Will consumers mold public sector HIEs?

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GHIT Notebook

March 3, 2008

Both Steve Case, ex-head of the one-time Internet giant AOL and now creator and head of Revolution Health, and Google's CEO Eric Schmidt managed to vigorously stir the pot towards the end of the Health Information Management Systems Society meeting last week Orlando. Their vision of a consumer-led revision of healthcare produced excitement, though what kind of future their comments point to is the real question.

Revolution Health started up a couple of years ago. It's an online portal for all sorts of information and community building that consumers can use to learn more about specific diseases, wellness strategies, and even the relative quality of various doctors and hospitals.

Google, which has been rumored for a year or more to be on the verge of launching a Google Health service, recently announced a pilot project with the Cleveland Clinic to see how well a Google-based technical platform can be used to help patients and doctors share information and collaborate on treatment strategies.

Personal health records are a central feature of each company's approach, more so Google Health than Revolution Health. The chord that connects the two, however, is the absolute belief that it will be the consumer that will drive any real transformation of healthcare.

Superficially, that's the same as many of the federal and state efforts now going on in health information exchange. Whether the focus is on standards, interoperability, governance, privacy, security or any of the other myriad challenges these projects are confronting, the end point is the quality of health care delivered to the patient. And, more and more, the patient community is being brought into discussions on HIE.

But there is a big difference. These federal and state efforts are top down. They start with the assumption that the health providers and insurers are still the gatekeepers of health care, that they control a patient's health data, and that what HIE is trying to do is to make that an easier and more efficient system.

Revolution Health, Google Health and Microsoft HealthVault, on the other hand, see the individual consumer as driving everything, which will force providers, insurers and everyone else to change and innovate accordingly.

Will these consumer-based efforts make the federal and state projects redundant? Unlikely, given that there's such a large legacy infrastructure that has to be catered to. Plus, what Revolution Health, Google and Microsoft are delivering is only a part of what a fully state-of-the-art IT infrastructure will bring to health care.

However, there will be some impact on big government-based HIE projects from the consumer base. As employers, providers and insurers get drawn into HIEs, government-based HIE effort will inevitably bend toward the demand of the health care consumer.

By Brian Robinson

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