Empowering the Healthcare Consumer with Information

About a year ago I started looking at the connected health market, and in particular looking at the problem of how do you give consumers easy, private, and portable access to their health information. Given that I was not a health care industry insider, and had deep experience in eCommerce, it was natural for me to look at the problem from that perspective. So the natural question was: what can we learn from eCommerce and financial services? The answer, it turns out, is …. a lot!

A quick look at the payment card industry shows that Visa™ supports 28 million merchants, interacts with 16,000 financial institutions, has 2 billion payment cards in use, and will process 50 billion transactions in 2010 alone!

Even more amazing is that every single one of those transactions finds us, often to our dismay, within a matter of days or even hours. We can swipe a credit card virtually anywhere in the world today, and have easy online access to the transaction information within a day or two.

And:

• not a single merchant has to know where we bank or what online financial services we use
• any brick-and-mortar or online merchant can connect to the payment card networks in a matter of days for under $1000
• the consumer initiates every transaction.

That’s right. 50 billion transactions, each initiated by an explicit consumer action (swiping a credit card or entering a credit card number online) at any one of 28 million merchants, ends up at the correct financial institution in a matter of  days or hours.

So the key questions are: why can’t we do the same thing in health care, when there is only about 1 billion ambulatory health care encounters in the United States each year? Why is that we are still talking about health information exchanges (HIE),  that cost millions of dollars and years to implement,  that only address the sharing of health records among providers and payers, and that are controlled by governments and payers instead of the consumer? Shouldn’t we be able to do better than that?

The answer is yes. And it starts by understanding the key characteristics that make the payment card networks work, and devising a model for health care that can leverage  these lessons learned.

So what are the key key characteristics of the payment card industry? Here is my view:

• The focus is on discreet transactions
• The consumers is at the center of every transaction
• The consumer is the integrator of their financial records
• There is no tethering of merchants together in order to share consumer financial records.

Payment Card Network Model

The image at the right shows the essence of the payment card industry network model. Each merchant makes a single connection to a gateway which handles the details of connecting to the various financial institution. And the consumer is in the middle of the process.

Compare this model to the credit bureau model that is most often talked about in health care. In this model providers and payers connect to an exchange in order to share information about the patient.

Health Care Credit Bureau Model

This results in a model with the consumer on the outside, hoping to get access to their information as a side-effect of the process. I can almost here the new “free healthreport.com” jingle being sung by the guy strumming a guitar, letting the consumer know that the powers that be have deemed it ok to receive a copy of your health record each year.

Ironically, the payment card network model can be implemented by individual merchants for thousands of dollars and in a matter of days or weeks. The credit bureau model requires millions or billions to implement and the process has been ongoing for decades.

So let’s look a applying the payment card approach to health care by going through a typical eCommerce process step-by-step and drawing an analogy for health care using HealthJibe and the RAZCODE Gateway.

• Step 1:
  • Finance:
    • The consumer visits the website of a bank, credit union, or other financial institution and fills out an application for a credit card. With this action, the consumer is essentially saying: every time I use this credit card, I would like my transaction data to end up here.
  • Healthcare:
    • The consumer visits the patient portal for a hospital or physician’s practice and clicks on the Powered by HealthJibe link, which allows her to select where she wants her health information to go. With this action, the consumer is saying: every time I have a health care encounter with this organization, I want my health care information to end up in this personal health care record.
• Step 2:
  • Finance:
    • The website to a payment card gateway, such as PayPal or Authorize.net, which allows the system to connect to the payment card network.
  • Health care:
    • The EMR system in the hospital or doctor’s office connects to the RAZCODE Gateway which allows the system to connect to a range of online personal health records and other health management services.
• Step 3:
  • Finance:
    • Consumer swipes his credit card or enters a credit card number at any merchant world-wide
  • Health care:
    • Consumer scans a RAZCODE embedded in a Microsoft Tag using the camera on her web-enabled smartphone
      

      Snapping a RAZCODE within a Microsoft Tag

      (as easy as swiping a credit card)

• Step 4:
  • Finance:
    • Consumer visits her financial institution’s web site and views the information associated with the credit card transaction.
    • Consumer visits her personal health record website and views the information associated with the health care encounter.

And then let’s look at the key characteristics of a payment card approach for health care information exchange:

• Focus on discreet health care encounters as transactions
  • Don’t focus on health records
• Get beyond tethering health information systems together into exchanges controlled by governments, providers, and payers
  • Consumers choose where they store and how they use their own health information
• Simplify connecting EMRs to PHRs or other health management services
  • Can be easy as enabling an eCommerce website to accept credit cards
• Simplify consumer-controlled health information exchange
  • Can be as easy as swiping a credit card

And there you have it. A payment card approach for health care.

Now let’s continue our journey by looking further at the parallels between financial services and health care.

Not that many years ago, we still received bank and brokerage statements in the mail and tracked our accounts and financial transactions in notebooks or maybe in a spreadsheet. But things changed rapidly when our financial information became available on line.

Today we do our banking online, we trade stocks and bonds online, and we take advantage of dozens of online financial management services such as:  mint, wesabe, greensherpa, Billeo, Geezeo, PearBudget, etc. that help us track, analyze, and manage the financial aspects of our lives. In short,  when our financial information became available to us online, innovation was unleashed.

Well our goal is to unleash innovation in health care the same way. When our health information is available to us online we can expect to see an explosion of innovative health management services that will help us track, analyze, and manage the health, wellness, and fitness aspects of our lives. And we are already starting to see this trend develop. Services such ash Microsoft HealthVault, Dossia, TrainingPeaks, Skinnyr and many, many more are starting to spring up.

As this trend develops further, we will all become more engaged patients and smarter health care consumers.

And this brings us to our BHAG — our big, hairy, audacious goal — for the RAZCODE Connected Health Platform, and our final finance analogy:

Let’s make the health effects of our every day actions tangible in order to improve our health and well-being and lower health care costs. In other words, let’s come up with a metric for health and wellness that is on par with our net worth in finance.

Our net worth is the sum total of all of our financial transactions:  all of our purchases, deposits, investment activities, and other financial transactions when taken together determine our net worth.  In other words, we are empowered because we can consider the effects of our financial activities on our networth.

Imagine the potential to effect human behavior if we could see the short-term health effects of our everyday actions.

I believe this is possible today.

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