Toward an Ownership (Health) Society

Earlier this year Secretary of Health and Human Services (HHS) Alex Azar gave a series of speeches outlining four key areas to spur innovation and the transformation of the health care system toward value-based care: "giving consumers greater control over health information through interoperable and accessible health information technology; encouraging transparency from providers and payers; using experimental models in Medicare and Medicaid to drive value and quality throughout the entire system; and removing government burdens that impede this value-based transformation.”

The most exciting of these ideas is putting patients in control of their data. Specifically, "Patients ought to have control of their records in a useful format, period. When they arrive at a new provider, they should have a way of bringing their records, period.” I would go further: Patients should own their records.

Historically, the providers owned the records. Why? If the doctor has your file, you have to go back to that doctor or start over. Starting over is a tremendous nuisance, so provider ownership of records is a huge impediment to competitive pressures. A health care system cannot reveal value if it is too costly to reject low-value care and move elsewhere. Starting over is the definition of duplicative testing, imaging, and other care and a reason for the bloated U.S. health bill.

If patients owned their records the entire history of vital sign, tests, prescriptions, and procedures would travel with them. This would eliminate waste, improve diagnoses, and raise the value of care. Patient ownership would improve the incentives for so-called interoperability of electronic medical records. Making records electronic does not change the business incentives; it is still in the providers’ interests to make it difficult to use the records elsewhere. But if any patient could bring their records to a provider, they’d have an incentive to make it as easy as possible to transport records. Oh, and by the way, failure to transmit records to a new provider would be theft.

Until patients own their records, they will not be the center of the health care business model. It is the most powerful step toward a patient-centered system.