Here at THCB we really can’t think of many lectures we’d rather sit in on than Peter Thiel’s Stanford course on entrepreneurship. And we can’t think of a better guest to catch than Netscape co-founder Marc Andreeson. In this talk, Andreeson talks about how healthcare IT is changing in the Facebook and Big Data Era era, the privacy issue and how the cloud may or not be eating software.
Is Software Eating the World?
Marc Andreessen’s most famous thesis is that software is eating the world. Certainly there are a number of sectors that have already been eaten. Telephone directories, journalism, and accounting brokerages are a few examples. Arguably music has been eaten too, now that distribution has largely gone online. Industry players don’t always see it coming or admit it when it arrives. The New York Times declared in 2002 that the Internet was over and, that distraction aside, we could all go back to enjoying newspapers. The record industry cheered when it took down Napster. Those celebrations were premature.
If it’s true that software is eating the world, the obvious question is what else is getting or will soon get eaten? There are a few compelling candidates. Healthcare has a lot going on. There have been dramatic improvements in EMR technology, healthcare analytics, and overall transparency. But there are lots of regulatory issues and bureaucracy to cut through.
Education is another sector that software might consume. People are trying all sorts of ways to computerize and automate learning processes. Then there’s the labor sector, where startups like Uber and Taskrabbit are circumventing the traditional, regulated models. Another promising sector is law. Computers may well end up replacing a lot of legal services currently provided by humans. There’s a sense in which things remain inefficient because people—very oddly—trust lawyers more than computers.
It’s hard to say when these sectors will get eaten. Suffice it to say that people should not bet against computers in these spheres. It may not be the best idea to go be the kind of doctor or lawyer that technology might render obsolete.
As of late this week, the new Yahoo Health is now up and running and showing a good deal of (as you’d expect) Healthline’s fingerprints. Here’s my interview with Healthline’s West Shell about them winning the contract to essentially take over the Yahoo site and more.
So pretty close to the surface are Healthline products such as Symptom Checker, Doctor Search, & Treatment Search. It’s a very good first step, and clearly a big improvement.
What’s not in this iteration is any integration with Yahoo Groups which has over 100,000 groups in its Health & Wellness category. There are over 25,000 alone about “Drugs & Medication”, 56,000 in Men’s Health, 9,300 in Reproductive Health, etc, etc. Figuring out what’s in those groups and making them much more user friendly is (I vote) the next job at Yahoo!
The giant is awake, out of bed and stumbling around the cave, but it hasn’t yet come out to frighten the villagers. Let’s hope it keeps moving!
There’s no doubt that despite my thoughts that Obama wouldn’t (and shouldn’t) have pushed health reform in 2009, it was a very big year for health care. Death panels, public options et al—one hundred thousand visits to THCB in August don’t lie.
So what should you look for next?
The finish is the start: It looks like some version of the Senate bill will be a done deal by sometime late January. That means that there’s about two years of health care industry players figuring out what it all means. The biggest two questions are; what will the types of plan sold in the exchanges look like? (high deductible with some preventive care thrown in is most likely), and what will the cuts and changes in Medicare payment actually look like in practice? (More of the same or real re-alignment around some kind of bundling). All these changes need reactions from the incumbents to reorganize around the new revenue streams.
Last Thursday I gave a talk to a very high powered group, the National Committee on Vital and Health Statistics. My old colleague Matt Quinn is now working for the soon to be very rich Agency for Health Research and Quality (another HHS agency), and he lined up a series of talks for the committee on non-traditional data sources. Non-traditional, by the way, means about anything that isn’t from one of the huge Federal government household surveys (like MEPS) that’s used by HHS to analyze health care spending and consumption. John Halamka, CIO of BIDMC and Chair of HITSP, gave an excellent summary talk about data sources that are being collated and integrated in Massachusetts. It’s available on his blog here. Bear in mind that a LOT of work has already gone into putting various patient data sets together in that part of the country. The most encouraging thing was how relatively easy it was for BIDMC to interface with Google Health and Microsoft HealthVault, and how problem free those interfaces have been.
My talk was about Health 2.0, and given that it was less familiar to the committee I both introduced the concept of social networking and consumer tools, and discussed how it might be integrated into a national data capture strategy to improve quality reporting and hopefully spur improvements in medical care processes. Both talks are available here. You need to go to 4.48.00 or so to catch where I start. John’s talk is after the discussion
Yesterday we tried to put EHRs into perspective. They’re important, and
we can’t effectively move health care forward without them. But they’re
only one of many important health IT functions. EHRs and health IT
alone won’t fix health care. So developing a comprehensive but
effective national health IT plan is a huge undertaking that requires
broad, non-ideological thinking.
As we’ve learned so painfully elsewhere in the economy, the danger we
face now in developing health care solutions is throwing good money
after bad. We don’t merely need a readjustment of how health IT dollars
are spent. We need to reboot the entire conversation about how health
IT relates to health, health care, and health care reform. To get
there, we need to take a deep breath and start from well-established
and agreed-upon principles.
Most of us want a health system that, whenever possible, bases care on
knowledge of what does and doesn’t work – i.e., evidence. We want care
that is coordinated, not fragmented, across the continuum of settings,
visits and events. And we want care that is personal, affordable and
Most of us also agree that, so far, we have not achieved these ideals.
In fact, health care continues to become costlier, quality is spotty,
and the gap between the health care we believe possible and the current
system is widening.
Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration’s investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I’d point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should–Matthew Holt
On Dec. 19, we published an Open Letter to the Obama Health Team,
cautioning the incoming Administration against limiting its Health
Information Technology (IT) investments to Electronic Health Records
(EHRs). Instead, we recommended that their health IT plan be rethought
to favor a large array of innovative applications that can be easily
adopted to result in more effective, less expensive care.
response to that post was vigorous. We received many comments and
inquiries from the health care vendor, professional and policy
communities – urging us to provide more clarity. One prominent
commentator called to ask whether we, in fact, supported the use of
EHRs. We both have been active EMR and health IT supporters for many
years. Dr. Kibbe was a developer of the Continuity of Care Record
(CCR), a de facto standard format for Electronic Medical Records
(EMRs), and has assisted hundreds of medical practices to adopt EHRs.
Dr. Klepper has been involved in EMR projects for the last 15 years,
and the onsite clinic firm he works with provides every clinician with
a range of health IT tools, including EMRs.
Nothing focuses the mind like an impending hanging. — Samuel Johnson
I’ve been preparing for tomorrow’s 3rd Health 2.0 conference in San Francisco, where I’ll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who’s-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.
The meeting is sold out at 950 participants. It’s worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he’d be surprised if 75 people showed up. There were almost 500, many of them with genuine influence.
Note: Amy Tenderich, who writes and maintains the wonderful Diabetes Mine,
just did this very illuminating interview with Google Health’s Missy
Krassner. As you’ll see, she doesn’t slow-pitch to Missy. This is a
sure-footed, tough-minded exchange about the real issues that are on
the table now in Health 2.0. – Brian Klepper
Slowly but surely, using the Internet for your health needs is
becoming as mainstream as shopping on the web: no longer futuristic,
but is it for everyone? And perhaps more importantly, are mainstream
commercial health platforms from companies like Google and Microsoft
really useful for people with specific chronic illnesses? I thought it
would be interesting to hear their side of the story.
So please welcome Missy Krasner, Product Marketing Manager for Google Health, whom I was lucky enough to catch up with for an interview last week.
Missy, shortly after Google Health launched last Spring, David Kibbe, former Director of Health IT for the AAFP, noted
that most of its services were “only mildly useful and sort of
‘toyish.’” How have these services evolved to be more useful to people
with health conditions?
After a long period of time I’ve finally wrestled Adam Bosworth to the floor and forced
the microphone to his mouth. Adam of course is the software guru (he’s one of the originators of XML) who went to Google to start Google Health, and spent much of 2007 talking about how he hoped Google Health would change health care. He then left Google Health (several months before it launched in March 2008) and at the very end of 2007 founded Keas. Adam will be at the Health 2.0 Conference and while Keas is in stealth mode at the moment, he may just be ready to show us all a bit of Keas’ technology by then.
But he also has very strong views on health technology, data, PHRs. HealthVault & Google Health, and much much more. Listen to the interview.
In real life Alice Kreuger has severe multiple sclerosis and is unable to walk without the use of crutches. She rarely leaves her home except for trips to see her doctor. In the virtual world of Second Life she leads a radically different existence. Here, she is the avatar Gentle Heron, the co-founder of the Heron Sanctuary – a self-described “support community” for others facing similar situations. In this clip she takes us on an eye opening and moving tour of her world. The clip was among the most popular at Health 2.0.