What is the opinion in the current FHIR implementation?.

I don't think anyone is disputing that the provider is the one with the most knowledge, but the counter-balance to that has to be the patient's intrinsic right of self-determination over their own body.

In other situations like client-attorney or client-accountant it's usually a healthy relationship, where the person with more at stake trusts the opinion of the person with more knowledge. I feel that the legal framework around healthcare puts the provider in the position of gatekeeper, and people think of them that way instead of as a partner.

To extrapolate that point of view to a public health policy, my goal is to restore the agency of the patient, so they start taking a more active role in maintaining their own health. Right now the relationship between patient and provider is intensely adversarial and somewhat akin to dealing with the IRS or DMV. When faced with a complete loss of agency, mentally checking out may not be the most productive response - but it's definitely the most common.

Our biggest killers are mostly behavior-driven, and if we want people to be an active participant in their own healthcare we have to give them a first place seat at the table. I realize this weighs against the ability of the provider to manage the situation, but in my opinion that's outweighed by the increase in active involvement on the patient side.

I've heard providers make the "information vs knowledge" argument often enough, although it's usually framed in much more condescending way - that's definitely a more convincing way of putting it.

/r/healthIT Thread Parent