The beauty of m-health is that it can reach almost every American. For example, studies show Latinos don't use the Web as often as other demographics, Eytan says. But they do use cell phones. "The engaged patient will include every American," not just engineers and others who are technologically adept.
Access to EHRs creates engaged patients
Empowered and engaged consumer-patients are armed with customized information about their unique health conditions gleaned from a variety of sources. They have easy, inexpensive, and portable electronic access to their personal health records that they can easily share with whomever they choose.
Physicians argue that electronic health records are too complicated, too expensive, and too time-consuming to implement and maintain. Especially with online records, there's too great a risk that privacy of personal health information will be breached.
Eighty years ago, physicians were similarly skeptical of the telephone, Eytan says. Professional organizations warned physicians they wouldn't get paid for taking phone calls and that patients would call them nonstop.
And while many Americans are satisfied with the status quo, Eytan says there will soon come a day when they will demand access to their personal health records. Kaiser Permanente now has 3 million people on a PHR and that number is growing. The tipping point will come when those health records ambassadors, as Eytan calls them, move to other states and demand that healthcare providers and insurers offer PHRs.
"The major change that's going to happen is about people getting their hands on their own medical data and their data traveling with them, rather than being bottled up inside a particular hospital," deBronkart says.
"These cognitive tools," Papier says, "will actually give the physician more time to do a more thorough exam." It could also curtail overreliance on testing. "These technologies are here today. It's not a meaningful use debate for five years from now."
Bob Stone, cofounder of Nashville-based Healthways Inc., warns not to believe that any one interface with patients will work.
"One thing we have learned in our business is there is no single silver bullet for establishing intimacy and sustaining engagement with the population," Stone says. "Everybody is different. Everybody has different comfort levels in terms of how they want to interact with caregivers. Some people love the phone. Some people hate the phone. Some people like snail mail. And as the population continues to age we will find more people who prefer e-mail or some form of social media."
Physicians and patients become collaborative partners
Patients come to appointments with Internet printouts tucked under their arms or stored on their PDAs. And instead of bristling at that, the clinician of the future will praise the patient of the future for doing his or her homework. Patients and physicians will build relationships and engage on a more personal level than is now the standard.
They drive many physicians crazy: know-it-all patients who come in to those five- to 10-minute appointments armed with a stack of Internet printouts trying to tell them how to do their jobs.
"We still hear about people whose doctor tells them, 'Look, who has the medical degree here?' And I understand that. Some patients are idiots," deBronkart says.
But the best way to improve medicine is to make it more collaborative, he adds. "It may be that this new form of relationship is not nearly as burdensome as people might reasonably anticipate," deBronkart says. "The reality is that there is an enormous flood of new information being published. It's just more than anyone can keep up with."
Paul Keckley, executive director of the Deloitte Center for Health Solutions in Washington, DC, agrees. "We continue to find that most consumers want information that they can't readily get from their hospitals and doctors." And they don't just want a photocopied handout with diagrams of exercises that ease general back pain. They want information that is personalized and customized, based on their own risk factors, preferences, and the exact nature of their back pain.
Ken Davis, MD, doesn't wait for his patients to come to him with their research—he helps them gather it. At the end of an appointment, the Conroe, TX-based physician brings his patient out into the hallway to a computer with Internet access. He shows her how to use MedScape and gives her a quick tutorial on how to find more information about the diagnosis. Taking a few minutes to do that saves him time, he says. A patient will come to the next appointment better informed and ready to work in partnership with the physician.
"You can engage patients with technology instead of it being a barrier," Davis says. "You can use technology to your advantage or you can get real upset because the patient went ahead and got a second opinion from the Internet. Doctors just have to get over themselves."
Patients actually start taking care of themselves
With wellness coaching from their team of caregivers, patients make lifestyle changes—they quit smoking, exercise more, and make healthy food choices. They check their blood pressure and show up for their colonoscopy appointments and monitor their glucose levels.
Of all the predictions about the patient of the future, this one is perhaps the most difficult to believe. Anybody who walks down the street today can see that people aren't interested in making lifestyle changes—they just want doctors to prescribe a pill to cure what ails them, even if what ails them is that they eat too much and don't exercise enough.
And when physicians talk about wellness, there's always that person in the room—usually a specialist—who says we can't make money if people are well, Davis says.
Physicians are paid to diagnose and treat sick patients, not to keep people healthy.
"Healthcare reform begins at home," Davis says. "Patients have to be empowered and they need to be expected to take some responsibility."
But it doesn't work when physicians just wag their fingers and lecture patients, or pretend not to notice that their patient weighs 300 pounds, or mention halfheartedly that he or she should quit smoking.