Why Good Ideas Sometimes Languish: Sigmund Freud Has the Key to Understanding How Deep-Rooted and Often Unacknowledged Resistance Can Thwart the Implementation of Popular and Meritorious Innovations

Article excerpt

At first blush it would seem that maintaining a personal health record (PHR) has many merits. Almost everyone would want to have health information about themselves readily available in a digital format and completely under their control. They could then make it accessible to anyone else they choose; for example, emergency health personnel or a new specialist physician. Yet only a very small minority of Americans have a PHR, which should not to be confused with electronic health records (EHRs) maintained and controlled by doctors and hospitals. A number of explanations are offered for this surprising finding, but the most compelling one comes from Sigmund Freud. In public policy as in personal psychology, unconscious or subterranean forces exert a powerful but underappreciated influence. The hidden resistance to PHRs could be the most powerful reason that explains why they have made so little progress in spite of their manifest virtues.

The basic definition of a PHR, as put forth by a 2008 U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology report, is "An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual." Furthermore, PHRs can be designed in ways that would allow individuals to decide which parts of the information included can be accessed by others, including various medical personnel.

A PHR may include information about an individual's conditions and ailments, medication and dosages, test results, immunization history, and allergies. As information is added over time, a PHR can also serve as an evolving medical record of treatments provided and their effectiveness.

According to HHS and medical researchers, PHRs improve the care provided by health care personnel. Given that people are treated by a variety of specialists in addition to their primary care doctor, often travel, and move with relative frequency, a PHR enables new health care workers to gain a much fuller and more reliable record of an individuals health and medical history than they gain when they have to rely on the patient's memory or wait for records to be collected from previous sources of care. Health care also benefits from not having to repeatedly prepare a health and medical history. This history can be prepared once and incorporated into the PHR. From then on, it can me made available to any subsequent health care professional the individual sees.


PHRs also increase patient safety. Given that medical information is be cataloged and easily accessible, PHRs " ... increase patient safety through exposing diagnostic or drug errors, recording non-prescribed medicines or treatments, or increasing the accessibility of test results or drug alerts," according to an analysis published in the British Medical Journal (BMJ).

In addition, PHRs encourage patients to become more involved with their own care. For instance, BMJ argues that the use of PHRs leads to "improvements in ... confidence in self care [and] compliance in chronic disease." Furthermore, "patients with long-term conditions, who have the most need to track their illness and treatments, and patients experiencing episodic periods of care or treatment that generate new needs for information or communication" stand to benefit. Moreover, in emergencies when the patient is unconscious, an authorized family member can provide access to the individual's PHR, thus providing health care personnel with information they may not have otherwise been able to obtain in short order.

Experts expect that PHRs can advance communication and trust between health care personnel and patients. Paul C. Tang, vice president and chief medical information officer at the Palo Alto Medical Foundation, and Thomas H. …