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.

IT Could Cut Canada's Health Care Costs by About $7B Annually

November 13, 2007 | Creation of Canadian electronic health records (EHR) system could save billions in costs annually. President of Canada Health Infoway predicts huge reduction in need for diagnostic tests, fewer days in hospital.

Richard Alvarez, President of Canada Health Infoway, the country's planned health information sharing program -- said that more effective information management through the use of IT could reduce national health care costs by $6 billion to $7 billion Canadian, or about $6.24 billion to $7.29 billion, annually, Charlottetown Guardian reports.

The savings would come from reducing hospitalizations based on unnecessary drug interactions and a reduction in duplicate diagnostic tests, the Guardian reports.

The Canadian federal government plans to invest $1.6 billion Canadian, or about $1.66 billion, into Health Infoway and leverage another $1.6 billion Canadian, or about $1.66 billion, from provincial and territorial governments.

"This is a $10 billion (Canadian) project all told by the time it is completed and we expect that to happen over the next 10 years," Alvarez said.

Alvarez said the nationwide health IT program will "start with hospitals, then pharmacies and community clinics, and probably the last to come on board will be family doctors' offices" (Original article from Charlottetown Guardian, 11/13).

Patients and Healthcare Providers to Experience Significant Benefits from the Use of the Internet

Thursday, 05 July 2007 | Frost & Sullivan
The growth of Internet applications in healthcare has been rapid. A growing number of patients are becoming increasingly involved in the healthcare service they receive. These 'power patients' possess characteristics that distinguish them from traditional patients and are an important factor in driving the use of the Internet in healthcare.

"Power patients are a growing share of the population and healthcare organisations will need to meet their needs," notes Frost & Sullivan Industry Analyst Konstantinos Nikolopoulos. "Free choice of doctors, control over treatments received, access to quality information about their care and extremely high levels of customer service are some of the expectations of power patients."

Besides, over the years, healthcare organisations have had to adapt to numerous changes, from advances in diagnostic and therapeutic procedures to the emergence of concepts such as managed care and telemedicine. The e-Health model represents another such change with far-reaching implications for healthcare organisations. In such a scenario, the Internet's capability to empower patients, support information exchange and thus result in new operational strategies, business and service delivery models can be very appealing although quite challenging.

Moreover, public health policies and regulations greatly influence the way in which healthcare organisations can use the Internet. For instance, uncertainty over privacy and security regulations regarding the use of electronic health information can deter organisations from sharing health records or administrative and financial information across the Internet.

"The transition to electronic healthcare and the use of the Internet to exchange health information raises serious security concerns," explains Nikolopoulos. "While the perception of the lack of security is inhibiting the use of the Internet for sharing clinical information, various technologies and procedures are being developed to deal with these security problems."

The European Union is already enforcing strict medical data security standards and the North American market is also demanding improved security and confidentiality in healthcare transactions with the Health Insurance Portability and Accountability Act (HIPAA).

In this scenario, all stakeholders will need to realise that in matters concerning security, privacy and confidentiality, ensuring 100 per cent absolute security and confidentiality is impossible. Instead, maintaining a good balance between actual or realistic needs, risks, costs and potential losses (including the impact on reputation), is essential. Until there is widespread consensus on such issues, security concerns will continue to inhibit the use of the Internet in healthcare.

The Role of the Internet in Healthcare is part of the Healthcare & Life Sciences IT Growth Partnership Service, which also includes research on patient data safety in the European healthcare IT markets, the computerised physician order entry systems market, the electronic medical records market and the hospital information systems market in Europe. All research included in subscriptions provide detailed market opportunities and industry trends that have been evaluated following extensive interviews with market participants. Interviews with the press are available.

If you are interested in a virtual brochure, which provides manufacturers, end users and other industry participants with an overview of the latest analysis of the Role of the Internet in Healthcare, send an e-mail to Radhika Menon Theodore, Corporate Communications, at rmtheodore@frost.comThis email address is being protected from spam bots, you need Javascript enabled to view it with your full name, company name, title, telephone number, e-mail address, city, state and country.

About Frost & Sullivan
Frost & Sullivan, a global growth consulting company, has been partnering with clients to support the development of innovative strategies for more than 40 years. The company's industry expertise integrates growth consulting, growth partnership services, and corporate management training to identify and develop opportunities. Frost & Sullivan serves an extensive clientele that includes Global 1000 companies, emerging companies, and the investment community by providing comprehensive industry coverage that reflects a unique global perspective and combines ongoing analysis of markets, technologies, econometrics, and demographics. For more information, visit http://www.frost.com.