Make Em or Move Em: Compulsion vs. Incentivization & The Era of Google

I'm in favor of applying the carrot (incentivization) before the stick (compulsory requirements).

Hospitals should get the carrot. Patients should get the carrot. Primary care docs should get the carrot. There are some players that may deserve a few hits with a big stick, but that's a conversation for another time.

Here's the thing about compulsion: When faced with an imposed quota or requirement, we either adopt a "meet em" or "beat em" strategy.

Let's look at a few healthcare examples of compulsion vs. incentivization to see what works (insert your own political overtones here).

Exhibit A: Beat Em Approach - The NHS imposes a '4 hour must treat' time that results in patients waiting in ambulances since they can't come through the hospital doors until they can be triaged within the specified time frame. Result: less ambulances available for emergencies. It's the old ER boarder strategy with a truly nasty twist (Hat tip to the Healthcare Economist).

Exhibit B: Meet Em Approach - Hospital administration does Total Quality Makeover and gets all kinds of things going in the right direction. Hospital staff, seeing efforts to remove bottlenecks are hospital wide, responds and reaches a seemingly unachievable goal. Result: entire hospital operates on a more efficient, macro life cycle, oh, and better patient care.

And my favorite recent example, the Google EHR pilot program in cooperation with Cleveland Clinic patients.

You can read on here, for a simplistic overview, or head over to Health 2.0 for a much more fiery commentary on the subject. Bob Coffield's Health Care Law Blog has great updated commentary and links. The HIPAA Blog is also running with the story.

Here's a PDF summary with a conservative view of the privacy issue from the World Privacy Forum (hat tip to VentureBeat - where David Hamilton has been providing excellent healthcare coverage).

Let me tell you how much more protected I feel now that HIPAA is around (cue crickets)...

Did I feel concerned about the privacy of my healthcare data and records pre-HIPAA? A bit. Do I feel any 'safer' thanks to HIPAA's protection? Nope. Not a bit.

And it's a pain to fill out multiple forms saying my docs can release information to my designated advocate in the event of an incapacitating injury/illness.

Not to mention anyone with a fax machine could probably fake a pretty convincing HIPAA form and get access to my medical records.

HIPAA regulated or not, why will Google's experiment work? It's offering consumers something we want, something we've asked for. They're dangling a pretty big carrot.

The easy comparison is that it's like doing your tax returns on the Internet and online banking. Initially, TurboTax and other web-based financial services providers met with all kinds of nasty press and consumer concern regarding the safety of putting our most treasured data online.

I bank online. Do I worry about whether someone with nefarious goals could access my bank data? Yes, of course, a bit. But the benefits of online banking outweigh the risks, which is I why I choose financial services providers based on their online utility.

I'll do the same with an EHR or any H2.0 tech offering, for that matter, just as I do before purchasing any good or service - look at the risks, and examine the benefits. Then I choose to buy/use the program (or not) based on what's in it for me (the carrot).

Online banking literally gave us access to our money online. Google's program will give us access to our healthcare online.

Why do I think we're ready to handle it?

In a market where it is difficult to discern the costs of services, where we're divorced from the actual financial impact of our healthcare 'purchasing' decisions, we'll take what we can get.

Lacking other data, we'll begin to make decisions about what healthcare goods and services we want based on the little information that IS available - our patterns of use and limited hospital/doc quality and ratings data. Oh, and plenty of press coverage, which is archived and searchable with, yep, Google.

In other words, we'll go with the little information we've got, and Google is going to give us as much data as we can swallow (it'll be up to us to make sure Dr. Reece's version of Health 6.0 doesn't happen).

Google's program will connect access for the two broadest portions of the toddling Health 2.0 market for us (consumers and providers) and help it mature at an astronomical rate, as they did with search, access to satellite imaging, etc.

Consumer adoption of Google's health toys will drive the demand side of the equation - but who will drive the supply side? Hospitals? Providers? HIT firms?

We're all talking about EHR and PHR systems that run on new, proprietary, custom-designed software - there's got to be a way for some tech genius to think up a format that uses programs most of us already have.

Give me a thumb drive and a document format (like MSWord) that would run on OS's like Windows, Ubuntu, or Leopard so docs could read my data at any provider site - then I might really feel my healthcare data is transferable and 'safe.'

Are you offering consumers the carrot or the stick? Pick one, and quickly, before someone else dangles the carrot that siphons off your patient population.