In many crime solving police procedural programs (NCIS, CSI, Criminal Minds etc), the perpetrator has used an untraceable, disposable cell phone.
But what is a disposable cell phone and where do you buy one? I’ve never seen one in my travels.
The answer – Walmart
The vendor – TracFoneContinue reading…
So the Fall Health 2.0 2009 conference in San Francisco at the Concourse Exhibition Center is over. The bunting is down, the cocktails are drunk, and everyone can get back to the sanctity of the WiFi enabled office or home. (Yes, we’re sorry about that problem and need to stress that it was NOTHING to do with AT&T who graciously sponsored the conference but were NOT providing Internet access).
But it doesn’t detract from the fabulous experience of seeing perhaps the most amazing line-up of health technology ever in one hall together–not to mention some of the biggest names in the Health IT world going toe to toe. Health 2.0 had over a hundred speakers and nearly 80 live demos and technologies on display on stage–not to mention 30 more in the exhibit hall. We featured Health 2.0 Tools for doctors, ePatients telling us what they needed, and a stirring address from CTO of the US, Aneesh Chopra. Then there was some remarkable integration over unplatforms in the tools panel–(I don’t know how often Esther Dyson gives standing ovations but that was great to see). And there was so much more.
Congrats to Remedy Rx Ventures and Unity Medical–joint winners of Launch! But honestly we believe that everyone who presented had something important to show and say. Thanks to everyone who came, demoed, sponsored, spoke, volunteered and worked so so hard (especially the volunteers who stayed late on Wednesday to move tables and chairs).
We had a great time and we made a difference. There’ll be videos and more up here next week. For now, take the weekend off!
My more detailed comments are below the fold.
By
Consumer directed HIE will become the most visible aspect of health IT stimulus and could lead a shift to consumer-directed health plans, increased interest in wellness programs and family-centered collaboration for the young, old and seriously ill.
At a recent Boston meeting on health records infrastructure, key stakeholders recognized the potential of patient control as a strategy to address privacy concerns that could otherwise limit ongoing health networking initiatives. MedCommons proposes one possible approach to making the national health information network (NHIN), currently conceived as a provider-to-provider exchange, consumer-friendly and consumer-accessible. We illustrate the need with a true story, propose a novel addition of independent identity service providers to the NHIN and then illustrate how this could be used to transfer the soldier’s CT to the US for a second opinion even as he’s being transported.
On the morning of the Boston meeting, a friend of mine called to say that his son was seriously wounded in Afghanistan and was being stabilized for transport via Germany to the US. He knew that his son had a CT in the field clinic and wanted to get it before the son was transported over four days through to Bethesda. Could the Health Internet be used to help this family?
The NHIN does not have to run like Big Brother. We propose a voluntary identity principle that distributes trust among multiple private and public institutions and gives consumers a choice of who controls their medical identity. Some might pick a particular hospital, others might choose their regional HIE while others could choose a private service such as a bank or telecom that is not a health care business at all.
The institution that manages a patient’s ID on the Health Internet is referred to as the IDP. To authorize health records exchange on the NHIN, an IDP would have to meet strict requirements and receive a NHIN Certificate. A NHIN Certificate is analogous to the SSL certificates issued to banks and other corporations on the Internet. Larger hospitals, military, VA and integrated delivery networks on the NHIN also hold a NIHN Certificate.
The issue and administration of NHIN Certificates could be handled by state or federal agencies or privatized to Verisign and similar services that already do this for the Internet.
We propose a Health Internet consisting of two kinds of certified entities, health care providers and identity providers. Both are chosen and trusted by the consumer but the identity providers are the key to effective competition and innovation.
Small group practices, insurance companies, web personal health records services and search engines would likely not carry NHIN Certificates and would participate in the Health Internet only under the control of the patient trough their IDP.
Substitutability, the central concept of the Boston platform meeting, is a key benefit of this proposal. An IDP that disappoints a patient could be swapped out without impacting the health care providers and a health care service that disappoints could be ignored or disconnected with a simple message to the IDP.
Public health and research users of the NHIN would not be affected since all entities that carry NHIN Certificates could still interact with each other directly under whatever rules and regulations the Certificates represent.
How would this have worked in the case of a soldier shot in Afghanistan and on his way to Bethesda?
– Before entering the service, the son might have picked Verizon as his IDP because they hold an HNIN Certificate and offer a family member override. He would have established the father, who also has a Verizon account as health care proxy.
– Upon induction, the health service saved the serviceman’s IDP selection (their Verizon health ID, possibly in OpenID format – see references below) along with the rest of his personal contact information.
– The father, when notified of the injury, is unsure which doctors will be available to consult on his son’s case, but needs to have the son’s CT scan at the ready as a first step.
– The father decides to do a transfer using a personally controlled health record service because it will give him control of the CT and make it easy to deliver the images to any physician that offers to help. Neither the father nor the health record service has a HNIN Certificate.
– The father goes to the military health service EHR portal. Without logging in, he goes to a form that requests his son’s Verizon health ID along with the MedCommons-type account ID where the CT is to be delivered.
– The EHR portal contacts Verizon for authorization on the basis of shared trust under the NHIN federation.
– When Verizon’s text message to the son goes unanswered, Verizon contacts the father as Health ID proxy. The father reviews the correctness of the familiar-looking MedCommons-type ID as a the destination and authorizes the transfer.
Note that the military health service does not actually know whether the son or the father actually authorized the request but they trust the transaction because the military health service knows that Verizon holds a valid NHIN Certificate.
In summary, the introduction of certified identity providers into the NHIN together with simple and commercially established OpenID protocol can transform the NHIN into the consumer-friendly Health Internet and bring simple regulation and market forces to bear on solving difficult privacy problems.
CODA: As of 10/4, the the soldier is stable, conscious and out of the ICU in Bethesda. A second opinion is in the works at a Boston hospital. The parents and collaborators are able to see and share 1.75 GB of imaging about their son. Let’s all hope for a good outcome and a speedy recovery.
Adrian Gropper is a physician and the CEO of MedCommons
References:
Patient ID on the Internet; October 12, 2007; Blog; http://agropper.wordpress.com/2007/10/12/patient-id-on-the-internet/
Web leaders initiate govt open identity pilot program; September 30, 2009; Health Imaging Editorial; http://www.healthimaging.com/index.php?option=com_articles&view=article&id=18927
So it’s the morning after the big Health 2.0 bash and the hangover is awful. My head is awash with flashing screens of medical alerts, rainbow-colored demos of virtual patients flitting from one personal health app to the next, and a blur of snappy, almost sneering answers to the same old questions about user adoption, ROI, and business models. I just spent two days getting high on health care’s highest high-concept, I can’t log into my own health plan’s portal to look up a simple eligibility thing, and it’s dull, gray cloudy morning in San Francisco.Whither the 2.0 revolution you’ve been reading about all week? Was the blueprint unfurled before the cognoscenti by Matt Holt and the NorCal health care keiretsu? Was there an exhibitor booth handing out the magic bullets, along with the usual pens and mugs? Um – no.Perhaps it’s my own perennial impatience with health care’s miserable status quo; perhaps it’s a sign of the inevitable coming of age for the 2.0 community, or space, or ecosystem, or whatever the corporate concept jockeys are calling a market this year. But at the risk of offending Matt and my other good friends in the keiretsu, this year’s conference felt for the first time oddly normative, almost reminiscent of other conferences like HIMSS and the World Health Congress, where Big New Health Care Ideas run headlong into The Great and Powerful Health Care Inertia Machine.
By THOMAS GREANEY
In his closing remarks to the Senate Finance Committee last week, Senator Baucus pointed with special pride to the effect the Committee’s reform bill will have on shaping the health care system in the longer run:
One point I want to make… is about delivery system reform. We are starting here in this bill to finally reform our delivery system so it’s based much more on quality and patient focus, moving ever so slowly, but inexorably, from fee for service….which causes a lot of the waste in our system. We’re not going to see savings, the benefits, to the system for a while… but after four, five, six years from now, we’re going to see the real benefits of reform.Continue reading…
In the fall of 2008 I had the opportunity to do some research on the, then dormant, EMR marketplace. The results came as no surprise. Most physicians did not have an EMR and were not interested in adopting an EMR due to cost and usability barriers.
Much has changed in one short year. Spurred by ARRA and its HITECH portion, there is a renewed interest for technology in the physician community. Some of it came from the promise of stimulus funds and some stems from the perceived inevitability of the need to have technology in one’s office. There is no feverish anticipation of the great things an EMR will bring to a medical practice. Instead, there seems to be a somber resignation to the upcoming demise of a trusted friend: the paper chart.Continue reading…
SAN FRANCISCO, Calif. – October 7, 2009 – Health 2.0 Accelerator member companies today joined together at the Fall 2009 Health 2.0 Conference to demonstrate a streamlined, consumer-centric integration among nine separate technologies creating a more streamlined user experience.
During the conference “Tools Panel”, eight Health 2.0 Accelerator members MediKeeper, change:healthcare, Sage, Kryptiq, MedSimple, Polka, ReliefInsite, PharmaSURVEYOR and Kinnexxus worked together to demonstrate a seamless, end-to-end user experience across disparate Health 2.0 applications. The demonstration enabled a consumer persona to sign into their personal health record and utilize their personal and clinical health information across several applications while using Microsoft’s HealthVault data sharing platform without having to re-enter information. The demonstration also utilized the Drug Code Lookup Service being piloted by member companies First DataBank and PharmaSURVEYOR that provides easy online access to First DataBank’s standardized drug codes to promote interoperability among Internet-based healthcare services.Continue reading…
Prostate cancer surgeons around the world are using surgical robots to assist in the most delicate operative procedures. Across the country, nearly 1,000 of these robots have entered hospital operating rooms, including our institution: Swedish Medical Center in Seattle, Wash.
These minimally invasive devices, called daVinci surgical robots, offer patients substantially less pain, short recovery time and quicker return to normal activities than traditional open surgery. And because of this, the da Vinci and I have done more than 900 procedures together.
The da Vinci robot assists me during surgery by taking my movements and making them better: more precision, greater freedom of movement and no surgical tremor. These robots offer unmatched surgical precision – meaning my hand cannot compare to the dexterity of the robotic arms. We simply cannot turn our hands 540 degrees. Da Vinci has 4 robotic arms, which I control at all times at the surgeon’s console. I look through a 3-D viewfinder at the console, which gives me visual depth, and a magnified view 10 to 15 times closer than human vision allows. This magnified view gives me more precision as well. Better visibility, better instrument movement means better surgery.
Through my years using da Vinci surgical technology, I know that it offers several advantages over conventional open surgery. These include less pain, faster recovery, and less blood loss which means reduced need for blood transfusions. Because the surgery is performed through small incisions there is less internal scarring and less risk of bowel adhesions.
Most importantly, with regard to prostate surgery, using the robot has demonstrated improved outcomes over open prostatectomy. In my experience this has resulted in less urinary incontinence, less erectile dysfunction, and excellent cancer control.
Coincidentally, I was diagnosed with prostate cancer in April 2006, and like all of my patients, the news was devastating. I looked at all the available treatment options and decided to pursue the robotic surgery over radiation therapy or open surgery. For me, radiation was a shotgun approach and the nerves that control sexual function are potentially at risk from the radiation. Having the prostate removed gave me information about the amount of cancer and whether it was contained inside the prostate. This is important in predicting the future behavior of the cancer and I would not get this critical information if I radiated the prostate.
Another important factor in my decision is that once radiation is performed, and if the cancer were to come back, surgery is not an option after radiation due to the high complication rate and difficulty created by the effects of radiation on the tissues. Tissue just does not heal well after it has been radiated. Conversely, if I had surgery first, and the cancer came back, then radiation was still an option. Essentially, I would be eliminating one treatment option if I had chosen radiation first.
Robot-assisted surgery allowed me to return to my normal activities quickly and this was important for my patients and practice. Through five small incisions about a half-inch in length, the robotic instruments and cameras are inserted into the patient (in this case, me). Compared to the open surgical incision, these incisions are significantly smaller and for many patients this alone is reason enough to consider the procedure over traditional open surgery. I was at home in just one day and at work within two weeks.
The typical prostate surgery patient after a more traditional operation is in the hospital two to three days and is recovering for four to six weeks. Almost all my patients have gone home the day following surgery, and most are back to normal activities by two weeks. 90 percent of my patients don’t take narcotic pain medication once they leave the hospital.
Today, prostate cancer affects 1 in 6 men in America. A non-smoking man, for example, is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined.
Every man is at risk for prostate cancer. While the causes for prostate cancer are largely unknown, one thing is certain – the chance of developing prostate cancer increases in men over 50. While age is clearly associated, I am seeing more and more men with prostate cancer under the age of 50 and even under 40. Close relatives of men with prostate cancer are also more likely to be affected.
This means that annually more than 192,000 men will be diagnosed with prostate cancer, and more than 27,000 men will die from the disease. This ranks prostate cancer as the second leading cause of cancer death in men just behind lung cancer.
However, the future is no longer as bleak as it once was. If caught early, prostate cancer is a treatable disease, which many men have survived. Today about 85 percent of prostate cancer surgery is performed using the da Vinci robot – it has become the norm for the surgical removal of the prostate.
As a surgeon, I’m acutely aware that the location of the prostate gland deep inside the pelvis makes these surgeries a complex and delicate procedure. Removing the prostate is just part of the procedure. Preserving the integrity of the tissues surrounding the prostate is essential to maintain urinary control and sexual function. That is why the benefits of robot-assisted surgery can be so critical.
Many men elect a robot-assisted prostatectomy because it often provides the fastest return to normal daily activities. My experience as both a surgeon and as a patient is proof. If you are diagnosed with prostate cancer, be sure to make an informed decision about your course of treatment by doing your homework and researching the best approaches available, including robot-assisted surgery.
Dr. James Porter is director of surgical robotics at Swedish Medical Center in Seattle, Wash. and a prostate cancer survivor. Under his leadership, Swedish is one of the first medical centers in the Pacific Northwest to perform robot-assisted surgery. Swedish’s robot-assisted surgical program was first established at Swedish in 2005. Since then, Swedish-affiliated surgeons have performed more than 2,000 procedures using the da Vinci Surgical System, more than any other robot-assisted surgical program in the Pacific Northwest. Dr. Porter is the first medical professional in the country to perform a retroperineral robot-assisted partial nephrectomy using the da Vinci robot (removal of a kidney tumor). Dr. Porter trains surgeons from around the globe how to use the da Vinci robot.
Yes, today is the big day for Health 2.0 or rather the first of two huge days. In less than 7 hours Indu and I will be stepping onto the stage and six months of work, rehearsals and excitement come to a climax. Many thanks in advance to all the speakers, sponsors, staff, exhibitors, volunteers and members of the Health 2.0 community for coming. We’re ready (or close as we’ll ever be!)
I can’t hope to capture all that’s happening, but here’s two big pieces of news. Myca just received an investment from Sandbox, the Blues venture fund. You can hear an interview I did with Nat Findlay, Myca CEO from a few days back here. You can see Myca both on the Clinical Groupware panel on Day 1 (today!) and in a sponsored Deep Dive on day 2.
And Keas, Adam Bosworth’s company, is formally launching on Day 2 and gets its own article in the NY Times today. You’ll be hearing more about this, and platforms and unplatforms throughout the conference!
Finally, THCB & Health 2.0 has its own little news. JD Kleinke (the Arriana Huffington of health care!) is emerging from a long period of seclusion and both pens his first article as a a THCB contributor today, but is also a very late addition to the “Can Health 2.0 Make Health Care More Affordable” panel at Health 2.0 today!
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