The desired end result is clear:  President Bush has set a goal for every American to have an electronic health record (EHR) by 2014.  But how do we reach this goal most efficiently and effectively?

I’m seeing two schools of thought emerge.  These schools of thought are based on classic push vs. pull strategies from Marketing 101:

• “Push”  doctors and hospitals to adopt EHRs, who will then educate consumers on the availability and uses of health and medical information
• “Pull” the end consumer to use PHRs, who will then put pressure on doctors and hospitals to adopt EHRs

Here’s a simple example to explain push vs. pull options.  Let’s say you’re a cereal manufacturer.  You can use advertising to pull consumers —  people will see your ads and go to the grocery store with the intent of purchasing your cereal.  Or, you can push retail channels of distribution — you get the grocery store to position your product favorably on shelves, with the belief that creating visibilility during the shopping experience is key to sales.  Push and pull marketing strategies are not mutually exclusive, but they are useful in thinking about how you want to divvy up your marketing dollar; ultimately, strategy is a resource allocation decision.

Until recently, there’s been a primary national strategy to push EHR adoption by providers. 

A December 2006 Markle Foundation report on PHRs — A Common Framework for Networked Personal Health Information — makes the case for emphasizing a pull strategy.

“Given the low expectations for EHR penetration and interoperability, health care transformation strategies that rely on EHRs and clinician-based health data sharing networks are not likely to yield substantial near-term impact….Rapid consumer adoption of newly networked services has proven to be possible — indeed phenomenal — in other sectors. Consumers can adapt to technology and culture transformation more rapidly than large health care institutions with long histories of business processes and legacy systems. Furthermore, even as the majority of clinicians continue to keep consumers’ data on paper, other important
personal health information — namely claims, pharmacy, diagnostic images, and lab data — are available in digital form today. We conclude that the immediate effort to catalyze health care transformation must include a strategy to create a networked environment for PHRs and related technologies that takes advantage of these currently available digital data streams.”

Emphasizing a push vs. pull strategy is a complex decision. I recently saw a presentation by James Hereford, EVP of Strategic Services and Quality at Group Health Cooperative (GHC). GHC has been a leader in providing PHRs and other health information tools to consumers. He commented that the single greatest factor in encouraging patients to start using a PHR has been a recommendation by the patient’s doctor.

So, what’s the right strategy?