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Roni Zeiger on what Google Health is doing next

For those of you who weren’t at Health 2.0 Meets Ix to hear from the mouths of the four horsemen (Halamka, Sands, Zeiger & deBronkhart) here is Google’s Roni Zeiger’s version of what went wrong with the “incorrect data from BIDMC to Google Health” story and what they’re going to do to fix it.

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DesmotivacionesNick Finchoate but earnestMargalit Gur-Ariefrancine hardaway Recent comment authors
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Desmotivaciones
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bev M.D.
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bev M.D.

Good point, Nick, about how the “test” was designed. However, Dr. Halamka, the CIO at BIDMC, is an M.D., so I do not let him off the hook. One look at Dave’s record and any M.D. could tell it was useless data, for either the patient or any dr. trying to use it. Only if the “test” was performed by a computer technician (which would be a bad design in itself for this application), should this have passed the test.

Nick F
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Nick F

In response to Bev’s comment about testing — it is quite likely that the application was tested and successfully passed those tests. Chances are the test was written to ensure that diagnosis codes were properly transmitted, etc. However, the challenge in testing this type of application is: how will a user interpret the data, and what actions might they attempt to perform based on the data? I don’t know all the details, but I can imagine that “user acceptance testing” for our friends at Google will be getting a lot more rigorous…

inchoate but earnest
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inchoate but earnest

bev’s & francine’s posts concerning EHR accuracy are interesting & will be made more so when they explain how existing records will be checked to make them accurate. As is often the case there’s little practical way forward other than to use & deploy the inaccurate record & improve it with increased use.

Margalit Gur-Arie
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Great analogy, David! Makes you wonder how the “e-Patient Dave” scandal will be viewed four hundred years from now….
As to legal cause of action, Google is covered rather well by its Terms of Service Agreement that all users must sign. You pretty much agree to use it at your own risk. There is probably no cause for action against the hospital either.
The only candidate for legal action is unfortunately the usual suspect: the doctor that relied on the Google data and harmed the patient. The argument would probably be that as a medical professional he should have known better.

francine hardaway
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As a user of Google Health, Bev I agree with you. There are two separate and interrelated issues here, fondly summarizable as “garbage in, garbage out.” First of all, hospitals and doctors must be incentivized to code the accurate diagnosis and not the one insurance will pay for (like the routine mammogram v. the screening mammogram). And then there needs to be quality control. After all, we have it on the web all over the place (“user name or password incorrect”), so we should have it in health care. Before we spend all the stimulus money Obama has allotted to… Read more »

bev M.D.
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bev M.D.

I usually try not to be scathingly critical, but I am scratching my head that someone at either Google or BIDMC did not actually examine a transferred patient record from a patient with a complicated history, to see what it looked like, before they went live with this idea. This often underutilized procedure is known as TESTING THE SYSTEM. Why did it take e-patient Dave to bring this to light???!!!! I fear for the future of health IT if this is what emanates when smart people are involved.

Dr. Dan Johnson
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Dr. Dan Johnson

While this is interesting and important — clinical diagnoses have “forever” been translated by clerks (“coders”) into ICD numeric codes — these are actually close to the clinical diagnosis, and thus do form useful clues for professionals who can have access to them, and are more accurate, in my experience, than patients’ own recollections. We fool ourselves if we think any medical record other than the primary document is precise (and even that is subject of problems of left-right descrimination, mis-speaking (tongue-ohs?), omission of negatives by transcriptionists (e.g., hearing ‘un-‘ as ‘ahhh…’) The most troublesome inaccuracies, in my experience, are… Read more »

Richard
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I wonder why they add a 2.0 to health.

David C. Kibbe, MD MBA
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David C. Kibbe, MD MBA

The Parable of the Wicked EMR It was a scandal. In 1631 two London printers published an edition of the bible that omitted “not” from the seventh commandment. [It should have said “Thou shalt not commit adultery,” but it didn’t.] The public outrage over what was dubbed the “Wicked Bible” was loud and immediate. King Charles I heard about it, and was incensed. This simple mistake by print compositors landed their employers in the Star Chamber before the infamous Bishop Laud, where they were tried, found guilty, and fined 300 pounds. They also had their print licenses withdrawn; the fine… Read more »