Tag: Web/Tech

Using virtual reasoning to redefine health care

is the CEO of Enhanced Medical Decisions, which is the company behind

The Internet is redefining the health care industry. Major transformations can be expected because Internet-based technology will deliver certain health care services more effectively and at lower costs. In the near future, much of the information that is currently imparted to consumers by clinicians will be delivered through and by web-based technology. If the web-based tools that deliver this information mature to the point of becoming reimbursable, beyond their current usefulness as value add-ons, the health care industry could experience a dramatic shift.

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E-patients can and will revolutionize health care

By taking advantage of new online health tools, e-patients and health professionals
now have the ability to create equal partnerships that enable individuals to be equipped, enabled, empowered and engaged in their health and health care decisions.

That was the vision of Dr. Tom Ferguson, who coined the term e-patients and launched in 2006. Ferguson intended to upload his book-length overview of the online health revolution, “E-patients: How They Can Help Us Heal Health Care.” But unfortunately, he died a month later 2006, after losing a fifteen-year battle with multiple myeloma.

Following Ferguson’s death, a group of his friends and colleagues completed the paper and adopted the blog to carry on his work, as well as our own. Each blogger brings a different perspective when commenting on Health 2.0 developments.

We think the “E-patients” paper remains relevant in 2008 (PDF, wiki) and we hope to extend the findings into the future. To that end, we are also working on the creation of the peer-reviewed Journal of Participatory Medicine with the help of Sarah Greene of the New York Times; Bruce Shriver, PhD, of the Liddy Shriver Sarcoma Initiative; and George Lundberg, MD, of Medscape. We welcome your comments and suggestions.

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Google Health finally up and open for business

After a long time in discussion, Google publicly launched Monday its free online personal health records. The operation first made headlines a couple of months ago when Google announced it at the Healthcare Information and Management Systems Society (HIMSS). I was invited to the Googleplex, but due to a prior engagement,  had to miss the chance to get it from the horses mouth.

Much like the "non-PHR" HealthVault, Google now allows consumers to download records from its eight initial partners and store them for free.Googlehealth

As the WSJ Health Blog points out, only a minority of medical practices keep records electronically. But the good news is that Google has been thinking not just about EMRs, but also about the rest of data that’s most useful (Rx and lab results) and has some big players, such as Medco, Walgreens and Quest on its list of initial partners.

Google will also have to spend more time now dealing with the privacy zealots and not just leaving it all to, well, me!

Although I wasn’t there, a much more famous health IT person was. John Halamka is the Chief Information Officer at one of Google’s initial partners, Boston’s Beth Israel Deaconess Medical Center (and of course colleague of THCB regular Paul Levy, and more recently himself a blogger). BIDMC has offered its patients a PHR for more than 7 years, and now that data can be brought into Google Health (and I assume vice versa). John’s post about the launch is below — Matthew Holt


Beth Israel Deaconess Medical Center is now live with Google Health. In the interest of full disclosure, I am a member of the Google Health Advisory Council and have not accepted any payments from Google for my advisory role. BIDMC is also working with Microsoft Health Vault and Dossia.

I’m now at Google Headquarters in Mountain View with the Google Health team – Roni, Missy, Maneesh, Jerry etc. and several dozen reporters.

Here’s the functionality we’ve launched.

When a user logs into Google Health and clicks on Import Health Records – the following choices appear:Googlehealth_2

  • Cleveland Clinic
  • Longs
  • Minute Clinic/CVS
  • Quest Laboratories
  • RxAmerica
  • Walgreens

They are all early integrators with Google Health.

At BIDMC, we have enhanced our hospital and ambulatory systems such that a patient, with their consent and control, can upload their BIDMC records to Google Health in a few keystrokes. There is no need to manually enter this health data into Google’s personal health record, unlike earlier PHRs from Dr. Koop, HealthCentral and Revolution Health. Once these records are uploaded, patients receive drug/drug interaction advice, drug monographs, and disease reference materials. They can subscribe to additional third party applications, share their records if desired, and receive additional health knowledge services.

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The Security of Patient Data

EXCLUSIVE TO THCB: HIMSS Analytics, the research arm of the powerful, thoughtful and highly regarded Health Information Management Systems Society, has published a sobering study, Security of Patient Data – see here – that highlights the gap between hospital patient data security practices and the reality of impacts if a breach occurs. The report, commissioned by Kroll Fraud Solutions, should be a splash of cold water to health care executives in all settings with responsibility for patient data. A link to the Executive Summary has been placed at the bottom of this post.

In the wake of several recent incidents involving breaches of celebrity records, what’s fascinating about the study is that the executives interviewed claimed a very high familiarity with HIPAA rules; they averaged 6.53 (on a 7 point scale) and 75 percent of those interviewed gave themselves a 7. The report attributes the high sense of HIPAA knowledge with the current rounds of HIPAA compliance audits and the penalties for non-compliance that have resulted in some cases.

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Diving Deep with American Well by Craig Stoltz

American Well, an ambitious startup designed to provide virtual health/medical transactions between patients and doctors, has been invited to present its product overview in a thoroughgoing way–a deep dive, in Health 2.0 patois.

In this liveblog, I need to control the depth, of course. I’ll try to boil this into five (5) key points about American Well:

1. Unlike other industries, health so far hasn’t succeeded in doing transactions (Amazon, Expedia, eBay, etc.) on line. Imagine Expedia if, instead of buying a ticket, all you got was a picture of your plane. What’s missing? In health, it’s the real care transaction.

2. American Wellness is essentially a brokerage system for online wellness services–real services, not just information. Connecting consumers with providers and, as important, the money–which is to say insurance reimbursement systems. Patients, docs, money, all tied together.

3. Consumers can access specialists, from anywhere, for a fee. Their calls, e-mails, etc. are aggregated and distributed to the appropriate specialists in real time.

[The liveblogger anticipates the big question: How does this provide continuity of care?

And the answer comes immediately–the AW marketplace delivers only specialists, not a primary care doctor. The tradeoff of getting someone with whom there is no existing relationship to have immediate access to care. ]

4. What’s the transaction like? The demo shows a consumer’s entry into the system. [The interface is very clean–you can tell they usability tested this really well.] First, consumer looks for a doctor. [PowerPoint slide joke: Doctor profile that comes up is an OB whose name is given as Otto Matic.]

Doctors presented with bios, videos, etc. Ratings? Yes, but not clinical ratings. Just consumer satisfaction ratings. [Needless to say, this is one of many services attempting to aggregate patient evaluations of doctors.]

Part of summary is–price transparency! The cost of the anticipated consult is listed. Patients can fill in their health background to let docs understand the situation more fully. Then doctors, in real time, review request and decide if it’s appropriate that they take it on.

Then: When patient and doctor both agree to a clinical encounter online, an interactive console pops up –the interaction can be live video via webcam, live  audio or typing chat, on-screen notes and documents, etc. Lab information, with patient permission, can be added. While it’s a virtual interaction, it’s a rich-media virtual encounter.

5. And the consumer’s regular doctor? Patient can send doctor report of entire transaction.

[The liveblogger’s question: What will the patients’ internists have to say about this?]

Other point: Insurer AIG has developed a new malpractice insurance product–per transaction, not annual. It’s embedded in the service.

Will this save money in healthcare? AW argues that by providing some care in the home, and keeping some transactions at lower cost, insurers, payers and patients can save money. This can keep people out of the ER, maybe.

The AW plan–essentially disconnecting care from a physical location–raises all kinds of questions not dealt with, even in this deep dive: Privacy? Coordination of care? How to deliver service of real value without risking misdiagnosis, etc. How will insurers ultimately reimburse this care? How different/better/worse will this be compared to in-store retail clinics? What conditions or situations is this kind of virtual care best suited to?

And finally, when will this launch? In 2008, CEO Roy Schoenberg, MD assures us.

Liveblogging the Health 2.0 “Unconference” by Craig Stoltz

So Indu is on stage, introducing the Health 2.0 "Unconference"–user-led
discussions around tables, all happening at the same time. Whoever
submitted a topic gets to "hold court" at a table.

So you are reading The Health Care Blog’s liveblog of an Unconference. This is so front-edge, high-wire techno-virtual I think I may get a nosebleed. 

Enoch Choi, a very 2.0 physician and veteran leader of
unconferences, is leading the show. "Very reality TV"–if you’re bored,
pick up and go to a table that’s more interesting. Topics are being
submitted as we speak.

  • Enoch is giving out topics
  • Social media and pharma!
  • Genomics!
  • Extending patient-physician relationship!
  • The future of alternative sales channels in pharma!
  • Increasing patient engagement!

I’m using exclamation points, but we’ll see how exciting these topics
actually turn out to be. People are finding tables now. We’ll see how
many wind up bolting–and what precisely the I’m-leaving-your-table
etiquette is.


The biggest crowd, curiously enough, is at the table discussing "information overload." David Sobel holds court. Interesting point: More information actually "disempowers" people due to confusion and excess. Information is not always power. It’s often annoyance, noise, even harmful.

*********Over at the table of the estimable Esther Dyson, there’s a hand-written sign "The Impact of Genomics Info." This is heady stuff: one discussant talks about the sensitivity of an individual’s genomic information, and that the system isn’t prepared for dealing with that.

"And doctors," it’s pointed out, "are not trained in genetic medicine."

Benjain Heyward of PatientsLikeMe seconds the motion: Doctors aren’t set up to deal with the information that patients often want about their genetic risks, etc.


BIG crowd over at the Pharma-and-social-networking table. Great point made: "What would pharma have to gain from trying to create and own their own social network?"

If you’re a patient with Crohn’s, it’s asked, where are you going to go to find support? A forum run by a drug company? Or one with more independence and credibility.

Something called GroupLoop is mentioned. It’s described as a network that has the ability to become a "cross between MySpace and health." We’ll have to check that one out.

OMNI: The Oncology Metrics National Index – Brian Klepper

An innovative Ft. Worth consulting firm comprised of experienced oncology professionals, Oncology Metrics, has linked private oncology practices throughout the country in a collaborative, knowledge-sharing enterprise, called the Oncology Circle. The first round of information brought together 22 practices containing 167 medical oncologists. Combined, the practices treated almost 63,000 patients annually, had $600 million in revenues and spent $375 million on drugs.

In a separate but related effort, Oncology Metrics has established a new national data aggregation effort, The Oncology Metrics National Index (OMNI), which brings together data from practices using electronic medical records (EMRs), mapping the data in each EMR to a standard template. Then those data are aggregated and mined to produce different cancer care-related clinical measures associated with procedures and processes: e.g., the administration of erythropoietin (anemia drugs), hemoglobin (Hgb) testing, and patient staging. A primary goal is to create a data mine that can allow each practice to see how it compares to others, and how they might improve. But a secondary and also very important objective is the development of transparency information that can help rationalize the practices and costs that have dominated oncology.

This is a leading edge project that leverages the data that is newly available through EMRs, and that is indicative of the kind of progress that we can anticipate throughout health care in the next few years. Clearly a company to watch.

TECH: Firefox effed up?

Is it just me or is the latest release of Firefox 1.0.4 a disaster?  Ever since I downloaded it, Firefox has been crawling compared to IE–literally taking 10 times as long to download a web site.  So much so that I’ve abandoned it.  I’ve trawled the web, changed a few settings based on some stuff I’ve read, but it’s still a disaster.  Any ideas?


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