I often wonder what will drive the next quantum shift in healthcare. If we ran a poll today, world class commissioning or the Darzi review would probably top the list. These ideas are fine, but it seems to me that they represent an incremental nudge rather than a quantum shift.

No, for an idea to qualify as a quantum shift, we would need to see the sort of transformation we have seen in the computing, retail, leisure, financial services and utility industries over the past 25 years.

People do not put up with poor service in these areas any more: they select their service carefully, compare prices and features, complain in droves and move their business when dissatisfied or when something better comes along.

So it beggars belief that people put up with the waiting, inaccessible appointments and service restrictions that go on every day in healthcare.

No doubt the political policy environment, liberalisation of markets and regulatory shifts have helped overcome problems in other sectors and may do the same for health.

Taking control

But there is one factor that is almost certain to overtake central reform. My prediction revolves around the internet and the concept of the personalised health record.

New technology is now allowing patients to go online and book appointments, request repeat drugs, view their health file summary or email their clinician.

But far and away the most exciting and enabling consequence of all this will be the development of personalised health records. Consumers in just about every other business want control and choice. It works well if you are downloading music, comparing insurance or booking a flight, so I reckon health will be no different.

Third parties will surely start to offer electronic space to store individual health records, facilitate interactions between providers, offer information, and develop online communities and support groups for patients with similar health problems.

Naturally, comparative information on cleanliness, quality of service and outcomes will follow as a development of good governance.

How far off is all this? Simply put, it is happening already. Microsoft has launched HealthVault, a system that allows people to store their health records online, and Steve Case, former chief executive of America Online, is backing Revolution Health, an online service that offers information on health and helps users find doctors in their area. Am I just following the trend or can I walk the talk? I've just spent a few hundred grand to find out, so I will let you know.

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