This schizophrenia creates an existential risk. If the system does not see patients as its customers, it cannot be disciplined by the market to serve them well. It will serve well instead its real customers, the payers. And with the move for more and more hospitals to become both provider and payer, the hospitals are perched on a wormhole down which they will disappear in a self-serving singularity while confused patients blink outside the event horizon.
That is beginning to change as legislative mandates are pushing the industry to adopt systems and procedures congruent with both spirit and letters of laws -- from HIPAA to the ACA (“Obamacare”). Particularly patient record portability, ownership, and privacy as mandated by HIPAA and the collection of electronic coded longitudinal population data as encouraged (mandated?) by the meaningful use provision of the ARRA (“The Stimulus”).
This is pushing healthcare IT technology into the hands of people who are not accustomed to it – providers and patients. For providers it means the use of Electronic Health Record (EHR) systems to record clinical encounters – that’s the laptop on which the doctor is furtively pecking away when the patient would rather the doctor be engaged with them.
For patients it has so far been limited to half-hearted patient “portals,” almost always associated on a one-for-one basis with a provider facility (i.e. there is no one-stop shopping for a patient go to and have their health data all in one place) as well as frighteningly nonfunctional patient service websites at the major payers.
Legislation has prodded the industry to apply information technology beyond its traditional administrative and control domains and into the domains of patient empowerment and the collection of population health data by providers.
What legislation hasn’t done is show the industry why these applications are in the industry’s interest.
In other words, nobody has been able to figure out how to make a buck from all this. What happens when you tell someone they have to do something they don’t want to do? Is it any mystery why these legislative mandates have been so passively-aggressively implemented by the industry?
Practice management (accounting) systems were changed
just enough to call themselves Electronic Record Systems. Patient records were digitized and opened
just enough to call themselves portable. The letters of the laws are (barely) met. The spirit has been missed by a mile.
There is another dimension to all this and it is a unique nature of the American health system. Our system is rendered schizophrenic by the fact that ideologically we require it to be subject to market forces – i.e. we believe that we should surrender to the market the role of ranking merit, just as we do in virtually every other sector of our economy.
We believe that if we just get out of the way and let the invisible hand adjudicate that good providers who provide good services will flourish and bad providers who provide bad services will go out of business. Because customers will choose providers…umm…wait.