Category: e-health

Mr. Google comes to Washington

published date
April 24th, 2007 by

From my post on the World Health Care Blog, which was picked up by the Wall Street Journal’s Health Blog

Google’s Adam Bosworth told the standing room crowd that came to have breakfast with him this morning that since he was in DC it was appropriate to “talk about rights,”rather than products. He enumerated a variety of rights (he also used the word “powers”) consumers should have:

  • Power to discover –from whom and where to get help
  • Power to own one’s own data — with complete control of how it is used. This he characterized as an “inalienable right”
  • The right to choice:
    • of provider
    • of insurer
    • of treatment –in partnership with physicians. If the physician sees their patient as a “partner” rather than a “puppet” it makes all the difference in the world in how the patient is treated
  • The power of privacy –meaning the consumer can decide what to disclose to whom, and whether to withhold information without having a large red X for “meds not disclosed” appear on their chart

If consumers had all these rights, they would engage in the power of action to make better choices, though Bosworth freely offered that he doesn’t have the magic bullet.

Bosworth made a couple of other interesting assertions:

  • That the technical challenges involved in getting data into consumers hands are not hard to overcome
  • That once consumers understand what’s really going on they’ll rebel against being exposed throughout their lives to the threat of bankruptcy from medical expenses and will put the burden back on the government or others

I asked Bosworth whether he felt consumers had a role in determining their diagnosis –in partnership with their physicians– as well as their treatment. His answer: “sort of.” He doesn’t want to see patients play at being doctors but he recognizes that physicians exhibit diagnosis bias and that consumers want a “breadthwise search” to see a long list of things they may or may not have so they can rule out the scary ones.

Those looking for details of the forthcoming Google Health offering were probably disappointed but not surprised that Adam didn’t reveal much. But here’s what I picked up in trying to read between the lines:

  • Google wants to include in their PHR transaction data between physicians and health plans, physicians and PBMs, labs and physicians and so on. They are not planning to rely on feeds from physician EHRs to do this –Bosworth made a point of pegging EHR adoption outside the hospital at <10% though I think he’s understating the truth– but to try to plug directly into the payment streams
  • Google is trying to lay the groundwork to have HIPAA overturned, and short of that would like to educate providers and patients about how to get at their information even within the constraints of current laws. They’d like to see consumers have the ability to review and challenge their records as is the case with credit bureau information
  • In keeping with the Google philosophy, Google Health is likely to be a “simple, sloppy solution”

And a final tip for those wanting to work with Google: he seems to like medical experts who’ve written books.

Pentagon bashing

published date
March 30th, 2007 by

In Disuse of System is Cited in Gap in Soldiers’ Care, the New York Times takes the military to task for lack of continuity of care. Information from medical records in Iraq and Afghanistan is not always transferred seamlessly stateside even though a system to do so has been mandated for two years.

No doubt there are plenty of problems. But it doesn’t sound worse than the civilian sector, where such inter-hospital medical record systems are almost never in place at all. No one should be under the illusion that this problem is limited to the Defense Department. And we don’t learn from the article if the system is any good, just that it’s been mandated.
Madigan Hospital at Fort Lewis in Washington State comes in for a severe pounding, being blamed for causing a soldier’s suicide because doctors didn’t look into the system to check his records. The Times makes the place sound like a backwater, resistant to the benefits of medical information technology.

I don’t know much about Madigan, but since it is one of the hospitals that signed up for institutional access to advanced decision support software, I give them the benefit of the doubt.

Something for 30 years from now?

published date
January 10th, 2007 by

I’m out in San Francisco on business and so decided to stop by MacWorld for a couple of hours. I was curious about the use of Macs in health care.

In the days leading up to MacWorld, Apple’s website said “The first 30 years were just the beginning. Welcome to 2007.” Judging from the paucity of health care apps displayed here, it could take another 30 years before Apple makes a serious move into health care.

I found just two health care companies exhibiting (maybe there were more, but I couldn’t find them).

  • AltaPoint, which bills itself as The Pinnacle of Practice Management Software had a sad little display and no one staffing it. One person was standing near the display and told me, “These guys are a fly by night operation.”
  • MacPractice, “The COMPLETE OS X Solution for Doctors’ Offices.” This company looked a bit more promising, though since their handouts say “Copyright 2005” I have a feeling customers haven’t exactly been banging down the door

There might be an opportunity for software developers to create easy-to-use EHRs for Macs, but it doesn’t seem to be happening yet.

Meanwhile, my colleague Eric Zimmerman suggested (only partly in jest?) that we could scrap plans for a national health care IT infrastructure and have everyone store their PHRs on iPods and use the iTunes store as the platform for exchanging records.

Journal Nature changes course on allowing comments

published date
December 22nd, 2006 by

In September the Journal Nature started allowing online comments. On the surface it sounded like a promising idea –getting papers out sooner and allowing a wider range of commentary– but as I asked in Nature opens the peer review door a crack. Will anyone step through?— it didn’t get off to a promising start:

I don’t see a single comment on the 10 pages that are listed on the Nature site.

Now the program has been withdrawn due to lack of interest. It’s not as easy as it may look to generate mass use of a tool like this even for a prestigious journal. One of the problems is that Nature was too restrictive on who could post and how the comments would be moderated.

In announcing the discontinuation, Nature’s editors said they found the majority of scientist-authors were unwilling to post their papers or were unwilling to criticize peers’ work publicly by posting comments on Nature’s Web site.

Of the 1,369 short-listed papers submitted during the four-month trial, authors of 71 papers were willing to post their work online, Nature said, receiving 92 technical comments.

The Public Library of Science’s PLoS ONE is starting to ask for questions and comments as articles are posted. PLoS is much more attuned to user participation and their experiment is more likely to succeed, based on a quick look at their guidelines.

We’ll see.

Enquiring minds want to know

published date
December 4th, 2006 by

Enquiring minds want to know

Found this disturbing piece in the New York Times:

BILL CLINTON’S identity was hidden behind a false name when he went to New York-Presbyterian Hospital two years ago for heart surgery, but that didn’t stop computer hackers, including people working at the hospital, from trying to get a peek at the electronic records of his medical charts.
The same hospital thwarted 1,500 unauthorized attempts by its own employees to look at the patient records of a famous local athlete, said J. David Liss, a vice president at NewYork-Presbyterian.
The usual approach has been to allow types of personnel who need to see the records to have access and log the results. But logging means nothing without consequences for improper access. What did Columbia do to discipline those who tried improperly to access celebrity charts?
It may be necessary to have a person monitoring the process in real time and denying access in some situations. This is what happened in the era of paper charts for a patient not in the hospital. For a patient in the hospital the chart sat in a rack and if there was a parade of people coming to peek they would have been stopped.