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PHRs and online movie rentals

September 29, 2008
by kate
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A few weeks ago, HCI posed the following poll question on our Web site:

The recently introduced Health-e IT Act includes incentives of up to several million dollars for hospitals that install and utilize approved EMR systems. Will this result in increased adoption?

One respondent posted a comment that I found to be very interesting. It read:

While well-intentioned, this plan fails to place the incentive on the only group who, at this point, can drive increased e-health: the consumer. We have been trying the tops-down approach for more than 20 years (MRI/TEPR). It’s time for a true paradigm change — patient engagement and patient control of their own health and healthcare. Provide an incentive for patients to adopt a PHR/PHMS and we’ll see global change within a few years. Provide choices to the consumer as to where to store their PHI — their own PC or a flash drive or Web sites, and adoption will leap forward! Demand drives change.

I had two immediate reactions to this. First and foremost, I’m thrilled that our readers are putting so much thought into answering poll questions and are willing to take a few moments to share their thoughts. Second, the response brought up a really interesting point. Are consumers the only ones who can drive increased e-health? This question might be easier to answer if the patient population in the United States wasn’t so unbelievably diverse. While there are indeed a number of patients who are both willing and capable of managing their own healthcare by utilizing Web sites or a flash drive, there are also an alarming number of patients who still don’t have the means — or knowledge — to log in to a site to access a PHR.

Yesterday afternoon, my fiancé Dan and I passed a Blockbuster video store and he commented on how a store like that can even stay open in these times, with all of the Internet movie rental sites available that enable customers to select movies online while paying a monthly fee that is significantly lower than renting individual DVDs from a store. But the more we discussed it, the more we realized that there are several key factors in play that will likely keep Blockbuster’s doors open for a while. First, a lot of people don’t have the foresight to decide days in advance what title they’d like to check out (“Will I be in the mood for a comedy like Old School or a drama like Shawshank Redemption?”). Instead, some people wait until the mood strikes them to rent a movie, at which time they head to the store; just as some wait until a health condition has escalated before dealing with it.

Secondly, the number of consumers who have Internet access in the home may be increasing, but we are still by no means at a point where it is universal. A number of people have to go to a library or café to even go online, and of course, some still don’t access it at all.

And finally, it comes down to the fact that people are just very different. For every person like me, who would jump at the chance to manage my own PHR, there is at least a few other people who would just as soon keep things the way they are.



Kate, I appreciate the way you juxtaposed PHR user populations with movie rentals. The comparison is very pertinent as you point out. The immediacy of need (or atleast 'want'), the options of getting it online, versus driving to the brick and mortar, and the specifics of service needs (fiction, documentary, or game, obviously wildly different user types.)

Your post reminded me of the kind of stratification of cost, quality and access that apply to healthcare.  Mercer recently looked at this (see figure below, "Employers Are Interested in Using Their Data"), calling them claimant groups,  stratified the commercially insured by costs as shown here. 

Translating this all into English, we're left with 1) people with chronic diseases, 2) folks with episodic and infrequent care needs, 3) catastrophic care, etc.  Most PHR initiatives driven by risk bearing entities or those with a clear, self-perceived mandate to their communities, and, who are able to invest,  have used PHRs to target those with chronic conditions.  As you point out, the sub-population who have tuned into the convenience of e-health are clearly early adopters.  (For folks interested in this area, it also goes by the term HealthCare 2.0; there are wonderful companies presenting at these conferences, from the biggest to the smallest imaginable players.)

Perhaps you can point our blog readers to an appropriate PHR article or two that illustrates some of the great PHR stories you've covered, ... from HCI, of course!