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:
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.