Most U.S. physicians are in the process of implementing electronic health records, motivated by the incentives provided through the HITECH Act. As physicians use EHRs more meaningfully, engaging with patients and their data is a primary goal for the investment of roughly $40 billion worth of taxpayer dollars.
But as physicians and IT workers continue to build the national health information infrastructure, will patients engage in turn? Many people in the U.S. aren't aware that their health data are indeed "theirs." Without patient engagement in their health data and knowing their numbers, people don't achieve optimal health outcomes, driving more intense health care resource utilization and costs downstream.
The Office of the National Coordinator of Health IT addressed this challenge in a video released last month. Think of this as direct-to-consumer promotion of health IT.
Why ONC Is Going DTC
In 1997, FDA relaxed rules for the direct-to-consumer promotion of pharmaceutical products. Since then, for every $1 spent on DTC ads, the industry earned $4.20 in increased sales, according to an analysis of the effect of DTC. While many downsides to DTC advertising have been argued, advocates of DTC cite that it increases consumer awareness of health conditions and treatment options, increases patient empowerment and improves physician-patient communication.
Fifteen years later, we've entered the era of DTC for health IT, with ONC promoting the benefits of health IT to patients, for patients. As a result of DTC campaigns promoting health IT, will patients clamor for data access the same way they have for prescription drugs?
"Many people don't realize how far behind other industries health care is when it comes to the use of information technology. They assume information is already being shared on their behalf, and by the time they realize it isn't, they're often in some kind of crisis," explained Lygeia Ricciardi, acting director of ONC's Office of Consumer eHealth. She added, "We want people to think about being empowered with information before that crisis hits."
To educate the American public about the benefits of health IT, the ONC closely worked with Aperture Films to produce the video, titled "Health IT for You: Giving You Access to Your Medical Records." The Aperture team was informed by a group of advisors spanning health education, participatory medicine and the health IT industry. I served as an adviser, along with:
- Peter Basch, physician and visiting scholar at The Brookings Institution;
- Shirley Bergin, COO/CMO of TEDMED;
- Alexandra Drane, founder and chief visionary officer at ELIZA Corporation;
- Regina Holliday, patient advocate;
- Julie Norris, a brand and marketing pro who led Kaiser Permanente's Center for Total Health; and
- Eva Powell, IT program director and National Partnership for Women and Families.
We met several times online, first providing input into the initial script for the video, and subsequently reviewing different versions.
"The animation is meant to have broad appeal and to translate the relatively esoteric world of health IT into terms anyone can grasp and get behind. It's meant to be fun and entertaining," Ricciardi explained.
Erin Poetter -- a policy analyst at ONC who was directly involved in managing the video's production -- noted, "Anyone that's had an experience with the health care system knows it can be better. The animated video depicts a brighter future where patients are at the center and have access to the information and tools they need to get the best care ... the care we all deserve."
The ONC video follows in a long line of government-sponsored public service announcements meant to raise awareness of a health issue: this time, the existence of EHRs and the benefits of patients' and loved ones' timely access to their personal health information. This PSA is purposefully designed to be an engaging, contemporary style of colorful animation, accessible to a broad range of health citizens.
Beyond the public sector, though, there are consumer-facing health IT promotional messages emerging via private sector channels, as well.
Dr. Oz Takes Health IT on the Road
No doctor today is more in-front of U.S. health consumers than Dr. Mehmet Oz. When Dr. Oz is on the cover of a magazine, sales skyrocket.
In 2012, The Dr. Oz Show launched "15 Minute Physicals" in U.S. cities to gauge chronic conditions, conducting 1,000 physical examinations in each city and recording exam results using Practice Fusion's EHR system. The project has visited patients in Philadelphia, Portland, Tampa and Washington, D.C., and will be in Baltimore and Pittsburgh before the end of 2012. At the end of each day, Practice Fusion data scientists analyzed all of the patients' profiles and presented a health "report card" to the mayors of the cities.
In each city, Practice Fusion was able to compare patients' health status with that of patients in other cities where the EHR is being used. In the case of Philadelphia, 38% of people had high blood pressure, compared with 16% of New Yorkers, 22% of people in Phoenix, 23% in Los Angeles and 31% in Houston. While a small sample, it was a powerful public health message for people watching the show.
While in Philadelphia, Dr. Oz told Forbes, "The electronic medical record saves time when done right, so doctors can spend more time with their patients."
Data About Me -- DaM Data
In addition to traditional media, such as broadcasting leveraged by The Dr. Oz Show, social media are playing a growing role in getting the word out about consumer-facing health IT. A video co-created by patients, doctors and health IT professionals, calling themselves The American College of Medical Informatimusicology (ACMImimi.org), hit the Web in August 2012. Called "Gimme My DaM Data," where "DaM" stands for "Data About Me," the song was written by Dr. Ross Martin of Deloitte. The blues riff features lyrics noting the challenges of patient access to their own health care information, such as:
You can send me your bill
Charge me anything
Drive a nice car
Live like a king
With all the dough
That I pay
Tell me why is it so hard
To get my data right away?
Gimme my DaM data
It's all about me
So it's mine.
The video features several people active in the participatory medicine movement, among them:
Dave DeBronkart, known as e-Patient Dave, who has presented his own story of participatory medicine and data access at TEDMED and across the globe;
- Todd Park, U.S. chief technology officer;
- Jamie Heywood, founder of Patients Like Me;
- Danny Sands, a physician at Beth Israel-Deaconess Hospital and past president of the Society for Participatory Medicine;
- Dr. Harry Greenspun of Deloitte; and
- Martin, himself.
Physicians Will Be the Best Sales Force for Health IT
It's early days for patient engagement with health IT, with most patients just beginning to be exposed to EHRs in physician offices as doctors expand their use of the systems in anticipation of Stage 2 of the meaningful use program. A key metric of meaningful use is patient engagement, with the objective of sharing information with patients to both inform people about their conditions and inspire dialogue between people and their providers.
Beyond this goal, though, is another compelling reason for physicians to engage with patients via health IT: accountable care and value-based care payment regimes. That's because bolstering patients' adherence to therapeutic regimens, like blood sugar testing, prescription drug filling and adherence, and exercise routines can help keep people healthy and out of the doctor's office and emergency department or prevent readmission to hospital -- another objective called out in the Affordable Care Act.
And it's physicians -- not advertising or social networks -- who are most trusted by consumers as touchpoints for health engagement.
Ultimately, physicians and nurses will the most effective sales force for consumer health IT.