Archive for Electronic Medical Records
by JParkinson
April 23, 2008 at 10:26 am · Filed under Consumer Engagement, Business of Health, Electronic Medical Records
Contrary to popular belief, I don’t believe that the internet is isolating. The internet actually connects people more and better both online and offline. Despite the scare that air travel was going to be harmed by internet communication, air travel is at an all time high. The so-called Web 2.0 movement has made purchasing and connecting with others easier and almost idiot proof. Instead of technology holing us up in closets staring blankly at LCD screens, our society has found that humans still need the physical presence of other humans — and now we have even more means of communication to connect with others. We text our friends to meet up at a bar. We send out “spam” email to our parents with daily photos of our new kiddo and their new grandchild. We video chat with our wives as we’re out on the road traveling. We meet our future wife on the internet and meet up for coffee because technology has allowed us to find other singles in our neighborhood.
Technology connects us and makes our lives more meaningful.
The healthcare industry does not yet understand this. They don’t understand that humans want to connect with other humans — preferably humans they know and like. They don’t want to connect with corporations, especially corporations that have a cringe factor to their brand — notice there isn’t a single healthcare brand in the Top 100 brands. They don’t want to connect with websites. They want to connect in meaningful, advantageous ways with people they value.
It’s trying to. I think. But doctors are too busy to care and they aren’t paid for accessibility and communication. Therefore, patients haven’t even been given the option.
There should be two main players in healthcare — doctors and their clients. Technology should be used to enhance the old-time, personal doctor-patient relationship — not cheapen it by using technology to connect you with some random doctor who doesn’t know you and vice versa. It’s unsafe and cheapens our profession.
Convenient Care Clinics and online video and IM visits with random doctors have arisen as a response to the deficiencies of our current policies that do not pay for intelligent care and instead pay for volume and more intensive care. They are excellent business opportunities to meet demand for patients who will take anything because their doctors are not accessible or available.
But they fracture our healthcare system even more.
If our policies and, therefore, our doctors do not respond to healthcare user demand, our healthcare is going to get more and more impersonal with less and less qualified caregivers. In effect, our safety is being threatened by cheapening the once coveted doctor patient relationship.
People get sick and need care when they need care. Giovanni Colella, former founder and CEO of Relay Health, said “People do not care if they communicate with their doctor, they just want to talk to a doctor.”
Of course Giovanni. When people are desperate and in need, they’ll take the best thing available. And when people aren’t given the option to communicate with their doctor, they’ll search for the next best thing. Since their own doctor isn’t available, they’ll take anything. When you’re starving and only rice is available, you’ll eat a lot of rice.
But you’ll eventually get kwashiorkor.
Technology has revolutionized every other industry except healthcare. I could develop the Killer App of healthcare and NOBODY WOULD USE IT.
That’s fine. You’ll be left behind as we create The New Digital Divide of Healthcare using technology to enhance a personal doctor-client partnership with your own personal neighborhood doctor. The age of using the internet to provide only simple text and impersonal, “jack-of all trades, master of none” information died on September 24, 2007.
Healthcare is personal. Healthcare is private. Healthcare is about a close doctor-client partnership to optimize the physical and mental health of both doctors and their patients. Doctors…we deserve it. Every day, we face life and death decisions. Our minds and our professional environment need to enhance our ability. Patients…you deserve it. Everyday, you should be happy and healthy so you can go about your business in this lovely world.
Doctors and patients — healthcare will continue to slip away from both of us and into the hands of a decreasing number of oligopolies.
We need to take it back. We need to partner with one another. We need to use technology to organize our needs. It’s not going to be cheap, it’s not going to be easy, but it’s going to be the best thing we’ve ever done to make our nation and our world a happier and healthier place.
by Vijay Goel
April 22, 2008 at 11:30 am · Filed under Uncategorized, Consumer Engagement, Electronic Medical Records
Only 2% of consumers are currently using a PHR, according to Revolution Health CMO, Jeff Gruen at the World Health Care Congress on a panel with Graham Pallett (Carol) and Jeff Rideout (Health Evolution Partners).
So why are these tools not being used?
Some initial thoughts:
- Awareness
- Concerns around security and privacy
- Data needs to be “easy” and ubiquitous
- Compelling or “killer” apps
Interest in the PHR is clearly renewed, with consumer oriented development occurring due to efforts by tech titans Microsoft (HealthVault) and Google (GoogleHealth). The real question is whether this is technology leading the wagon or if there are real unmet user needs creating opportunities that the technology can begin to address.
There are clearly different (and competing) objectives for PHRs from the consumer, provider, and payor perspectives.
Consumers have a number of different needs that could be addressed by a PHR:
- ER in coma
- Questions/ clarification from doctors and care providers
- Followup information
- Appointment reminders
- Coaching
- Storage of data/ condition over time to give to provider
- Peace of mind
- Access to information (e.g., history, vaccine records, end of life instructions)
- Pharmaceutical safety/ coordination
- Ability of care providers to take care of loved one/ relative
Given the number of needs and potential user needs, it appears that we don’t have clarity around the initial consumer “beachhead” and the minimum functionality required to create real value. How much of the clinical record needs to be captured and even autopopulated? What degree of certainty needs to exist around the data? How transportable does it need to be? Do clinical or claims records even capture the information relevant to consumer needs?
For now, we have a platform looking for an application– it will be interesting to see in what direction (if any) the development of the PHR unfolds. Which company will create the Visicalc or “Facebook” style apps that create value on top of the platforms is the question for the entrepreneurs and Venture Capitalists…
This post is cross-posted on Consumer Focused Care
by Fred Fortin
February 20, 2008 at 6:05 pm · Filed under Uncategorized, Policy Makers, Electronic Medical Records
Robert Gellman, a privacy and information policy consultant based in Washington, D.C., has prepared a report for the The World Privacy Forum — a non-profit public interest research and consumer education group — on why personal health records (PHRs) could threaten privacy. Possible privacy consequences outlined in the report include:
• Health records in a PHR may lose their privileged status.
• PHR records can be more easily subpoenaed by a third party than health records covered under HIPAA.
• Identifiable health information may leak out of a PHR into the marketing system or to commercial data brokers.
• In some cases, the information in a non-HIPAA covered PHR may be sold, rented, or otherwise shared.
• It may be easier for consumers to accidentally or casually authorize the sharing of records in a PHR.
• Consumers may think they have more control over the disclosure of PHR records than they actually do.
• The linkage of PHR records from different sources may be embarrassing, cause family problems, or have other unexpected consequences.
• Privacy protections offered by PHR vendors may be weaker than consumers expect and may be subject to change without notice or consumer consent.
Gellman concludes that,
While PHRs may have some laudable goals, they also are a tempting target for companies or others that want to evade whatever privacy protections remain in the health care system in order to make a profit. Whether the benefits of PHRs are sufficient to overcome the real dangers to privacy remains to be seen. It is something that each potential user of a PHR must consider before enrolling. Any consumer worried about the privacy of personal health information should proceed with great caution before agreeing to sign up for a PHR, particularly those operating outside of HIPAA.
by Fred Fortin
January 18, 2008 at 12:31 pm · Filed under Uncategorized, Insurance, Industry Sector, Public Purchasers, Health Plan/Payer CEOs, Policy Makers, Business of Health, Medical Tourism, Retail healthcare, Electronic Medical Records, Research, Alternative Medicine
I don’t know if you’ve noticed but as we move into 2008 there’s a glut of papers, reports and predictions about what is going to happen in health care. Some have such a definitive tone, it makes you wonder if any have read Nassim Nicholas Taleb’s, The Black Swan, which engenders in the reader a humble appreciation and respect for role of high impact, improbable events in social affairs.
Anyway, I’ve taken the time to look through some of these pronouncements. Many are rehashes of the what I would call “more of the same” prognostications, others find us at various tipping points — unsustainability being a key concept here — in health care and forecast some, often vague, deep changes to come. Below are some of the bits and pieces of these various offerings of the future that caught my eye.
- Expect large institutions to make significant IT investments; RHIOs will still struggle with architecture and governance models; EMRs creep closer to reality, and health plans will continue to implement consumer-directed vendor partnerships. (Forrester)
- Doctors are using the Internet far more than their national averages, using email, obtaining professional information from online journals, attending courses and conferences, receiving professional updates and performing professional, administrative functions. . . In essence, in the short space of time that the Internet has been easily accessible through the Web, doctors have harnessed its power in both their personal and professional lives. All indications are that they will continue to do so. ( Masters)
- Two areas that are going to get a lot of play in the next year or two. There are a number of products in the telemedicine space that use IT not as a database or workflow tool, but as a telecommunication and management system, teleradiology is one prime example. The other is interoperable home-monitoring devices. There’s good value with keeping people out of nursing homes, and it’s getting a lot of attention right now from doctors, hospitals and health plans. (Brailer)
- Don’t see much of a business case for health 2.0 technologies, although personal health records as a concept has some validity, particularly as a service provided by health plans and employers. Still in a wait-and-see mode on PHRs. (Brailer)
- Medicare’s Hospital Insurance (HI) Trust Fund is already expected to pay out more in hospital benefits this year than it receives in taxes and other dedicated revenues. The growing annual deficit is projected to exhaust HI reserves in 2019. (Friedman)
- For the first time, a safe, effective and reversible hormonal male contraceptive appears to be within reach. Several formulations are expected to become commercially available within the near future. Men may soon have the options of a daily pill to be taken orally, a patch or gel to be applied to the skin, an injection given every three months or an implant placed under the skin every 12 months. (Schieszer)
- U.S. health care costs are growing at 8 percent per year, an unsustainable rate that will be forcing every employer to make a crossroads decision in the next 12 to 36 months: either continue to provide health care benefits to employees and become very aggressive about controlling expenses or exit the insurance market completely and let employees fend for themselves. (Deloite)
- Physician-hospital tensions will increase. Employer-health plan tensions will increase. The non-conventional provider movement (complementary and alternative medicine) will be pitted against the conventional. Off-shore resources will compete against high-cost domestics. The under-insureds will compete with employers for funding and services. Biologics developers will attempt to fend off traditional pharma to capture the high ground in diagnostics and therapeutics. Tension, anxiety, and turf battles for success will heat up, but so, too, will opportunities. (Deloite)
- In an environment where employers and consumers are demanding more for less, medical tourism, telemedicine, and other innovative disruptions offer attractive options for people who require expensive surgery and procedures but do not want to be limited by their health care insurance policies. (Deloite)
- Significant change is unlikely prior to 2010 and is apt to be gradual thereafter. Although urgency is still the operative word, the players involved have a healthy respect for the complexity of the problem and the runaway costs that will result if they get it wrong. Even if some changes emerge in the first year of the new administration, implementation would take at least a year. Bigger changes would probably follow, being phased in starting in 2011. (Booz Allen)
- A surge in the number of retail clinics will force states, payers, and policy makers to think about the right model for the delivery of primary care. (PWC)
- The market for individual health insurance could take off. (PWC)
- We envision the proliferation of “health infomediaries” (HIs) who help consumers navigate the insurance, channel and service options in care delivery. HIs will become a fixture in the landscape for both the well and the chronically ill, and for a much broader socioeconomic segment of the population. (IBM)
- The combination of the push for universal coverage, the erosion of employer-based insurance and the aging population is expected to drive this continued shift to individual and government-based coverage. (IBM)
by Fred Fortin
December 11, 2007 at 7:51 pm · Filed under Uncategorized, Insurance, Policy Makers, Health IT, Business of Health, Electronic Medical Records
Today, was the third and last day of the WHIT. 3.0 Conference in Washington, D.C.. It was the day that some of the heavy hitters of the technology industry — Tim Berners-Lee, Steve Case, and Adam Bosworth, came to give their take on health care and innovation.
The fast talking Berners-Lee (inventor of the world wide web) gave a short and speedy history of the thinking that led to the early development of the web, and a view into his current work on the semantic web. He tried to show the relevance of the semantic web for health care and broadly encouraged a “just do it” approach to identifying and building the necessary ontologies relevant to the health care system. Berners-Lee then cajoled his audience on everything from adhering to the “golden rule of one web” to giving all things their unique URI, to demanding data in RDF/SPARQL.
Steve Case (Co-Founder America Online (AOL) Chairman & CEO Revolution Health) gave his considered opinion on the state of the U.S. health care system, then proceeding then to make eight predictions:
- Consumers are going to take control of health care big time;
- Centralized approaches to controlling information in health care will breakdown with access becoming more open and distributed;
- There will be less not more government regulation of health care because the pace of innovation will demand it;
- There will be a torrent of innovation relevant to health care with the inevitable, but short term chaos, to follow;
- There will be more emphasis on being healthy and taking more individual responsibility;
- The personalization of health care will proceed with the development of consumer technology tools; and finally,
- The “killer app” for health care is, and will be. . . (drum role) . . . “community”. Facebook, IM, Chat — social media, and the people aspect of health care technology — will be the key driver of any progress.
I was really looking forward to Adam Bosworth (Chief Executive Officer, Keas, Inc.; Former Vice President Google, Inc.) in order to get an idea of where he was heading with his new start-up company, Keas, Inc. But alas, unless we could read between the lines in his speech, he gave no clue even under direct questioning.
What he did deliver to the crowd was an eloquent and impassioned rant on just how broken the health care system is. This was probably old news to this audience, but one always likes to hear a good thrashing of the idiots, incompetents, and evil doers that victimize the hapless patient. While not very nuanced about what to do about the multiple catch-22s inherent in health care, it was a fine speech.
Bosworth did make several important points worth noting. He, like many others in the information technology industry, have a hard time empowering consumers as a result of privacy rules. Consumers need to gain control of their health care information. “Giving patients control over their own data is what we need to do,” says Bosworth emphatically. But the government denies us that ability. Government is “trading off the deaths of hundreds of thousands of people to prevent the exposure of very few” with these laws against ” possible and rare risks to privacy.”
Bosworth also wants a new health consumer bill or rights (No mention of President’s Clinton’s Patient Bill of Rights and Responsibilities circa 1998 — no matter) that will make sure consumers have access to their data electronically from all the players in health care. This is critically important if consumers are going to be able to use the information intelligently.
On another front, Bosworth wants to get physicians participating in online communities talking about health care. Most are fearful and reluctant to do so due to a host of good financial and legal reasons. He wants protections and financial reimbursements to promote this kind of critical exchange with consumers.
This years’ WHIT Conference was thick with energy, excitement and vision. People are starting to see future possibilities in how the health care system could change. You could hear consensus being built, and how innovative technology along with new business models, can strengthen the political will to take action. Grant Harrison (VP, Integrated Consumer Experience, Humana Inc.) in his presentation on learning what health means to people — “not a state but a skill” — said ” that when we say people are not engaged in their health it just means we don’t understand how they are engaged in their health. ” The path to that understanding is being blazed as we speak.
by Fred Fortin
December 10, 2007 at 5:43 pm · Filed under Uncategorized, Insurance, Health Plan/Payer CEOs, Policy Makers, Consumer Engagement, Business of Health, Value-based health care, Electronic Medical Records
The WHIT 3.0 conference in Washington, D.C. continues to steam along with some great presentations. I particularly liked David Lansky (Senior Director Health Program, Markle Foundation) and his work on the public interest when it comes personal health records (PHR). His thinking involves the creation of a “ecosystem” which is sympathetic to PHRs. Soon, he argues, we will have an ecosystem which sees three main actors: the 21st century consumer, global internet companies, such as Google and Microsoft, and traditional health care institutions. Three separate and clashing cultures now define these actors. You can envision the aggressive consumer, who wants fully what health 2.0 has to offer, tangling with global entities, unregulated and operating on a huge scale, and both of these confronting conservative, slow and paternalistic, traditional health care institutions. He offers some strategies that involve cooperation on data liquidity, building a national privacy and security framework, and evolving a PHR business model that makes PHRs available to all.
But the presentation that I’ve been trying to get my head around was trotted out by Roy Schoenberg (Chief Executive Officer, American Well Systems) and what they are doing in his shop. Roy boasts, — and I tend to think he’s really on to something — that he is developing the “killer app” in health care. His plan is to offer to consumers online access to health care — not just information — 24 hour, 7 days a week, 365 days a year. This ‘access on demand’ to doctors and specialist integrates a host of complex technologies, and unique relationships with health plans and providers to offer real time health care. It brings these services online to a convenient place (the home) where consumers can be comfortable and for less cost.
This is the very definition of a disruptive innovation.
by Fred Fortin
December 9, 2007 at 10:17 pm · Filed under Uncategorized, Health Plan/Payer CEOs, Policy Makers, Health IT, Business of Health, Value-based health care, Electronic Medical Records
Day one of the WHIT 3.0 conference started with a hot and hip review of the first 5,000 days of the internet by Kevin Kelly (Co-founder & Senior Maverick, Wired Magazine) followed by a series of impressive speakers who kept the temperature high until the reception finally cooled us down later that evening. Kelly expounded on the sheer magnitude of the web and his description of the web, which I’ve seen him present before, being just a series of screens to one, huge global machine that is online all the time. He worked the theme that if it’s not on the web or readable by it, it doesn’t exist. That innovation becomes more powerful when you add community and how products are now being transformed, through the web, into services - Kindle is not a digital reading device, but a reading service. For health care, this means taking the electronic medical record and seeing it not as a stagnant file, but a vital component of the medical conversation between doctor and patient, for example.
John E. Abele (Founder and Chairman, Boston Scientific Corporation) in a discussion with Kevin Kelly, made a few points worth noting. With regard to the federal HIPAA law which governs the privacy of medical information for health care organizations in the U.S., John observed that while addressing an important concern, HIPAA has set us back. He asks, “Has it provided more protection for the privacy of our health care information?” Maybe for a small number, but, he says, “we’ve thrown the baby out with the bath water” when it comes to health IT innovation. The law prevents, presumably, more robust sharing of medical information that can lead to better outcomes and more effective health care. On another front, in response to a question about what China has to teach us in health care, John opined that the Chinese Ministry of Health believes that they have a blank slate when it comes to health care reform, and that they have a mission to create a practical health care system. This is something, he says that we in the U.S. may want to watch carefully and learn from their efforts.
David J. Brailer (Former and First National Coordinator for Health Information Technology, and Founder, Health Evolution Partners) polled the audience about where they thought their health data would reside in the future. With health plans? Government? Providers? Information technology companies? The results were typical he says, about even numbers across all four responses making our ability to work through this issue all the more difficult.
Jeffrey Gruen (Chief Medical Officer, Revolution Health) took us through his “Revolutionary Health Care Manifesto” that promised to democratize access to medical information and empower consumers. He realizes that the world is indeed getting flatter — health care included - but, more important, it is spinning faster. He acknowledges that health care folks are over whelmed by the rapidity of change. But we are not the only ones suffering from future shock, so are entire institutions, as they try to understand where it’s all going, and where they stand in it. Health 2.0 to Gruen is all about the bringing together of content, context and community: valuable health information, with “what’s it mean to me” and the ditching of the lecture for a conversation with others.
One other hot spot for the day was the energizing presentation given by Vijay Govindarajan (Professor of International Business’ Tuck School of Business) and author of the book 10 Rules for Strategic Innovators. His provocative comments on goal setting for the true strategic futurist — “set unrealistic goals!” — along with his exhortations for bottom-up thinking, looking beyond the present challenges to what health care could be, and getting on with it — a call for action — couldn’t have been better timed.
More tomorrow.
by Fred Fortin
November 29, 2007 at 1:01 am · Filed under Uncategorized, Electronic Medical Records
Just briefly, I want to talk about the electronic medical record (EMR) from the point of view of patient expectations of how they will be managed. We ‘ve talked about errors in the record, as well as the complexity of the privacy issues. And for the record, I want to repeat what Fred Trotter wrote as it concerned Microsoft’s new Health Vault:
Medical records belong to the patient, except when they don’t. They should be accessible to the patient except when they shouldn’t. The records of minors are always open to their guardians except when they are closed. Segmenting data in order to protect portions of health information is currently an intractable problem of free-text analysis. Tagging patient records with critical information is difficult. Trust is far more complex than is first seems. Finally, patients should be allowed to “control” their own record, except when that control would allow them to do something that would invalidate the record.
But the question I have concerns that of omissions and completeness. Will patients have different expectations of doctors and hospitals once they know they’ve converted from paper to electronic medical records? Will the EMR take on a different status of sorts in the patient’s mind? In the old days (most of which are still with us) the patient knew that his or her paper record was scattered about the different providers, and for most, there was no single, all encompassing medical record. But the vision and the hype for electronic medical records is just that — if there’s an emergency, a hurricane, or you are on vacation without your medication, your info will be at hand through the net.
But as we know, that will not be the case most times. Either by design, incompatibility, law, or systems failure, something will be missing. Will it be important information? Who knows. But the public, as it has with banks, credit cards and other electronic dependencies, may believe it to be complete. They may, in fact, have a view of EMRs that is more in line with the industry’s marketing image than with the intricacies or record-keeping reality.
by Fred Fortin
November 9, 2007 at 1:57 am · Filed under Uncategorized, Policy Makers, Regulators, Transparency/Public Disclosure, Electronic Medical Records
Fred Trotter wants to talk to you about Microsoft’s new Health Vault (MHV).
He hopes that by publishing his concerns that he might be able to draw some attention from the medical community to what the free software community is saying about MHV. “Its something of a blind date,” he says “but I strongly believe the two of them should definitely meet!”
Specifically, Trotter wants to examine the implications of a proprietary software personal health record (PHR) on software freedom and his concerns about the ownership, privacy and security of the medical information put in it. He writes,
“The ideals of software freedom are that users should have control of software, rather than companies controlling users through software. It may seem like a trivial point to my geek readers, but without control of software it is not possible to have control of data.”
His arguments span a number of issues:
- MHV fails in its commitment to maintaining the longevity of medical information across future generations (the seven generations test, he calls it), a commitment that is vitally necessary to understanding of DNA and its relevance to medical conditions over time, for example;
- A private, for-profit, corporation is an inappropriate storehouse for records that future generations will need;
- Microsoft has a long history of standards abuse and “famous” for incorrectly implementing standards and creating new incompatible “dialects”;
- Portions of medical records operate under different disclosure rules based on whether they reveal a persons HIV status, for example. How can this kind of complexity be managed he asks?
“Medical records belong to the patient, except when they don’t. They should be accessible to the patient except when they shouldn’t. The records of minors are always open to their guardians except when they are closed. Segmenting data in order to protect portions of health information is currently an intractable problem of free-text analysis. Tagging patient records with critical information is difficult. Trust is far more complex than is first seems. Finally, patients should be allowed to “control” their own record, except when that control would allow them to do something that would invalidate the record.”
And finally, he argues that the publicized attestations as to the privacy and security of health information in MVH have not been really validated. “What matters” according to Trotter, is not what Microsoft, or anyone says, but “what the software actually does and the only way to determine this, one way or another is to read the source code.”
The mistake he argues, is that we, the medical community, are assuming the issues with MHV and PHRs are legal/medical and ethical ones rather than legal/medical/ethical and technical problems.
We may want to take a listen to what he has to say.
by Tony Chen
October 18, 2007 at 12:52 pm · Filed under Business of Health, Electronic Medical Records
We’ve been anxiously watching Google and Microsoft developments into the healthcare arena. Just a few weeks ago, both Vince and I reported on Microsoft’s new HealthVault product. Fred also had a nice post on Google’s PHR challenge.
Yesterday, Google’s new health chief, Marisa Mayer gave us a few more hints on where Google is heading:
“If you look at health care, there’s already a huge user need, people are already using Google more than any other tool on the Web to find health information… And the health care industry generates a huge amount of information every year. It’s a natural core competency for us, to understand how to organize all that data”
Mayer also addresses physicians:
“The goal for a lot of doctors is how many patients can they see in a day… That means their minutes per patient has got to go down, and the less time they have to spend finding and going over patient records the better. Ultimately we will design a product that’s useful for users, and also helps doctors do their job more quickly and more efficiently.”
Mayer also confirmed that they are testing a prototype platform that includes: personal medical records, health care-related search features, diet and exercise regimens, a localized “find a doctor” application.
A few observations:
- Interesting that Google has their search guru leading this healthcare vertical (versus a healthcare person, tech/engineer person, or a product management person).
- Google’s strategy seems to be quite similar to Microsoft (or maybe it’s vice versa). Scratch the two biggest consumer healthcare itches - proactive health management & proactive health info search. However, Google acknowledged and addressed physicians also. Yes, consumer-driven healthcare will be big, but it will play out differently in healthcare. Google realizes it has to meet the needs of two sets of customers: consumers and physicians. I think Microsoft gets this, too, though their Azyzzi efforts seem to be untied to Health Vault.
- I’m still uncomfortable with the idea of having Google (or Microsoft) managing/storing my health records, anyone else feel the same way?
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