At a time when healthcare consumerism is emerging in all the advanced, industrialized nations, research into the phenomenon is bringing forward new understandings of what consumers need and want. What’s more, the phenomenon of healthcare consumerism is international, indeed, global.
Discussions around consumerism were numerous at the World of Health IT (WoHIT) Conference, held in Barcelona, Spain, in November, and extended across presentations and discussions around patient engagement, health information exchange, and interoperability, among other topics. Among those who has considered consumers, and helped lead research on the subject, is Kaveh Safavi, M.D., J.D., senior managing director of the global health practice in the New York-based consulting firm Accenture. Dr. Safavi, who consults with client organizations in the United States, Europe, and globally, sat down during WoHIT, to speak with Healthcare Informatics Editor-in-Chief Mark Hagland, about this topic. Below are excerpts from that interview.
You and your colleagues have been examining healthcare consumer attitudes, both in the context of the U.S. healthcare system, and in an international context.
Yes, that’s correct. We recently surveyed U.S. healthcare consumers around a number of topics, including access to their EHRs [electronic health records]; and we asked physicians the same questions. What we found was interesting. First, we asked healthcare consumers whether they believed that consumers should full access to their EHRs; limited access; or no access. The results were as follows: 92 percent of consumers believed that consumers should have full access to their EHRs; 7 percent said they should have limited access; and only 1 percent said they should have no access.
Then we asked physicians what level of access they believe healthcare consumers should have, to their EHRs. And only 18 percent of physicians said that they believed consumers should have full access to their EHRs, while 74 percent said they should have limited access, and 7 percent said no access whatsoever.
That’s a huge contrast.
Yes, it absolutely is. And, interestingly, 49 percent of patients believe that they already have full access to their EHRs.
What does the concept of the engaged consumer or patient mean, now, in an international context?
It depends on whether the healthcare system believes that competition should be a part of the healthcare system. In the U.S., we believe that competition for patients is a good thing; it’s a part of our model. Meanwhile, in other countries—ones with public health systems—there’s more of a sense that healthcare is an entitlement. So consumerism in those systems is being driven more as a right issue than as a market issue. When access is driven as a market issue, it tends to focus on things like appointment access. But is access on the consumers’ own terms? That’s a little bit different. We see that consumers are having expectations around things like banks and retail; so healthcare consumers are not looking at this as a competitive issue, but as a service or satisfaction issue. We’ve had a survey result finding that 49 percent of consumers say they would switch doctors over the differential in access. The barriers to switching are high, while the loyalty level is low. So this idea about the experience, separate from just appointment access, is a reflection that consumers want access and care delivery on their own terms. And we in healthcare can’t depend on the idea that healthcare is different.
Is there a conceptual difference in how patient care leaders frame consumers, versus patients? Does it change how providers interact with those who receive healthcare services?
There is a difference, but it’s one with a nuance. There was a false dichotomy for at least ten years. We said, are they consumers or patients? And we’ve discovered that they’re both, and those archetypes interact with each other. So the sick patient in the bed doesn’t know what diagnosis should occur or when, of course, meaning that they don’t have precise or educated expectations around purely clinical issues. But when it comes to a porter taking them to their bed or getting a meal on time, their expectations are very high in terms of service, just as in any other industry.
There’s a term we call “liquid expectations”—the idea that you move expectations from one segment of your life to another. I think that’s a really interesting part of healthcare that we’re starting to recognize as a reality. So if I’m building a healthcare system, how do I address service as a quality? In most industries, they recognize that service experiences are designed based around consumers’ experiences with your product. In healthcare, we don’t do that. We will do polling and try to base how we architect services around that polling, but it doesn’t make sense. We see that time and again, for example, in surveying about what telemedicine should be like—because consumers didn’t know what to expect.
We saw this in the south-central U.S., where they tried the [telehealth delivery-based] system where the physician would drive out to a center; but when patients were cajoled to show up, they preferred it, even though they had said, ‘I don’t want to see my doctor on TV.’ But they ended up loving it, because the doctors suddenly had all kinds of capacity. And from the doctors’ perspective, they were staffing multiple exam rooms, so there was more productivity, if patients didn’t show up. By setting up these centers with remote access, it worked out great. So our industry is struggling, because if it accepts the fact that it has a service opportunity, it doesn’t understand how to fix the problem.
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