06/25/2008 05:12 am ET Updated May 25, 2011

Health Care Reform is Coming -- But From the Bottom Up

The latest round of announcements from Google and Microsoft about their partnerships and initiatives to fix the US healthcare system reminds us all that it is seriously broken. Health care costs are growing at 4.4 times the rate of inflation and 3.7 times the rate of increase of the average workers earnings. They now exceed the average profit per employee at some of the largest U.S. corporations. There is an acute shortage of primary care physicians, Medicare costs exceed its revenues and without substantial change, meeting the health care needs of the boomers will subsume 30% of the national budget in 2030. As you might expect, there is no silver bullet, and neither government legislation nor unilateral actions on the part of large insurance companies or high-tech giants will fix the system. Not surprisingly, many of the changes we need are coming from the bottom up as patients, with the help of enterprising entrepreneurs, are relating to the health care system in fundamentally different ways resulting in far greater efficiencies than could be achieved by government mandates.

At the heart of this bottom up revolution is a concept called Health 2.0, which promises to do for medical care what the Web did for travel only a few years ago. When was the last time you called an airline to make a reservation, book a car, resolve a bill or check your frequent flyer miles? Well apply the same concept to your doctor's office except substitute travel issues with medical tasks like filling out a form, making an appointment, obtaining a prescription, paying a bill or in some cases obtaining a diagnosis. All of this is beginning to happen with the advent of physician's portals that connect doctors and patients electronically and enable the performance of these administrative functions and more. (Full disclosure -- I am a board member and investor in Medfusion, a leading provider of physician's portals in the United States.) But the physician portal is really just the plumbing, the pipe that enables all kinds of patient-centered applications. One of the prophets of the Health 2.0 revolution is Dr. David Kibbe, a principal in the Kibbe Group, who in a recent conversation suggested the following:

--Patients will have access to their complete medical record either on their desktop or from a remote server and it will be refreshed regularly by their physicians via the portal I just discussed;

--Hundreds of independent developers are working on applications that will fit on top of Microsoft and Google initiatives centering upon the EMR or electronic medical record. Applications include likely adverse reactions to a particular drug, access to expert information and relevant user groups in response to a particular diagnosis and actual in-home monitoring and testing with the results instantly posted to your personalized record;

--Third party payers (think Blue Cross-Blue Shield and Cigna) and the large HMO's are beginning to pay for virtual office visits (structured consultations with your doctor or his nurse via email) as well as providing online access to administrative functions that should make your relationship to your health insurance company more like the one you have with your airline; and

--Doctors practices are even beginning to reinvent themselves enabling scheduling via cell phone, posting waiting times on their web portals and eliminating virtually all paper forms in favor of a web based approach.

All of this is happening because the patients -- read customers -- are demanding it. Recent surveys suggest that consumers will switch from one medical practice to another based upon the availability of electronic access and this trend will only increase as the boomers descend upon the medical system with a vengeance. Virtually all patients will have access to high speed data lines, experience with online interactions and high expectations. But their demands should have a positive impact on the health care system: less expensive office visits, more efficient use of physician time, less paperwork and less postage for appointment reminders and bills. And with all of the entrepreneurial energy focused on this national crisis, the developments outlined here are just the beginning of Health 2.0, a bottom up revolution in American health care.