Just in case you don’t think that THCB is enough, Shahid Shah who among other things runs The Healthcare IT Guy blog, has put together a page with many if not all of the health care IT related blogs on it at HITSphere. There are a couple there that I haven’t picked up on including a news source about consumer health informatics and one from Microsoft. Although Shahid has also put up the IBM one yet, showing commendable corporate even handedness! Note the lack of blogs from health care specialists Cerner, Epic, et al–perhaps they just don’t dare go into Mr HISTalk’s territory. I’m trying to figure out how to get my feed to send itself there when I talk about technology…which the casual THCB reader knows that I do from time to time.

Meanwhile, check out the new HITSphere index and wander around. I suspect in a year this page will be an interesting historical artifact, and we’ll need new tools to sort all the new different blogs and postings out there.

The ever wonderful Jane Sarasohn Kahn has a new commentary up at iHealthbeat on  iPods and Health Care. It’s really more about how consumers are using new media in general in health care rather than podcasting per se, but it’s well worth a read.

I’m talking at a conference at the end of the week about consumer health records.  Given that you all by now know the history of how the company I was with that sold consumer health records to health plans was ahead of its time didn’t survive, you won’t be surprised to know that I’ll be talking on a topic I’m calling  An Archaeology of the Commercial PHR Movement.

Well today it looks like another start-up that announced with much fanfare a couple of years back is biting the dust, or at least going back to the machine shop for some serious work. RedMedic is sending out letters asking its subscribers to print out their records, and telling them to go to MedicAlert instead. Unfortunately when they contacted me a couple of years back, I told them that I thought they’d have a very tough road. Hopefully, they’ll come out of this somehow, but unfortunately they look like they’ll be another layer in the rubble on which hopefully a viable PHR will be built.

Now that cell phones and Wi-fi have proven to be safe and essential for health care facilities, there’s a race on to get signals into those buildings. This is proving to have some interesting possibilities, but is also bringing some technical challenges to hospital technology managers. Frequently buildings are too dense to allow good cell phone signal, while increased demand for Wi-fi and VOIP is putting pressure on the ad-hoc Wi-fi networks being built up in many hospitals. One solution gaining traction is to locate PCS, cellular and paging, and Wi-fi services centrally and create a series of ceiling-based transmitters to amplify and distribute the various signals. One company in the forefront of this is InnerWireless, which has announced several installation wins in recent weeks. I recently spoke with Jim McCoy, chief technology officer of InnerWireless, and Tuomo Rutanen of Ekahau to find out a little more about what’s going on inside the wireless world for hospitals.

Wireless and Wi-fi are different. InnerWireless’ technology deploys Wi-fi, as well as PCS, cellular, 2 way radio, 2 way paging and other signals. Conventional practice for Wi-fi is to deploy those points throughout a floor or department. Innerwireless co locates those Wi-fi access points at one place per floor, combine their outputs and then injects them onto their distributed antenna, therefore giving every user the strength of multiple antenna to access. This enhances Wi-fi data and more importantly VOIP performance. There tend to be around 6 distributed antenna per typical 20,000 sq ft floor, each one up in a ceiling panel where it’s installed once and forgotten about. All other services (cellular, PCS, etc) are piped to the same access point from aggregated through a main console room. And of course once the central points are in for cellular, it’s probably more cost-effective to layer Wi-fi into that system than to do it with ad-hoc networks.

In addition InnerWireless, Ekahau, and others are developing the ability to track patients, products and equipment in a cost-effective real time manner using the Wi-fi network–an always-on alternative to RFID which works sort of like an “indoors GPS”. They are both deploying tracking tags on people and equipment, and the size and price of those tags is falling rapidly. Ekahau’s approach takes advantage of the existing Wi-fi network, whereas InnerWireless uses its installed antennas and adds several more battery-operated sensors (probably 20 more per floor) to extend the accuracy of its trackers. Innerwireless is running their tracking over a different system within their infrastructure and are using the 802.15.4 standard for the tags.

These are two innovative companies attacking a key problem for health care facilities. Given the problems hospitals have locating their staff, patients and other movable parts, expect this technology to spread rapidly.

Cerner’s stock price is up another 5% today. It’s P/E is nearing 45.  And this is for a company that basically sells more services (i.e. consulting) than software. No doubt that the re-architecting of their technology back in the last Millenium paid off big time, but this recent spurt really is on no new news, other than GE overpaid for IDX.

But does this mean that one of the oft-mentioned candidates for takeover (Oracle is a frequent mention, but any big tech firm might do) is having another look?  Or would the really ballsy play to be shorting Cerner here? Here’s the chart, and yes we should all have bought in May.

Technorati: healthcare, health, technology, policy, politics, economics,medicare

You can skip this one if you’re bored but the Personal Health Record and associated stuff just won’t quite go away. I’ve not only got a tawdry past associated with the PHR/CHR, and have spent far too long thinking about it, but I’ve also fooled myself into creating a paper for a forthcoming academic presentation on the subject–which will be an archeology of the attempt by commercial vendors to get the PHR up and running.

Now USA Today has a piece on PHRs which goes onto talk about yet another new one (Mymedicalrecords.com) which is basically a "fax paper in vault" which looks exactly like half of the ones that came out in 1999, such as PersonalMD.com.  And BTW their technology was backwards even for then! So it look as to me as though USA Today has been a little bit snowed.

So let me give you my four categories of PHR

1) The PHR that is looking into a real EMR.  See the version that PAMF or Group Health of Puget Sound uses based on their Epic system.

2) The PHR that looks into the claims database of an insurer and changes the view of the CRM system the patient sees.  This is the one that I was selling back in the day, and that WebMD via its Wellmed purchase is now just offering to plans, and has had Empire launch (and Wellpoint announce it will be launching). The recent IBM announcement is in this vein, although I doubt any American trust their employer enough for that to be a success. (see yesterday’s 60 Minutes as to why)

3) A PHR that allows a patient to look into their doctor’s system if they have one, or not. RelayHealth has a version of this, and Medem’s iHealthrecord is able to look into Allscripts EMR (and theoretically a bunch of others too). This is the ultimate answer for most of America (or some version of it) but it’s dependent on using physicians as a distribution channel to patients and that’s a bit of nightmare.

4) A standalone device like Quicken, that may in some way be able to take in some portion or version of the EMR from providers. This is the route Capmed is going, and where RedMedic, MymedicalRecords, et al are heading.  I remain very, very skeptical about this — particularly their attempts to make consumers pay for it — but to be fair that’s what MedicAlert does and plenty of people are buying that bracelet.

Of course if you want to get everyone using one of these PHRs you’d be better off putting your whole state or national insurance system into it, as the Germans are doing.

Meanwhile, back in the UK, they are trying to get their related Choose and Book system up and running. This is a referral and appointment system between GPs and hospital specialists. (Note that in the UK there is very little patient self-referral). The answer seems to be that it is slowly beginning to work (in some places) and that it is increasing the role of the patient in choosing who they are referred to. (A choice which didn’t really exist before). Meanwhile, this article focuses on the early adopter the Whittington hospital, in North London, using Choose and Book. Of course The Whittington has always been ahead of the game introducing new and amazing things to the world. Yup, I was born there!

CODA: The USA Today piece horribly misquotes Mark Bard as saying that DrKoop.com had this PHR idea back in 2001 but never really got it going. DrKoop.com had this PHR idea before it was up and running in 1998, but couldn’t get it right and took the easier route of instead being a web health content portal. It never got the PHR thing into any level of production and having been an Internet star in 1999, it was on the famous March 2000 Barron’s list of companies that were losing too much money to survive (the article that helped start the dotcom crash). By 2001 it was basically going under. At least I hope Mark is being mis-quoted!

Last week’s PHR conference that I didn’t go to (cos they held it in DC and I’m too cheap to fly there by myself) now has an available transcript. (All big PDFs–you have been warned).

The intro is long but good. It has a talk from Carolyn Clancy (AHRQ chief) then a quick 3 person panel on PHRs from CapMed, Brown and Toland (using Medem’s iHealthrecord) and Cleveland Clinic (similar to the PAMF system Paul Tang spoke about). Finally it has a tour de force from Newt Gingrich, who explains exactly what we should have all have a personal health record and gives me no clue as to why we’ll get there. But that doesn’t stop companies giving him $200K a year to join his Center for Health Care Transformation–purely because they are interested in his words of wisdom; sure, yup that’s all they’re interested in!

I haven’t got to this yet but here is the Intel lunch talk, and here’s the last session with Esther Dyson et al

Yesterday’s the AHIMA meeting morning presentations were excellent. The presenters were all on their game, and were also relatively amusing (especially Mark Frisse). But although I know a lot more about the DC based machinations of the national health initiative after this and the Brailer talk yesterday, I’m still of the opinion that there’s less there than meets the eye.

Carole Diamond runs the Markle Foundation and their Connecting for Health Program with the help of David Lansky, who used to run the Foundation for Accountability which Markle has swallowed (more or less) whole. In her speech she talked about Connecting for Health

Connecting for Health cares about

1 Tech standards and adoption

2 Policy framework for successful EMR/PHR/RHIO implementation

3 The consumer

Continue reading…