The point of course is that intelligence is an emergent property: it may look as John describes it in his first paragraph, but afterwards it appears to have been purposeful and intelligent.

Personally, I have mostly given up on the government. I think consumers *will* drive adoption, by demanding it. They will start to get their own data, whether from 23andMe or Labquest, and will start demanding that their doctors and institutions give in. It wasn’t the banks that led the online banking movement; it was millions of consumers using Quicken and demanding access.

And of course, it will be lumpy. Techies and kids will play first, along with sick people who became techies in order to manage their own conditions and data. Once they have led the way, it will be easier for the rest of the population.

But it is not only the consumer that will play a major role here. This post appears to gloss over the big elephant in the room, that of minimal adoption of IT among healthcare providers (which is really what much of this debate is about). Health data can assist the consumer in making good health choices, but where will that data come from? As has been demonstrated by the poor adoption of stand-alone PHRs, the consumer is loathed to self-populate such systems.

Looking ahead though, I do agree with you Esther, that much of the future change in healthcare and IT within that sector will be driven by the consumer, but only if we can give them tools that are not only easy, but actually fun to use and provide meaningful assistance in managing their health. The large platform plays of Microsoft, Google and Dossia will do the bulk of the heavy lifting of bringing consumer heath data into a repository that a consumer can invoke within a given personal health app. Provided these platform plays can build sufficient populations of users, they will create viable markets for application providers to build out interesting apps for population sub-segments.

But this just leads me back to my original premise, without more aggressive physician adoption/engagement of digital tools, it will be a very long road ahead. This is where a complete realignment of incentives needs to occur and leadership from the feds is desired. Unfortunately, the feds have spent significant resources on the wrong things (NHIN/RHIOs, standards, certifications) and not enough resources on creating value for IT adoption (incentives, reimburse for eConsultations, adopt teleheatlh practices, etc.).

In a few short months we will have a new administration. Hopefully, their HIT policies will be more grounded in creating a healthy, vibrant environment for delivering value to physicians who adopt HIT than what we have seen to date.

Editor’s Note: This post concludes a series on health information technology (IT). It follows posts by Mark Leavitt and Nancy Davenport-Ennis. This blog series appears in tandem with new papers on the Health Affairs Web site [2-week …