The WSJ reported that EHR expenditures reached $20 billion in 2013.
So, when one considers the evolution of the digital world and patient empowerment, they seem to feed off each other. The rise of EHR's and Meaningful Use is a forced behavior change for all stakeholders in the health care eco-system; and while the business side of health care is adopting, the vision of a patients' inevitable self-empowerment through EHR use may be capricious. Let's look at Meaningful Use and some of the challenges for patients.
Let's start with the definition on Meaningful Use from the government IT site:
The benefits of the meaningful use of EHRs include:
- Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care. Providers will know more about their patients and their health history before they walk into the examination room.
- Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors' offices, hospitals, and across health systems, leading to better coordination of care.
- Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families.
Of the three bullets, the first two seem to get the big nod..yeah, that makes sense. Seems almost like a big "DUH"…who wouldn't want that?
But then there is that third bullet and the pesky, unpredictable patient wrapped inside it. Two assumptions are made that should be on the minds of all marketers, HC IT folks and others and challenged:
1. If you build it, they will come (and be empowered!): This is a broad promise that has no place in reality. The complexity of a person's relationship with their health is not addressed.
Let's look at segmentation. Simple truth is that people/patients are complex and can be segmented in a dozen ways; look at the natural segments that range from "Active Health Managers" who will engage with EHR and make decisions…but they may be 20-25% of the population; at the other end of the segmentation scale are those who refuse to engage, whether it is because they have an External Locus of Control and give themselves up to Fate, or perhaps because they are so trusting in their doctor's, they might view a report or be exposed to content but not do anything until they are face-to-face with their HCP.
2. It will be easy to use. With the shake-out among EHR's as well as their evolution to include paid messaging, the usability of the software they have created can stil be an issue. Interaction Design and outcomes-focused content are the best answer and the only potential insight into how a variety of people can find their way to utilize and find value…meaningful value…with their EHR as they come on-line.
We all need to realize that patients are consumers and a bad experience with an EHR will damage adoption. We are an impatient society. The content/User Experience will need to address the caution of the elderly as well as a mother who is on the run. The first and most important 'outcome' is engaging someone's attention.
So, between addressing behavioral segments, the new EHR systems need to acknowledge demographic factors. For example, my mother told me recently her doctors at the hospital system her GP is attached to, sent her an email with a link to Register and gain access to her records. She told me she loved it. Yet, when I asked her a few weeks later how she was using it, she said she had lost her password and did not understand how to get a new one; her doctor had called her about an upcoming test because they said she had not responded to an auto-generated appointment email.
All this touches on what I consider — besides Adherence and outcomes — a core issue and opportunity for marketers, Brands, companies, etc: the patient/doctor dialogue. How do hospitals and ACO's take advantage of the relationship of trust and the tools of empowerment?
Here is an infographic from the Gov't showing the impact of EHR: http://www.healthit.gov/patients-families/electronic-health-records-infographic
So, to wrap it all together: Meaningful Use 2 cannot be the same experience as the "forced adoption" of EHR's (companies and practices got a lot more $$ incentives than any patient will see). Patients are consumers. Any patient adoption of EHR has to be viewed as the art and science of marketing: Persona and stage driven content, EHR-relevant tools and even App gamification. All will have an enormous influence patient adoption. Of course, you need the means the to measure the impact on outcomes. If anything, the "outcomes" are a series of progressive metrics — outcomes starts with engagement with content and ends with less hospitalizations, etc. This kind of thinknig requires a twist of the old Sales Funnel — namely, an Outcomes Funnel.
Adopt they must, right? No. Once again, if a hospital applied its magic of building trust and relationships online as it does every moment of every day, Meaningful Use 2 adoption would be a non-issue. Intercepting an ICD-9 (or 10) Code is not being relevant. Knowing what the emotional/rational needs of a person at the stage the Code infers and delivering helpful, relevant content with ease, that is the Holy Grail.