Should the EHRs be controlled by the patient or the health care organization?
Kennedy: We think in order for this to be successful, it needs to be patient driven, patient controlled. The reason is that if you look at what's costing so much money in health care today, it's chronic disease management. Chronic diseases are not something you go to the doctor and get fixed. They're something you manage over time. To deploy tools that don't have a patient-centric approach and expect, by automating the physician's office alone, to see substantial improvements in the cost of care really isn't that rational.
Dare: You need a good clinical record that care providers can rely on. And you need consumers who want to be healthy to have access to that information and be able to augment it, and I think that's a partnership. People don't just stay put in one place. We are mobile. What's the more significant piece is that your health information can follow you.
Fasano: There are a number of models out there. Some [regional health information organizations] are more successful than others. I have a personal opinion that there will be trusted clearinghouses that become connectors in this industry. The model I point people to is the Visa model in the financial services industry. Your financial information certainly moves around that industry quite seamlessly, both nationally and internationally, and it's considered pretty secure. The same will be necessary in the health industry.
I don't think it's going to be easy for us to say one model is the right model versus another -- regional versus national versus a broad clearinghouse. I think the industry will have to go through some learning, because obviously health information is different from the few bits and bytes that get transferred about your credit card transactions.
The vast majority of money in health care is spent on chronic diseases, such as diabetes. That's the responsibility of the patient to maintain. How much control should consumers have versus health care organizations over their e-records?
Dare: We did a survey of consumers over a year ago. Do they want to be the person totally in control and managing their own care? Do they just want to tell their care team what to do and when to do it? The research was clear. People don't want to be out there on their own. They want to be connected to their primary care physician.
The research showed consumers want [these] things:
1. They want secure messaging or an e-visit. It could be e-mail or a video. They don't want to have to go to the office. They want to talk to the physician when they want to talk to them -- maybe not always in real time. That starts an ongoing conversation where both the physician knows what's going on and the patient has responsibility.
2. The consumers told us they want timely access online to things like lab results and other tests so they're not waiting for that. So it's not one or the other. It's that partnership between a primary care physician using technology to enable that relationship.
Kennedy: What you have to do is provide a tool that the patient can use as well as the physician to make that teamwork more effective and make that application available to the patient so they can take advantage of it for the 99% of the time they're not in the doctor's office.
What's the greatest challenge going forward?
Fasano: The broader industry, because it's not connected or integrated, really has an issue with how it gets paid. We pay for care. As long as the industry pays for care, you're going to get care. Until we think progressively about how to incent physicians' groups and hospitals around health ... to incent people to [live] healthier lives so that care won't be needed is a real mountain to climb in this industry. The broader industry focuses on the fact that you need to have care provided, so come into my office or let me put you into the hospital. Both of those events cost money these days. I'd prefer it where you don't need to come into my office and I can get paid for an e-visit. What innovation that would be in this industry.