The Health 2.0 public option

Justmeans health writer and RAND researcher Sam Werthheimer recently reported on interesting trends from the Health 2.0 conference in San Francisco.  Just because the conference was dominated by private ventures,  however, doesn't mean that governments aren't also trying to apply web 2.0 to improve health delivery.

US health reform efforts are banking on effective health information technology (IT) as a means for improving the efficiency, quality, and value proposition of health care delivery. One of the central pieces of the IT world is the electronic health record (EHR), both for clinicians to access and update during clinical encounters, and also or the patient to access remotely.

Evidence from the UK's National Health Service, however, suggests that patient-accessible EHR may be something that is important to researchers, policy makers and clinicians, but of little interest to patients. At least when it's a system provided by the government. We've previously discussed evidence showing slow adoption of the UK's system by health providers.  Called HealthSpace, the online portal allows patients to communicate with their physician, keep track of appointments, and also access a summary of their health record. For example, the summaries were only used in 4% of primary care interactions.

Now the British Medical Journal is reporting on the patient side of the user experience. The NHS had estimated that 5%-10% of the population over age 16 would opt into using HealthSpace. Instead, only 0.13% of eligible persons have registered for the system, primarily due to: "a "clunky" user interface (some aspects of which have been upgraded since the research was undertaken), the need to enter much of the data oneself, limited functionality which did not seem to match how people actually looked after their own health, and the low levels of knowledge about, or interest in, the product from healthcare staff."

Ouch.

To make matters worse, researchers have been unable to locate a single person who has used the system to access the summary of their health record. That's right, not one person in all of  England. Or Scotland. Or Wales.

It'll be interesting to see how similar commercial services, such as GoogleHealth (launched in the UK in 2008) and Microsoft's HealthVault (deployed in the UK this past June) will fare. On the one hand, they are likely to be much more user-friendly and patient focused, coming from established service providers. On the other hand they will contribute to the fractured health IT infrastructure that most health reformers are railing against. So is the only option to choose between functional patient-focused systems that don't serve the health system as a whole, or integrated systems that patients won't use?

Let me know where you stand, and if you know of evidence showing that you can deploy an EHR on a national level that patients will actually use.