The 2008 ACUMEME eHEALTH AWARD

The ACUMEME e-HEALTH AWARD is given to Canadian Healthcare delivery organization that has successfully extended e-Health application(s) that further our national objective of a comprehensive, interoperable, and transferrable electronic health record (EHR.) The Award promotes and recognizes the exchange of best practices within the field of e-Health.

ACUMEME is pleased to announce the 2008 e-HEALTH AWARD WINNER is the Rapid Electronic Access to Clinical Health Information (REACH) EHR Viewer Initiative in the Province of Ontario’s Local Health Integration Network’s 5 and 6 respectively. Constituent Hospitals include the Credit Valley Hospital, Halton Healthcare Services, and William Osler Health, Headwaters Health, and Trillium Health Centre.

REACH is shaping the future of patient care in Canada. As the first Integrated LHIN’s, REACH extends a seamless (“read-only”) connection to critical patient information aggregated from multiple vendors and multiple sites. For over 1.8 million Canadians residing in LHIN’s 5&6 this ensures their historical patient data is available along the entire continuum of care---regardless of geographical location. Utilizing state of the art clinical portal technology (provided by vendor MEDSEEK,) the REACH platform intuitively weaves together all existing clinical data and services from 11 Hospital sites into one intuitive, unified, patient-centric view at the point of care. When Physicians, hospitals, labs, pharmacies, clinicians, consumers, and researchers are connected through integrated IT systems—healthcare delivery is safer, more efficient, and value-driven.

REACH promises to have a significant effect on patient safety and wasteful duplication, while extending Canadian’s a regional care system where privacy, security, and confidentiality are respected and easily moderated. Congratulations to REACH (and its member constituents) for winning ACUMEME’s 2008 e-HEALTH AWARD.

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Additional information on the REACH EHR Initiative.

Most US Doctors Aren’t Using Electronic Health Records

June 19, 2008 | By STEVE LOHR

A US government-sponsored survey of the use of computerized patient records by doctors points to two seemingly contradictory conclusions, and a health care system at odds with itself.

The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records.

Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.

The national survey found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.

Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.

“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.” Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.

“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay,” said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.

To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations. The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.

Individual doctors will be offered up to $58,000 over the five-year span of the project, which is intended to test the impact of incentives on the spread of electronic health records. Further programs across the country are planned. The report published in the journal also found that electronic health records were used by 51 percent of larger practices, with 50 or more doctors. Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records.

The findings of the study, which was paid for by the Department of Health and Human Services and a grant from the Robert Wood Johnson Foundation, broadly echo previous research on the adoption of electronic health records. Large medical groups have long been the early adopters, and small practices have struggled.

But the new study is based on a large sampling — more than 2,600 doctors across the country — and a detailed survey, making it more definitive than past research, experts say. The results, they say, also show a strong endorsement of electronic health records by doctors who have them, especially for what the report termed “fully functional” records, which include reminders of care guidelines, based on a patient’s age, gender or medical history. For example, 82 percent of those using such electronic records said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care.

“Those numbers are huge and very encouraging,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration. Dr. Brailer also pointed to the 54 percent of doctors without electronic health records who said that not finding an electronic health record that met their needs was a “major barrier” to adoption. In short, they are not satisfied with the existing products, which tend to be designed for hospitals — big customers — instead of small practices.

“What we see is a deficit in innovation, and that is something innovators and the capital markets can address,” said Dr. Brailer, who leads a firm that invests in medical ventures, Health Evolution Partners.

One wave of innovation is coming from big technology companies, like Microsoft and Google, which recently have begun services that offer consumer-controlled personal health records over the Web, which are stored in the companies’ data centers. These consumer-controlled health records are intended to link up and exchange information with electronic patient records in doctors’ offices and hospitals.

Dr. Peter Masucci, a pediatrician with his own office in Everett, Mass., embraced electronic health records to “try to get our practice into the 21st century.” He could not afford conventional software, and chose a Web-based service from Athena health, a company supplying online financial and electronic health record services to doctors’ offices. Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record. Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.

“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

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Original Article

Taking e-Health to the next level

Chief executive officers, chief information officers and other senior managers from healthcare provider organizations across Canada, along with representatives of sponsoring supplier firms, shared a diverse set of views and some fascinating insights into healthcare IT implementation challenges at the eighth eHealth Summit, held June 11-13 in Mont Tremblant, Que. The conference is organized annually by Canadian Healthcare Manager http://www.chmonline.ca).

An overview of the current status of eHealth in Canada was provided by Shelagh Maloney, executive director, external liaison, for Canada Health Infoway. Roughly one in three youth and adults in Canada — nine million people — are living with one or more medical conditions, Maloney said. Central to addressing the critical challenge of managing chronic diseases is to get these patients involved in their care.

“If you’re like a growing number of Canadians,” she noted, “you want to take an active role in managing your healthcare.” Maloney cautioned that there’s no quick fix to this problem — a point that was repeated by other speakers at the summit. She referred to the progress that’s being made toward implementation of electronic health records (EHR’s), but also eluded to an area that became a minor theme throughout the conference: health consumerism.

“The health consumerism trend is creating an environment where providers and patients alike want the right information, at the right time, to make the right decisions,” Maloney said, adding that consumer eHealth solutions, many of which deliver a broad range of information to patients, are gaining support.

CANADA’S progress in eHealth was put into a global perspective by Susan Hyatt, president and CEO of the corporate strategy firm HyattDIO Inc., and a former vice-president at Canada Health Infoway. A “global business platform” for the delivery of healthcare is being enabled by eHealth, she said, in which English is the pervasive language, brands are going global and eHealth infrastructures are prevalent, even in poorer countries.

“We’re seeing the emergence of a global healthcare bazaar,” Hyatt said. “And when things go global, everyone is affected.” To stress the point, she showed a map of the world in which such unlikely candidates as India, South Africa and China were identified as having “strong EHR, eHealth activity.”

Common to all national initiatives are a clear and well-articulated vision, a common architecture, and transparent governance and accountability frameworks. In Canada, however, there are some additional factors at work. “The privacy commissioners in Canada are engaged in early dialogue,” said Hyatt. “As well, Canada has portfolio management with targeted investment programs, and a well-defined co-investment strategy to manage risk.” However, there’s one significant area where Canada, along with the United States, lags: the adoption of electronic medical records (EHR/EMR’s) by primary-care physicians. This problem is well-known, yet Hyatt acknowledged that solving it remains something of a conundrum.

IN THE SUMMIT’S keynote presentation, Kevin Leonard returned to the question of technology and the role of the patient in managing chronic diseases more effectively. Leonard is associate professor in the Department of Health Policy, Management and Evaluation at the University of Toronto, and research scientist at the University Health Network’s Centre for Global eHealth Innovation.

The economic logic for patient involvement is compelling, Leonard said: “Out of a total healthcare spend of $146 billion in Canada; about $90 billion is for chronic diseases. And it’s estimated that of this, $50 billion is spent on providing information such as test results, care advice and repeat prescriptions.”

Just as customers having access to their personal financial information has reduced the banking industry’s costs, great savings will also be gained in the healthcare system, as more patients bypass the “hands-on” personal method and obtain personal health information for themselves. Consequently, a tremendous amount of strain will be removed from the healthcare system. Consumers from all types of industries are playing larger roles in both purchasing and developing products and services. The growth of social networking websites such as YouTube and Facebook are prime examples. In healthcare, however, such grass-roots contributions have been slower to come to the fore, although recent initiatives like Google Health, Microsoft Health Vault and Patients are emerging as alternatives to the status quo.

Healthcare has been slow off the mark in this area, Leonard suggested, because the system uses language and jargon that’s not accessible to the average consumer, and because patients may not yet appreciate the benefits to be gained from better access to their information. As well, there are no “information access” points to facilitate communication between patients and the healthcare system.

Ultimately, patients lack the encouragement, the education and the means to gain the information they need. To get patients more involved in an effective way, Leonard argued that more research is needed to determine how to do it properly. This research might help answer several questions, for example:
• How should patient access to EHR’s be supported?
• Who should control access?
• Does this lead to improved patient outcomes?
• How does increased record ownership address privacy issues?

He proposed that for these and other questions to be answered effectively, patients need representation by a formal organization. “This organization must represent both the ill (chronic and otherwise) and recognized, and invited to the table with other organized stakeholders.”

ONE OF THE KEY challenges in eHealth implementation is that of leadership, an issue that was addressed at the summit by John Hylton, president and CEO of John Hylton & Associates, and Canadian Healthcare Manager’s regular leadership columnist. Hylton presented some startling statistics: 90% of healthcare organizations run without a plan, and of the 10% that do have a plan, 90% fail to execute their strategies successfully. As well, 95% of a typical workforce doesn’t understand its organization’s strategy, and 60% of organizations don’t link strategy to budgeting. To the extent that eHealth and technology fit into an organization’s strategy, this lack of foresight can lead to some big problems.

“It needs to be recognized that different stakeholders want different things from health reform and from health technology,” said Hylton. “Unless we can agree on what we’re hoping to achieve, the wheel-spinning will continue.”

It’s also important to realize that technology is not a panacea. “Many expect way too much too soon from technology, while others harbor disappointment and even resentment about failed technology projects,” he said. “The truth is somewhere in between.” Hylton warned that if we consider all of healthcare’s many technology needs together — not only eHealth and information and communication technologies — then its apparent our current ability to assess, deploy and pay for innovation is inadequate.

“It’s also helpful to remember that there are many healthcare issues that preoccupy funders, administrators and trustees,” he said. “Technology is just one. Constant change and shifting priorities have created a planning environment that frustrates intelligent planning and decision-making, and there’s no doubt this impacts technology planning and decisions as well.

“As the OHA, for example, recently observed, ‘the current funding environment does not effectively support the adoption, collaboration and integration necessary to enable the realization of eHealth’s true value.’” Hylton said improvements in the use of technology will only come about when healthcare leaders, particularly system leaders, start to be much more intentional about the path they want to follow. Moreover, in every healthcare system, some individual or team has to “own” this priority. Budgets and personnel must be aligned to ensure success, and incentives need to be put in place that are directly tied to achieving measurable improvements in the uptake and effective use of technology.

“Strategy-focused organizations work through competing challenges and interests to identify the key strategic priorities that are most important for achieving improved performance,” he said. “The bottom line is that we need more strategy-focused organizations in healthcare. You might say all this is Management 101, but the fact of the matter is that our health system needs more Management 101.”

THE LEGAL risks involved in the implementation of EHR’s were the subject of a presentation by Richard Corley, partner with Blake, Cassels & Graydon LLP, who described his perspective as that of a “deal lawyer specializing in complex IT and outsourcing transactions in the healthcare field.”

The development of eHealth in Canada has seen a rapid increase in complex IT health system deals, Corley said, and recently the deal structures have tended towards more integrated multi-vendor environments, smaller and shorter deals, more onshore/offshore combinations, and a greater emphasis on better governance. There are expanding legal requirements around privacy, security, record disposal, medical device regulation and liabilities for claims. The laws and regulations that apply most directly to healthcare providers are the requirements under federal and provincial privacy laws in Canada, including the Personal Information Protection and Electronic Documents Act (PIPEDA) and the more directive requirements under the Health Insurance Portability and Accountability Act (HIPPA) in the United States, whose security rules apply to the storage, maintenance or transmission of electronic protected health information by health plans, healthcare clearinghouses and healthcare providers.

There are numerous requirements for security in EHRs, Corley noted, including subcontractors’ breaches and the losses and thefts of storage devices. Another concern, which has made the news on too many occasions in Canada, is the improper destruction of paper-based records and EHR’s. He also discussed the risks posed by projects that integrate and implement new eHealth information systems with existing systems and/or outsource the provision of such services to a third-party service provider. Integration and outsourcing projects are notoriously difficult to implement effectively and many have proven unsatisfactory, he said.

Best practices for IT integration include: clarifying objectives and gaining executive support for the project; clearly documenting requirements, scope and costs; securing expert help and internal support; good governance before, during and after implementation; allowing enough time for due diligence; avoiding unnecessary complexity; maintaining required flexibility; planning transition and repatriation; ensuring that required expertise is maintained; and having a contract to address contingencies.

WHERE WILL eHealth be by 2015?
Offering answers to that question at the eHealth Summit was an expert panel that took out its crystal ball and peered into the future. The panelists were David Cowperthwaite, project manager for Panorama; George Eisler, CEO of the BC Academic Health Council; Michael Lauber, chair of Ontario’s Smart Systems for Health Agency; and Judy Middleton, CIO of the William Osler Health Centre.

The panel was by no means filled with wide-eyed optimism, but it did express confidence that by 2015 EHR’s would be in place for the majority of Canada’s population. However, there was consensus, albeit from varied viewpoints, that achieving that end will produce further resourcing and funding challenges: once the eHealth infrastructure is built out, how will it be maintained?

“There’s a big difference between implementation and adoption, and usage for benefits,” said Cowperthwaite. “I worry that a lot of people will still not be getting good care in 2015, and there will remain an enormous gap with First Nations.”

Lauber was more optimistic that technology could be delivered to rural areas, and that enhanced broadband delivery will ensure the viability of initiatives such as telehealth. Eisler, however, worried that Canada won’t have enough people trained in technology to maintain the system.

From a hospital perspective, Middleton echoed this concern, because advanced facilities will require both predictable funding and access to highly qualified personnel.

The ninth annual eHealth Summit will be held June 10-12, 2009, in Montebello,
Quebec.

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The eHealth Summit http://www.hfconferences.ca/ehealthsummit/ Series is an annual forum (organized by Canadian Healthcare Manager Magazine http://www.chmonline.ca) for Canadian healthcare executives to exchange ideas, find out about innovations, share common challenges and discuss the strides that have been made in eHealth implementation across the healthcare continuum. The spirit of the conference is purely educational and 'think-tank' oriented.

Canadian Health Records Situation A Travesty

Janet French | The StarPhoenix | Wednesday, July 02, 2008

Canada's foot-dragging on embracing electronic health records is a flaw in the system as revealing as a patient's paper hospital gown, a longtime national health reporter says.  Globe and Mail public health reporter Andre Picard told a Health Quality Council conference on transparency in Saskatoon Friday the nation's lack of electronic health records is a "travesty" that helps make personal health information tricky to get and hard to understand once you do get it.

"Metaphorically, our butt-cracks are showing," he told about 200 conference attendees, who tittered at the remark.

Canada's health system needs to break out of the culture where basic health information -- including your blood sugar readings, blood pressure, cholesterol levels and how those numbers change over time -- is rarely shared with the patient and treated like a "state secret," Picard said.

"We're still in the era of paternalism," Picard said. "We're changing, but we're not changing quickly enough."

Picard gave the example of returning from a trip to Malawi with a parasite. When Picard asked his specialist what the name of the parasite was, the doctor was puzzled about why he wanted to know.

"Why do I want to know what's living in my body?" he said. "I just couldn't believe the arrogance of that. But it's not that uncommon, unfortunately."

The information in medical records belongs to patients, not health-care providers, he says. Standardized, electronic records available throughout the system would simplify access, Picard says. Patients might fare better if they approached health care like they shop for a vehicle, Picard said later in an interview.

"If you go to buy a car, you want the manual," he said. "If you get it fixed, you're not only going to get the bill, you're going to get an explanation of what went wrong and maybe you can avoid it happening the next time. It's the same philosophy."

Too many patients are compliant when they'd be better off asking questions, he said. "They have a great deal of respect for their physicians, which isn't bad, but it's taken too far. We just sort of take their word as gospel."

There's a bonus to inquisitiveness: Research shows engaged patients are healthier, less likely to experience a medical mistake and cheaper for the health-care system, he said.

"I think he's right," said Jean Morrison, the Saskatoon Health Region's vice-president of performance excellence and chief nursing officer, after Picard's talk. "We're a public institution, and people have the right to their information and they have a right to information about what goes on within public institutions."

Bobbylynn Stewart, the region's acting privacy commissioner, says it's "very easy" for patients to see their health records. The department will make copies at 25 cents a page and if an inpatient requests to see his or her chart, a staff member will explain what the jargon means.

Morrison admits many patients would not be able to understand their records without help. The region strives to eventually include a written analysis of tests in the notes to make records more comprehensible, she said. Although lab results, prescription information and diagnostic images are now computerized, Morrison estimates less than one quarter of the region's health records are electronic. The region would like to be paperless, but the provincial government will have to pony up the cash to make it happen, she says.

"Creating electronic records is a costly business because you are truly transforming the health system," Morrison said. "It's the software, the hardware, it's the training of the people, it's the way you do business. It's a multi, multimillion-dollar issue to do that. In the Saskatoon Health Region, we're talking tens-of-millions of dollars."

For skeptics who think information should be kept tightly under wraps, Picard points to Canada's tainted blood scandal, or the Newfoundland scandal where flawed breast cancer tests were done on women for eight years before the health authority admitted the errors.


"We can look at all kinds of elements that came into play, but No. 1, the starting point for that, was people covering up information and not being open about it," he said.

"In my experience, the price of secrecy and the price of paternalism is dead patients and wounded patients," he added.

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jfrench@sp.canwest.com

Using “Virtual Reasoning” to redefine Healthcare

by Dr. Marlene Beggelman

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.

Tools
Early stage Health 1.0 information has predominantly been available in the form of an “e-pamphlet” with a one-size-fits-all approach. Subsequent generations of Health 2.0 tools are interactive and deliver personalized, and therefore more valuable information that is geared specifically to the user’s input. With the advent of advanced tools, consumers are no longer limited to being passive recipients of pamphlet-style information; in these milieus they interact with each other or with sophisticated software that analyzes cases on an individualized basis. Advanced tools are being used by Internet entities as bait both to drive traffic and to capture detailed user profiling data.

Several categories of interactive Health 2.0 tools are available, including advanced search engines that deliver more accurate results; social media sites in which individuals hone their medical knowledge through interactions with each other; and finally, expert systems - sophisticated software programs that analyze a consumer’s profile and, based on the analysis, pinpoint the most relevant educational information necessary to support the consumer’s health care decisions. Expert system tools basically simulate human reasoning.

Virtual Reasoning – a New Model
Speculation about where Internet health care might be taking us can be approached, in part, as a projection of the next generation of the most advanced web-based health care tools. If what consumers and payers want from health care is an acceptable cost-quality trade off, assurance that care is appropriate for the situation, that the diagnosis is correct, and that errors of commission and omission are kept to a minimum, web-based tools need to move beyond simple information retrieval to the level of analytic services – expert systems that are virtually capable of reasoning, rather than only presenting facts.

If Health 2.0 products bring you cholesterol guidelines, then virtual reasoning tools, in counter-point, should calculate your LDL (bad cholesterol) goal based on your level of risk for heart disease and assess whether or not you are taking the right medicine. If Health 2.0 delivers personalized information, virtual reasoning systems offer the equivalent of a virtual second opinion.

As virtual reasoning tools reach a greater level of maturity, they will represent cost-effective alternatives to certain health care services traditionally performed face-to-face by health care professionals. At some point, they will cease to function merely as value add-ons and become reimbursable, revenue-realizing businesses in their own right, augmenting some of the educational and analytic services now in the purview of health care providers.

The logical end-point of expert system and decision-support adoption will be a new reimbursable segment of the service industry in which lower cost services are rendered through technology solutions. When physicians are reimbursed to use expert system technology, they will have sufficient incentive to adopt electronic medical records (EMR/EHR) as well.

For tools to replace certain traditional face-to-face services they have to be integrated into the clinician’s normal workflow and electronic medical records systems. EMR/EHR companies will first incorporate expert system tools for much the same reasons as the PHR initiatives do – for the value-added benefits they offer to the customer base. In future models, though, fully integrated tools will sit “under the hood” of an EMR/EHR, continually combing the medical record data for errors and oversights as new data is entered. They will compare treatment to evidence-based recommendations, follow response to treatment over time, generate outcomes data, and generally function as an automated quality assurance system.

Physician Adoption
Physicians will ultimately be reimbursed for the time they spend administering care through the medium of information technology. Early pilots will likely be initiated by payers (large, self-insured employers) who believe that the potential for improved, more appropriate care will result in significant cost-savings. These technology adjuncts will free health care professional from the mundane functions of data gathering, recording, and administering; they will enable physicians to focus on the more rewarding cognitive aspects of medical practice. With more free time, physicians can move squarely into a consultancy role in which they help their patients assimilate and analyze increasingly complex choices.

Significant activity around tool adoption is already underway: Microsoft, Google and other Internet companies have been acquiring advanced search and expert system tools; programs in which web-based service delivery is reimbursed are being piloted; and Google Health has taken the first steps to make a large number of tools available on their platform. How quickly the process eventually unfolds depends on a number of factors that mostly revolve around any upcoming changes in health care financing and in the political climate. No matter how health care financing is structured, however, the need for tools that enhance health care quality and efficiency still applies.

Dr. Marlene Beggelman is the CEO of Enhanced Medical Decisions, which is the company behind DoubleCheckMD.com.

Google Health and the Personal Health Record (PHR): Do Consumers Care?

By Keith Schorsch

Google Health’s unveiling last week and Microsoft’s HealthVault launch last October are important milestones in the evolution of Health 2.0. Both of these heavyweights have the resources and potential to improve the health consumer’s customer experience. I have followed the active (and important) conversations about privacy concerns, HIPAA, and Google Health’s terms of service, which are well represented by Erik Schonfeld’s post on Techcrunch and Larry Dignan’s post on ZDnet. And I read with interest Google’s rapid response offered by Google Senior Product Counsel Mark Yang.

What’s missing from all of these conversations is the elephant in the room. Namely, do consumers really care about having online personal health records? Current evidence suggests that less than 3 percent of health consumers maintain a PHR online, according to Lynne Dunbrack, program director at Health Industry Insights, who commented in a recent interview. It reminded me of the post on The Health Care Blog a couple of years ago, PHRs, EMRs, and pretty much useless surveys.

And while Google trotted out some great enterprise partners last week for its announcement, I didn’t hear any consumer voices or testimonials on how Google Health will fulfill an unmet need. To me, PHRs and electronic medical records remain an industry-driven vision, not a consumer-driven one — focused on efficiency and reducing costs. It seems we’ve lost sight of whether the consumer really desires and is willing to participate in these services. What are the circumstances for using a PHR and do the benefits outweigh the perceived risks?

Google Health does seem simple, straightforward, and easy to use, albeit with some major holes in content and functionality that I imagine will be filled over time. However, I struggle to see how it’s creating value for the average health consumer. Yes, data portability is important in some sense and does add a level of control for the consumer, but how much work is required by the user to create this asset? And how important is data portability to the consumer? We all remember the predictions of the paperless office. The “paperless record” feels like this decade’s version of the “paperless office.”

The best news around this announcement is the upcoming Google API that will allow others to create applications on this platform. There are myriad privacy and security issues with data moving from Google to third parties. For example, I’m not sure what personal health info was sent to Daily Apple when I signed up for their widget, nor am I fully aware or comfortable with Daily Apple’s privacy and security. But despite this, I think the API holds the most promise for consumers.

The bottom line, for me anyway, is that Google Health feels like a good, incremental step toward putting more control in the hands of the health consumer. People should have more information about their next treatment or medication than they do about their next book or automobile. Without a clearly delineated consumer benefit, however, this is a platform waiting for a killer app.

Keith Schorsch is the founder and CEO of Trusera.com, a social health Web site. Read Original Article.

Google Health beta -- What's really new and different?

May 23, 2008 | Google Health beta -- What's really new and different?
By David Kibbe

From his role as Director of Health IT for the AAFP, co-creator of the CCR and with his involvement behind the "NDA firewall" with the Google Health team, David Kibbe probably has a better vision than most about what's new and different with Google Health. And he is indeed optimistic.

Much of the discussion about Google Health beta's recent launch as an online PHR or healthURL seems to me to miss the point about what is really new and different. Here's how I see it:

1) Computability. What Google Health does that no other platform is yet capable of doing is to make personal health data both transportable AND computable. Right now, this is the news. By supporting a subset of the Continuity of Care Record (CCR) standard for both inbound and outbound clinical messages, Google Health beta makes it possible for machines to accept, read, and interpret one's health data. It is one thing to store health data on the Web as a pdf or Word text file, for example one's immunizations or lab results, where they can be viewed. It is a giant leap forward to make the data both human and machine readable, so that they can be acted upon in some intelligent way by a remote server, kept up-to-date, and improved upon in terms of accuracy and relevance. That is what the CCR xml subset supported within Google Health beta achieves for the consumer that is really new and different; this is what HealthVault and Dossia are to date missing.

Right now, those web services are only mildly useful and sort of "toyish" -- allowing the user to create a meds calendar and get email reminders (ePillBox), or setting up preferences for health and medical news searches (MyDailyApple), or suggesting alternative medications to the ones you now take (SafeMed). But disruptive innovations are often considered simplistic and compared to toys when they first emerge (remember the first Apple computer?) and there is no stopping these developers and these partner companies from making their services more intelligent, more useful, and more convenient to the consumer. Which brings me to ....

2) Rapid design evolution. Google Health beta has established a robust and growing community of programmers and developers eager to attach their widgets, services, and full-scale apps to the Google Health beta juggernaut. Most of the public doesn't see this activity, because it is hidden behind the Google NDA that the developers have to sign, swearing themselves to secrecy about what's going on at Google Health. But it is an enthusiastic, really smart, and tirelessly innovative group of people who have been attracted to the Google Health platform. They are going to help Google's engineers rapidly evolve the design of Google Health over the next few months and years, in ways that are completely impossible to predict, depending mainly on how fast Google Health's operators are willing to move. Design creates value, and value causes infrastructure to change. Modularization of the entire EHR and PHR space may now be possible.

While I recognize that most of the commentary about Google Health beta and Microsoft HealthVault will concentrate on privacy concerns, barriers to data entry, and questions about whether mainstream health data sources will participate or not, I think the disruptive potential has already been unleashed. Watch what happens as the Google Health platform modules and component services grow and start to interact with one another. Read original article.