Matthew Holt

More on HITECH , Microsoft mea culpas, Google, et al

I draw your attention to a troika of articles, all of which show how things can be slightly misinterpreted.

First, who knew that Blackford Middleton was either the most influential health policy wonk out there, or single-handedly responsible for the Haliburtonization of health IT? If you read the WaPo article about it, it looks as though there was some kind of terrible conspiracy to impose an evil fraud in terms of unnecessary health IT spending on the taxpayer. And for example MedinfomaticsMD over at Health Care Renewal (who appears to have jumped from the position that some health IT installations have real problems to the less tenable one that all EMRs kill) is just one going loopy about it.

I've known Blackford for a while, and even though I don't necessarily agree with everything he espouses I think two things are clear. One, the studies his team did (and does) at CITL were done honestly and competently, and they in general reflect what most of us have observed–EMRs have the potential to improve care quality and save money, but that most of the money saved flows back to payers. This has been the experience both in integrated systems in the US, and in health systems in Europe. There are those of us who think that much of the $2.4 trillion is wasted and IT might be part of the solution to trim that waste.

So it was not a great stretch for the Obama team to make the logical leap that health IT is a good thing, and and that subsidies will have to be given to physicians to get them to adopt EMRs (or wider uses of clinical IT). Fer chrissakes even many on the right agree with them. This was not Halliburton sticking it to the US taxpayer in order to boost Dick Cheney's stock options. (Insert your favorite conspiracy theory about the reasons for the Iraq war here if you don't like that one)

Second, complaining about the Feds spending money on this is a little late. It was front and center in Obama's campaign, which explicitly stated that he would spend $50 billion on health care IT over 5 years if elected. And this was well before the downturn in the economy, which in the WaPo article appears to be the trigger event.

You don't like it? Then you should have voted for someone else. You don't think that the money should go on CCHIT certified EMRs? Then make your case vigorously (as has been done many times here on THCB). But to paint this as some type of deep conspiracy in which Middleton and HIMSS pulled a fast one, ignores the many volumes of research and practice showing the overall benefits of IT use in health care.

* * *

Second, I'd forgotten about about being interviewed for this piece in CNET News about Microsoft & Google in healthy competition. The competition being referred to of course is between HealthVault and Google Health. but as both the Microsofties and Googlers interviewed point out, they're delighted to have the other around. This is a market that's in its early stages.

The point that I'm attempting to make in my quote is that most of the activity among consumers online is in information seeking and communication–in the absence of personalized data. Healthvault, Google Health, Dossia, WebMD, KP HealthConnect et al are trying to bridge that gap, by putting the data that's strewn across the health care system into the consumers hands–and make it manageable.

As we know, that is not easy. The ePatient Dave 'BIDMC to Google Health' story is yet again brought up and yet again Dave is not exactly thrilled with the portrayal. He comments that blame has been unfairly put on Google, all they did was take the data BIDMC sent them. And many of us were very impressed that Dave, John Halamka at BIDMC, Roni Zeiger at Google and Danny Sands (Dave's doc and also a Cisco exec) got on the phone and figured this out in a sensible open manner. How often does that happen in the case of those millions of medical clerical errors buried in those manila folders?

(To be fair, overall Ina Fried who authored the series–part 1 is here–has done a nice job of catching the issues).

* * *

Third, and least. Someone sent me this piece which I'd missed about how I'd upset Sean Nolan (guru of MS HealthVault). I do want to apologize to Sean and the MS team. I owe them a review of Healthvault comparable to the one I did of Google Health a while back. Truth is part of the reason I'm writing this whole post at midnight rather than joining my wife and dog snoozing is because of said guilt. But I'm also feeling guilt from a bunch of other parts of my life not being as "done" as they should be. You know, wives loved, exercise taken, friends cared for, day job being completed, etc. My reasons for not reviewing or featuring HealthVault are related to those issues and overall incompetence on my part. So just to set the record straight

  • I am massively impressed by the commitment Microsoft has shown to health care.
  • I have no pre-conceived bias towards either company. I think it's clear that Microsoft has spent more resources in health care overall (and I think Google would admit that) but Google is clearly  the more dominant of the two companies on the web overall (and in delivery of SaaS products). My only bias is in favor of better (and more) use of technology for people to better manage their health.
  • To be transparent, while THCB has had no funding from either Microsoft or Google, Health 2.0 (which I co-run & co-own) has received sponsorship money from Microsoft, but not Google. However, in terms of presentations Health 2.0 has featured Microsoft and Google (I think) absolutely equally.
  • ….and yes Sean (and Tracey and colleagues) I will get to that review…honest

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