The Internet is abuzz over Google’s (s goog) release of the open-source version of its Chrome OS, and for good reason. It’s free, which will save hardware manufacturers licensing fees, and it appears ideally suited for the netbooks that have become such a hot item for the mobile crowd (GigaOM Pro, sub. required). But Chrome is not without its detractors, and it’s worth remembering that Google isn’t King Midas — in fact, there’s a substantial list of Google products and services that have flopped, floundered or simply disappeared into the ether. Here are a few of the most memorable:

• Google Lively was a web-based virtual environment that allowed as many as 20 people to sit in a virtual room and chat with each other. The offering debuted in July 2008 only to have Google pull the plug a mere four months later.
• Google Print Ads was dropped earlier this year after the company’s vision of bringing web-like automation to the world of traditional media failed to materialize. The effort went belly-up just three weeks before the death of Google Audio Ads, which ended a three-year run in February after the company failed to gain traction in the radio ad game.
• Google Answers spent a year in beta before a full-blown launch in May 2003, but the effort to create a fee-based knowledge market never gained much traction outside a small base of users and the service was dropped in late 2006.
• The social networking site Orkut launched early in 2004 as an independent project of noted Google developer Orkut Büyükkökten and has caught fire in Brazil, a market that accounts for roughly 50 percent of its membership. The site reportedly claims roughly 100 million users, which is impressive, but Google can’t be happy that its effort is virtually unknown in Europe and North America while Facebook, LinkedIn, MySpace and others have gained such impressive traction.
• Google Catalog Search debuted in 2001 as a way for consumers to go online to check out their favorite print catalogs that had been scanned and uploaded. Of course, retailers were already taking their inventories online themselves, and the effort was put to rest earlier this year.
• Google Health was released as a beta test in May 2008, but the service has yet to find much of an audience among insurers or the general public. Which may have something to do with the combination of the words “health” and “beta test.”
• The location-based service Dodgeball was shut down in 2009 after Google had acquired it four years earlier, and while Google continues to operate Jaiku – a social networking service it picked up in 2007 — the company has effectively abandoned the project. The technologies and expertise from both startups is being incorporated into other Google businesses and projects, however.

No company bats 1.000, of course, and a company as experimental and entrepreneurial as Google is bound to have its share of failures. As the blogosphere gushes over Chrome, though, Google’s stumbles help provide some perspective. Are there any other names that should be on this list?

On November 16, 2009, Joseph Shapiro had an interesting story on NPR about patients turning to online communities for health information. I recommend you check it out at http://www.npr.org/templates/story/story.php?storyId=120381580.

Here’s an excerpt from the story:

According to a recent survey by the Pew Internet and American Life Project, 61 percent of adults say they look online for health information. There’s a term for them: e-patients.

About 20 percent of e-patients go to Internet and social-networking sites where they can talk to medical experts and other patients, says Susannah Fox, with the Pew Internet and American Life Project.

“They are posting their first-person accounts of treatments and side effects from medications,” says Fox. “They are recording and posting those podcasts. They’re tagging content. They are part of the conversation. And that, I think, is an indicator of where we could be going in terms of the future of participatory medicine.”

Fox says patients are far ahead of doctors and hospitals when it comes to using the Internet. According to a study in the New England Journal of Medicine last year, only about 17 percent of doctors say they use computerized medical records. (Source: Joseph Shapiro, “Patients Turn to Online Communities for Help Healing,” NPR, November 16, 2009)

To hear the story on NPR or to read the manuscript, go to http://www.npr.org/templates/story/story.php?storyId=120381580.

Post by Dan Dunlop, The Healthcare Marketer

For many people, getting started with Total Recall means taking charge of their personal health information. Here are a few options for you to check out:

• Google Health lets your store your health data online. You can import data from some partner hospitals and pharmacies.
• Microsoft HealthVault also lets you store your health data online. A number of devices can upload data to your account. Some third party sites and applications use HealthVault for storage.
• Minerva Health Manager stores your health records on your PC, and also on a USB stick to share with a hospital, new doctor, etc.
• Polka’s My Health has a web-based interface that synchronizes with SmartPhones

From Total Recall blog

Are you having trouble remembering when you started taking digestive enzymes to control your indigestion? When was the last time you took a systemic enzyme for joint pain, and what was the name of that product?

If you’re having trouble remembering your health history, or you just want to keep tabs on lifestyle and supplement choices, Google Health might help.

At www.google.com/health, consumers have the opportunity to record their use of health care services, products and spending. This personal information can then be sent to health practices, or, practices can send information to individualized Google files.

The landing page of Google Health also includes a link that allows users to search for health services. Google Health might provide patients and health care practitioners with more accurate drug, supplement and treatment histories.

Google Health is a personal health information centralization service (sometimes known as personal health record services) by Google. The service allows Google users to volunteer their health records – either manually or by logging into their accounts at partnered health services providers – into the Google Health system, thereby merging potentially separate health records into one centralized Google Health profile. Volunteered information can include health conditions, medications, allergies, and lab results. Once entered, Google Health uses the information to provide the user with a merged health record, information on conditions, and possible interactions between drugs, conditions, and allergies. (source)

Well, how does Google Health works? Take a tour to check what does it actually offer.

In this post, I’d like to share with you the main reason why I like Google Health, which is a share profile feature enabling its users to invite others they trust (whether it’s a family member, a trusted care network provider, friends, and/or a doctor) to view their medical records and personal health information.  It’s pretty easy. If you have already signed up a Google Health account, click on “Share this Profile,” and type in the email address of the person with whom you’d like to share your profile. Google Health will send an email to them with a link to view your profile. The link will only work in connection with the email address of that person — your profile can’t be accessed if the link is forwarded on. You can stop sharing at any time, and you can always see who has access to your information. Those who are viewing your profile can only see the profile you share — not any other one in your account.

There are also some extra protections to make sure your health information stays safe, private, and under your control:

• The sharing link in the email expires after 30 days, but the sharing access itself does not expire — it will stay in place until the user decides to stop sharing
• Viewers can only see — not edit — your Google Health profile
• You can review a user activity report to see who has viewed your profile

In my opinion, I feel that Google Health can contribute as part of Government 2.0. But this is subject to the level of trust given by the government on a public listed company. Anyway, I hope this piece of information helps =)

This has been a year that I will not be sad when it is laid to rest.

In June I fractured my right heel while hiking in Tevas. (Note to self, if you are hiking, where hiking boots!). July rolls around, a number of stressful events occur and I end up with some sort of stress related, intestinal nightmare. Been on Prilosec for last couple of months, saw GI last week, endo scheduled for mid-December.  Then, in a charitable act I do the local benefit ride, Hub on Wheels, only to go down in a wet corner, fracturing right wrist and receiving a nasty laceration above right eye.

How many separate institutions have been involved in my care over the last six or so months (physicians, clinics, lab and hospitals)?

Heel, 2: Radiologist and podiatrist, each separate practices.

Intestinal problem, 2: Primary care doctor (clinic), lab work, (clinic), specialist (Boston Medical Center).

Bike crash, 2: Trauma/ER (Brigham & Women’s), plastic surgeon (Faulkner Hosp.), orthopedist (brigham & Women’s).

Six separate institutions, each with their own separate systems, distinct policies and procedures for gaining access to/copies of one’s records.  And in my initial inquiries, I’ve yet to find any of these institutions that will provide my records neatly packaged in a common CCD or CCR format on a CD or USB that I could then easily upload into my personal health platform (PHP).  All institutions stated I can certainly get a copy, but it will require going to separate offices, facilities, filling out release forms what have you to get those records, and they will be, rum roll please…

on paper.

Since none of the institutions mentioned above have a relationship with either Google Health or HealthVault, if I want my information stored in one of these accounts, I will have to enter the information myself or use one of the services on these platforms (Health Postbox Express or yourHealth), which you can send your records to (or automatically retrieved from your clinician) and they’ll upload your personal health records for a small fee.

My God that seems like a lot of work. I work in this industry and find this task of collecting my records daunting.  Is it any wonder that consumer adoption of these platforms and PHRs in general is so lackluster?

There is a sliver of hope in that the meaningful use requirements for HIT adoption under ARRA do support consumer access to their records and better yet that physicians provide their customers a PHR in 2013 (still don’t know what that PHR might be, could be a disaster if it is nothing more than a tethered, portal view into EMR), but that still does not overcome the basic challenge for just about anyone:

• How do I get copies of my records?
• How do I know my records are complete and accurate?
• If the records are incomplete or inaccurate, how do I rectify?
• What format (standard) should I ask for if I have a choice?
• How do I get these records into my personal health record account?

These may seem like basic questions, but they are very real and there is no clear and compelling document out there today (if you find one please provide a link in comments section) that lays it out in plain English (or other language of your choice).

Google Health, HealthVault, WebMD, Dossia and PHR vendors are you listening?

What the market needs, heck what I need is a clear and concise QuickStart Guide that addresses the questions above. Any takers?

Sean Khozin är läkare på i Brooklyn och medvetet på digitala tjänster i kontakten med sina patienter. På Hello Health kan man både boka antigen vanlig mottagningstid eller videomöte med sin läkare. Hans system är helt integrerat med Google Health. Många av lösningarna som dr Khozin använder är anpassade för den amerikanska sjukvården. Finansieringssystemet i USA skiljer sig som bekant mycket från det svenska systemet. Vi följer hans blogg med stort intresse för att kunna låna bra idéer!

Another Health 2.0 Conference has come to pass and with broken wrist limiting typing fluidity, going to keep this synopsis short and sweet.

Not sure who said first impressions are lasting impressions, but coming up on the facilities that were to house this year’s Health 2.0 conference, I had a moment of trepidation upon seeing the signage for Health 2.0 (yes, the picture to right is real) with a back-drop of a funky auto parts and repair store across the street.  Once in the cavernous hall (note to self – cavernous halls should not concurrently house exhibits and stage) all went smoothly until one opened up the laptop and alas, no Wi-fi (actually there ended up being sporadic service but it was so bad as to be almost worthless).  An event focusing on Internet tools for health and no Wi-fi – am I in some sort of perverse David Lynch movie?

On to the event itself…

Highlights:

The Health 2.0 Accelerator demonstration was pretty impressive.  In the demonstration, nine different applications were used in a fairly seamless fashion to facilitate a consumer’s interaction with the healthcare system. A simple, yet powerful demonstration of what is possible when independent software vendors (ISVs) agree on some basic open standards, in this case OAuth and CCR to securely move data around a network. This example, while still a little too cumbersome or most consumers, points us in the right direction and might make an ideal case for the Health Internet.

Ability to meet many innovators in one place.  Health 2.0 is really the only game in town today that draws a wide range of innovators to one location.  J.D. Kleinke wrote a very good post on the event where he thought maybe the event was becoming a little too corporate.  I really do not see much problem with that, in fact, would like to see more realism demonstrated by these innovators through their articulation of clear and compelling business models, but I digress.

Best Demo: A tie, HealthVault & Quicken Health are the hands-down winners for best demos (outside of the Accelerator mentioned above).  HealthVault demonstrated their new “widget store” that is available within one’s personal MSN Health & Wellness account.  Leveraging data that one has in their HealthVault account, the MSN health widgets make that data truly actionable.  Over time, one can envision a health “AppStore” in MSN Health quite similar to Apple’s AppStore for the iPhone where ISVs build a wide range of health apps for the consumer that can be readily accessed all in one place.

While I have always had reservations about Quicken Health (too limited, only addresses one problem, financial) was very impressed with the architecture of the application.  Beautiful user interface, very nice tools built right in (e.g. hover over a given lab and you get a brief abstract of the lab test and its purpose). Another nice feature was the ability to contest claims, electronically, right from within Quicken.  Having dealt with many a mis-labeled/assessed claim before, that feature alone (no more voicemail hell) practically sold me on getting this app when it is released later this year.  Upon further thought though, better check with my payer first to see if they even would allow me to contest a claim electronically.

Excellent briefings with several companies including an update with Google Health, a deep and thoughtful dive with Within3 (keep track of them, they may have something if they move fast enough), a good update from Allviant (product CarePass is in beta), a great conversation, as always, with the folks of Polka and a surprising interview (amazed at how far they have come, more in near future) with MedHelp (another one to watch).

Disappointments:

While the Health 2.0 Accelerator succeeded, the Clinical Groupware session failed.  First off, I am not sure those in the audience fully understood what the term “clinical groupware” means and why it is important to consider.  Second, there was almost no discussion on what type of underlying architecture is required to make apps run in a clinical groupware environment.  So what we were left with was some very broad statements that clinical groupware is good for you, good for the industry, etc. but nothing about how it would actually work. Then there were the vendors in this session that did little to further the discussion.  Instead of demonstrating data sharing and substitutability of their apps, key tenets for clinical groupware to work, we were shown apps working in isolation.

Payers certainly have a voice in the healthcare discussion but do they really have a voice in the Health 2.0 discussion.  Certainly the organizers of this event think so but I differ.  Ultimately, it is employers that are footing the bill and have the most to potentially gain in offering their employees such tools.  And if not employers, how about the benefits consultants who advise them?  Getting quite tired of sessions composed of payers talking about how they always want to do good for their members.  Let’s be real, they want to maintain and/or improve margins and few consumers trust them.

The apparent fawning over the latest Health 2.0 rock star(s).  At the Spring event it was Jay Parkinson and Hello Health.  This fall it appeared that we had two: Roy Schoenberg of American Well and Adam Bosworth of Keas.  I’ll give credit to American Well to at least having a product/service in the market, but do they really need to be placed on a pedestal as the poster child for telemedicine? Roy is extremely polished and presents well, but hey, they are far from being the only game in town and not sure why they had two separate stage apearances, one on each day.  As for Adam and Keas, Adam certainly has a great publicist (gets an article on Keas in the NY Times on the first day of Health 2.0, coincidence, I doubt it) and is well known in IT circles, but he has also been extremely slow in introducing his product – suppose to go GA sometime this month.  So here we have a company founder without a live product in the market again being invited up on stage on two separate occasions.  Why, I can’t figure it out as my initial assessment of Keas is that it is a fairly simple product with low barriers for competing products (e.g., if Google put their mind to it, they could do the same with their search features and Google Health pretty easily).

The venue was just a disaster, enuf said.

Where are the established HIT companies, where are the intersections between these traditional ISVs that ultimately hold the data and these Health 2.0 ISVs looking to get their hands on it to power their services.  Bridges need to be built as today, Health 2.0 sits like an island, isolated in a very broad sea.

Wrap-up:

Health 2.0 is a great networking event.  Just about everyone in this particularly market is there and its always good to connect with people face-to-face as phone calls, emails, etc. only go so far.  Content of sessions though is a very mixed bag and appears highly slanted to those vendors who pay to play (sponsors, exhibitors, etc.) and not as expansive as it could be.  Hopefully, like many things in life, the organizers of this Fall’s Health 2.0 will learn from the many mistakes made and the next one will bring more value to attendees.

In this post, I will talk about working with the open source zend framework and Google Health API . The zend framework offers an elegant method to access health data and post notices. I will talk about using the ClientLogin method first. ClientLogin method is recommended for desktop applications by Google. This post is based on the zend framework documentation and Google health API documentation.

The zend packages are available from Fedora repositories.

Authentication

Authentication is the first step in working with Gdata. The ClientLogin method uses standard username and password for authentication. We will be using the developers sandbox (https://www.google.com/h9) for our testing. The authentication code could be:


function authenticate()
{
$user = "user@gmail.com";
$pass = "passwd";
$h9service = Zend_Gdata_Health :: H9_SANDBOX_SERVICE_NAME;
$client = Zend_Gdata_ClientLogin :: getHttpClient($user, $pass, $h9service);
return $client;
}


This code creates a http client using the ClientLogin mechanism for the H9 sandbox service and returns the client. This should be your first step.

Health Service

The next step is to create a Google health service client from the http client. This could be the code:


$client = authenticate();
$useH9 = true;
$healthService = new Zend_Gdata_Health($client, "MyService", $useH9);


In this code block we call the authenticate() function to get the http client and create a health service client.

Profile List Feeds

ClientLogin Mechanism requires that we extract the profile ID for subsequent queries. It provides profile list feed from which we extract the profile we want.

The register feed is:

https://www.google.com/health/feeds/register/ui/profileID

The profile feed is:

https://www.google.com/health/feeds/profile/ui/profileID

Since one user can have more than one profile ID in Google Health, we need to extract the profile ID we need. For ClientLogin mechanism, we need to set the profile ID for the health service client. In the following code, we extract the profile from profile list feed and set the first profile ID for the health service:


$feed = $healthService->getHealthProfileListFeed();
$entries = $feed->getEntries();
$profileID = $feed->entry[0]->getProfileID;
$healthService->setProfileID->($profileID)


In the code above, we use the profile list feed to enlist all the profiles for a particular user. This feed is available only under ClientLogin authentication mechanism.

Feeds and Queries

Now that we have the profile ID, we can get all the CCR entries from the feed. To do so, we construct a query and use that query to get all the feed entries


$query = new Zend_Gdata_Health_Query("https://www.google.com/h9/feeds/profile/ui/$profileID");
$profileFeed = $healthService->getHealthProfileFeed($query);
foreach ($profileFeed->getEntries() as $entry) {
$ccr = $entry->getCcr();
echo '<p>' . $ccr->getXML() . '</p>';
$count++;
}


In the code above, we just print the CCR entries in XML format. If you want to print text of, say medication, you could use this code:


$query = new Zend_Gdata_Health_Query(SCOPE . "profile/ui/$profileID");
$query->setDigest("true");
$profileFeed = $healthService->getHealthProfileFeed($query);
$entries = $profileFeed->getEntries();
foreach ($entries as $entry) {
$medications = $entry->getCcr()->getMedications();
foreach($medications as $med) {
$xpath = new DOMXpath($med->ownerDocument);
$elements = $xpath->query("//ccr:Medications/ccr:Medication/ccr:Product/ccr:ProductName/ccr:Text");
foreach ($elements as $element) {
echo $element->nodeValue . '<br>';
}
}
}


In the code, above we use setDigest to get the entire feed as one entry. Hence it will loop only once here. We then use DOMXpath object to query the CCR text. We could get text of other categories this way.

Sending Notices

You can send notices to the profile which can be as simple as a text message or can optionally include a CCR element. I will just point out that it is very simple to send these. It is just one call.


$subject = "This is my subject";
$body = " This is the message ";

$healthService->sendHealthNotice($subject, $body);


Its as simple as that.

This concludes this post. In the next post, I will talk about other methods of authentication. This post should hopefully help anyone to get started on the Gdata API immediately.

When you visit a doctor, he asks for the previous medical prescriptions to review your report. Most of the time, you either forget to bring the report, or you have lost it. In such a situation, your doctor does the same tests and check ups that you have already gone through. Your time, and money are wasted and you get the same medical report that you had before. What if you could organize and up-to-date your medical report and other relevant information at one place – don’t get surprised, this is now possible for you to store and organize all your medical reports and documents online.

Google health is a new feature from Google that allows users to store, organize and up-to-date all medical information. This application is safe, secure and above all, it is absolutely free. Below are some simple steps that you need to follow in order to get access to the Google health. .

1. Sign up: Browse the Google health page. If you have a gmail account, you can directly sign in to it – however, you can create an account easily in no time. Login to you account and get access to the Google health.

2. Track medical history and find more about disease conditions:Create your own google health profile. Enter conditions, medications and allergies, if any. You can also click the reference links that are available on the site and read more about symptoms, causes and treatments of diseases, which are of your interest.

3. Import your medical document reports: Google health has partnered with various hospitals, labs and pharmacies. You can import your records from health care providers by linking with their site.

4. View your medical history: You can view a summary of your medical history on the net.

5. Analyze your medical record: When you update your medical records, Google health checks for potential interactions between drugs, allergies and disease conditions. Review them and see if there is any issue you can discuss with your doctor when you visit him.

6. Make your health information more effective: Refill medical records online – you can also ask for second opinion or get customized health information based on the profile you have created.

7. Search for health professionals and hospitals: You can search doctors online based on specialty and location.

Chilmark has not been a big fan of the National Health Information Network (NHIN) concept. It was, and in large part still is, a top heavy federal government effort to create a nationwide infrastructure to facilitate the exchange of clinical information. A high, lofty and admirable goal, but one that is far too in front of where the market is today.  The NHIN is like putting in an interstate highway system (something that did not happen until Eisenhower came to office) when we are still traveling by horse and buggy. Chilmark has argued for a more measured approach beginning locally via HIEs established by IDNs (our favorite as there is a clear and compelling business case) and RHIOs in regions where competitors willingly chose not to compete on data, rather seeing value in sharing data.

But what might happen if the folks in DC stopped talking about the NHIN as some uber-Health Exchange, but instead positioned it as a consumer-focused platform?

That is basically what happened yesterday at the ITdotHealth event where the new federal CTO, Aneesh Chopra and new HHS CTO Todd Park presented their conceptual idea to a pretty select group who had gathered together to discuss the idea of platforms in HIT to support discrete, substitutable, modular apps. (John Halamka gave a nice write-up of the event in which he participated on the first day).  Chopra and Park were seeking to float this idea among the movers and shakers of new models for HIT, gauge the interest and ultimately solicit support for the concept.

In somewhat of a re-branding exercise. Chopra and Park are proposing that the NHIN now be viewed not so much as solely a clinician to clinician care coordination exchange platform but rather one that also will focus on the consumer, creating a secure Health Internet to facilitate consumer access to and ultimately control of their personal health information (PHI). The basic NHIN, let’s now refer to it the Health Internet, is still composed of the same technology stack: platform independent, open source, freely available with published standards, etc. that support an independent software vendor’s (ISV) ability to build apps upon the Health Internet stack for consumer consumption (e.g., health & wellness services, PHRs, etc.). In June, we attended the NHIN CONNECT conference and our write-up provides a few more specifics on the Health Internet.

At the ITdotHealth event many of the participants (Google Health, HealthVault, MinuteClinic, etc.) stated that they “are in” and are willing to work with the feds to insure that their respective platforms/services will be able to readily connect to and exchange PHI upon a consumer’s request over the Health Internet.  Even EMR giant Cerner voted tentative support for the idea if the Health Internet would assist them in helping their customers (clinicians, clinics, hospitals) meet some of the forthcoming meaningful use criteria that is now being formulated by CMS – Chopra at the June CONNECT event and Park at this one basically inferred that providing the capability for an EHR to connect to the Health Internet would address some aspects of meaningful use.

Chopra also stated that he has the support of numerous federal agencies (DoD, CMS, and other agencies) who are now working together with HHS to define how the Health Internet might serve their respective constituents.  These agencies have not yet formally committed to allowing PHI to migrate to the Health Internet, but today are addressing the critical process issues of consumer access, control, and consent as it pertains to on-ramping PHI to the Health Internet. Chilmark believes that these issues will be resolved within the year.  When that happens, we can expect some pretty significant movement of PHI across the Health Internet.  For example, the DoD alone has nearly 4M active duty members (multiply that by 2.2 for dependents and the number skyrockets to over 8M) whose PHI may begin to flow on the Health Internet.

And it is not just Google Health, HealthVault or others that may be beneficiaries of the Health Internet.  In speaking with a representative of the VA (yes, VA is a supporter as well) he related that this will allow veterans an opportunity to choose the best services out there in the market to assist them in managing their health.  No longer will the VA have to try and create such apps themselves, or find partners to create the apps to sit on top of the VA PHR HealtheVet. Instead, the VA can simply direct a veteran to the Health Internet where such services will reside and instruct a vet as to how to access those services.

This is exactly what Chopra and Park envision with Chopra adamantly stating at the beginning of his talk that they seek, through the Health Internet, the creation of a fertile environment where innovation can flourish and ultimately consumers will benefit.

Finally, HHS & the Feds are Talking About the Consumer

Chilmark has been quite disheartened as of late with the lack of attention paid to the consumer, the citizen who is footing the bill to get doctors and hospitals wired.  We chided the HIT Policy workgroup for HIEs for their complete lack of acknowledging the consumer’s role and ownership of PHI.  We came back from DC recently disillusioned at the nearly myopic focus of ONC on clinicians.  Chilmark is concerned that the $44k allotted to a physician to adopt an EHR is not enough, another forcing function is required and what better forcing function than the citizen, the customer of the physician to drive adoption of EHRs.

Low and behold others at HHS and elsewhere had similar feelings and are now moving aggressively forward with a concept that directly addresses the consumer. Hallelujah!

The Plan:

At the ITdotHealth meeting, Park and Chopra stated that if interest is high (sure seemed to be at this meeting), they wanted to take that feedback back to DC and work with the federal team to start laying the groundwork to get started ASAP.  Hypothesized goals and objectives include:

The federal team will begin by working with industry stakeholders (PHR providers, EMR providers, services, hospitals, fed agencies, etc.) to identify the gaps, determine if the existing protocols are adequate and lay-out a roadmap to rectify. They also stress that they will seek involvement of consumer representatives and privacy advocates to insure their input is included early on in the process.

By February 2010, begin filling the gaps and modify protocols and standards where necessary.

Launch beta in early Q2′10 moving mock PHI over the Health Internet to test the system, make modifications and hardened the network.

Though they did not go so far as to say when the Health Internet will move live PHI, our estimate, assuming all goes relatively smoothly, is that the Health Internet will be open for business by late Q2-early Q3′10.  This is a very fast track for the Health Internet, but certainly doable as the core infrastructure is already in place and this exercise is more of a fine tuning effort, than building from scratch.

Putting on the Pragmatist Hat:

Chilmark is very encouraged by the idea of the Health Internet and the new direction it is taking, creating a consumer directed and controlled interstate for the secure transfer of PHI. Not only does it finally acknowledge that at the end of the day, all the HIT spending in the world will make little difference if we do not get the one who has the most to gain, the consumer, involved, but this initiative may also create a fertile environment for innovation to occur.

But there are some challenges ahead for the Health Internet, which include:

The DURSA (Data Use & Reciprocal Support Agreement), which all NHIN (Health Internet) users (data providers, services, ISVs, etc) must sign to participate, stipulates that participants must abide by HIPAA requirements. Now HealthVault is on record stating that they have no problem with HIPAA, but Google is another story where they have been fairly adamant that HIPAA does not apply to them.  Will Google now agree to HIPAA?  And what about other ISVs and service providers, will they adhere to the requirements in the DURSA?

Beyond the feds and HIPAA requirements, there is a morass of state-specific laws as it pertains to the release of PHI, many of which go far beyond HIPAA in  their requirements.  As the Health Internet looks to create one common “health interstate” for the movement of PHI, how will these state laws be reconciled to allow this to occur?

Lastly, there is the issue of bringing awareness to the public.  While the vast majority of consumers use Google for a second opinion, very few use the Internet to store, access and share their records.  Very few even know what a PHR is.  Whenever the topic is raised in conversations with lay people, maybe one person might have heard of Google Health or HealthVault, but it is a rare person indeed that has any understanding what these services are for and why they might be interested in using such a service. This may ultimately be one of the biggest challenges for Chopra and Park, but to their credit, they are making the right moves now, garnering industry backing who can assist them in “getting the message out.”

Chilmark Research will assist as best it can from its vantage point.

Aneesh and Todd, we are in!

Pertama kali dirilis tahun 2006, Google Health yang dapat diakses di https://www.google.com/health berawal dari gagasan untuk menyimpan dan memanajemen data terkait kondisi kesehatan seseorang dalam format yang lebih praktis. Aplikasi kesehatan gratis buatan Google ini dapat digunakan oleh seluruh pemilik akun Google (dan diklaim aman oleh Google). Terlepas dari isyu privasi, keamanan dan lain-lain, bagaimana dengan implementasi Google Health di Indonesia? Pertama, siapkah kita?

Google sendiri adalah sebuah korporasi yang bermarkas di US, sebuah negara dengan sistem kesehatan yang telah “tertata rapi”. Salah satu fitur aplikasi Google Health di antaranya adalah mengimpor rekam medis (dari fasilitas pelayanan kesehatan yang berafiliasi dengan Google atau memasukkannya secara manual jika fasilitas pelayanan kesehatan kita belum bekerja sama dengan Google Health).

Jika entry data/informasi kesehatan dilakukan dengan baik dan teratur, dengan menggunakan aplikasi ini, pengguna (dan jika diinginkan, dokter yang melayani pengguna) dengan mudah dapat memantau riwayat medisnya. Pengguna juga dapat melihat kemungkinan interaksi obat yang sedang, telah atau akan dikonsumsinya. Google Health akan memberikan pemberitahuan mengenai kemungkinan interaksi obat tersebut.

Masih tentang obat, obat atau medikasi yang akan dimasukkan ke dalam profil pasien tersebut juga dapat berupa merk obat yang sudah terdapat di register Google Health (obat yang dipasarkan di US) atau diisikan secara manual. Untuk obat yang diisikan dengan cara kedua, analisis interaksi obat belum dapat dilakukan.Namun hal ini dapat diantisipasi dengan cara memasukkan komposisi obat tersebut alih-alih merk obat. Satu hal yang penting untuk diperhatikan adalah :

“Fungsi Google Health adalah untuk membantu penggunanya menyimpan dan memanajemen informasi kesehatannya, dan mempermudah aksesnya, bukan untuk membuat keputusan medis”

Fasilitas yang terdapat dalam Google Health dapat dimanfaatkan secara optimal ketika sistem dokter keluarga (family physician), sistem asuransi kesehatan (health insurance system), sistem informasi kesehatan telah berjalan dengan baik dan masyarakat telah sadar dan paham akan kesehatan, rekam medis dan hak-hak pasien terkait dengan rekam medis dan kesehatan.

Menurut Peraturan Menteri Kesehatan no. 269 tahun 2008, rekam medis merupakan milik pasien dan bersifat rahasia. Sehingga rekam medis dapat memberikan manfaat bagi pasien tersebut secara legal, medis maupun kepentingan lainnya. Sifat rahasia rekam medis bersifat tidak absolut, artinya rekam medis dapat dibuka untuk kepentingan hukum, ilmu pengetahuan atau berdasarkan permintaan atau izin dari pemilik (pasien yang bersangkutan). Pasien juga berhak untuk memiliki salinan rekam medisnya, namun hak yang satu ini jarang sekali diketahui dan digunakan oleh pasien. Sehingga memiliki rekam medis secara online di aplikasi online seperti Google Health adalah salah satu hak pasien.

Sedangkan yang termasuk di dalam sistem informasi kesehatan adalah sistem pencatatan kesehatan seperti pencatatan obat yang dibeli oleh pasien di apotik, pencatatan rekam medis elektronik di klinik dan sebagainya. Google Health bekerja sama secara non komersial dengan beberapa instansi kesehatan seperti klinik dan apotik di US terkait dengan rekam medis pasien seperti. Fitur impor data dari instansi-instansi tersebut ini tentu saja didukung oleh sistem pencatatan kesehatan elektronik yang telah tertata baik. Fitur impor ini tentu saja belum dapat digunakan secara optimal (atau mungkin malah tidak sama sekali) oleh masyarakat Indonesia pengguna Google Health.

Berikut beberapa tautan terkait dengan rekam medis online dan Google Health yang sekiranya dapat memberikan masukan yang berguna :

1. Akhirnya Datang Juga: Google Health
http://anisfuad.wordpress.com/2008/05/21/akhirnya-datang-juga-google-health/

2. Google Health About
http://www.google.com/intl/en-US/health/about/index.html

3. Google Health – How to implement it in Singapore (or other countries) http://bleongcw.typepad.com/simple_is_the_reason_of_m/2008/05/google-health.html

4. Mencoba Google Health, Rekam Medis Elektronik
http://daniiswara.net/2008/05/21/mencoba-google-health-rekam-medis-elektronik/

5. Feature Baru Google Health
http://www.chip.co.id/internet-networking/feature-baru-google-health.html

6. Online Health Records: What’s the Big Deal?
http://www.accessmyhealth.org/documents/How%20safe%20are%20my%20records.pdf

7. Americans Overwhelmingly Believe Electronic Personal Health Records Improve their Health
http://www.connectingforhealth.org/resources/ResearchBrief-200806.pdf

Post ini diambil dari blog saya sebelumnya. Saya sedang menimbang-nimbang kelebihan dan kekurangan kedua blog tersebut untuk dinobatkan sebagai blog permanen Mohon masukannya ya..

On September 14th, Children’s Hospital of Boston made a joint announcement with eClinicalWorks (eCW) whereby ambulatory practices affiliated with Children’s using eCW will be able to export patient data into “MyChildren’s.” MyChildren’s is the personal health platform (PHP) that Children’s Hospital provides for its customers and is based on Indivo, the open source PHP that was developed at Children’s and is the foundation for Dossia.  On Friday, Sept 18th, Chilmark Research had the opportunity to speak with the key people at Children’s who are behind this initiative (Dan Nigrin, CIO, Greg Young, heads up PPOC (affiliated practices) and Ken Mandl, Harvard Prof and key person behind Indivo) to gain a better understanding of what they are doing and its significance. Here’s what we learned.

Some background:

Children’s Hospital, which is affiliated with Harvard has the Children’s Hospital Informatics Program (CHIP) which developed the Indivo platform and has always been a very strong advocate of the concept of the “patient-controlled medical record.”  Their initial work, both technology and policy, led to Microsoft’s HealthVault, Google Health and Dossia, all of whom have adopted similar platform models and policies regarding consumer access and control of their personal health information (PHI).

About 3 years ago, Children’s group of affiliated ambulatory practices, PPOC, (about 75 in all) made the joint decision to go digital and adopt an EMR solution, in this case eCW in a hosted delivery model (ASP).  Today, the majority are now live with eCW and the balance, with exception of ~5 practices who have chosen not to adopt, will be live by Sept 2010.  Children’s Hospital uses Cerner as its EMR.

Children’s did a “soft” release of MyChildren’s in mid-April’09.  Little promotion to date and currently about 1200 users.  Soft launch was intentional to understand user needs and desires as well as await a larger, more aggressive launch in late 2009.  In early 2010, MyChildren’s will transition to the latest Indivo release, IndivoX.  It is also in early 2010, that data will begin flowing from eCW EMRs in affiliated practices into a patient’s MyChildren’s account.

The Offering: eCW, Cerner and MyChildren’s:

By connecting the affiliate practice EMRs to MyChildren’s a parent will be able have a more complete longitudinal record of their child.  The data elements that will flow into a MyChildre’sn record include immunization records, allergies, ambulatory lab data, meds, basic physical measurements (height, weight, BP, etc.) and problem lists. An interesting tidbit we learned during the call is that growth data is absolutely critical in evaluating the health of a child.  Thus, getting this data from the ambulatory setting is an important objective for Children’s in monitoring the long-term health of its patients.

MyChildren’s will support the creation of specific care plans based on specific diseases/conditions, e.g. asthma, that are a combination of template and physician input drawing data from the MyChildren’s platform that is specific to the patient/child.  MyChildren’s will also enable a parent to automatically create school and camp health forms.  Like the care plans, the school/camp forms will draw upon the data MyChildren’s collects from both ambulatory (eCW) and inpatient (Cerner) encounters to populate the forms which can then be printed and submitted to the requesting body.

Inpatient lab data will not be imported into MyChildren’s, which we found odd.  Children’s explained that in the inpatient setting a significant amount of lab data is generated and they did not want to overload a given patient’s account.  This may indeed be true, but can they not at least provide a subset of that data, that which is most critical to both a parent and possibly an affiliated practice?  This has come up in internal discussions and is being evaluated.

In the future, they will also be importing pathology results, images and clinical notes into a MyChildren’s account.  When asked about after visit summaries (AVSs), Children’s stated that this is another element they are considering but do not have specific plans today. They have purposely decided not to import genetic data into MyChildren’s.

One of the more interesting aspects of this announcement is their intention to use Indivo (MyChildren’s) in an HIE capacity.  Specifically, inpatient Cerner data will pass through Indivo and on out to affiliated practices and vice versa.  EMR users in either setting, inpatient or outpatient will be able to readily pull-up data within their native EMR (that is parsed through MyChildren’S) thereby minimizing disruption to existing work-flow practices.   Granted, this is not as high-powered as say a native HIE solution from someone like Axolotl or Medicity, but it does solve the immediate needs of Children’s for a very nominal cost.

The Wrap:

Besides walking the talk by supporting consumer access to and control of their PHI, Children’s Hospital is putting these processes and practices in place via MyChildren’s to support the patient-centric medical home concept which they believe will continue to gain acceptance and support among policy makers. Here in Massachusetts where healthcare costs have continued to escalate at an alarming rate, payment reform is now a top discussion topic with the medical home concept receiving significant consideration.  Children’s sees the writing on the wall and is taking a proactive approach.  Hat’s off to them.

It is also good to see how a PHP (MyChildren’ in this case) can become the nexus for care, a nexus where the patient is truly at the center, where they are in control of their PHI.  Supporting this patient-centric care model is rare.  Sure, many healthcare providers will state that they support the concept, but it is hard to find many that actually put it into practice.  Children’s Hospital of Boston, along with others such as Kaiser-Permanente, Beth Israel, Cleveland Clinic, Mayo, and even more recently New York Presbyterian are leading the way.  Question now is: How far back are the followers and how quickly will they come and join this growing and inevitable trend with more than words, but actions?

This year was Chilmark Research’s third AHRQ’09 event. The previous two we attend in 2007 and 2008 left us, how shall we say it… underwhelmed and really did not have much intention of attending this year.  But that was before ARRA, before meaningful use, before certified EHRs, and certainly before we were asked if we would be interested in presenting and moderating a session entitled: PHRs, What are they good for?

Of course we accepted the invitation to present and moderate the PHR session and well, with so much else happening in DC right now, probably would have attended regardless to get a read on the market from the rarefied air of AHRQ grant recipients.

Unlike past events that were composed strictly of AHRQ grant recipients, AHRQ employees, and numerous beltway bandits (they prefer to be called govt. contractors), this event took quite a different tack casting a much broader net bringing in all sorts of presenters from government, academia, numerous NGOs, private sector, some patients, etc., all who have never received an AHRQ grant.  While I did not have a chance to interview the countless AHRQ grant recipients in attendance (still the majority) on this new format, those I did talk to found this new approach refreshing and enlightening.

From our perspective, this is now the best bang for the buck healthcare event today in the US (it is free after all), something we would not have said last year.  Congratulations to the AHRQ Team that pulled this together – you did a fabulous job in bringing a wide range of viewpoints and perspectives to this event and we are quite positive that all attendees came away with something of value.  Now, if we could just do something about that Godawful website of yours.  Suggest you pick up a copy of Don’t Make Me Think and give it to your Web development team – in fact, by a case of that book and distribute it throughout HHS as we find virtually all properties to hurt our feeble minds.

Key takeaways from the event:

Our concept to push beyond the PHR term and start talking about PHPs was very well received by many in the audience of the session we moderated.  Several came up to us afterwards and talked about their own “platform” initiatives.  Also, was surprised (probably shouldn’t have been) that Kaiser-Permanente is now looking beyond their successful Health Manager to a “Web Presence Platform” for their members.

Patient safety improves by leaps and bounds when transparency is applied and patients are provided a mechanism to report errors that are taken seriously.  Twenty-five percent of errors are easy to understand, report and rectify, its the other 75% that are extremely challenging. The best approach to address that 75% is through close collaboration between the patient and their care team. Unfortunately, there are few examples and mechanisms in place today as to how to facilitate this process.

University of Illinois – Chicago has done some absolutely amazing work on patient safety front with some very novel approaches, e.g. residents have to report at least five mistakes in a given period to move on and applying analytics/reporting to weed-out the physicians with the highest number of complaints and errors..  And guess what, their liability insurance coverage costs have plummeted.

Regarding patient safety, results of a large consumer survey found that consumers seek five key things:

• An explanation & recognition of responsibility,
• Accountability,
• Evidence of action taken to insure future risk in minimized,
• An apology,
• Personalized response to their specific case, no form letters!

Pretty commonsensical to us, but that is the funny thing about commonsense, it is rarely common.

HHS has some great people doing great things but HHS marketing S*ucks (don’t believe us, go back and just look at their websites and take it from there).  This results in few knowing of the good work and initiatives occurring within HHS.  For example, the creator of healthfinder.gov spoke about how they looked closely at user interactions to improve the site and also how they rebuilt it to address prevention rather than disease.  Healthfinder.gov has a wealth of information that has been fully vetted, really a great resource, and even better, its for free.  At AHRQ’09, Healthfinder told us they are now developing a widget that can be freely installed on any website, which will allow a user to enter very basic demographic info and get preventative health content that is relevant to them.  So all you small start-ups, you don’t need to begin paying for content via third parties such as Healthwise but instead could begin by installing the new healthfinder widget for fully vetted health prevention content.

GE launched a global initiative across all sites with 100 or more employees entitled “Healthy Worksite”.  Currently 95% of sites are participating.  In the future, GE will “certify” sites if they meet certain metrics such as:

• Insuring that 70% of food served at the onsite cafeteria are healthy and providing a 20% discount to employees for purchasing “healthy food.”
• Site has an active smoking cessation program in place.
• Site provides incentives for employees to participate in fitness programs.

In return for being certify, not only will the worksite be a good corporate citizen of GE, but will receive worksite bonuses/paybacks in the form of lower healthcare costs (premiums) they’ll have to pay.

An interesting aspect of the GE program is no support for an employee sponsored PHR.  Rather, GE will simply provide employees links to various sites (both payer-centric, e.g. Optum or independent e.g. WebMD or provider, e.g., Mayo or Cleveland Clinic) and let the employee chose whether or not to participate.  And in a change from the norm, GE plans to measure net employee participation in prevention programs rather than more specific health information to avoid the nasty tangle of PHI.  Not sure how they’ll do this as in 2010, they’ll be launching a company-wide health risk assessment (HRA) program.

Lastly, coming out of the PHR session we moderated was the finding from Group Health that After Visit Summaries (AVSs) provided to patients after a visit have been transformative to care. Maybe, just maybe there may be a tie-in between what the Univ. of Chicago has done on the patient safety reporting front and what GHC has done with AVS.  The parallels are there. Both rely on close, collaborative and honest communication, both are transformative to the practice and delivery of care. Both need the patient and at times, the family involved – they need their input, their voice. Both lead to the opportunity to lower errors and improve outcomes and in doing so provide the opportunity to lower healthcare costs.

Yesterday, we outlined why the PHR term has the potential to stunt future advances in consumer health and engagement via HIT.  Our thesis is that the PHR term is rooted in a dated concept of simply providing the user/citizen a virtual file cabinet for their health records.  Since the initial introduction of Internet-based PHRs nearly a decade ago, adoption has been by and large abysmal.  Our belief is that adoption, or lack thereof, is symptomatic of PHRs not having a sufficient value proposition for the vast majority of potential users.

But where we really get concerned with the PHR term is that in the meaningful use recommendations that were accepted in July.   Under meaningful use guidelines, those obtaining Stimulus (ARRA) funding for adoption of a certified EHR must provide a PHR to their patients by 2013.  Trouble here is how will HHS define what that PHR is?  Last year, HHS paid a princely sum to have the PHR term defined (see below).  This term, we have been told, is what will be used within the context of meaningful use rule making.  If this is indeed true, adoption of PHRs will continue to be lackluster.

PHR, Personal Health Record: “An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.”

To move beyond the limitations of this definition (and the baggage that goes with it) Chilmark proposes a new term, Personal Health Platforms (PHPs) with the hope that others will pick up the banner moving us beyond where we are today and hopefully get HHS to look beyond the narrow confines of the PHR definition that they have before them.

What is a Personal Health Platform?

Our proposed definition is as follows:

A Personal Health Platform (PHP) is an Internet-based platform that securely stores and manages a citizen’s personal health data, data that may be derived from multiple sources including among others clinical systems, payer systems, self-enter data, and biometric.  The PHP also provides the framework and capabilities to support applications, services and/or tools that a citizen may invoke to leverage their personal health data enabling the citizen to make better, more well-informed decisions regarding their health or the health of a loved one.

The second sentence of that definition is the key differentiator. A PHP does more than simply store the data, it makes that data actionable.

While the acronym may be new, at least in the context of healthcare, the concept is not.  There are a number of examples of PHPs in the market today with WebMD arguably one of the most well-known.  Microsoft’s HealthVault, Google Health and Dossia are other examples of PHPs.  One could even argue that tethered systems such as Kaiser-Permenante’s MyChart is a PHP for MyChart provides a wide range of services to K-P members.  In each of these examples, the PHP is not just a repository for health data but provides users various tools, apps and services that leverage that data to enable a deeper level of engagement, something a PHR, as defined above, cannot do.

As an example, Sean Nolan, Chief Architect for HealthVault recently talked about how one might leverage HealthVault ecosystem partners medLAB and Keas leveraging lab data to create personalized care plans.  Another example is the recent partnership between Medikeeper and change:healthcare wherein change:healthcare will become a widget on a citizen’s Medikeeper dashboard enabling the citizen to make wiser, more cost effective health decisions that are based on health data stored in a Medikeeper account.

Now that we have introduced the term PHP, and the justification for the need of this term in future policy discussions, our next step is to create an ontology for the PHP market.  You’ll have to stay tuned for that one which we hope to get out next week between our trip to the AHRQ conference and the Health Data Management event in Boston.

A core element of healthcare reform in its broadest context is cost. The first step in controlling cost is to gain visibility about what healthcare actually costs at a level where action can be taken. Microsoft Health Vault and Google Health are platforms that can provide that visibility for consumers. That information can then be de-personalized and used to provide visibility from multiple points of view including hospitals, private practices, regions of the country, type of procedure, etc.

The problem

If I receive healthcare services that involve more than a single provider I will be billed for services from the primary provider and a host of other providers and services including labs and pharmacies. These will show up as line items on a statement I receive from the provider if I am a direct pay or on a statement from my insurance company. Some will be prompt; some will show up months later. All of them will be printed on paper.

Any effort on my part to analyze this data will require hours to transcribe it to an electronic form and then to assign it to specific illnesses or injuries and then classify it in meaningful sub-categories for analysis. If I find a potential issue it is difficult to challenge it in a timely manner.

Proposed solution

You could provide an interface to providers to capture the data in its electronic form and post it on my personal health record (PHR) as a standard spreadsheet, e.g., Excel. That format would:

• Identify the service provider with a link to a database for more information, e.g., what services does XYZ Medical provide and how I can contact them – an Internet link would probably take care of most providers.
• Provide a generic classification of the services, e.g., hospital, lab, ambulance, etc.
• The date of service
• Some description of the service which could be a billing code* and a standard translation
• Amount billed, allowed, payer paid, I pay

It should include charges that are covered by insurance plus non-covered charges such as non-prescription pharmacy at drugstores and other providers that are subscribers to Health Vault or Google Health. It should allow me to add in costs related to trips for treatment, special clothing or devices not covered by insurance, etc.

It should provide the means for me to assign each line item or set of line items to a particular illness or injury or some general classification of my choosing, e.g., seasonal allergy.

Benefits

• I could accumulate charges related to an incident to get a better understanding of what it cost
• I could explore options for less costly solutions, e.g., clinic vs. emergency room
• I would have more confidence in the accuracy of my charges if I could see them sorted in ways that make sense to me, e.g., see that two charges for the same service or item on the same day were for something that could reasonable occur more than once on the same day
• I would be able to challenge any apparent issues in a timely manner and with a minimum of effort using the data and information in the report
• I would be able to get a sense of the charges that have been invoiced and those that have not
• I would see the value or limitations of my insurance to negotiate for more cost effective insurance in the future.
• I would be better informed about the cost of healthcare and therefore better able to participate in discussions of options and solutions.

Costs

Participation in this service could be part of a provider or payer’s package of services. A translation from their standard formats to yours would have to be developed but we should be dealing with relatively standard data elements as specified by HIPAA and the current work on electronic medical records. The cost per provider or payer should be relatively small.

I leave the cost and benefits of de-personalizing data for broader analysis to you but I suspect that it is relatively small once the data exists in a standard format.

* Related discussion on problems with billing codes initiated by e-Patient Dave on Twitter

Inhale (cough cough cough) Ex (cough cough) hale. This is basically my whole day now. I had a chemo treatment Wednesday that knocked out most pain for me and I am proud to say I have not had a pain pill since. On the other hand, I am now taking codeine for my cough almost every four hours. I have never experienced asthma first hand or even second hand for that matter, but, each breath to me, is what I would imagine a person experiencing asthma would have to encounter.

Take a deep breath… (yeah right) What would enable me to take a deep breath? Well, what is stopping me from taking a deep breath? A tumor. According to Google Health a tumor is “an abnormal growth of body tissue”, ok, simple enough. Treatment would be chemotherapy. Right now we are looking for the correct chemo to apply to reduce or completely rid my lung of the tumor. So far it seems, when my chemo is adjusted or changed, more tumors appear. While on a chemotherapy my tumors seem to slowly fade. But as soon as I up the dose,  lower the dose, or miss a dose, more tumors appear. For one reason or another, such as: chemo is too strong, or health insurance says I have to order through a mail order company and it takes them two weeks to even figure out what they are doing on their end, this causes an adjustment in my chemo and causes more tumors to appear.

Take a deep breath… The last week or so I have had to look at my friends; those claiming to be friends, those claiming to want to be in my life for one reason or another and those I thought were friends. I recently was in the hospital and had visitors; most visitors I ever had were my sons and my boss. I was on the phone a lot with well-wishers; most of the time my family called. I had people offering me a ride home; other times I took a bus home once released. I went out and was supposed to have a friend meet me, he couldn’t make it (genuinely) and so that Monday took off work to spend the day with me (went to New Roc City – and City Island – so much fun!) About to go to Oklahoma, a friend volunteers to go with me; most times I can not get a friend to go to an appointment. Another friend volunteered to get me to the airport at 6am tomorrow morning.

Take a deep breath… The last week or so I have had to look at my friends; those claiming to be friends, those claiming to want to be in my life for one reason or another and those I thought were friends. I recently was in the hospital and someone insisted I give them my info so they can come visit after having a really bad date with them and them calling thinking I was ignoring them but in fact I was in UrgiCare with no reception. I was moving recently to DC and a guy who claimed to want to be back in my life insisted on coming to see me and spend time with me despite the fact I would not be able to move and I said he did not have to come… I did say he insisted?.. He did not show nor was he man enough to even answer his phone or return a text. Then the friend I spoke to last night, I was coughing so much I started gagging and barelywas able to get the words out that I am not able to talk anymore (OBVIOUSLY); they said, “can’t you just drink some water?”

According to Google Health a tumor is “an abnormal growth of body tissue”… lol, is that a little harsh? I just want to make a point that my “people tumors” are diminishing, there are more people now in my life for the good then for the bad. Something I am doing within myself is clearing out the “people tumors”. Life is short we need deep breaths, we need to be surrounded by those that are good for us, not the ones who mean us harm, or are selfish or worse yet just really do not care and are on their own agenda; the ones who cause our coughs or our shortness of breath who do not allow us to breathe. Do you have a friend that blatantly lies to you? ex. “Im coming to NY to see you right after work” Left PA on September 28, Mr Elliott you ok? Thought it was 8 hours, not 8 days… Do you have selfish friends? ex. Cough cough cough coughcoughcoughcough gaaaaaaagg  can you drink water to stop that cough so that you can continue to talk to me, cause thats whats important right now.

What do you need to get rid of your abnormal growth of bodytissue(s)? Go ahaead, take your deep breath.

Google has new product called Google Health. According to the video, you can import your medical record to Google Health.

Google promises they won’t sell or share your personal detail and information to anyone without your permission. If you believe them, you can sign up.

Scott Shreve, formerly of Medsphere, wrote a good post imploring Google to get back into the Personal Health Cloud game, a game where Microsoft HealthVault now appears to be the only game in town.  Everything Scott says in his post Chilmark Research agrees with and we would even go so far as to say that Google Health has been nothing more than a distraction to the broader market.  A distraction in that Google Health has really done very little to create a truly compelling platform, yet due to its size, market presence and media and market pundits belief that Google is the be all to end all, Google Health gets far more press and attention than it rightfully deserves.

As Scott points out, it is not as if the Google Health team does not have a lot of good people working for them.  All who I have met have a passion for what they do.  No, the problem is not with them, it sits higher-up in the corner office where senior Google execs have yet to dedicate the resources to truly make the Google Health platform a viable alternative to HealthVault.  Yes, Google has made a some announcements, most recently with regards to Advance Directives, over the last several months that demonstrate that the team continues to build functionality into the platform, but none of this functionality is new, none of it novel, none of it that goes beyond what HealthVault had at least a year or more prior. (Note, the Advance Directives feature is pretty significant as it signals a change to the core data model of Google Health allowing it to store unstructured data – something that Google Health did not support previously.  This does open numerous opportunities for expansion of services within this platform.)

And don’t even get us started on Google Health’s abysmal efforts in attracting new partners to the platform to create a truly viable ecosystem…

The sad thing is that innovation is driven as much by competition as it is by shear creative inspiration.  Without a viable competitor, HealthVault may become complacent and we, the consumer of such services will ultimately pay the price.  Please Google, for the sake of all, at least quintuple the size of Google Health’s team so that it is at least a tenth the size of HealthVault’s.  Maybe then we will begin to see some sign of a viable competitor, a viable platform and a viable choice for the consumer and Google Health will once again become relevant to the market.

One of the most important components of what the late Rev. Charles Meyer refers to as The Good Death is to get our medical and legal affairs in order long before end-of-life is near.  Such a pro-active plan allows us to have our collective faculties around us when making decisions like what kind of medical care we prefer, who we want making decisions for us if we are incapable, where we want to die, etc.  Making such decisions is vitally important, yet seldom at the forefront of our minds.

In order to help us with this endeavor, the National Hospice and Palliative Care Organization’s Caring Connections, a leading provider of advance care planning information, and Google Health™ have joined together in a goal of increasing the access to and availability of advance care planning information and resources on line.  As J. Donald Shumacher, President and CEO of NHPCO, stated: “How can medical professionals honor your health care wishes and preferences if they don’t know what they are?  Advance directives are useless unless they are available during emergency health care situations.  Google Health will make these documents accessible on line and will eliminate a huge barrier of access during times of need.” 

Through this partnership, users of Google Health can access and download a free, state-specific advance directive and then store the scanned documents securely on line.  For more information on accessing this important resource, go to www.google.com/health and create a count for yourself.  Then download and print the advance directive form for your particular state at www.caringinfo.org/googlehealth.

Best wishes on your planning.  Melody

On July 16th, the Office of the National Coordinator for Health IT (ONC) held a lengthy meeting of the HIT Policy Committee where a wide range of topics were addressed by various workgroups.  As we reported earlier, the Meaningful Use (MU) Workgroup presented the second draft of recommendations, that were approved.  Over the course of the day, the Policy Committee also heard from the Health Information Exchange (HIE) Workgroup and the EHR Certification and Adoption Workgroup.

Now there has been a lot of fussing about just what constitutes an HIE as well as the bigger issue of how do the feds insure that HIEs of one form or another are in place to support the MU criteria for information exchange.  Looking at the slides that the HIE Workgroup used for this meeting, it appears that they were attempting to first educate the broader committee on just what an HIE may be, what types of data may flow through an HIE in support of MU criteria and finally some recommendations to consider for HIEs to support overarching HHS objectives.

In reviewing these slides Chilmark was struck by the four models used to represent HIEs today (see below).  First thing we thought of upon looking at these models is: These models only represent what is being built today and more importantly, completely ignore the consumer/citizen and their future control of personal health information (PHI)? Where is citizen’s PHR or personal health cloud account (Dossia, Google Health or HealthVault)?  Are these PHRs or health clouds not HIEs in their own right, albeit truly citizen/patient-centric?  The HIE Workgroup appears stuck in old models, models that have struggled to prove themselves relevant and viable to the market.

Roughly a week after this meeting, on July 22nd the eHealth Initiative (eHI) released the results of its annual survey of HIEs, the sixth year they have done so.  Through the generous sponsorship of HIE vendor Axolotl, one can get the full report for free and on Aug 4th, eHI will host a free webcast to go over the results.  While the report had many positive things to say about the current state of HIEs, claiming that more are operational, more are showing some form of return on investment (either soft or hard) and that more data is being exchanged, Chilmark found it interesting that the primary issue facing HIEs today is “Privacy and Confidentiality.”  With stricter HIPAA consumer consent criteria forthcoming as the result of the passage of ARRA legislation, this will only become more difficult.

Another small bit of information tucked into the eHI report are some numbers regarding consumer access to their PHI within an HIE.  Of those 67 operational HIEs today, a paltry 12% have some form of consumer access to their PHI.  Might not greater engagement of consumers by these HIEs lend not only public support for HIEs, (and future funding as well as relevancy- both still a nagging issues) but also address the biggest issue HIEs are confronting today, privacy and confidentiality?

Then one goes back to look at the models presented by the HIE Workgroup, models that have no place for the citizen. These are not models that the public can readily support for the public has been completely left out of the equation.  And ARRA legislation has given $300M in taxpayer/public money earmarked for HIE development over the next two years…

Hold on here, we need a major rethink on what an HIE is, who an HIE serves and the relevancy of HIEs to the public interest.

Granted, Chilmark will cut the Workgroup some slack as they are, we believe, making these recommendations with the best of intentions.  What is troubling though is that this Workgroup has failed to create a vision for HIEs that not only supports MU criteria, but more importantly, supports the citizen’s need (and possible desire) to take greater stewardship of their health records.  What the HIE Workgroup has proposed instead is a continuation of the status quo, which is truly unfortunate at a time when we as a nation are looking for new approaches to better engage citizens in self-managing their health, fostering healthy behaviors and empowering them to make wiser healthcare decisions for themselves and their loved ones.

It is time to move away from such paternalistic models so prevalent in healthcare today and represented in what the HIE Workgroup presented on July 16th. Let us create a new vision for HIEs that puts the citizen in the center.  Thankfully, there are some thoughtleaders adopting this model, best represented by the efforts in Washington State, which now has three healthbanks, two using HealthVault the third using Google Health.

John D. Halamka’nın Harward Business Review’da çıkan yazısına göre, ABD sağlıkta IT konusunda büyük bir adım atarak değişik yerlere dağılmış hasta medikal kayıtlarının düzenlenmesinin yolunu açtı. Türkiye’de bazı farklılıklar olmakla birlikte hasta kayıtları şu şekilde oluşturuluyor:

1. Hastaneler tarafından: Değişik hastaneler her ziyaretinizde, her türlü laboratuvar sonucu, radyolojik tetkik vs tüm kayıtları sizin isminizin altında topluyor. Değişik hastanelere gittiğinizde, çok yakın zamanda yaptırdığınız tetkikin verilerine ulaşılmadan o tetkikler çoğunlukla yeniden yapılıyor. Devlet hastaneleri birbirlerinden tam haberdar değil, ayrıca özel hastanelerin tetkiklerine de devlet hastanelerinde ulaşılamıyor.

2. Sigorta şirketleri tarafından: SGK ve özel sigorta şirketleri hastaya ait tetkikleri ve ölçümleri veri tabanında saklıyor. Ancak bu iki sistemin birbiriyle bir bağlantısı yok. Hatta özel sigorta şirketimizi değiştirirsek, eski verilerimiz eski şirketimizde kalıyor.

3. Kendimiz: Bu kategori de Türkiye’de boş sayılabilir. Hastaneden aldığımız bir röntgen CD’si bu anlama gelmemektedir. Medikal dataların bir bütünlük içinde ve farklı zamanlardaki gelişmeleri ele alarak toplanması ve değerlendirilmesi gerekir, bu bağlamda hizmet veren iki yazılım var, Google Health ve Microsoft Vault. Bunların da Türkiye’de henüz aktif olduklarını söyleyemeyiz.

Türkiye’de Healthcare IT pazarı olması gerekenin çok altında, bu konuda yapılan çalışmalar umuyorum önümüzdeki yıllarda çözüm önerilerini arttıracak ve bizim de bu verimlilik ve güvenliğe ulaşmamızı sağlayacak.

Bu konu ve sağlıklı hayatla ilgili diğer yazılar için Philips’in desteklediği şu sayfaya bakabilirsiniz.