Today, I am reporting from the Health 2.0 Conference in San Francisco. More than 950 business, clinical, and technology luminaries have gathered together for the second annual conference organized by Indu Subaiya, MD, and Matthew Holt of THCB fame. I was invited to speak on a panel reviewing the findings of a first-of-its-kind multinational survey commissioned by Edelman Public Relations that reviews the dynamics of "engagement" in health. It explores the changing roles and relationships among digital channels, sources and tools in five key national markets around the world. There's good news in The Health Engagement Barometer survey for physicians. Despite all the "new media" and channels for digital health information, people still place a high degree of value in expert opinion, and the health expert they trust most is usually their personal physician.
As I write this piece looking out the 19th floor window of my room at the W Hotel, a large yellow constructions crane interrupts my view of the Bay Bridge, water and mountains beyond. It strikes me as the perfect metaphor for Health 2.0.; It is rising up all around us, but where is all this technology taking us? Are patients better served and is care being improved because of health-specific search engines, patient and disease social networking, on-line personal health records, and retail genetic testing? Or is the plethora of health information that is now available to patients only frustrating them because the health delivery system and their personal physicians are so unprepared to deal with it? How will an industry being rattled by shortages of skilled labor and a burgeoning populating of aging patients with chronic diseases respond to an ever-increasing demand for services? It certainly won't be able to respond using the work-flow and business models of the past. Telling patients they must make a phone call, book an appointment, drive across town, wait in a waiting room, and wait again in an exam room for 5-10 minutes with their doctor just won't cut it anymore. And yet, if we don't make changes to a reimbursement system that only pays doctors for seeing patients one on one in an exam room somewhere, how can we expect the health delivery system to incorporate and embrace new models of care?
Having information is good. Turning information into knowledge is even better. But what happens when we need to act on that information and the system that is in place is unable or ill equipped to respond? It's not exactly like you can write your own prescription or perform your own surgery. You need to enlist the help of a medical professional, and all the Health 2.0 in the world won't get you what you need unless there is somebody at the other end of the line who is being paid to help you. Health 2.0 will only transform healthcare delivery when the delivery system itself is transformed. Pioneering young doctors and entrepreneurs like those at Hello Health (Dr. Sean Khozin, pictured) and especially more enlightened and progressive payers are very much needed if we are going to change the status quo. We must reward clinicians who harness technology to deliver the most appropriate level of care for their patients when and where it is needed. Until we do, we'll just keep adding fuel to the demand side of the equation while totally frustrating everyone on both sides of the equation.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft Corporation
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I agree with your assessment, Dr Crounse. The Health 2.0 movement will only be effective and achieve its full potential if it can be woven into the fabric of mainstream medical care systems. I also agree that the antiquated reimbursement models are not helping. It appears that Microsoft understands this with your Healthvault platform where information can be amalgamated from Health 2.0 sources as well as the more traditional, physician directed sources.
At Midmark, we provide much of the infrastructure for 92% of office exam rooms across the country and are looking to ways to facilitate the Health 2.0 movement.
At recent Health 2.0 conferences, the role of the physician and medical office has been somewhat minimized. I hope that will change. Without their support and buy-in, the power of these technology will fall short of expectations.
Thomas Schwieterman MD
Thanks for writing, Tom. Keep up the good work. We need to have every player in the vast ecosystem of care engaged in driving innovation and change in the industry.
Bill Crounse, MD
It's really so simple: physicians' offices need to be paid by insurers for three additional products beyond office visits: 1) phone calls or video calls between doctors and patients, 2) emails between doctors and patients, and 3) RN-to-patient telephone advice calls (which generally have MD input). Just simply paying for these three items would decrease demand for office visits, and would go a long way toward ending our current "hamster wheel healthcare" and toward deemphasizing the office visit appointment as the only way to access care. Sandra Barton, M.D., Kaiser Permanente, Portland OR
I couldn't agree more, Dr. Barton. And organizations like Kaiser and Group Health are blazing the eHealth trail much faster than others. I'm encouraged that payers and government leaders are beginning to see the light, but we obviously have much more to do before such services are widely available and encouraged.
Thanks for your thoughtful comment.
While it is true that patients ultimately need a health professional for treatment, managing and coping with chronic diseases can be made much easier with health 2.0 technologies regardless of whether the physician has bought in to these technologies along with the patient. However, to your point, the significant gain comes when the physician and patient are both using the technologies to replace less efficient means of communicating health status and treatments.
I'm encouraged that payers and government leaders are beginning to see the light.