The Obama team is talking very seriously about including health information technology in his “main street” stimulus package. While I generally agree with the predictions of doom and gloom for providers saddled with the burden of data entry, this creates a potentially huge opportunity for Health 2.0.
As very publicly warned in this forum and others, a stimulus package focused entirely on existing EMR/HER technology would not only offer no proven health benefits (Linder, et al. Arch Intern Med. 2007) but also would financially harm clinical practice. Kaiser Permanente’s Hawaiian experiment with EMR added approximately an hour a day of data entry work per physician (Scott et al., BMJ 2005).
This impact will fall disproportionately on primary care.
Primary care doctors often confront patients without a diagnosis,
making a forms-based approach impractical, and their work is much more
in assessment than action, with a 15-minute encounter can result in as
much effort in unreimbursed data entry as a three-hour surgery. Primary
care can’t afford to shoulder this burden: an article in Health Affairs (Colwill, et al., 2008)
predicts a dramatic deficit in primary care physicians. They anticipate
a 29% increased in the demand for such physicians through 2025 but as
little as a 2% increase in the supply. PBS’s Newshour’s health unit reported last Tuesday on multi-year waits to get on some primary care physicians’ panels.
This opens a tremendous opportunity for Health 2.0. Patient
participation is most effective in assessment and monitoring, reducing
that load on primary care. Even without financial incentives it should
not be too challenging to enlist primary care doctors in support of
Health 2.0, transitioning their role from detective to analyst as
Health 2.0 tools help them to arrive at appointments with data in hand.
User-generated healthcare fits nicely between the extremes of suffering
at home and interventional medicine, facilitating the primary care
physician’s role as strategic consultant and advisor and advocate for
medical intervention. In a project for a national HMO, my team provided
patient-engagement software that, for example, cut the number of office
visits from three to one in the protocol for a common diabetic
medication change. In another controlled experiment, we significantly
shifted problems from emergent to routine through on-line monitoring.
When self assessment identified a potential problem, we scheduled a
routine office visit.
One of two results will come from the Obama Health IT stimulus:
either physicians will be overwhelmed with inefficient health
databases, or Obama’s team will take the advice of Drs. Kibbe and
Klepper and will earmark money for improving the process of health data
collection as well as the medium for its storage. In the first case,
Health 2.0 will come galloping to the rescue of physicians desirous of
sharing the burden of data entry with their patients; in the latter,
Health 2.0 will be integrated into the process. Frankly, many of us
with experience in process re-engineering in the web era will find the
first case more familiar.
Peter Schmidt, Ph.D. is an investment banker specializing in health IT at Cronus Partners LLC.
He has a Ph.D. in computer simulation for healthcare. Prior to joining
Cronus, he was president of DGL, a New Zealand-based
patient-connectivity software provider where he helped connect doctors
and patients at one of America’s leading provider organizations and
also provided systems for the care of Katrina victims. He also was the
CTO and COO of an e-learning joint venture of Oxford, Stanford, and