Privacy, Electronic Health Records, and Consensus

Electronic medical records. Electronic health records. Personal health records. It doesn't matter whether you refer to them as EMRs, EHRs, or PHRs, the concept is still basically the same. Since the subject is one near and dear to us here at the Health Care Reform Now! Blog, it should come as no surprise to you that we are very excited about the best practices standards released last Wednesday by the Markle Foundation.

In an attempt to bring some of the spirit of the Health Insurance Portability and Accountability Act (HIPAA) to the digital arena, Markle has debuted their standards with some heavy hitters backing it. Google, Microsoft, Intuit, WebMD, Aetna, the AMA, and others have all stepped up to the plate on this one in an attempt to create a true set of industry standards and policies.

Research shows that more than half of modern Americans are interested in the advantages of having easily accessible online records. It also shows that one of the greatest barriers on the consumer level is fear of privacy issues. With a large segment of both the major and minor players in health care already on board at the time of announcement we could be well on our way to making it a non-issue.

Marianne Kobalsuk McGee over at Information Week took note of another vitally important aspect of this announcement:

Meanwhile, for other companies looking to jump on to the consumer personal health record bandwagon, the framework has been assembled early enough in this emerging market so they too can develop their products and services with the framework's privacy policies and practices in mind, Diamond said.

I have the distinct feeling that this is going to have repercussions across the industry. It seems that progress is being made. Now to keep an eye on the implementation of these standards...

SOURCE: "Google, Microsoft Back Online Health Records Privacy Framework" 06/26/08
photo courtesy of dominiekth, used under its Creative Commons license

Social Networking For Health

User-generated content is not the first thing you would look for when searching for health care info on the Internet -- or is it?

Kenneth Corbin of Internet News brings us an interesting perspective on the common ground between social media and health care:

"We're in the early days here of what is essentially a data experiment," Scott Mowbray, editorial director of Health.com, said of the fast growing online body of health information -- much of which is created by people who aren't doctors.

"News in health is not only something that's been discovered," he said. "It's you discovering something that might already be out there. To you, it's news as soon as you have a disease. Suddenly, it's the most important news in the world."

This rings true in my experience. Having watched a number of friends battle cancer and other chronic diseases, I have frequently been consulted to help them find info about their condition or proposed treatment online.

[...] panelists said that there is another, less structured revolution taking place where people seeking information about a health issue are looking to connect with others who have experience dealing with the same condition.

It's a form of social networking, though very different from what is found on a mass-appeal site like Facebook or MySpace. But the principles of viral distribution and user-generated content (UGC) are the same.

"It's about personalization of the information," said Benjamin Heywood, president of Patients Like Me, a site housing online communities for people dealing with specific diseases. "What you really want to know is the information that's relevant to me -- based on my situation, my condition."

Commonality of experience is a huge part of the draw. Being able to read about what experiences someone else had during their gall bladder surgery, chemotherapy, new diabetes treatment, etc., not only helps to personalize the situation but also gives those just starting treatments such as these to get an idea of what they are in for.

The image of a physician leaning over you saying "this won't hurt a bit," is an image everyone knows. Everyone is also familiar with the pain that is usually expected to follow that statement. With health care oriented social networking you would go into such a procedure knowing that it might cause you to become painfully light sensitive, or so nauseous that you cannot eat. Just like other strata of the social networking world it is the personal narrative that people seem to find magnetic.

As a social media consultant myself, I am well aware of some of the issues faced by projects like these. For one thing (Sanjay Gupta of CNN also comments on this in the article) people are always much more likely to actually leave a comment or write a post when they are angry. Rarely do they seem so disposed when it comes to positive or complimentary information.

This natural tendency skews the efforts of sites like these, but the question is does it skew too far to be effective?

SOURCE: "Health Care: Social Networking Gone Serious?" 06/09/08
photo courtesy of M. Keefe, used under its Creative Commons license

Microsoft EMRs: What's in a Name?

Amalga. It's a name you will be hearing quite a bit about if you follow the news about electronic medical records. Amalga is Microsoft's new name for their portfolio of health care oriented applications. Marianne Kolbasuk McGee reports for Information Week:

The new "Amalga" brand is now the umbrella name for all Microsoft enterprise health care industry software, including products formerly known as Azyxxi and Hospital 2000, which were products Microsoft acquired. Microsoft's Amalga brand offering spans clinical, operational and financial functions in health care.

In addition to its Amalga product line for hospitals and other health care providers, Microsoft last October entered the consumer health care market with HealthVault, a platform that provides free Web-based health-related search and personal health record tools.

Touting new technology "on the architecture side" that provides better security and reliability, Microsoft seems to be continuing the consolidation of its efforts into a more vertical approach. These new enhancements are slated for general availability in fiscal 2009. Products under the Amalga name cover a wide array of information management needs throughout all aspects of the health care industry.

With its Microsoft Amalga product, formerly known as Azyxxi, Microsoft offers health care providers with a "unified intelligence system" that enables doctors and other clinicians to "get data anywhere data is stored to help them make more intelligent clinical decisions," said [Microsoft health solutions group's general manager of enterprise marketing Davide] Vigano. In most hospital environments, there are multiple disparate systems and applications in many departments, making it very difficult for say, an ER doctor, to access a patient's radiology or drug information in other systems, said Vigano.

Microsoft Amalga helps health care provider access that information to make better clinical decisions, he said. Azyxxi, now renamed Microsoft Amalga, was originally created by doctors and developers at from MedStar Health's Washington Hospital. Microsoft acquired the software in July 2006 and since then has been enhancing it for use by other organizations.

Right now Microsoft's seven early adopters of the software include a variety of different types of hospitals and health care providers. They include MedStar, New York-Presbyterian Hospital, Johns Hopkins Health System, Novant Health (in North and South Carolina), H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida., St. Joseph Health System (including its entire operations in California, west Texas, and eastern New Mexico); and the Wisconsin Health Information Exchange, a regional health information organization, or RHIO.

The software suite known formerly known as Hospital 2000, targeted at a global market, has experienced a name change as well. It is now the Microsoft Amalga Hospital Information System. As pointed out in the Information Week article, both Azyxxi and Hospital 2000 were originally developed by smaller independent companies and then acquired by the software giant.


SOURCE: "Microsoft Re-Names Its Enterprise Health Care Software" 02/13/08
photo: screencapture of the Microsoft's Amalga page

Azyxxi: Microsoft's Magic Word for Health Care

Azyxxi, it sounds like a fictional word, a magic word from a fairy tale, or the name of a wizardly librarian in some fantastic novel. While it is none of these the latter description is closest to the truth. Azyxxi is a librarian of sorts and it is also said to perform almost magical feats.

So what exactly is Azyxxi? It is Microsoft's new unified health enterprise system. It is an aggregator of financial, clinical, administrative and patient records and is rapidly becoming Microsoft's most well known foray into the field of electronic medical records (EMRs). If the facts match the PR it will put an amazing array of data at the fingertips of health care professionals, allowing them to access that data through computers, laptops, PDAs, tablets and other devices.

Sharon Linsenbach at E-Week takes a glance at things as Microsoft prepares its largest rollout of Azyxxi yet coming in early 2008:

St. Joseph Health System, a network of hospitals in the Southwest with nearly 20,000 employees, is moving over to Microsoft's Azyxxi unified health enterprise platform...

"With Azyxxi, all our physicians -- those in the hospitals, community-based and in group practices -- will have virtually instant access to a patient's health information, thereby increasing connectivity between providers and improving care for patients," Dr. Clyde Wesp, chief medical information officer for St. Joseph Health System, said in a statement.

By then end of 2009 the entire hospital network is slated to be finished. A multitude of physician's groups, fourteen acute care hospitals, and three home health agencies spread across California, Texas, and New Mexico will then be using the platform. They will be joining earlier adopters such as Johns Hopkins, New York-Presbyterian Hospital and Novant Health.

The news keeps getting brighter on the subject of EMRs. Stories like this one and the FCC's Telehealth initiative (see yesterday's post) keep cropping up. Each day, advances in information technology are implemented on a wider and wider scale. George Halvorson writes of a "perfect storm" in favor of health care reform; if current news items are any indication it would seem that storm is on the horizon.


SOURCE: "Hospital Network Adopts Microsoft Health Care Platform" 0/29/07
SOURCE: "Azyxxi- Official Site"
SOURCE: "Azyxxi- Wikipedia Entry"
photo courtesy of Chris Metcalf,, used under this Creative Commons license

Microsoft Acquires Global Care Systems from Thailand

Microsoft has just purchased Global Care Solutions (GCS) of Thailand, a company known for its hospital administration software. GCS has been operating for years as a privately held company and works directly with the Bumrungrad International Hospital, a facility that is famed for the volume of multinational tourists it cares for.

Of the various articles about the acquisition I have found, only PC World magazine touches on the aspect most important for those interested in Electronic Medical Records (EMRs):

What makes GCS software special is the amount of specialized record keeping required by Bumrungrad. Doctors at the hospital see over 1.2 million patients each year, including 400,000 foreign patients from 190 countries, meaning varying language, insurance and billing data. Half of the 3,200 patients seen at Bumrungrad each day walk in without an appointment, yet GCS's scheduling software ensures patients wait an average of 17 minutes to see a doctor.

While the software is not in use outside of seven hospitals in the Asia-Pacific region, it is an interesting development and one that could well have ramifications stateside as the debate about Electronic Medical Records continues.

In the meantime the business relationship with Bumrungrad Hospital will continue as will attempts to further develop and refine the existing software solutions. Peter Neupert, vice president for the Health Solutions Group at Microsoft, seemed quite ready to embrace the research and development opportunities the merger represents.

"We now have a partner that's willing to experiment with us," said Neupert. He said future work will include software development as well as experimenting on how RFID (radio frequency identification) can improve hospital care.

Microsoft will focus GCS software sales on hospitals in emerging countries, said Neupert. The software fits well with emerging market hospital needs, requiring just a small investment in computer hardware, he said.

While the stated territory is the Asian Pacific, one must wonder what might evolve from this deal that would be useful here in the States? Any application robust enough to handle a plethora of languages, billing standards, and wide variety of insurance procedures bears watching. A seventeen minute wait for walk-ins to see a doctor? To most people in the U.S., that is quite simply unheard of.

SOURCE: "Microsoft Buys Thai Health Software Vendor" 10/29/07
photo courtesy of TerraPrints used under this Creative Commons license

HealthVault: Holy Grail or Pandora's Box?

How many aspects of your life do you handle online? Do you buy books from Amazon? Do you bid or sell on eBay? Do you check your bank balance in a browser? How about your investments? Do you communicate by email more often than you write physical letters? Most modern Americans do at least one or two of these things on a regular basis. Now consider this, when was the last times you looked at your prescriptions, X-Rays, or health records online?

The advantages and cost savings of EMRs are consistently touted, both on this blog and in many other places. The recent unveiling of Microsoft's HealthVault makes it seem a viable EMR option is looming on the horizon. While at first glance this is a good thing there are many who seem uneasy about it. Robert Langreth, Senior Editor for Forbes, is one of them:

Microsoft, the company whose personal computer software is regularly attacked by hackers, the company reprimanded by governments for its aggressive monopolistic behavior?

While the aknowledged leader in the field of computing, Microsoft's history does lend itself to some unsease when considering privacy concerns (Win XP, Service Pack 2 anyone?). Langreth's interview with Peter Neupert, Microsoft VP in charge of development for their health group, is an interesting one as Langreth tries to counter that perception.

Microsoft argues that HealthVault can avoid the countless security problems that have afflicted its operating systems. "It's an apples and oranges comparison," he [Langreth] asserts. "It's a lot easier for us to manage a service for reliability, security and privacy than it is to manage hundreds of millions of distributed personal computers." Microsoft is working with two hacker organizations to test the security of its system.

Although HealthVault will be free for consumers, this is no philanthropic effort. Microsoft hopes HealthVault will translate into more search revenues through targeted health-related ads. The site includes an improved online search that uses a machine-learning algorithm to help consumers search through articles on health issues by breaking broad topics into concrete subcategories.

"By providing a great health search experience, we will actually improve the search loyalty of Microsoft overall," says Sean Nolan, the Microsoft programmer who designed the site. He admits though that moving into the medical record arena "is a huge crazy challenge." Among other issues, Microsoft will have to tiptoe the line between assuring people their information is private -- and serving up advertisements relevant to the health problems they have.

Walking that line might be easier than suspected. The success of numerous social networking sites, as well as online products such as the Google suite of applications show that while this is a concern it seems a rapidly diminishing one. People everywhere are getting used to seeing keyed text ads in the margins of their Gmail / Hotmail / Yahoo mail, getting reccommendations from eBay and Amazon when shopping, and generally having their data not only stored on the net but also implemented for promotional means.

Is this good? Is this bad? Will the public embrace or revile it? Only time will tell.

It is, after all, "a huge crazy challenge."

SOURCE: "Who Are You Going To Trust?" 10/08/07
Photo courtesy of: Library of Congress via pingnews.

Microsoft Trumps Google with Online Health Service

Microsoft has beaten Google to the punch on offering an online health records solution.

Both companies have been developing online systems for Electronic Medical Records (EMRs) for quite some time now. A prototype of Google Health was shown to health professionals and advisors in August of this year, but has yet to launch and may be experiencing difficulties after having recently lost its leader Adam Bosworth.

While Google Health remains in limbo, Microsoft's HealthVault, announced in Washington yesterday, is now online and includes an impressive array of partners, as pointed out by the New York Times:

The organizations that have signed up for HealthVault projects with Microsoft include the American Heart Association, Johnson & Johnson LifeScan, New York-Presbyterian Hospital, the Mayo Clinic and MedStar Health, a network of seven hospitals in the Baltimore-Washington region. The partner strategy is a page from Microsoft's old playbook. Convincing other companies to build upon its technology, and then helping them do it, was a major reason Windows became the dominant personal computer operating system.

The service is free to consumers and revenue will be generated by search driven advertising, something ubiquitous in Google's online applications such as Gmail.

Information Week compares this to other efforts :

Microsoft's consumer-centric model for PHRs differs from the approach others are taking, especially employer-sponsored PHRs, like Dossia, a consortium of employers including Intel and Wal-Mart, which is building a PHR system for its workers.

Although Dossia says its employer members will not have access to workers health data, in the larger picture, trust and privacy questions are issues that hinder consumer confidence in electronic medical records systems overall, including PHRs offered by health plans and insurers.

However, with the consumer being the controller of data in HealthVault, users may be more accepting, said Deborah Peel, founder of privacy advocacy group, the Patient Privacy Right Foundation, who was a speaker at the HealthVault event.

CRN reminds us of prior Microsoft attempts using this consumer driven model:

Whether consumers will trust Microsoft to manage sensitive health information is an open question. Microsoft takes pains in HealthVault's terms of service to specify that it will not use any information stored at the site for commercial purposes or release it to any outside parties without explicit permission. However, customer concerns about giving Microsoft access to a treasure trove of personal data killed off Microsoft's Hailstorm project five years ago, which aimed to aggregate users' financial and other personal details in one Microsoft-owned repository.

SOURCE: "Microsoft Rolls Out Personal Health Records" 10/04/07
SOURCE: "Microsoft Unveils Free Web Health Tools for Consumers" 10/04/07
SOURCE: "Microsoft Beats Google To Consumer Health Market" 10/04/07
photo courtesy of Orangeacid using this Creative Commons license