If there is a next big thing in healthcare
information technology in 2007, it will be the role of consumers in this sector of the industry, according to a consensus of experts.
In 2006, coalitions of
major employers and payers both unveiled
ambitious plans to try to empower their
employees and plan members with personal
health records, continued development of
data-dependent quality improvement programs, and
private and public sector
pay-for-performance schemes, and all will have an impact on the healthcare industry, IT experts say.
"I don't know that there is going to be one
thing, and that may even be the story,
because we've got a bunch of things going
on," says Stephen Lieber, president and chief executive officer of the Healthcare Information and Management
Systems Society in Chicago. "I think you're going to see more and more
development around tools for the consumers, especially from employers, trying to use the consumer to be the vehicle to bring about change in healthcare. I'm just not sure it will develop fast enough to be the big story for 2007 because it's still too
But Steven Waldren, the physician director
of the Center for Health Information
Technology at the AAFP disagrees.
"I think it will happen in the consumer
space," Waldren says.
"I think we'll see
some big players not typically in healthcare
IT start trying to provide services to
consumers. The Dossia project is just the
first of many," he says, referring to the
PHR joint-development effort launched in
early December by corporate giants Applied
Materials, BP America, Intel Corp., Pitney
Bowes and Wal-Mart. The following week, the
Blue Cross and Blue Shield Association and
America's Health Insurance Plans uncorked
their own PHR project.
The wild card for these schemes is whether
workers will entrust their data to PHRs set
up by their employers, or will allow payers
to get their hands on even more data than
they now receive through the claim's payment
data stream -- sensitive clinical
information such as laboratory and genetic-test results, alternative or over-the-counter
medications, family histories and allergy
lists that could be used against them.
"That's the million-dollar question,"
Waldren says. "Why would I want to risk
giving my information to my insurance plan
or my employer? Are they trusted enough?
That's the huge risk."
The Markle Foundation recently released
results of a consumer survey that mirror
those of surveys taken in 1999 and 2005 by
the California HealthCare Foundation that
indicate consumers are loath to share their
personal clinical information with their
employers or their insurers.
If a network existed to provide access to
their personal health information online,
79% of respondents to the Markle survey said
they were either "very concerned" (53%) or
"somewhat concerned" (26%) their insurance
company would somehow gain access to the
information. Employers were almost as
mistrusted, with 74% of respondents
indicating they were either very concerned
(56%) or somewhat concerned (18%).
Still, Waldren says he recalls when the
Internet was young that many people vowed never to do their banking or buy anything
online, but now a lot of people have stopped
writing checks entirely.
With the coming of health savings accounts
linked to high-deductible plans and "the
whole financial push of being responsible
for the dollars," the desire for convenience
may overwhelm consumers' privacy concerns,
Waldren says, but, "The jury is still out."
"We've seen every other industry move from
nothing online to just content online, then
services online and then communities
online," he says. Right now, healthcare
consumers have climbed the adoption curve
past seeking healthcare content to obtaining
healthcare services online, Waldren says.
The December action by Congress to scuttle a
scheduled cut in physician Medicare
reimbursement rates and instead offer
doctors a 1.5% bonus for voluntarily
providing quality data will have an impact
next year on healthcare IT -- or maybe not.
"Depending on how much buzz it'll create in
the physician community, they might see that
as an opportunity to invest in EHRs," Lieber
The high cost of EMR systems is "as
much a barrier in the physician community as
anything else. It's cash out of their
pocket," Lieber says.
At the small-office level, however, where
EMR system adoption rates still hover around
10%, according to several surveys, "the 1.5%
incentive is just not enough" Waldren says.
"I just don't know how beneficial that will
But that's just the start, according to
Trent Haywood, the chief medical officer of
the group purchasing organization VHA.
"I think you'll definitely see pay for
performance begin to build momentum," says
Haywood, who came to his current post in
December after six years at the CMS, most
recently as deputy chief clinical officer,
where he oversaw its clinical quality
"You've seen it on the hospital side, and now
you're going to see it on the physician
side," he says. Haywood says he does not
envision IT mandates, "But what you will see
is the push for more information around
quality, and that will provide a better
business case for IT investment."
Haywood's advice to healthcare leaders for
"I would tell them now is the time to
strongly consider adoption of health IT," he
says. It will be very important to be able
to capture that performance data and export
Laura Adams, president and CEO of the Rhode
Island Quality Institute, a statewide health
information exchange, says regional and
state health information organization
members will be pressuring vendors for
products to do the kind of quality
improvement that will be in greater demand
"I think increasingly health information
exchanges and IT proponents are going to
have to articulate IT's role in quality
improvement a lot better than we have,"
Adams says. "Everybody is going to be under
enormous pressure for transparency and
accountability, and that technology is just
going to have to produce," she adds.
Physician William Bria is the chief medical
information officer at Shriner's Hospital
for Children in Tampa, Fla., and chairman
of the Association of Medical Directors of
Information Systems, a professional
association of physician
Bria says the push toward consumer
empowerment and the development of personal
health records will be tempered by issues of
"The pressure for the electronic health
record in America is getting greater all the
time, and the most interesing thing to me is
some of the pressure from Sam Walton (the
late Wal-Mart founder) and Intel and from
businesses. Businesses mean one thing:
Business could provide the financial and
political pressure to bear to get IT done,
"It's a big moment," he says. "At the same
time, there is just constantly more and more
data about privacy and violations. Just this
morning there was another one in the New
York Times (about another data leak via a stolen laptop) and that's not escaping
anyone's notice. Society is basically going
to demand that there is much more
accountability and patient control. If its
not handled in that way in our rush to
electronic healthcare, there is another
collision that's going to occur."
Further out, Bria says, clinical computing
will be integral to the advent of
patient-tailored treatments using
breakthroughs in genomics, proteomics and
metabiomics, with computers helping
physicians make diagnoses, "not just saying
you have asthma, but you have asthma 15 or
asthma 99, and the next thing is: What does
that mean? There will be targeted treatments
for all kinds of conditions that have
different genetic signatures. The use of
computers and just keeping track of
everything is not going to just be a luxury
or a cool thing to do like it is now. It
will be necessary. Without it, you just
won't be able to do it."
Hoda Sayed-Friel is vice president of
marketing at Medical Information Technology, or Meditech, a
vendor of enterprise hospital information
For 2007, Meditech plans to move hard into
providing systems to deal with chronic
disease management, but on the provider side
only, at least for the time being.
"Several years ago, we started developing a
patient portal, but we backed off of it.
The market wasn't ready for it," says
Sayed-Friel, who agrees with Bria, that
privacy will be a key issue.
"As a consumer, I would not give my
information to my insurance plan or my
employer," she says. "The trusted entities
are the ones trusted today, my primary-care
physicians and the hospital where I go to
get care. I trust them today, and I know
nothing has happened with it. At least the
plans have IT infrastructure to deal with
healthcare. Employers have no clue. They're
hiring third parties. They're either going
to re-invent what the marketplace should be
doing in this area, or it's going to fizzle,
because they have no clue as to what needs
to be done. There is no in-between."
"Privacy is enormous, and neither of those
initiatives will take off if the privacy
isn't nailed down," Sayed-Friel says.What do you think? Write us
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