Tuesday, October 6, 2009

Will E-Consumers Revolutionize Heath Care?

The long-term answer to improving the health of the nation’s population and curbing costs, experts agree, is to help people make smarter decisions day in and day out about their own health. And the most powerful potential tool in the march toward intelligent consumerism in health care may be the Web.

Steve Lohr, “A New Web Tool to Take Control of Your Health," New York Times, October 6, 2009

“Health 2.0” means that the patient gets to talk back. What the patient wants and needs finally matter. And this belated revolution - from provider autocracy to patient autonomy, from Doctor-as-High-Priest to shared provider/patient decision-making, from bricks ‘n’ mortar medical delivery to cybercare - is bigger, broader, and more profoundly de- and re-stabilizing to health care organizations of all types than anything information technology could ever bring to bear., Finally, the specific technologies associated with health 2.0 are cheap enough and unobtrusive enough to get out of the way, and let all of us focus on the point: what the patient wants and needs.

J.D. Kleinke, “Health 2.0 A Go-Go: A Revolution by Any Other Name Would Smell as Sweet,” The Health Care Blog, October 6, 2009

In my daily reading, I make it a point to read Matthew Holt, a British ex-patriot living in San Francisco who has declared himself an expert on reforming American health care and who founded The Health Care Blog and the Health 2.0 conferences , and Steve Lohr, the New York Times resident expert on health care innovation.

Both have provocative things to say, and their thoughts right now have converged because Health 2.0 is having a two day gang-bang IT conference in San Francisco. The theme is how Health 2.0, consumer-generated IT content, will revolutionize and improve health care. All the little guys, entrepreneurs empowering consumers to probe and penetrate the system, and the big boys, the Web-MDs, the Googles, tne Microsofts will be there.

For good reason. As Steve Lohr says in his New York Times piece today,

Already, surveys show that a majority of adults in America routinely scour the Internet for health information. Doctors joke that the standard second opinion of diagnosis and treatment has become a patient’s Google search, with the results printed out and brought to the doctor’s office.

But the Web is still mainly a vast trove of generalized health information. The ideal, health experts say, would be to combine personal data with health information to deliver tailored health plans for individuals.

So what is holding Health 2.0 back? I suppose the answer is three fold:

One, revolutionary trends in health care take time to implement and catch fire. As reformers in Congress are learning, unwinding and rewinding an entrenched system, the largest Americana economic sector full of special interests and employing 14 million Americans, isn’t easy. Health 2.0 is still in its early stages, only three years old in fact.

Two, a heavily regulated economic system, is full of barriers to innovations and frustrations to would-be entrepreneurs , as Regina Herzlinger of Harvard BS, is fond of pointing out. She should know. She teaches a course at the business school to physicians who have abandoned practice to become entrepreneurs who can make a difference.

Three, the pervasive cloud of the malpractice fears hangs over innovative physicians, who are afraid to make risky moves for fear of being sued on the basis of not having complete information before taking any action.

One of the main problem facing innovators, seldom mentioned, is the “vast trove of generalized information” that Steve Lohr mentions. That is the problem: they are generalized rather than being specific, and they require doctors to make decisions in the physician absence of the patient.

Take the problem of e-visits. E-visits sound wonderful. Theoretically , they should save patients and doctors time and money, and address minor problems expeditiously and lower costs for all. But, alas, these visits become part of the medical record, and they may be woefully short of information – information that could be fodder for malpractice lawsuits. Result is: only a small percent of doctors make e-visits part of the office practice routine.

Fortunately, there is an e-answer to this e-dilemma, as I explained recently to a reporter who was asking me what I thought the next big e-trend would be in these words:

“The next big data trend in health care will be structured patient data entry for e-visits. Although e-visits are much hyped, less than 10% of doctors use e-visits as a means of diagnosing and treating patients and making care more convenient and accessible and cheaper. “

“Why is this? Because current patient-generated complaints are unstructured, inconsistent, incomplete, unsafe, and subject to lawsuits. “

“On the other hand, patient-initiated interviews based on chief complaints, age, and gender using clinical algorithms are structured, consistent, complete, and safe in the malpractice sense because they supply a documented medical record based on a patient-given history. They provide useful information for a differential diagnosis. “

“Furthermore, these structured e-visits can be entered seamlessly into an office-based computer or into an electronic medical record.

Dr. Richard Reece is author, blogger, speaker, and reform observor. Dr. Reece’s latest book, Obama, Doctors, and Health Reform (IUniverse.com) is available at amazon.com, barnesandnoble.com, and booksamillion.com for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic). For information on speaking fees and arrangements, call 860-395-1501.


Alex Bettencourt said...

This article is quite the eye-opener. Another reason our health care is costing our country so much money is medication non-compliance. It's costing our country $292 billion a year!

When so many prescriptions and drugs are pushed onto us, it can be overwhelming to manage! That's one of the reasons RememberItNow! was created.

RememberItNow! is an online health service which sends text-message medication reminders and features a private care community, and much more.

Watch our story here http://www.youtube.com/watch?v=MJXYaT9KseA

Or visit us at http://www.RememberItnow.com

Richard L. Reece, MD said...

Because it is politically incorrect to say so, one of the chief reasons for poor outcomes is non-compliance to doctors' orders. This may be due to cost, but it also may due to patients returning to their old behavioral habits that made them sick in the first place.

Alex Bettencourt said...

That's true. I think it could be a little of both, but you are right. Sometimes it's the miscommunication between patient and doctor, and a lot of people simply nod their head when receiving medication instructions.

It's the same thing I do when my mechanic is explaining to me all the problems and solutions for my car. I don't want to look ignorant, so I do my best to follow directions.

Also, I think a lot of times it's because we don't know what specific questions to ask about our medications.

I think if people followed these tips it could help right?

Richard L. Reece, MD said...

Printed instructions and period followup email reminders will help, but in the end, people will do what they want to do, however clear and specific the instructions. We are, after all, the land of the free.