For the patient worried about how health care reform is about to change everything, say the experts, the good news is that change will come, but very, very gradually.

The ironic part is, that’s also the bad news.

The implementation of the Patient Protection and Affordable Care Act — the official title of the 2010 law now commonly shortened to the ACA or, informally, "Obamacare" — will pick up steam considerably Oct. 1, when people who are now uninsured start signing up for coverage, to take effect in 2014.

But for the rest of Hawaii residents, their health care is going to look the same. Make an appointment, drive down to the clinic, sit in the waiting room, get a once-over from the M.D., contend with the co-pay.

That’s the present. The new system — one involving a wider range of health care professionals working in a team format — is forecast as the new reality, probably some time away. Picture the phone ringing and your health providers are calling you for an appointment, having checked your records and seeing you’re due for one.

State officials have made what is called "health care transformation" a major priority, with a draft plan approaching its June 30 unveiling date (see story, Page F4). Broadly, the policymakers, planners and educators foresee patients having consultations involving doctors, physician assistants, nurse practitioners, social workers or myriad other professionals. Or, they said, occasionally patients might meet with multiple providers, sometimes in person, sometimes through telecommunications.

"I see us at a good decade away from what is logically the answer, as compared to where we are today," said Jerris Hedges, dean of the John A. Burns School of Medicine, an institution at the center of preparing Hawaii for that future. "The new future is throwing people together who may not have worked together before. They have to figure out how to work together."

What’s really happened here, the experts say, is only partly a product of Obamacare. Health care has been slowly moving in the direction of collaboration, they explain, but the expansion of insurance coverage mandated by the ACA is forcing the issue.

Health care reform is adding about 30 million to the Medicaid rolls and mandating coverage, through private employers or individual subscriptions, more or less universally. The somewhat patchy network of health care providers across the country will be strained further to deal with the shortages — to the breaking point, in some places.

This impetus is producing a range of responses across the industry, some as part of "demonstration projects" funded through the ACA, some as a matter of economic necessity in a business with rising costs, some just to meet the basic need to grow the capacity of the health professions.

One spontaneous response, for example, began in 2002, aimed at addressing the shortage of providers. That’s when a group of University of Hawaii faculty members, individually involved in career-awareness tours of the Manoa campus for high school students, realized they could coordinate their efforts, said Sheri Gon, an instructor in the medical technology department.

That was the start of Ho‘omalamalama, a collaborative group including Gon’s field as well as medicine, nursing, nutrition, public health and social work, all of which, she observed, will soon be in higher demand because of health care reform.

"The scary truth is we’ll see more people retire and not enough graduates to replace them," she said. "We see more interest, but I don’t see them lining up outside our door to get in."

In the short and medium term, various strategies are emerging to cope with the workforce gaps. Not surprisingly, some of them are technological. Gon cited the development of inexpensive and accurate at-home tests for colon cancer and other illnesses, each one signalling one fewer reason for patients to go to the clinic.

The technological advance that is top of mind for those driving health care reform is the move toward electronic medical records, which "put information at the fingertips of patients and improves access to providers," said Mary Boland, dean of the UH School of Nursing and Dental Hygiene.

The move to electronic records is being supported through ACA grants across the country but, Boland said, some providers, including Kaiser Permanente and Hawaii Pacific Health, do have a head start on the digital road, she said.

"We are moving away from the ‘make an appointment’ model to increased use of email communication and care management by nurses to support individuals and families to take ownership of their health management," Boland, who was traveling last week, said via email. "In Hawaii, Kaiser subscribers and Hawaii Pacific Health patients have smartphone apps that provide access to their records, notify them of lab results, make appointments, refill prescriptions."

Sharing records will not only better enable provider collaboration, but it will enable health care systems to better anticipate patient needs and deliver care more effectively, said Ray Vara, newly appointed president and CEO of Hawaii Pacific Health. HPH is a nonprofit system anchored by Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Straub Clinic & Hospital, and Wilcox Memorial Hospital and Kauai Medical Clinic.

"We haven’t been waiting, nor do we intend to wait for further guidance as those policies continue to roll out," Vara said. "We’ve been working on this for the better part of the last decade or so, in terms of how to make that evolution to an environment that really focuses on keeping the communities healthy rather than taking care of just those individuals when they’re sick. … The backbone of that is electronic medical records."

The digital records help providers keep track of their patients, but for the patients’ part, consumers often need help trying to navigate the whole system. Especially over the next few years, during the inevitably chaotic process of health systems reinventing themselves, the role of the social worker will become crucial to bridging the gaps.

Lana Kaopua, a former health care social worker herself, chairs the masters program for social workers with a health concentration at UH-Manoa.

The ACA is promoting the concept of the "patient-centered medical home" as a way of organizing coordinated care, and the social worker will serve as a translator and guide, Kaopua said.

"Of growing importance will be the need for social workers in hospitals and other health settings, in behavioral health and substance abuse treatment, and long-term care and other services for the growing population of older adults," she said.

They also are central in policymaking, too: Social workers will help drive the development of models for how the American hodgepodge of small medical practices and large provider groups can all achieve the team approach. Many doctors in private practice are simply not set up for all this partnering and data-sharing.

All professions in the industry will be pressed to "work to the top of their license," Hedges said, meaning that all health care providers will be expected to tap a wider range of skills.

And on the financial front, Hedges is concerned that with all the system efficiencies that could accrue from reform, that some of it come to the health care providers themselves. There’s already a workforce shortage, and without compensation it will become even harder to lure them to the profession.

Where adapting to reform is concerned, he added, there is a generational divide: The medical students at JABSOM, on the one hand, see little problem.

"From the new trainees’ perspective, they’re very in tune with the way things are going," he said. "Throughout their whole education, they have not been the solo learner, a lot of it has been in team work, and they’re used to communicating regularly with their network."

The difficulty will be encountered partly with practitioners who have done things a certain way for many years and are unenthused by the prospect of a total overhaul, he said.

"It’s not that they can’t be redirected, it’s just that there’s just so much change being thrown at people," Hedges added. "Change is painful."