By Peter Schmidt, The Health Care Blog

The Obama team is talking very seriously about including health information technology in his “main street” stimulus package. While I generally agree with the predictions of doom and gloom for providers saddled with the burden of data entry, this creates a potentially huge opportunity for Health 2.0.

As very publicly warned in this forum and others, a stimulus package focused entirely on existing EMR/HER technology would not only offer no proven health benefits (Linder, et al. Arch Intern Med. 2007) but also would financially harm clinical practice. Kaiser Permanente’s Hawaiian experiment with EMR added approximately an hour a day of data entry work per physician (Scott et al., BMJ 2005).

This impact will fall disproportionately on primary care.

Primary care doctors often confront patients without a diagnosis, making a forms-based approach impractical, and their work is much more in assessment than action, with a 15-minute encounter can result in as much effort in unreimbursed data entry as a three-hour surgery. Primary care can’t afford to shoulder this burden: an article in Health Affairs (Colwill, et al., 2008) predicts a dramatic deficit in primary care physicians. They anticipate a 29% increased in the demand for such physicians through 2025 but as little as a 2% increase in the supply. PBS’s Newshour’s health unit reported last Tuesday on multi-year waits to get on some primary care physicians’ panels.

This opens a tremendous opportunity for Health 2.0. Patient participation is most effective in assessment and monitoring, reducing that load on primary care. Even without financial incentives it should not be too challenging to enlist primary care doctors in support of Health 2.0, transitioning their role from detective to analyst as Health 2.0 tools help them to arrive at appointments with data in hand. User-generated healthcare fits nicely between the extremes of suffering at home and interventional medicine, facilitating the primary care physician’s role as strategic consultant and advisor and advocate for medical intervention. In a project for a national HMO, my team provided patient-engagement software that, for example, cut the number of office visits from three to one in the protocol for a common diabetic medication change. In another controlled experiment, we significantly shifted problems from emergent to routine through on-line monitoring. When self assessment identified a potential problem, we scheduled a routine office visit.

One of two results will come from the Obama Health IT stimulus: either physicians will be overwhelmed with inefficient health databases, or Obama’s team will take the advice of Drs. Kibbe and Klepper and will earmark money for improving the process of health data collection as well as the medium for its storage. In the first case, Health 2.0 will come galloping to the rescue of physicians desirous of sharing the burden of data entry with their patients; in the latter, Health 2.0 will be integrated into the process. Frankly, many of us with experience in process re-engineering in the web era will find the first case more familiar.

Peter Schmidt, Ph.D. is an investment banker specializing in health IT at Cronus Partners LLC. He has a Ph.D. in computer simulation for healthcare. Prior to joining Cronus, he was president of DGL, a New Zealand-based patient-connectivity software provider where he helped connect doctors and patients at one of America's leading provider organizations and also provided systems for the care of Katrina victims. He also was the CTO and COO of an e-learning joint venture of Oxford, Stanford, and Yale universities.