It is important to note that the above sentiment came from a provider in a staff-model HMO. Because of the perceived benefits of messaging, PHRs, and the ability to exchange health data, large providers may be willing to absorb the costs involved in building these systems and compensating providers for the time spent using them. Practitioners who are not in a closed system may struggle more with low or nonexistent reimbursement for responding to patients’ messages. For example, one survey of physicians noted that 80% claimed they would be willing to exchange secure messages with patients if they received payment for that service. A slowly growing number of insurers are paying for messages and online consultations. However, in those cases, the payments tend to be low in comparison to office visits.
Identifying a party willing to pay for consumer health IT is a critical issue. There is little reason to be optimistic that individual patients will be willing to pay for it. As an example, Qutinet originally pursued a model through which individuals would pay to access smoking-cessation services. With little demand, the company re-thought its approach and is now selling group subscriptions to health plans, employers, and state health departments. From a policy perspective, rigorous research on the health impacts of consumer health IT may be necessary to motivate insurers and employers to shoulder its costs. As Ted Dacko, president and CEO of HealthMedia, explains “There is only one thing that matters in health care: outcomes.” It is also worth pointing out that if, as is asserted by many e-health experts, health plans and providers will play such a central role in promoting greater use of these technologies, individuals who lack insurance may be at a disadvantage.
In addition to the challenges in building the economic case for providers to engage in health information technology and thus promote its use among patients, there are technical obstacles as well. The ability to exchange lab results and other information to make PHRs most useful and appealing to consumers may depend on the development and implementation of standards for data security, permissions for sharing information, and interoperability. Addressing these challenges is a central component of the work of the Office of the National Coordinator for Health Information Technology in DHHS.