Are we our workers' keepers?

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.

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