Over the past decade, I’ve seen a number of studies asking people whom they trust among various health care stakeholders. Nurses, pharmacists, and doctors always come out at the top.  Beyond that:

·Trust of hospitals tends to be high (60–80%)
·Trust of health plans is at the bottom of the heap (10–20%)

Is this written in stone for the future? I don’t think so…and the dynamics for change are in motion.  Please read on.

Here’s the emerging picture I’m seeing:

·Hospitals are dragging their feet in connecting you with your electronic health information.
·Health plans are highly motivated to connect you with your health information.

Hospitals Keeping You from Your Health Records

Yesterday the American Hospital Association released a 68 page letter commenting on proposed regs for Meaningful Use Stage 2. Putting aside my usual analytic tendencies, I’ll simply describe the letter as whiny, snivelly, “can’t do”, mean, and thick-headed.

The lightening rod issue is around patient access to EHR information:

As proposed, Stage 2 MU rules put many requirements on hospitals to provide patients with electronic access to much of their health record within 36 hours

The AHA advocates that the standard for providing patients with electronic data should remain the current 30 day period specified in HIPAA

I have not seen a single commentary that is “fer” the AHA POV.

…but there are many who are “agin” the AHA POV:

e-Patient Dave, “American Hospital Association declares war on patient empowerment. Please act.” (start here for a great overview)

Regina Holiday “Lives not Livelihoods in Meaningful Use”

Lodewijk Bos, International Council on Medical and Care Compunetics,  “AHA-Erlebnis”

Deven McGraw, Center for Democracy and Technology, “Hospital Association Fights Digital Access for Patients”

Christine Bechtel, National Partnership for Women and Families, “Don’t Let Them Destroy Patient Protections in Health IT!”

If hospitals were truly interested in advancing accountable care, they would be leaders — not laggards — in connecting YOU with your health records.

Health Plans Connecting You with Your Health Information

Last summer the Boston Consulting Group reported on a survey of 120 health insurance executives. One of the most significant findings was health plan recognition of the need to become more retail oriented and improve the customer experience.

This week another survey of 100 health plan executives sheds more light:

With all the talk about the vaunted triple aim of healthcare: better care, better health, and lower cost, it shouldn’t come as a huge surprise that health plans tapped improving the customer experience as their top priority for 2012….

The survey indicates that member portals and e-commerce are among the big ideas where payers plan to invest to improve the consumer experience. Embracing multi-channel commerce, mobility, and social media are also on payers’ agendas.

Shifting Trust?

Please don’t take my commentary as anti-hospital or pro health plan. I’ve worked on both sides of the fence.

Economic incentives are shifting. This week the hospitals really blew it in gaining patient trust. Health plans (finally) are working to dig themselves out of a deep hole with patient trust.

…and this could have a dramatic impact on who we trust to act in our best interests.

Vince Kuraitis, JD, MBA, is a health care consultant and primary author of the e-CareManagement blog, where this post first appeared.

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17 Responses for “Hospitals or Health Plans: Who Do You Trust to “Connect” You with Your Health Records?”

  1. John says:

    This is an interesting post that goes hand in hand with the development of mHealth apps. Ultimately, mobile medical applications that can potentially revolutionize the delivery of healthcare while reducing costs depend on the FDA’s approach to regulation.

    In Europe, mHealth is already beginning to change the nature of the physician-patient relationship.
    http://bit.ly/ynprju

  2. John, Great point that supports the general observation that hospitals are dragging their feet and health plans are leading the charge in connecting you with your health data.

    With some exceptions, hospital enterprise software vendors have not created APIs that allow outside vendors to build apps pulling data from and/or adding data to the hospital data.

    Some of the exceptions I’m aware of include Greenway, Allscripts Helios, Practice Fusion, and the Cerner PHR experiment. Please add others.

    However, the light bulb is coming on at health plans about opportunities to appify data and allow consumers mobile access to data and services. For example, Aetna recently acquired iTriage and intends to make the platform open and avaiilable to others.

    The HIE software vendors also are increasingly aware of the need to think of themselves as a platform and to build APIs for outside apps.

    Hospitals need to rethink the notion that hoarding patient data is a viable competitive strategy.

  3. Sandra_Raup says:

    Maybe this is just the beginning of consumer empowerment. And the really useful information for consumers may not be in the hospital but in their ambulatory providers – as well as the information they contribute themselves. Consumers are just beginning to realize they don’t have to be captives to the healthcare system – you’re right that in many ways Europeans have already figured that out.

  4. rbaer says:

    Let me be the party pooper in this world of largely unrealistic expectations (I am not defending the AHA, I am rather interested in the big picture):

    (1) What empiric proof is there that a general increase of patient involvement would create more good then harm?
    As medical provider, I see a lot of unreasonable requests for testing and a lot of wrong internet based diagnoses/suspicions. I see also very good input, for instance a patient yesterday who (likely correctly) self diagnosed with a rare benign tumor that I have never heard of (it’s not in my specialty area, I have seen that happen too), and as a side note, the quality of internet research and other involvement has dramatically increased when I started practicing in a highly educated university town (compared to the mostly very affluent suburbia prior to this).
    2) In the same vein, what empiric proof is there that patient involvement would lower cost and make HC more efficient?
    3) What percentage of patients with an important medical problem do have
    -a sufficient cognitive basis
    -enough time and interest/motivation
    -technology requirements
    to be highly involved? Very often, when I discuss options and talk about evidence and probabilities, I hear “you are the doctor” or “what would you do?’.
    4) Is it automatically a good thing if patients control the flow of of information? Is a patient entitled to say, start a second (3rd, 4th, 5th)opinion from scratch and withhold past medical history or imaging studies?
    5) How many people commenting here and elsewhere with great enthusiasm have a financial stake in consumer health (and/or would be diagnosed, as per DSM 6, with device-o-philia)?

  5. Sandra_Raup says:

    rbaer, I just heard tonight at a meeting of a trial using a shared care plan that reduced re-admissions to hospitals by 30% and ED utilization by 50%. I have to look up the source, but it sounds like there’s data coming out on that. And I wonder why so skeptical? It makes sense that people manage their finances better if they’re involved – why is health so much different? Most people have to do most of their own healthcare, anyway – if they aren’t involved, how are they able to do that? And I certainly hope people have a “sufficient cognitive basis” to understand their own health – why wouldn’t they? Even if people ask, “what would you do?”, that doesn’t mean they don’t understand or are incapable of doing so. I often ask people that even if I’m planning on taking responsibility for an activity, such as making a major purchase or engaging a professional.

    • rbaer says:

      To clarify:
      Patient involvement can be a blessing – just depends on the patient and the condition/problem at hand. I was referring to unfocussed involvement and patients being encouraged reading their MR. That may do more harm then good. If they do it at all, because the only number I have seen was here on THCB that 70$% or so are “very” to “somewhat” interested. Any numbers in cluding “somewhat” don’t count. I work in an educated, tech savy university town. The percentage of people signing up for partial chart access is quite low (I see who signed up when results come back).

      Cognitive: I thought we are talking mostly about inpatients and the AHA issue. Just go into various hospitals and see how many patients have serious cognitive or motivational issues – dementia, psychiatric disease, drug problems, very low educational status +/- poor english skills. Hospitalized people tend to be old, and very frequently, dementia or mild cognitive impairment coupled with low interest in health care matters will limit patient involvement.

      I/o encouraging people to browse their charts, a high school class in health education/literacy covering issues like nutrition, prevention, lifestyle, benefits and limits of diagnostic testing and medical treatments, overtreatment, using the internet for health information, navigating the HC system could be a blessing … possibly too early, but maybe some messages sink in. If that would ever happen, of course the various interest groups would make sure that the current irrational consumption of HC services is perpuated and influence the content.

      • Sandra_Raup says:

        rbaer, Thanks for clarifying. I do understand what you’re talking about, but I think you should look at the issue through a different lens. If we really want the expensive healthcare to be worth it for the people who consume it, it has to be more tailored to their needs. That means creating systems that bring the patient into the conversation no matter what their status. Objectifying patients, giving them treatment they don’t really understand because they can’t, doesn’t really deliver the value we could at a much lower cost.

        Example: I once worked with a young gang member who was a paraplegic from a GSW to the spine. He had developed a massive sacral ulcer from sitting in his wheelchair. Although his family was willing to do what they could to help him out, in the end the only solution available (because of the strange way govt pays for care) was an extended nursing home stay – something he was very unhappy about. In the end, the most expensive! But what really struck me was the conversations between the medical residents who spoke to him regularly and him and his family and friends. It struck me that we need more medical residents who have been gang members in the past so we have medical practitioners who can communicate with this population who are expensive to society! This may be an extreme example, but it’s typical – what’s delivered to these populations is very high quality in its own way but entirely misses what would really be valuable to populations who need different styles of communication and relationship. Just my point of view after spending 20 years working in a couple of urban-setting Level 1 Trauma Centers.

        • Also worth clarifying here that there are many reasons patients want and should have access to their data that are not necessarily related to their personal interest to engage with the data:
          I’m moving.
          I want a second opinion.
          I want a new doctor.
          I am going on vacation and want to keep bring an electronic copy with me in case I am sick or injured.
          I want to keep my PHR up to date.

          • Sandra_Raup says:

            You’re so right, Vince! We’re a mobile society these days so it doesn’t make sense to be tethered to your local provider if you have health issues.

      • southern doc says:

        I’m more concerned about the majority of my patients who have no jobs, no insurance, no transportation, and no literacy. Computers: give me a break.

        But high speed internet access to their medical records: bring it on! Great place to spend the bucks.

  6. Sandra_Raup You are spot on in observing that the future might well be with ambulatory providers.

    In an industrialized world that required massive capital expenditures for hospital plant and equipment, hospitals were the center of the health care universe in local communities.

    I understand that hospitals want to remain relevant and financially viable. But in a digital world, there is no center of the universe — the nodes are distributed. NOT sharing data widely and appropriate will lead to hospitals becoming marginalized. Yes, potentially they can “control” data in their own silos, but in the future the value comes from connecting data from many nodes on the network, not from controlling one silo.

    Can you imagine a digital health world where information is truly patient centric and doesn’t revolve around the hospital? I can!!

    rbaer I understand your question and you are certainly free to have your opinion of whether sharing data with patients is a “good” idea.

    However, the decision will not be made through the lens of science and evidence. There is no jury out there weighing the evidence.

    The decision making lenses will be technological, political, practical, intuitive, economic.

    HIPAA already gives patients a property right in their data — an ability to access a copy within 30 days.

    That said, as Sandra points out many have been studying the issue through a scientific lens.

    The studies overwhelmingly come back showing that people WANT access to their health data.

    As you speculate, the studies also come back that many (most) don’t know what to do with their health data or don’t want to invest time.

    There also are studies that suggest that patients can benefit greatly from access to their health data.

    …and there will probably be unintended consequences of providing patients with access to their health data.

    That’s all ok. We will learn and adapt.

    • southern doc says:

      “the decision will not be made through the lens of science and evidence”

      Well, thanks for admitting what a lot of us have suspected for years. We’re entering an era of faith-based health care.

  7. Peter1 says:

    I generally want more transparency in medical information (and everything else) but if hospital staff know you’re going to be looking over their documenting shoulder will the information input adapt to just being benign and mostly useless, except for necessary medical jargon?

    If anyone has ever been to a meeting then read the minutes you’d know that what the minutes record (depending on the writer) is usually no where near the the actual tone and substance of the meeting. Context is just as important.

  8. rc0917 says:

    None of this matters. That is what Liberals, and a good number of Republicans for that matter, do not understand. It does not matter if it is a good bill or a bad bill. It does not even matter if the majority of people agree with an individual mandate or not. All that matters is whether or not it is allowed under the current constitution. Can the government force an individual to buy something, yes or no.

    I say no, but I am also not a constitutional scholar. I like many aspects of this bill, but if the only way to get it to work is unconstitutional then we have two choices. Change the constitution or start over and create something that is.

    • BobbyG says:

      “Can the government force an individual to buy something, yes or no.”
      __

      The usual mischaracterization. No one will be “forcing” you to do anything. You will still have a choice. Obtain/maintain health insurance or pay the minimal tax penalty. And, there are — specifically — in the PPACA terms stating that you cannot be subject to civil or criminal sanctions for failing to pay the “penalty.”

      Deputies will NOT be arriving at your door, cuffs at the ready, to inflict “force” on you.

  9. Peter1 says:

    “Obtain/maintain health insurance or pay the minimal tax penalty.”

    Unless you’re a Christian Scientist (oxymoron), then on religious grounds you’ll get a pass. I bet their ranks swell if mandate passed.

  10. Joe says:

    Great and valid points all around

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