What a personal health record is good for: Changing the customer

I am still preparing a short presentation for the panel I’m appearing on with a compelling sounding name (“Personal Health Records, What Are They Good For?“) at the Agency for Healthcare Quality and Research Annual Conference, on September 14, 2009, and in that preparation, was passed this article by my colleague Paulanne Balch, MD:

The Atlantic Online | September 2009 | How American Health Care Killed My Father | David Goldhill

In that article, which I highly recommend reading, I was struck by this quote:

You are Not the Customer

Not every hospital relies on paper-based orders and charts, but most still do. Why has adoption of clinical information technology been so slow? Companies invest in IT to reduce their costs, reduce mistakes (itself a form of cost-saving), and improve customer service. Better information technology would have improved my father’s experience in the ICU—and possibly his chances of survival.

But my father was not the customer; Medicare was. And although Medicare has experimented with new reimbursement approaches to drive better results, no centralized reimbursement system can be supple enough to address the many variables affecting the patient experience. Certainly, Medicare wasn’t paying for the quality of service during my dad’s hospital stay. And it wasn’t really paying for the quality of his care, either; indeed, because my dad got sepsis in the hospital, and had to spend weeks there before his death, the hospital was able to charge a lot more for his care than if it had successfully treated his pneumonia and sent him home in days.

Of course, one area of health-related IT has received substantial investment – billing. So much for the argument, often made, that privacy concerns or a lack of agreed-upon standards has prevented the development of clinical IT or electronic medical records; presumably, if lack of privacy or standards had hampered the digitization of health records, it also would have prevented the digitization of the accompanying bills. To meet the needs of the government bureaucracy and insurance companies, most providers now bill on standardized electronic forms. In case you wonder who a care provider’s real customer is, try reading one of these bills.

The quote makes me recognize why this aspect of health information technology is the most interesting to me (and it should be to you, too). The customer of a personal health record has to be the patient (and their family), by definition. When the consumer of information becomes the patient and their family because of the personal health record, they become a customer, too. Think about how changing the customer will change health care. David Goodhill alludes to it in the last paragraph of his piece – take a look.

In addition to the excellent crowdsourcing help I’ve received on what information to bring, I think this idea is really important, too: The personal health record is good for changing the customer of health care. This just-released Kaiser Permanente Thrive commercial shows it. Enjoy.


Ted, the "crowdsourcing" link above seems broken: it says just "http:///?p=3353", which don't work so good. :–)

And, you're completely right about the "who is the customer" question. Jay Parkinson and many others have talked about it.

I wonder, though, what differentiates the institutions that still have customer-oriented thinking as in PATIENT-oriented thinking. Is it only the integrated practices like Kaiser and Mayo? Which is the chicken and which is the egg?

I have an entire section on my blog of over 200 posts talking about HealthVault and Google Health. When a patient participates they do get educated one good benefit.


The PHR, like everything else out there today is about aggregation of data and making it useful and available. Also with medical devices becoming smart with the "blue tooth" era, we have more data coming from sources that is not input from humans, but the automated processes of a device. What do we do this this? There is no way any MD could keep on top of the various software programs that report back, a nightmare for the MD.

The PHR handles this, HealthVault. It will be interesting to see who drives this portion and I might venture to say it might be the consumer getting this ball rolling.

It is amazing though when you take the time and aggregate with a PHR and see how much information is really available when you pull it in, and on the downside, finding errors too, so that offers another chore, correcting what is not correct on file.


Fixed the link – thanks for troubleshooting! I think every organization has patient-oriented, customer-oriented thinkers. Maybe the differentiation comes in terms of alignment of this thinking with the business model, however, I think information transparency does a lot to counteract challenging business models. Do you agree? Said another way, information transparency plus aligned business model is the ultimate win, but does the presence of one or the other get us part way there – Is a ginormous change in reimbursement required to see progress?

I've run this concept by a few people and it feels like I may be 1-2-5 years ahead of my time (that information transparency is powerful in and of itself regardless of change in reimbursement model) – interested in your view,


Ted Eytan, MD