You Say You Want A Revolution

This week I read another healthcare top 10 list forwarded by a friend. This one, from HealthLeaders, trumpeted the following innovations as the most important ones shaping healthcare in 2006. I’ve edited these for brevity, and presented them in reverse order in tribute to David Letterman:

10. Consumer directed care
9. Disease Management programs
8. PHRs with and without EHRs
7. Interactive Remote Patient Monitoring
6. Concierge, cash and retail care models
5. Self-care, self-service and self-empowerment software
4. Office-based electronic prescribing and dispensing
3. EHR add-ons like web-based scheduling and virtual visits
2. EHRs
1. Pay for Performance

Healthcare consumerism is in, EHRs and PHRs are coming, and Pay for Performance is moving us toward greater quality and accountability. That’s certainly so if you measure using column inches in the trade publications. And I, for one, certainly believe these innovations should be shaping healthcare.

Sometimes it’s hard to see the change from the ground though. I am fortunate enough to be able to communicate online with my doctor and her office, however my wife has to do things the old fashioned way with hers, and our kids’ pediatrician’s practice is a solidly stuck in the paper era. I get data-driven personalized preventive reminders from my car dealer and my dog’s veterinarian, yet none from the doctors who care for my family. I know a handful of folks who are trying the new “consumer directed” flavor of insurance, but I know none yet who can access cost or quality data for their particular providers. My stepfather takes 32 pills a day for a three different chronic conditions, and gets little help from anyone, other than my mother, in managing his care.

Change is clearly needed. It’s really only a matter of time. But that’s just the thing. The joining of healthcare and information technology is like a marriage between members of different cultures that have different innate senses of how time moves. I remember, back in 2000, working for an Internet EHR/PHR company, and having the distinct impression that I was sitting and spinning at the intersection of the fastest and slowest moving industries in the U.S. I don’t think that’s changed. We measure technological change in months and quarters – healthcare changes occur over years, decades, generations.

The 100 thought leaders who collectively ranked the above listed 10 innovations placed Pay for Performance at the top. If that’s wishful thinking, it’s well placed. Aligning incentives may be the best way to accelerate the change that healthcare so sorely needs. And perhaps even tip a slow moving evolution into a true revolution.

August 4, 2006

2 thoughts on “You Say You Want A Revolution”

  1. David,

    Do good incentives, properly placed, ever fail to produce changes in behavior?

    My boys tend to hit each other less and finish their dinner when the reward for doing so is dessert.

    If you paid me more, I might even ease up on overuse of ED services (but only in the extremely unlikely event that somebody determined this was good care)



  2. Hi There Eric, Your wife will be in luck very soon. As a pediatrician who has utilized the Personal Pediatrics administrative support system for conversion to a paperless high tech low cost exclusively house call practice, I can say that the pediatricians who are paying attention to what is happening in health care will choose a different method of adaptation to the financial pressures of private practice. Instead of hiring nurses to do all the work for their patients, why not utilize this modern system which will enable a pediatrician to all but eliminate his overhead, give patients a variety of non reimbursible services for a reasonable cost, and spend time with families, all while doubling his income. Sound impossible… take a look at Personal Pediatrics… The pediatrician of the past and future… Today. We primary care providers are not just all going to go out of business. Natalie Hodge MD

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