Steven Freedman MD, PhD, Professor of Medicine at Harvard Medical School and senior physician at Beth Israel Deaconess Medical Center in Boston, has focused on a critical but neglected area in health care reform - the patient-physician encounter.

By making the patient and their family informed partners in their care, his team believes this transparency and TRUST will lead to improved outcomes and decreased harm.

Dr. Freedman and his team has developed and piloted an electronic communication tool, (called the Passport to TRUST program, where the potential causes of a patient's symptoms are described to the patient and their family, any tests or treatments justified as to how this will change management, the timelines and follow up mapped out, and their questions or concerns addressed. Following their successful pilot, they are about to initiate a larger controlled study at Harvard and other institutions to measure the effect on quality, patient satisfaction, expected cost savings and scalability. They will also be studying the incorporation of this model into training of medical students and residents at Harvard Medical School. Since physicians control 91% of costs, this structuring of the doctor-patient interaction is likely to have profound effects on improving quality while decreasing costs. This includes improving health literacy and improving compliance with medications and treatment regimens, especially as 'personalized medicine,' genomics, and as new technologies emerge.

An important element of any health reform program is the ability to bring together the different stakeholders and demonstrate sustained improvements in health outcomes. Thus he and his team are looking to develop partnerships with insurers, PMBs and other key partners to develop effective models and robust outcome measures (e.g., increased prescription compliance, testing linked to action, decreased hospitalizations) that can be tested in different settings.

In March of 2012, Dr. Camilia Martin and Dr. Steve Freedman received a large grant to develop and test a digital form of Passport to TRUST in collaboration with NexJ, Inc., Toronto, Canada.

"We cannot accept that our health care system is too hard to change. Rather, change can only occur when we dare to be an active participant in our health, whether patient, parent, or physician. It is daring to ask for a roadmap to health. It is daring to question the norm and say it is unacceptable. It is time to turn the page in this great country where we have the means and technologies to right the system."

-- Steven D. Freedman, MD PhD

"Dare to ask..."