In my article in the June 2009 issue of Medical Tourism Magazine™, I proposed an “electronic framework” for portability of health records. It envisioned having a personal health record (PHR) system stored in a central location and directed and controlled by the consumer. I described this as a complement to the electronic medical records (EMR) initiative and as a positive catalyst for change. The EMR initiative is ongoing, but rolling out much slower than anticipated, both in the United States and abroad.
The original timeline to full adoption of the EMR model in the United States has been extended because of concerns about cost, liability in the event of software malfunction, changing standards, and full interoperability among different systems for healthcare providers.
At the same time, public awareness of health issues and costs continues to increase as a result of recent U.S. healthcare legislation: costs are increasing for healthcare overall, and many insurance companies raised insurance rates in advance of the new legislation.
While some employers are lowering their insurance coverage or stopping it altogether, others are choosing to self-insure (i.e. paying the costs for their employees and having a third-party administer claims) or not providing any coverage at all.
As health information exchanges come online in the next few years, some employers are expected to shift to defined contribution plans that enable consumers to buy their own health insurance. Additionally, corporations are providing incentives and funding wellness programs for employees to become engaged in their own health management.
Patient Engagement Delivers Healthier Outcomes and Lower Costs
The driving forces of reduced health insurance coverage, and higher insurance premiums and deductibles are pushing more cost and responsibility toward the consumer. Portability has also become a major factor for healthcare consumers who increasingly choose and move among employers, providers and insurance companies.
This trend is likely to continue and accelerate as a higher proportion of costs are passed to consumers and self-directed health plans become the norm.
Patient engagement has been called “the blockbuster drug of the century” for its potential to improve the quality of care and lower costs.
Patient engagement has been called “the blockbuster drug of the century” for its potential to improve the quality of care and lower costs. Patient engagement or patient “activation” (from the supplier perspective) describes the skills and confidence that equip patients to become actively engaged in their healthcare.
As healthcare delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients’ ability and willingness to manage their health, known as “patient activation,” will be a critical piece of information affecting healthcare providers’ ability to control costs and improve outcomes.
Intuitively, patient engagement in their own health should produce healthier outcomes and lower costs, but new studies have emerged that provide empirical evidence to support these claims.
An analysis of 33,163 patients of Fairview Health Services, a large healthcare delivery system in Minnesota, found that patients with the lowest engagement in their health management averaged costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients who were most involved in their health management.1
A significant contributor to better health outcomes from patient engagement is the attitudes of doctors to this activity. The Manhattan Research annual survey of practicing doctors found that 70 percent of doctors report at least one patient sharing some form of health measurement data with them.
The study also asked doctors what they thought of self-tracking. The firm found that 75 percent of doctors believed that self-tracking leads to better patient outcomes.2
Having true portability of health information provides everyone with the ultimate flexibility in making better decisions leading to better health outcomes.
Increasing evidence also shows that investment in employee wellness programs is paying off. A recent Harvard University study reported in Health Affairs estimates that medical costs fall by $3.27 and absenteeism costs by $2.73 for every dollar spent on employee wellness programs.3 Indeed, there is a new emphasis on health outcomes rather than just treatment.
To obtain the best health outcomes, your health information must follow you. This may happen within some healthcare practices or within a regional health network, but sharing of information among multiple providers is far from ubiquitous and will take years of investment in healthcare IT for real portability to become a reality.
Introducing geography into the equation in an increasingly mobile society further increases the complexity. When treated out-of-network or even at an offshore center, portability of health records is critical before treatment and for subsequent follow-up consultations.
Given the extended timeline for full rollout of healthcare EMR systems, it is more important than ever for consumers to enter the healthcare “information loop” as active participants. This will help ensure that the information healthcare providers need reaches them in a timely and complete manner. Consumer engagement can make that happen.
New Tools for Health Management
The technology landscape has changed radically in just a few short years. New tools, such as tablets, smartphones, and cloud services, have emerged to enable consumers to manage all aspects of their lives. Healthcare management will be no exception. The table below shows the rapid growth in iPods, iPhones, and iPads during the first two years of their launch.
Meeker, M., Perkins, K., and Byers, C.; “Internet Trends”; D10 Conference; May 30, 2012.
According to a 2012 Deloitte consumer survey, half of all surveyed plan to own a tablet in 2013 and two-thirds will own a smartphone.4 Because of their unique portability characteristics, these devices installed with specialized apps provide a powerful new way of aggregating and consuming data.
Many analysts believe the tablet will be the dominant device for consumption of data in the near future. Given the direct correlation between screen size and content creation, tablets will inevitably be used for content creation as well.
These tablets will be used in both personal and business settings; in fact, the same device in both settings as shown below will be used in almost half the cases.
“Devices, Consumption, and the Digital Landscape”; Deloitte; 2012.
Given the rapid market adoption of the new tablet devices and dual use – both business and personal — of these devices, employers have a strong incentive to tap into their utility to support employee management of their own health.
The number and types of devices available to manage health are not limited to tablets and smartphones. Literally dozens of approved devices are on the market to measure and record everything from blood glucose to blood pressure, cholesterol, weight, pulse and much more.
Each of these devices is usually paired wirelessly to another connected device that records, transmits and stores data for future use, analysis and retransmission. The early days of the internet were delineated by version numbers (1.0, 2.0); the newly emerging Connected Health movement will likely follow a similar path.
Connected health maximizes healthcare resources and provides increased, flexible opportunities for consumers to engage with providers to better self-manage their care and manage overall health and wellness. Technology is a key driver. The latest consumer software coupled with the increasing number of connected devices available for personal use.
The Perfect Storm: Blueprint for Consumer Engagement
The healthcare industry is in the midst of an enormous structural change fueled in no small part by stakeholders (government, insurers, employers, patients) and technology (devices including tablets and smartphones, storage, connectivity, and applications).
The convergence of these forces promises to shape a more dynamic, transparent process of delivering healthcare, but only if these new tools are actively used by the participants most affected — the consumer. A number of key components will enable this.
1. Continued growth in smartphone and tablet adoption and increasingly sophisticated applications geared toward supporting consumer engagement.
2. Development of applications that can aggregate, store, analyze and share information from multiple disparate sources (providers, insurers, devices, web, etc). This will provide a more complete picture and avoid recreating the information silos common in the current healthcare model.
3. Increased stakeholder support and development of wellness and incentive programs to encourage active participation by consumers in their health management.
4. Consumers who actively collect and aggregate health data and connect via health-related online communities that share common health experiences. This will inevitably lead to better informed decisions and health outcomes.
Consumer engagement can begin with the adoption of tools available today. As EMR systems come online in the next few years, push/pull functionality (the ability to send information and have it received by the other system, or the ability to request information and receive it from the other system) should be the goal of any interaction with these systems in the near future. Full interoperability with EMR systems may be the ultimate goal, but having a consumer-centric approach will ultimately lead to faster adoption and integration.
The rapid growth in smartphone and tablet capabilities and applications will enable consumers to manage their health as they do for other aspects of their lives, such as consuming content, arranging travel, and financial management. Having true portability of health information provides everyone with the ultimate flexibility in making better decisions leading to better health outcomes.
The optimal consumer health management tool ties various technologies and resources together within a single platform, rather than a collection of random and disconnected apps.
The optimal consumer health management tool ties various technologies and resources together within a single platform, rather than a collection of random and disconnected apps.
References
*(1 Hibbard, J.H.,, Greene, J., and Overton, V.; “Patients with Lower Activation Associated with Higher Costs: Delivery Systems Should Know Their Patients’ ‘Scores’”; Health Affairs, 32, nO.2; 2013. 2 “Taking the Pulse”; Manhattan Research, LLC. 2011-2013. 3 Baicker, K., Cutler, D., and Song, Z.; Workplace Wellness Programs Can Generate Savings;” Health Affairs 29(2); 304-311. 4 “Devices, Consumption, and the Digital Landscape”; Deloitte; 2012. )
About the Author
Mr. Kevin Power is the founder and CEO of The Good Health Group, a company involved the development of a consumer health management application platform for the tablet, smartphone and PC.
He has more than 30 years of operating and board experience in the telecommunications and information technologies industries for the both public and private sectors.
