People power

Health Management Technology, Feb, 2005 by Robin Blair

The main players in the healthcare industry--hospitals, integrated delivery systems, physicians and payers--often underestimate the power of consumers.

As an industry, healthcare is known for a few factors beyond its lag in IT adoption. One of them is the unusual degree to which the recipients of the industry's product--employees, patients and consumers--seem to have the smallest say in how the product's delivery process transpires. This stands in sharp contrast to sectors such as retail and financial services, where high public expectations are routinely met.

Last October, at the AHIMA conference, I frequently heard an acronym that I grew fond of, although there wasn't a single "e" in it: PHR, for personal health record. ChartOne's Beth Friedman began her breakout presentation by describing her own personal health record and how her friends also have started their own. How many of us, she questioned, have assembled PHRs for ourselves and our families--and have done the deed with paper and manila folders in bureau drawers, instead of via the technology we promote? "Most" was her answer. Available stats from HarrisInteractive last fall indicated that two in every five adults keep some form of PHR, but that only 13 percent of that total keep their PHRs electronically, and that fewer than 5 percent keep Web-based records.

In recent years, vendors Rob Seliger and Debra Williams and I--PHR holders all, I'm sure--have shared in HMT our personal accounts of encounters with a healthcare system founded on paper. We all knew what could be and should be, and we all got battered by what was: paper documentation, manual processes and a ton of risk.

The day of the consumer is not right around the corner, to be sure, but neither is it 20 years away. Consumer-directed health plans--and the emergence of high-deductible plans and HSAs--routinely allude to giving consumers more control over how their healthcare dollars are spent. They don't routinely allude to the heftier portion of healthcare costs that consumers will shoulder, but that, too, is part of the equation. Employers have creatively shifted a portion of rising healthcare costs to consumers for more than two decades. Now is no different than then.

Consumers may not be expert healthcare purchasers yet, but they sure know how to comparison-shop for PDAs, mortgages, furniture, digital cameras, brokerage services and airline tickets. They're educable. When these Internet-savvy buyers learn to shop smarter for healthcare--and they will, once they start shelling out 10K a year for services--don't think EHRs won't be a requirement.

Before that happens, let's hope the Institute of Medicine doesn't have to issue another heart-stopping report. Eventually, consumer demand will drive EHR adoption, and probably faster than an 10M report will. Jane and John Q. Public will abandon their physician of 15 years for a practitioner who uses IT to protect them from risk. As they shop for new does, EHRs, e-mail, medical references on handhelds and electronic access to lab results will be on their "must have" lists.

What's at the heart of tomorrow's proliferation of EHRs? Bureau drawers full of manila folders, of course.