The 6 P’s: Who are the Users (and Re-users) of Patient-specific Clinical Information?

by Adam Rothschild, M.D., M.A.


Electronic health record (EHR) systems are big news (and big money) these days. Our government is pushing adoption and “meaningful use” of EHR systems because computerizing patient-specific clinical information can benefit our nation’s health care system. The primary focus has been on the benefit to the care of individual patients, but computerizing patient-specific clinical information can also benefit other parties in the health care systemi. I believe that there are 6 major parties that serve to benefit from the computerization of and access to patient-specific clinical information. I refer to these parties as the 6 P’s.

The six P’s are as follow:

  1. patient
  2. provider
  3. payer
  4. public (as in public health)
  5. posterity (alternatively PhD’s)
  6. product makers (alternatively pharma).


At this juncture in the national discussion of EHR systems, it should be self-evident why patients serve to benefit from the computerization of patient-specific clinical information. I will thus not further belabor the point.


Ditto for provider. By “provider” I refer to all individuals and organizations that deliver care to patients, including but not limited to physicians, nurse practitioners, nurses, physical therapists, hospitals, home health agencies, etc.


By “payer” I refer to third parties that pay for patients’ care. I use the term broadly and include both for-profit and not-for-profit health insurance carriers, government-run health insurance programs such as Medicare and Medicaid, and even the many self-insured corporations that utilize health insurance companies solely for their administrative functions but not for their assumption-of-risk functions.

Payers will ideally be able to automatically monitor the quality of care that their patients are receiving. While many payers currently analyze claims data for this purpose, actual patient-specific clinical data will likely provide a much more precise and useful dataset. Knowledge of the quality of the goods and services that payers are purchasing should help them to design programs to improve value for their covered patients.


By “public” I refer to the population overall, as in public health, whether on a local, regional, national, or even international level. The potential public health applications of having large quantities of computationally tractable patient-specific clinical information are enormous. Examples include real-time detection of emerging infections, simplified identification of locations of environmental hazards, and real-time access to community-wide antibiograms.


By “posterity” I refer to the use of patient-specific information for clinical research. I use the term “posterity” because good research adds permanently to the scientific knowledge base, and, well, I needed a word that starts with the letter P. Since PhD scientists do a lot of research, you can alternatively think of this one as PhDs.

Product Makers

Like it or not, medicine cannot be practiced without products that health care providers use, such as pharmaceuticals and medical devices. Manufacturers of these products, of course, rely heavily on patient-specific data for FDA approval of their products but also—and possibly more relevant with respect to EHR systems—are under increasing pressure to monitor the safety of their products in the post-marketing phase.


While patients and providers benefit mostly from providers’ direct use of patients’ individual clinical information, the other 4 P’s benefit mostly from analysis of many patients’ clinical information in aggregate (de-identified where appropriate). Because patients seek care from providers who will be using disparate EHR systems, this is yet another reason to implement national terminology and communication standards for clinical information sharing; the value contained within EHR systems will likely not be realized without it.

In closing, when you are thinking about who are the users and re-users of patient-specific clinical information, think the 6 P’s.

iIn addition to the benefits of sharing and re-using patient-specific clinical information, the 6 P’s also serve to benefit from yet-unimplemented sophisticated clinical decision support. Further discussion of this topic is beyond the scope of this blog post.

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3 Responses to “The 6 P’s: Who are the Users (and Re-users) of Patient-specific Clinical Information?”

  1. Mom says:

    Explains things very clearly. Nice job.

    What about family history under “Posterity?”

    • adam says:

      Good thinking, Mom. It is useful to consider patients who might benefit from clinical information of their relatives. I hadn’t considered this use case, but it is certainly valid. That said, I think that I would classify this use case under the “patient” category, for it’s basically one patient benefiting from the availability of and linkage to another patient’s (i.e., his relative’s) information.

  2. Ed King MD says:

    If you are not measuring you are not managing.
    EHRs are here to stay.
    Keep up the good work Adam.

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