home setting; - long-term follow-up in lifestyle correction |
| The nature of interaction between patient and health professional | Usually one-time or occasional | Continuous and planned (regular) |
| Agents of health management | 1. Patient 2. Doctor |
1. Patient 2. Doctor 3. “Healthcare provider” who organizes interaction |
| Who initiates interaction and why | 1. Patient, due to pain or discomfort 2. Planned check-ups (professional or annual) |
Patient, due to pain or discomfort; planned reminders from “provider” Planned mandatory check-ups |
| Who makes decisions about goals and plan of health management | The doctor; the patient signs an “informed consent” | The patient him/herself with assistance and information support from the doctor |
| How decisions, goals, and action plan relate to medical diagnosis | Standards of examination and care are determined by medical diagnosis | Maximum personalization; adapted to individual physiology, psychology, social context, and lifestyle |
| Doctor's role | The key: decision making, drawing the plan of examination and treatment, legal liability | Expert, consultant, and coach in health management |
| The role of user (patient) | Passive: turn to the doctor in time; follow recommendations; pay for services; actual lack of responsibility for one's unhealthy behavior | The Key: goal setting, decision making, implementation of health management plan through behavior change; responsibility |
| Major instruments of health management | Medications; surgical procedures and operations | “Planning and control of following the therapeutic regimen and/or modifiable lifestyle factors”: 1. Healthy food 2. Sufficient motion and exercise 3. Reducing toxin exposure 4. High quality sleep and rest 5. Effective stress management 6. Healthy relationships |
| Major sources of information about patient's health condition | Doctor (results of examination), laboratory and instrumental examinations | Patient: questionnaires, case monitoring with wearable devices; the “old” sources if necessary |
| Place where care is provided | Separate medical organizations not interacting with each other | An integrated information space (ecosystem), contributed by a “family” doctor and “provider” (supports the infrastructure) |
| Place where health information (health record) is stored | Medical organizations; generally isolated from the patient; access is usually closed for patient and other health professionals | The patient him/herself (through User Account); patient opens access to health professionals |
| Major mode of patient-doctor interaction | Physical contact in doctor's office | Continuous (planned) and remote, including telemedical instruments; personal contact if necessary |
| Automation instruments | “Traditional” MIS comprising CRM (customer relation management) and ERP (enterprise resource planning): 1. Electronic medical record; records of medical services 2. Auxiliary services (pharmacy, laboratory) 3. Accounting and finances |
1. User accounts of patient (consumer), doctor (service supplier), and “provider” (responsible for infrastructure) 2. Accounts are integrated with “traditional” MIS and telemedical instruments |