electronic medical records, Reece personal musings - A Voice in the Wirelessness, Part 2

One does not begin with the right answers, one begins with the right questions.

Peter Drucker, 1909-2006

The Health 2.0 term represents irrational exuberance around unproven healthcare ideas that do not have a sustainable business model.

Dmitri Kruglywak, Hippocrates.com, September 15, 2008

There’s a lot of excitement these days about Health 2.0, using Web 2.0 technologies to connect consumers to health care through social networks, consumer sites, wellness programs, and personalized medicine. The idea is to apply easy-to-use software to search for health answers through wikis, blogs, videos, and other online communications, in order to connect people with each other, and to improve health and health care.

Finding A Sustainable Business Model

The problem is to find an sustainable business model that people will pay for. This problem has been brought to everybody’s attention by the failure of physicians to embrace online technologies and EMRs and the quiet exit of the Revolution Health Group (RHG) from the Health 2.0 marketplace. RHG was backed by $250 million supplied by Steve Case with the promise it would “revolutionize” and “transform” health care by supplying consumers with information. It didn’t happen. Revenues weren’t there to sustain the idea, and Waterfront Media, whose Everyday Health is the #2 health website, after WebMD, has agreed to buy RHG for $300 million.
According to Consumer Power Report #148,

Health blogger Dmitriy Kruglyak sees the demise of Revolution Health as a stand-alone operation as undermining the premise of the "Health 2.0" movement. He says that, given Steve Case's substantial funding, Revolution "tried almost every Internet health idea under the sun. Many of those came by way of acquisitions, while many were developed internally by copying competitors. While it is hard to call this approach focused, at least they had a chance to try and copy almost everything that had promise, giving them the first dibs at success." But, "despite impressive starting war chest and exhaustive experimentation, most revenue streams failed to materialize, aside from plain-vanilla advertising."

Not Pessimistic

I am not so pessimistic. A sold-out Health 2.0 conference is being held in San Francisco on October 22 and 23, and all the big players, Microsoft, Google, WebMD, Yahoo, and 50 other major and minor web playes, will be there, fired-up and raring to change the health care landscape through personal health records and other various and sundry applications.

Sitting Back and Asking

Now is a good time to sit back and ask: do we have another bursting of dot.com, Revolutionhealth.com, or credit-derivative.com bubbles on our hands?
Health 2.0 is not the same as Medicine 2.0, which applies more to physicians and their failure to adopt EMRs on a massive scale, but these 2.0 ventures share the problem of being financially unsustainable.

In yesterday’s blog, I asked: Is it possible 85% to 90% of physicians have solid reasons for not installing complete EMRs and does their reasoning make sense? I answered by saying clinical judgment at the point of care should not be trumped by algorithm intelligence.

EMRs Don’t Make Business Sense for Physicians

But a second more fundamental reason for rejecting EMRs is that EMRs simply don’t make business sense and represent a failed business model. Why would any rational doctor, many of whom are economically marginal already, install an EMR that
• has no tangible return on investment
• costs $30,000 or more to install
• slows productivity for 6 months or so
• benefits others, i.e. health plans, but not physicians
• changes and disrupts existing practice patterns
• has shown few improvements in meeting quality standards when compared to doctor groups not using EMRs.
• may be used to exclude or rate practices, and decrease reimbursement
• when used in P4P programs, has not resulted in bonuses that meet expenses of participating .

Legal EMRs

Now, unfortunately, another reason for not installing EMRs has surfaced. Poor EMR design and user errors may make physicians vulnerable in malpractice actions (“Is Your EMR Legal? AMA Medical News, October 13, 2008). If doctors buy the wrong EMR or use it wrongly, they may be easy targets for malpractice attorneys. Among other things, the article says, the EMR should,
• Assign authorship to each entry.
• Function as a normal way of doing business
• Record the time and identity of each user.
• Make alternations obvious..
• Be easy to audit.
• Allow open billing.
• Have controlled access.
• Allow cut and paste functions.
• Identify original sources.
• Allow free text entry.
• Meet certification standards and safeguards

The problem with all of this is that certification standards are continually evolving, and many EMRs may not meet all the standards. Almost any EMR can be disqualified as a legal record in court. Each user should have login names and passwords and ideally its users should undergo training for proper ENR use.

This may all be necessary, but many physicians are too busy practicing medicine to worry about the legality of an EMR and examining its various functions, which is yet another reason why they don’t rush into EMRs.

Hype alone, either for Health 2.0 applications or for EMR installations, is not enough to transform, rationalize, inform, and discipline consumers and physicians. The business model must be reasonable, affordable, and sustainable.