You Say You Want A Revolution

This week I read another healthcare top 10 list forwarded by a friend. This one, from HealthLeaders, trumpeted the following innovations as the most important ones shaping healthcare in 2006. I've edited these for brevity, and presented them in reverse order in tribute to David Letterman:10. Consumer directed care9. Disease Management programs8. PHRs with and without EHRs7. Interactive Remote Patient Monitoring6. Concierge, cash and retail care models5. Self-care, self-service and self-empowerment software4. Office-based electronic prescribing and dispensing3. EHR add-ons like web-based scheduling and virtual visits2. EHRs1. Pay for PerformanceHealthcare consumerism is in, EHRs and PHRs are coming, and Pay for Performance is moving us toward greater quality and accountability. That's certainly so if you measure using column inches in the trade publications. And I, for one, certainly believe these innovations should be shaping healthcare.Sometimes it's hard to see the change from the ground though. I am fortunate enough to be able to communicate online with my doctor and her office, however my wife has to do things the old fashioned way with hers, and our kids' pediatrician's practice is a solidly stuck in the paper era. I get data-driven personalized preventive reminders from my car dealer and my dog's veterinarian, yet none from the doctors who care for my family. I know a handful of folks who are trying the new "consumer directed" flavor of insurance, but I know none yet who can access cost or quality data for their particular providers. My stepfather takes 32 pills a day for a three different chronic conditions, and gets little help from anyone, other than my mother, in managing his care.Change is clearly needed. It's really only a matter of time. But that's just the thing. The joining of healthcare and information technology is like a marriage between members of different cultures that have different innate senses of how time moves. I remember, back in 2000, working for an Internet EHR/PHR company, and having the distinct impression that I was sitting and spinning at the intersection of the fastest and slowest moving industries in the U.S. I don't think that's changed. We measure technological change in months and quarters - healthcare changes occur over years, decades, generations.The 100 thought leaders who collectively ranked the above listed 10 innovations placed Pay for Performance at the top. If that's wishful thinking, it's well placed. Aligning incentives may be the best way to accelerate the change that healthcare so sorely needs. And perhaps even tip a slow moving evolution into a true revolution.