Are we our workers' keepers?

Are we our workers' keepers?

Summary: Yes, everyone knows personal health records are a really good idea. But no one uses them… Perhaps it’s time for a little libertarian paternalism: A coalition of employers is about to offer/push PHRs to their employees, which should result in healthier, better-informed employees and wealthier, better-served employers.

TOPICS: Tech Industry

Last week I had dinner with Omid Moghadam [below left] and Anne Chapman of Intel.  They had just had an interesting day meeting with a variety of would-be supporters in Washington: The Wall Street Journal had just broken – a week early – the news of a new coalition of employers who plan to offer personal health records to their employees.  But the reporter – Gary McWilliams – didn’t get it all, even though what he did get was interesting and accurate.   There should be more information next week, when Moghadam speaks at the Markle Foundation-sponsored Connecting Americans to their Health Care conference  next week in Washington.


The  context is that everyone agrees that personal health records are the wave of the future.  They will help individuals manage their own health better; they will let (authorized) doctors and health professionals share information and collaborate on caring for each patient better; they can provide shared context to support better patient-doctor communication….  In short, as I propounded in my newsletter last year, they’re a modern miracle, and they can bring nothing but good to US health care. 

Yet, to everyone’s frustration, uptake has been pathetically low.  There are a number of providers on the market, but patients won’t use them (who wants to enter all that data?) and doctors rarely accept or offer them (you can print out your information from your PHR, but you will nonetheless be handed a clipboard each time you see a new doctor or visit a new clinic).   

I could go on at length about why… but what’s more interesting is that this new coalition may actually help to change things.  Individuals do care about their own health, but they lack clout and money…and discipline.  Even though PHRs are often free, individuals alone aren’t going to get them established in critical mass.   Meanwhile, most health care institutions – the ones with the money and clout – are interested either in patients getting a lot of expensive care (the providers) or in patients getting as little or at least as inexpensive care as possible.  (I’m talking about the institutions here, not about the mostly dedicated and patient-loving people who staff them.) 

The only institutions that actually care about individuals’ health are the individuals’ employers (even though, like the individuals themselves, they also want to save money).  So getting employers excited about PHRs – both as a mechanism for better health and for cost-effectiveness – is exciting. 

Getting Wal-Mart involved is brilliant – even as the company faces huge PR and fundamental challenges; see the New York Times.

If anyone can roll out a big, complex program across a large workforce, it’s Wal-Mart.  (As it happens, wal-Mart’s person on this case, Linda Dillman, is the same woman who led its RFIS roll-out – another totally sensible but courageous and leading-the-pack move that belies notions of Wal-Mart as a stodgy, stuck-in-the-mud behemoth.)  

Wal-Mart  will have to manage this program with good marketing, genuine delivery of value and some deft footwork to persuade the cynics, but like so many socially responsible programs, PHRs are a way to do good as well as to save money.  And it fits nicely with Wal-Mart’s minute-clinic initiative. 

The challenges – as Moghadam and Chapman and everyone else involved know well – are still huge.  The Journal piece said nothing about portability, but these PHRs won’t be worth much if they don’t belong to the employees themselves.  Employers’ interest in their workers’ health is time-limited; individuals care about the long term, even if they may lack the discipline to do much about it.

And, even though Wal-Mart, Intel, British Petroleum America  and a number of yet-to-be announced employers will be pushing PHRs, they’ll have to do a better job than companies such as WebMD have done so far, with effective marketing campaigns, doctor education and so forth.  That brings me to my favorite visualization  of a health record: It’s personal, aspirational, simple enough for a child to understand… You can see its purpose, and it’s for human beings. That’s the message. 

Other links:


Markle Foundation


Topic: Tech Industry

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  • ... and nobody came

    Maybe there's no demand because individuals have no positive stake in this. As it stands, our health records are available to everyone but us; if you doubt it, just [b]try[/b] to get a copy of your own. This won't change that -- it just makes it easier for everyone [b]but[/b] us to pass our health records around.

    Which, when they're getting used for pre-employment screening to keep insurance costs down, doesn't altogether look like a Good Idea.
    Yagotta B. Kidding
    • Maybe we're doing it wrong.

      Then they're not doing it the way I would like to see it. In my view, my personal health record is mine, and I should be the only one with access to it. I see it as a magnetic card or some kind of flash card thing that I could carry with me in my wallet or purse. When a doctor or someone else wants it, it is up to me to grant them permission by handing it to them (perhaps subject to some limitations on what information I am allowing them to access). The doctor could also be given permission to add to the record before returning it to me. As far as my ability to view my record, if the interface is something standard like USB, then it's just a question of software.
  • They are doing it wrong

    First of all, the only form a healthcare office should be handing you is one listing current health problems you are there for, and asking if there are any changes in your health record.

    Asking you to completely fill out your healthcare history each time you visit is wrong. People forget/misremember things all the time, and even enter information that is in disagreement/wrong with their recorded history. Only list changes or additions to your healthcare history, not your life all over again.

    Second, one of the things HIPAA was leaning toward but failed to achieve was a universal standard for recording health information. What we need is a single ANSI format that works for all people for all facilities, not just transfer of information between providers and payers.
  • demand-driven progress

    This is a very clever idea and a nice effort.

    Perhaps it is, as you wonder, too glib to assume that the interests of employers and employees are well enough aligned. Not only is the employee's interest longer term but, at least institutionally, the employer's interest is in a productive unit, the employee's interest is in a quality of life.

    What employers certainly bring to the table, at this juncture, is an almost unique capacity to organize large capital-intensive projects. I wouldn't want to see them leave this table, by any means.

    The elephant in the room would seem to be unions: where are they? In theory, unions provide the service of lifetime loyalty and, at least as least as far as fraternite will take it, quality of life. In *theory*, employee interests in health care should be more closely aligned with their union.

    I wonder if modern unions can find a way to combine their strengths with the strengths of the employers: yes, encouraging employers to bring their purchasing power and organizational capacity to bear to help create a PHR market, but also, where possible, subordinating the actual purchasing decisions to democratic processes and independent choices of the employees.

    • More government regulation and expense

      Employers shouldn't having anything to do with this. It will just lead to more bureaucracy and expense for business, which means dollars they can't pay employees.

      Employers already walk a legal minefield with regard to employees' health. Saddling them with responsibility for PHRs is just going to increase liability and cost.

      Bad idea all around.
      • it's a win for employers

        Nobody is "saddling" these companies with PHRs, they are taking them on voluntarily.

        For companies like these, a benefits package is something worth more to employees than the cost to the company: it's a way of stretching a compensation budget. For insurers, doing business with employers is attractive for demographic reasons and because of economies of scale.

        So, don't feel bad for employers (at these scales) who are taking on PHRs: there's nothing self-sacricing about it.

        If you are talking about the burdens on small firms: We are still very far from regulations that require PHRs. Meanwhile, these large firms have the opportunity to try to create a situation where PHRs, integrated into a larger overall health care package, lower costs and improve outcomes. In other words, it's an open question: PHRs may turn out to simplify life for smaller firms.

    • Quality of Life

      I think that the interest in quality of life that most people have is very short term, at least when it comes down to influencing behavior. I think even short-sighted employers have more concern for the long-term health of their workers than the workers themselves.
      Erik Engbrecht