Do Patients Want To Be Customers?

A close friend of mine is unfortunately no stranger to healthcare.  A missed diagnosis was followed by a botched surgery leaving him with chronic pain.  He has sought help and largely been offered pills and more surgery.  Most recently, he had a cough and fever.  Going to his doctor he apologized, noting he did not have an appointment, but was worried. His doctors response- no problem, you’re a good “customer”, I’ll get you a script for some antibiotics.

For many of us in healthcare, this might have seemed a benign exchange.  After all, we are being asked to think about patients more as customers, to offer a higher level of service and follow up, and ultimately provide value around the the services we provide.  However, patients may view this differently.  In my friend’s case, this was an epiphany.  At that moment, he lost all faith in his physician and in fact began to generalize about providers generally.  If his doctor saw him as a source of revenue, someone who would be back for repeat business, what did that mean about all those appointments to follow?  Up till that point, my friend thought their relationship was based on mutual goals, working together to solve my his healthcare problem.  Disappointed and angered, he fired his doctor on the spot.

There seems to be a disconnect.  As providers, we'd like to think we are at Maslow's level 4 (self-actualization), or at least level 3 (psychological needs), but we are at level 1 (basic needs, survival mode). 21st century healthcare offers more than ever before, but in exchange for treatment options, the business of healthcare has now replaced what most of patients want- a partner to help them through some of life's greatest challenges.

I don't believe most providers consciously think of patients as opportunities for revenue.  However, I would be disingenuous to suggest that at time providers become overwhelmed and forget their work is their patients. Further, growth decisions, which lines of business to support and grow at a hospital system level, are in financial justifications.  And for their part, today’s healthcare environment requires patients must take a more active role in their health rather than expecting things to be done to them, magically making them well.  

Today we seem stuck at the lowest level of the hierarchy, what I'll call the impersonal "other" for lack of a better word.  The next level up would be customer, someone valued as an opportunity for a long term relationship rather than a one time transaction.  At this level, we would treat as if we want people to come back.  Currently, unlike most businesses, there is no follow up in healthcare.  We may not be able to get to the third level, where the goals of the doctor and patient align.  Perhaps someone can create a business model successfully executing on this vision.  If they do, they'll be very successful.

Why Can't someone Give Me the Perfect Managed Personal Health Record (mPHR)?

I'm not as scared of dying as I am of growing old, Ben Harper, Glory and Consequence

Whether we admit it or not, most of us are afraid of growing old.  There is a sense of loss, of youth and vigor, coupled with the burden of managing your health in relative isolation.  Although as a country we would like to think that we are each responsible for our own care, most of us as individuals would prefer for someone to be there, helping us through our time of need.  Years ago when I was advising one of the Presidential hopefuls regarding a healthcare platform,  I suggested that the campaign should be propose that individual was responsible for their own health, but as a country we would partner to provide the tools for the individual to succeed.  Now, almost a decade later, we are not much closer to this goal.

Personal Health Records (PHR) were thought to be the answer.  These records differ from more traditional EMR in that they are owned by the patient and aggregate information from multiple sources to give a complete picture of the patient.  For example, they might include clinic visits from multiple providers, hospitalizations and updates on an exercise program.  Literally billions were spent on PHRs by the likes of Microsoft (HealthVault) and Google.  Both efforts were failures with thousands (in the single digits) rather than the expected millions of enrollees.  As noted by David Shaywitz, healthcare is a negative good, something viewed more with resentment than in anyway positive.  And that extends to things that keep us healthy.  To interact with your health means you are imperfect, you are mortality.

Rather than a PHR, I would like to propose a different tool, a managed PHR (mPHR).  This would be owned by the patient, but managed by a surrogate, a care coordinator (CC).  This person would be responsible to keep the person on track, taking their medications, keeping their appointments, explaining their illness (or at least research) their problem.  This may seem far fetched, by I believe CC will be a new job in 3-5 years.  And when this army of providers spreads across the land, they'll look for a tool to do their work.  And it won't be an EMR.  It will be a mPHR.

What would the perfect mPHR do?

Here is a list I've compiled

Upload data from disparate hospitals and clinics
It would store and view previous radiology exams
It would do med reconciliation and education
It would send reminders
It would manage exercise programs
It would allow differing levels of permissions and access...for the patient, the advocate and family
It would message those defined in the persons ecosystem if the PHR identifies a down trend.
It would report on utilization and changes in utilization
It would collect biometrics including wt, BP but also depression and pain indices with reporting and messaging
It would link/suggest support groups based on the problem list
It would leverage secure texting and email for messaging
It would be platform agnostic & cloud based

The critical thing here is actually not the functional requirements...these have already been fairly well defined...it is the ability to easily work with surrogates and family while maintaining some level of choice and control by the patient.

This is not an idle ask.  I am now working with a developer building senior communities with integrated care and care coordination.  I can buy an EMR, but not an effective PHR for these communities.  With any luck at all, we will be managing thousands of lives in these communities in the next few years.

To all you bright entrepreneurs out there, help me out.  Build the perfect mPHR.  If I am right, and there is a lot of evidence I am, you'll transform how we care for one another, and make a lot of money doing it.  I won't be your only customer.