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

I while back my colleague and I were discussing how far the bar code has come and how there are different kinds of bar codes and how a lot of information is being packed into those humble stripes. I had read that in Japan, advertisers put black and white matrix on posters and you can take a picture of the code using your mobile phone and get additional information or coupons for the service. People will figure our ingenious ways to put technology to good use.

I came to know the existence of Microsoft Tag via Glen Gordon. I downloaded Microsoft Tag Reader iPhone app and played with it a little. Toyed around with a few ideas and planned a project that could use it. Then I got busy at work. There is so much stuff to do at work that I find it hard to work on any of the personal projects.

This afternoon @lizasisler tweeted about Microsoft Tag and wondered how it could be used to better Health Care. We exchanged a couple of ideas.

@lizasisler: Saw @MicrosoftTag @ #WPC09 Neat printable interactive barcode technology http://www.microsoft.com/tag/ Thoughts on good #Healthcare uses?

@rsringeri: @lizasisler @MicrosoftTag have med devices display MS Tags that can be snapped with mobile app to upload to @HealthVault.

@lizasisler: @rsringeri Nice! Think there could be great @MicrosoftTag uses in Healthcare – drug/equipment uses/education etc

@rsringeri: @lizasisler agree. Instead of the paper manual in the box, put a MS Tag on the device that takes you to the device’s home page on you iPhone

@lizasisler: @rsringeri What abt using @MicrosoftTag as emergency gateway to @HealthVault information. Click on tag interact with/access HealthVault?

@rsringeri: @lizasisler emgcy access is a great idea. My @HealthVault should have a section where I can put in non-stealable data, get a tag, ….

@rsringeri: @lizasisler … snap tag from mobile device and download vital emgcy data to Healthcare prof’s device. Blood Group, diabetic, allergies

Here are some ideas for meaningful use of Microsoft Tag in Health Care

• Medical devices like BP and Blood Glucose meters can display, in addition to numbers, an MS Tag with the data encoded. I can then whip out my MS Tag reader app on my iPhone, snap a pic and upload the data to my Health Vault repository. No cables to fumble. No PC to connect the device to. Instead of trying to make the device Internet enabled, just modify the screen to display an MS Tag. And if I happen to use multiple devices to manage my health I don’t have to buy cables for each of these devices and connect them to a computer one after another. Most device manufacturers do not bundle a cable to connect the device to a computer.
• Instead of including product manuals, instructions with med devices, just put couple of MS Tags on the device. Whip out the Tag reader app again, snap the pic and the iPhone can now play a video demo of the device or load a PDF manual, with click enables links.
• Enable Health Vault to create an MS Tag that encapsulates data that I decide to make available to emergency medical personnel. I could carry a MS Tag card in my wallet (or a dog tag) that can be used by medical personnel to gather vitals stats like blood group, allergy information in situations where I may be unable to communicate that info.
• The above idea can be expanded to create a portable medical record I can carry for my visit. Prior to my doc visit, I logon to Health Vault, select a bunch of data points, export that as an MS Tag, save the tag on my iPhone, and assign an expiration date to it. At the doc’s office, the doc or other Health care personnel can “read” the encoded information using a MS Tag Reader. I don’t have to print anything nor do I have to logon to a computer at the doc’s office to make the information available.
• Put MS Tags on medication bottles. Snap pics of all the medications and an app can figure out and warn about potential drug interactions. Couple that with data from med devices and the app can alert you – hey your blood sugar is high pop this pill from your prescription

These are just a few ideas I dumped from my brain. What’s yours? With the availability of Microsoft Tag API here, I guess it’s only a matter of time before we see some implementations.

Update:

Check out Vizitag, their blog and follow them on Twitter. Interesting applications of Microsoft Tag and bar codes.

What if I were to make a note of those occasional strange things going on in my body? You know, those annoying aches and pains that are hardly worthy of notice at the time. On the other hand, what if just a few are precursors of something going wrong? What if a few small symptoms could signal the need for attention to prevent a heart attack, stroke or some other potentially deadly disease? Or just identify something, the progress of which can be slowed by early medication? What if thousands of people made occasional notes in their PHR and these notes were examined after they had significant medical events? Most posts would probably be insignificant, but what if some proved to be useful? We have little or no access to that kind of data today, but we could.

What if a large number of yoga places were to log attendance electronically (mine does now) and then periodically post when attendees took what level and type of class to their PHR? (With their permission, of course.) Again, a large amount of data that might correlate to risks or significant benefits. There are at least two useful ways of looking at that type of data. Does yoga create a risk or benefit? And, does an unrelated change in medication or lifestyle have more or less impact on people who practice yoga than people who have no record of similar activity.

What if I could use an iPhone application to keep track of when and how long I bicycle, my top speed and average and how many feet I climb? What if I could add the results from my heart monitor? And what if I did that for several years? Risks? Benefits? Correlations with medical events?

What if I went to an acupuncturist and he included notes about what we did and why and I made notes before and after about what was happening to me?

All of this, and certainly more, is possible. Indivio, HealthVault and Google Health and their expanding network of participants such as CVS and Walgreen are moving us in that direction.

Note that all of the data collection discussed here is outside the normal scope of electronic medical records and that the value of almost all of it arises out of the ability to correlate it after a medical event with data that is within the scope EMRs.

Narrow-scoped EMRs will be able tell public health authorities how many people go to the hospital for a spreading virus like H1N1 and how long they are there. EMRs will also report how many people go to see their doctor and whether they go multiple times. PHRs could add data about how many people self-diagnose themselves with the flu. They could tell public health how many of these self-diagnosed and how many doctor-diagnosed victims stay home and for how long or go to work despite their symptoms.  Also, which family member brought it home and how did it progress through the family? There has to be a pony or two in there somewhere.

Expanding the scope doesn’t mean that the amount of effort or cost to system owners will increase. Proprietary systems will have to develop interfaces to other proprietary systems, add one more to access Indivio based systems won’t have much impact. Expanding the scope may even decrease costs a bit by moving some application development and maintenance from proprietary systems to PHRs. At a high level the cost benefit is potentially very attractive. It would be a shame to miss this opportunity because of a lack of creativity and overly narrow focus.

Code Red: How software companies could screw up Obama’s health care reform.
By Phillip Longman http://www.washingtonmonthly.com/features/2009/0907.longman.html

This is a well written discussion of open source systems, specifically “the largest and most successful example of digital medicine is an open-source program called VistA.” It notes that, “For nearly thirty years, the VA software’s code has been continuously improved by a large and ever-growing community of collaborating, computer-minded health care professionals, at first within the VA and later at medical institutions around the world. Because the program is open source, many minds over the years have had the chance to spot bugs and make improvements. By the time Midland installed it, the core software had been road-tested at hundreds of different hospitals, clinics, and nursing homes by hundreds of thousands of health care professionals.”

It then goes on to contrast the failures of proprietary systems developed commercially.

What purports to be a defense of open source software does a better job of explaining how complex and difficult it is to develop and install an EMR system. Almost 30 years ago, enterprise resources planning systems, ERP, were the knights in shining armor that would save American industry. They were difficult to develop and brutal to install. Even today, they are difficult to install. Because of the life and death consequences of EMR systems and the sheer size of a nationwide set of linked data bases, an EMR system is more difficult to develop and deploy than ERP. We may need to rethink our objective of implementing fully functional EMR systems in the next few years.

I am optimistic. Our technology and our skills are vastly better than they were 30 years ago when ERP was being developed and VistA was starting. We can do a lot more a lot faster now. But there are limits on what we can accomplish in a limited period of time. A single example of an open source system does not justify relying on just one technology model, i.e., open source. On the other hand, I agree with Philip Longman that success with the system does justify doing whatever is necessary to keep it as an option.

Would we be better off at the national level to concentrate on a limited set of applications, e.g., fully integrated management of lab reports and pharmaceutical orders and results? Can we link larger applications to a backbone built on HealthVault or Google Health? Are there modular approaches we can take? Are personal health records a better place to start? We need to keep working on solutions but we also need to keep working on the questions that determine what solutions we can expect and when.

Comments on the same article by Bill Crounse, MD Senior Director, Worldwide Health Microsoft: http://blogs.msdn.com/healthblog/archive/2009/07/15/code-red-no-just-what-the-doctor-ordered.aspx

I was invited by an Account Supervisor from a PR firm to participate in a small component of Microsoft’s Connected Health Conference. Since I’m not in Washington state, the way people like me could participate was via Twitter chat. Basically, we read and write tweets using a hash tag (#datalib) for discussions on the subject.

Said rep. suggested TweetChat.com as a way of easily joining in. So, at Thursday at noon, I prayed that the wireless connection would hold up and jumped in.

I wanted to try it out a) to try my hand at this new form of chatting, b) to see what the whole thing was about, and c) to meet some other relevant Twitterers. And I satisfied all three of those interests.

a) The twitter chat:

• It was a bit disjointed. The moderator started asking questions; then we decided to introduce ourselves. So we did, and got rolling right away.
• There were multiple threads of conversation going on at the same time, just like in a regular chat. Only, they were all sort of about the same topic, so it was pretty hard to follow who was replying to what.
• That said, the kind of discussion we had would probably be better suited to threads on a message board.
• I was afraid the whole time that all the things I was posting in #datalib would be confusing to any of my Twitter Followers who didn’t know I was in the middle of a ‘chat’ session
• It promptly ended, with no summary or conclusion; more questions than answers; and a someone better understanding of why Twitter is not a chat program!
• Here’s the transcript, dynamic though it may be: #datalib
• Overall, not bad for a first go! Kudos to the moderators who were handling a barrage of questions from all angles.

b) the Topic

• We started trying to define data liberation; I threw in terms like ‘transparency,’ and ‘accessibility’
• Specifically I was curious about HealthVault form the health-care provider’s perspective, and what I and my patients could get out of it
• From what I gather, HealthVault is a Microsoft construct that will allow patients (or their designated care-givers) access to a universal, digital health record; it will be accessible from any number of portals, where patients can enter and review their data; it’s not entirely clear to me  how the records will be accessible to healthcare providers, but there will be some form of permission needed to be granted by the patient to do so

• There were some tech/integration/compatibility questions, but they were deferred to the website
• One chatter suggested an ID card that could be swiped at ‘Health Kiosks,’ that would bring up a patient’s file; the moderators mentioned access from mobile phones and other options
• We voiced praise for Health Vault: reducing redundancy, empowering patients, patient safety
• And we voiced concerns: patients having direct access to data without an interpreter (doctor) could be dangerous, physicians might be reluctant without incentives/compensation, user-fees would deter patients, those not tech-inclined or without caregivers who are may fall through the cracks
• It’s already happening in Hawaii, and it looks good (mind you, this IS an advertisement): see Microsoft Health Stories
• @HealthVault asked us what benchmarks should be used, I replied the “only benchmark that matters would be chronic care outcomes; morbidity & mortality improvements in HV vs. non-users.”
• Lots of unanswered and new questions…
  

I’ve seen Microsoft and eHealth in the news lately. There has been talk of Telus and Microsoft being involved in managing patient-centered eHealth records for Canada. I might add, they are planning to use Health Vault. I hope they ask us, first!

and finally:

c) New people

• Managed to ‘meet’ a good handful of relevant Twits (!), including @SusannahFox, @cindythroop, @donshep, @iChrisBarnes, @connectologist, @PatrickMann, @pondisci, @ThroopCat, for anyone reading this who wants to find some professionals/patients with similar interests

It worked out well enough and certainly piqued my interest in the HealthVault or similar constructs. I’ve wanted something as integrative as this for as long as I can remember, I’m just  going to have to think a lot more about this patient- (as opposed to provider-) centred model.

So honestly – how many of you banders do it? You know what I mean…eating a no-no lap-band food … such as pizza, pasta, nachos….oooh my! And then after you’ve chewed to your hearts content, spit the food out because you know if you swallow it, it will just come back up? I’ve been doing that – but only in the safety of my home. I want to know if this is just a weird thing that just I’m doing or if there are other banders that can relate.

In other news, I’m getting LASIK eye surgery to correct my vision today at 11am PST! Eeek. I’m going to Pacific Cataract and Lasik Institute in Bellevue, WA. Very nervous. Extremely nervous. I’ve had to wear glasses for the past 2 weeks v. contacts so my eyes will “go back to their normal shape”. See photo below.

Lise with glasses

Also have been tracking my steps via this cool pedometer that the folks from HealthVault sent me after reading my blog post about their cool weight tracking application – which rocks and is totally free. I realized that I’m not walking as much as I should be – only about 4,000 steps a day v. the recommended 8-10,000. But it sure was a nice gift from the HealthVault folks!

With Google Health out, Mayo Clinic is joining the club of PHR, or Personal Health Records. It’s new online PHR solution based on Microsoft’s Health Vault.

I am yet to investigate it and see how it compares to Google’s solution.

YAY for more options and variety

Link to MayoClinic Health Manager

[via Medgadget]

PHRプラットフォーム（国内正式版、海外ベータ版など）の説明会をこれまでに行った医師会はありませんでしたので、
　　　　　Personal Health Record　⇒　日医 “個人の健康医療情報”
2009年1月26日、株式会社ミュートスが開発した国産初のプラットフォームのデモ、説明会を開催しました（白山ののいちPHR研究会）。
　　ブログタイトル「講演会、セミナー等のご案内」
　　　http://plan.hakusan-nonoichi.ishikawa.med.or.jp/phr/
オンラインPHRについては、Microsoft (2007-10-04 HealthVault)、Google (2008-05-19 Google Health)などがすでにプラットフォームをリリースしています。
政府の「重点計画-2008（H20.8.20）」によると、官製PHR「電子私書箱（仮称）プラットフォーム」、「電子私書箱（仮称）ポータル」は2010年度までに基盤整備を行うことまで決定しています。　
(1) PHRに関する情報提供は今後も続けます。
　白山ののいちPHR研究会
　　http://hnma.umin.jp/
HP内会員専用ページで配信中。
　　富士通総研 主催（同時通訳付）2009年2月10日(火曜日)
　　　「日米におけるPHR と医療の近未来図」
　　　http://jp.fujitsu.com/group/fri/events/conference/conference-18.html
　　カンファレンス関連資料をアップロードしました。

(2) 医療機関とのアライアンスについて
　　白山市・野々市町のオンライン（インターネット）視聴者数
　　　　　　　　　15歳以上、自宅、職場からのパソコン経由
　　７万人以上と推定できますので、それぞれのクリニックが地域コミュニティー単位で、調剤薬局、株式会社ミュートスなどと提携し、PHRポータルサイトを活用することは可能ではないかと思います。
　　ご希望がありましたら、担当者への連絡係となりますので、メールでお知らせ下さい。

Scripps Translational Science Institute, Navigenics, Affymetrix and Microsoft will team up to determine how personal genomics information influences health decisions.  

The 10,000-participant study will examine individuals’ long-term psychological reactions and behavior change — or its absence — resulting from receiving individualized risk information. Participants will complete a questionnaire about a wide range of health behaviors at the start of the study before they receive their genetic disease risk results.  They will report their psychological and physical response to this information after three months and at the end of the first year, then annually or once every two years for the next 19 years. Individuals’ data will be available on Microsoft’s Health Vault, a Web-based electronic medical-record system launched last year.

It’s intended to be the foundational study of preventative genomic medicine  - Vance Vanier, chief medical officer of Navigenics.

A minor but important note is that the individuals will be recruited through the Scripps Health System, who could be more health conscious and better educated than the general public.  It is not clear how representative these results will be to the general population, particularly those who would need more information about interpretation of the genomic data, their risk and genetics in general. 

Remember Microsoft Health Vault? Yes, it’s not only Google out there trying to elbow their way into the pain and misery of the world. Microsoft, who have caused so much of it themselves (I jest!), are of course aiming to become big players too. They have signed up with Kaiser Permanente to test their Vault on Kaiser’s employees. It is suggested that Kaiser were “particularly impressed by Microsoft’s technology for protecting the privacy and security of personal data.” And as a side note, although MS and Google are using different platforms, it appears that they are aiming for true interoperability. We’ll see.

Google Health
Microsoft Health Vault

The big competition here is between Google Health and Microsoft’s HealthVault. (Revolution Health is more of an information portal at this point, and who is going to trust their health insurance company?). Whereas HealthVault’s strengths seem to lie in tying together different health information silos on the back end, Google Health is focusing more initially on the consumer side. It is trying to do an end-run around the health establishment by trying to get consumers to manually load their own medical information into their profiles. HealthVault allows this as well, but seems to have stronger partnerships with back-end health data providers. Google will no doubt tackle the existing health data silos as it proceeds. It really has no choice if it wants to organize the world’s health information.

from: http://www.techcrunch.com/2008/05/19/google-health-a-quick-peek/
http://www.techcrunch.com/2007/10/04/microsoft-beats-google-to-online-health-records-with-healthvault/

Before I share the main course for today, let me first touch base with the chosen labels for our endless babble involving technology’s role in potentially enhancing or carrying medicine and health care to the next better level—Media, Medicine 2.0 and Health 2.0. I initially have veered away from the latter term in my previous posts as I would like to apply my time more on Media (being mostly new media) and Medicine 2.0. These are more tangible to my focus at this point. I wanted to alleviate the great confusion these digital surnames bring us all. Though further on, I also realized that I too have to be educated on what these terms entail. The differences in detail between the two are also important. We could all learn something new everyday. That said, what is Medicine 2.0 and Health 2.0? Ms. Frankie Dolan, creator of MedWorm shares her understanding with us in her blog, Frankie Speaking Frankly.

…Health 2.0 is the application of Web 2.0 technologies in the area of health, whilst Medicine 2.0 is the use of Web 2.0 technologies in the area of medicine. Some examples can be seen in the Medical 2.0 Directory. I have come to think of Health 2.0 websites as being those that provide services geared towards the consumer, and Medicine 2.0 those geared towards services for the medical professional…

Now that that is in place, on to our dish.

It seems like big web corporations such as Google, Microsoft and AOL are all on board the Health 2.0 caravan in pitching in their share of the possible solutions (or possible market share) in the seeming broad revamp, evolution, and even revolution of health care. This could begin an effective model in technologically advanced societies that have an electronic medical system of some sort in place or that are actively transitioning (or have transitioned) their medical records to e— such as the U.S. This could eventually spread across the globe.

Let us begin with Google. According to CNN,

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that’s likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google’s new service, which won’t be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that’s also required to use other Google services such as e-mail and personalized search tools.

Here is a screen shot cropped from the Liquidmatrix Security Digest.

The original beta page itself has apparently been taken down. Google has not officially announced this new venture. This project, code named “Weaver” according to Mashable, is evidently made possible with the participation of the non-profit hospital, Cleveland Clinic, which by the way publishes medical e-books that are available free to download in some e-book sites such as Wowio. From the same article in CNN.com,

Contacted Wednesday, a Google spokesman declined to elaborate on its plans. The Associated Press learned about the pilot project from the Cleveland Clinic, a not-for-profit medical center founded 87 years ago.

But the health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their e-mail discussions.

Prodded by the criticism, Google last year introduced a new system that purges people’s search records after 18 months. In a show of its privacy commitment, Google also successfully rebuffed the U.S. Justice Department’s demand to examine millions of its users’ search requests in a court battle two years ago.

The Mountain View, California-based company hasn’t specified a timetable for unveiling the health service, which has been the source of much speculation for the past two years. Marissa Mayer, the Google executive overseeing the health project, has previously said the service would debut in 2008.

Either way, this is something to look forward to. Hopefully the security bases are, in fact, securely covered.

The other 2 big leaguers who are having their own new hits are Microsoft and AOL.

Here is Microsoft’s Health Vault.

According to Mashable,

HealthVault is a web-based personal health record tracking data such as blood pressure, cholesterol levels, surgical procedures, etc. Centralizing medical data for physician access alleviates problems in both personalized care and also insurance.

Microsoft does not expect a flood of users to immediately populate the site and is instead looking to existing healthcare institutions for help. Ideally patients will permit hospitals, doctors, and clinics to insert information into their HealthVault records. Early partners of HealthVault include the American Heart Association, Johnson & Johnson, the Mayo Clinic, and seven hospitals throughout the Baltimore-Washington metropolitan area.

Last but not the least for today is AOL’s Revolution Health and Health Talk.

Here is a report from CNet News.

AOL co-founder Steve Case announced Wednesday his online health and wellness company, Revolution Health Group, has acquired HealthTalk, pushing his company into the ranks of the second-largest health information site on the Net.

HealthTalk will operate as a site within the Revolution Health Network, which includes CarePages.com and RevolutionHealth.com. The Revolution Network is also affiliated with drugstore.com and SparkPeople.com.

More and more examples add to our pages as we continue to explore the important role of media in medicine. The more we know about what is out there and which way we are heading, the more we empower ourselves to participate in our very own process and quality of health care as patients. Thus, we might improve our choices and strengthen our voices about what really matters to us in maintaining our health. As doctors, including other medical professionals, who are abreast with technology can also broaden our reach in terms of understanding, communicating, and ensuring the quality of care we are giving. The important bottom line, as we have emphasized again and again, is the need for effective communication among us all.

Prontuário pessoal de saúde ou prontuário eletrônico do paciente é um documento compilado e mantido pelo paciente sobre sua sáude.

Para saber mais sobre prontúario pessoal de saúde escreva para prontuariopessoal@promovida.com.br

Dr. José Hamilton

Promovida Gestão de Saúde

___

Referências:

1. American Health Information Management Association 2008. http://www.ahima.org/

“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.”

See my complete post over at the World Health Care Blog.

In the last couple of years there has been an increased level of interest among consumers about Personal health records.Although many are not aware of the term “Personal Health Record”as there are many confusing definitions in the world.With the entry of Internet heavy weights Microsoft and Google onto PHR world,there is now a renewed interest among media and consumers alike.

Last month,when Microsoft launched its much awaited PHR as a platform-Health Vault,PHR market had finally arrived,although the tipping point has not reached,but this will be a certainty when Google launches their version of Personal health record.

Unfourtunatley,there are several myths surronding Personal health record and also about Health Vault.

1.Personal Health Records offered by Microsoft corporation is a real PHR-NO! it is a platform in which many earlier vendors of PHR products have joined,with the storage of data done at Microsoft centers.Hence,the name Health Vault.Health vault is not exactly a PHR.

2.PHR offers panacea to all the ills of health care industry-by reducing errors dramatically-Up until now there has been no studies which show how PHR work and benefit health care industry.Physicians and also patients are slow to adopt the use of PHR because of the issue of population of health data-Who is going to do that?Health care worker or the patient himself?

3.PHR are cheap-Although many vendors of PHR offer the product for free-Free does not necessarily mean good.Because it costs money to host the data and maintain them in long run.So how do they make money-Is it non-profit or purely profit.If so,will your health data be sold or used for any other purpose like research or advancement of Health car?

4.PHR are easy to maintain-Contrary to what is described in the media and in several online sources,PHR are difficult to maintain,Imagine writing about your health data every day of your life,entering information about your any medical investigation or surgical procedure,all these are laborious task-which many of us detest.

5.All PHR are equal-Not all in the market are created equal,some have excellent features while majority of them lack even some basic essential features.Design and development of a PHR requires immense skill sets not only among physicians but also among technologists.

So,the next time you use a PHR use it with caution.

We have credit rating report,we have all our credit bills but when it comes to our health we don’t have any records?why is it?Are we lazy or ignorant?

Despite the presence of numerous vendors in the market, numerous studies have shown that only few people are remotely aware of personal health record concept.Many would like to have one,but don’t know how to start with one.

The best course to take will be to start looking around the internet for sources which provide free personal health records and start using them before moving on to paid version. Of course,the products in the market come in all varieties-good.bad.ugly.Free does not necessarily mean bad at the same time as highly priced does not mean good.

Many of the paid version PHR fall woefully short on quality of delivering the right kind of information.They are difficult,messy to use and do not serve any purpose at all. Imagine,using them during your medical emergencies when you need them the most and you cannot access them.

Since,my last post Microsoft has already launched its Health Vault-which is an online based PHR,This is a congregation of many PHR providers around USA.Although a good idea now, the future remains to be seen. Many have launched a vitriolic attack on the privacy issues and about Microsoft handling personal health records.But,it is still in early stages now,and we need to watch it carefully before we can denounce its usefulness as just another vapor ware.

Microsoft is a billion dollar software company and I am sure they would have expended lot of thought into developing health vault,and it is not just another run of the mill product.It has a great future.It is still a better product than many existing products in the market today.

We we carefully think about the future of our health,then I am sure everyone will think of making a record of all illness and investigation we undertake.

Health is defined as not just absence of disease but a state of mental well being.So having a record of personal health will go a long way in defining the way we see our health in future.

“The value of what we’re doing will go up rapidly as we get more partners,” said Peter Neupert, the vice president in charge of Microsoft’s health group.

–New York Times October 4th, 2007

Ehh..? And I thought they made operating systems and mp3 players! Microsoft’s ‘health group’? The NYTimes reports this unblinkingly, of course. Microsoft, software company and giant collator of private information is using that synergy to expand its Big Brother operations as a ‘health group’. Am I the only one that is bothered by this kind of thing? Microsoft says that it is,

starting its long-anticipated drive into the consumer health care market by offering free personal health records on the Web

I’m unimpressed. No–I’m sick, actually. Sick because no one is going to care about this just like no one, at least yet, seems to care that the venture capital for the social networking scheme, Facebook, was put up by the Central Intelligence Agency.

Maybe I’m overreacting. It wouldn’t be the first time. Maybe this new MS venture will be, as they say, ‘really cool’!!! Next Microsoft’s ‘health group’ will link up to your Kroger Plus card so that your health insurer can instantly adjust your rates when you purchase a pack of squares or a box of Twinkies.

I’m no Luddite, but this is truly bizarre. Business Week fawns over MS’s plan and details how it might make a billion bucks a year off this newest Big Brother subsidiary. MS is calling it Health Vault and of course claims that it will be secure. And if you believe that I can sell you Dick Cheney’s waistline. Nothing is secure. And your health records won’t be either. But that isn’t my biggest concern. Why the f/k do we even need this? Oh, yeah. Efficiency. We have almost 50 million folks with absolutely no health insurance whatsoever and the US with all of its magical private market has no answer but to continue creating more uninsured people. The magical market does however have a great plan to sell those of you that still have insurance, for now, yet another service to make your life more convenient.

So what if it adds to the surveillance state. Won’t it be worth it to not have to fill out that stupid clipboard for the umpteenth time when you go visit the clinic?