Consumers, powered by technology and information and driven by a demand for quality healthcare, will ultimately pave the way for electronic health record (EHR) systems, even if the vast majority of MDs are reluctant to implement the new technology in their practice.

That observation was one of several that emerged from a healthcare IT panel discussion during the 4th annual Nasdaq OMX Healthcare Forum, co-sponsored by Leerink Swann, Monday in New York.

"As an Ob-Gyn, I'm used to long gestations but healthcare IT getting into the provider world has been about the longest," quipped Steve Klasko, CEO of University of South Florida Health (USF Health; Tampa).

Klasko, who is also dean of the College of Medicine at USF, offered his views on healthcare IT from the provider perspective during the panel discussion, which was moderated by George Hill, VP of investment banking at Leerink Swann.

"Patients are not going to be patient anymore in healthcare," said Glen Tullman, CEO of Allscripts-Misys Healthcare Solutions (Chicago), another member of that panel. "Traditionally they have been told what to do, increasingly patients are taking a more active role. They're being enabled by personal health records ... and even more so when you see Microsoft [Redmond, Washington] and Google [Mountain View, California] are entering the healthcare market."

Allscripts provides workflow systems to ambulatory physicians and, according to Hill, probably has the leading position in the market.

Interestingly, when it comes to getting answers to their healthcare questions, 100 million times a month patients go to the Internet, Tullman noted. He added that interoperability between various EHR systems would also become critical, as patients begin to demand that their doctors use the same technology they expect when they rent a car or buy music online.

"We're going to see a pretty dramatic change in how patients vote with their feet and with their dollars, and I think it's going to change healthcare dramatically," Tullman said. "I see information as doing in healthcare what its done in every other major industry in this country taking cost out and improving quality."

At USF Health, Klasko said, "we've worked hard to get physicians to adopt EHRs and we're at about a 10% saturation rate. What's going to change the driving is really the consumer." He said USF recently did a study in which researchers asked patients under age 35 throughout the country what they expect from their healthcare providers and more than 70% expect they will have online scheduling be able to schedule doctor visits online with comparative rates, just like consumers now do with airlines by 2010. More than 85% of respondents expect to have portability of their information, like their bank accounts, where if you move from one bank to another you move your records electronically. And, Klasko said, more than 90% expect to have two-way electronic communication with their provider on their iphones or mobile devices in some way.

While some docs may be tempted to roll their eyes at patients who claim to have diagnosed themselves using information they found online, the amount of healthcare information available on the Web is not necessarily a bad thing.

"The Internet has been a tremendous resource for the informed consumer in healthcare," said Ken Ferry, president/CEO of iCAD (Nashua, New Hampshire), another member of the panel. "When you find things early you can not only have a tremendous impact on the patient's health, but you can also save companies a lot of money."

iCAD, a company in the radiological image and workflow analysis business, is focused on helping radiologists find more cancers, particularly the hard-to-find cancers, earlier and try to prevent those cancers as well, Ferry said. The company's biggest challenge is to make the technology as accurate as possible, he said, emphasizing that radiologists are under a "tremendous amount of pressure under a perfect storm today" due to a shortage in the field. "Our goal is to bring the best technology that really supports their work flow."

Noticing that quality seemed to be a recurring theme during the discussion, Hill asked the panelists to address what he referred to as "an ugly head" that is being reared in healthcare, that ugly head being pay for performance (P4P).

"One of the biggest challenges in pay for performance, or pay for quality, has been the information," Tullman said, noting also that another common theme across the panel was technology. "We all use technology in different ways, we have to understand that technology is a means to an end. As soon as we begin to understand that healthcare is an information business, and use technology to get at that information, we'll begin to solve some of these problems."

"As we get better information systems that allow physicians to say 'here's how I can influence in a positive manner the population health and here's how I can get paid for it,' then we'll be able to address these problems."

Tullman said there is a need for incentives to be better aligned in healthcare and, once that is accomplished, P4P will be more acceptable. To make his point, he told a quick story about another panel he sat on with the head of a hospital who, during his introductory comments, said "my goal is to keep this community so healthy that none of the beds in my hospital are filled." When the hospital executive sat back down Tullman asked him what his real goal was and the guy said, "I get paid based on the utilization of the beds in my hospital."

On the development side, economics are playing a much bigger role, noted panelist Martin Young, VP of corporate development and marketing at Phase Forward (Waltham, Massachusetts), a provider of data management solutions for clinical trials and drug safety. "Increasingly what we think we're going to see in the development activity is this focus on economics, comparative, reimbursement-type information and people trying to collect that earlier and earlier in the process," Young said.