ZDNet Healthcare

July 2nd, 2009

Will security paranoia kill wireless health IT?

Posted by Dana Blankenhorn @ 11:56 am

Categories: Aging, General, IT Management, Networking

Tags: Security, Information Technology, Health Care, Wireless, Wi-Fi, Wireless And Mobility, Dana Blankenhorn

Frost & Sullivan is out with a piece praising the potential of wireless technologies in health IT, but warning of security concerns.

Yesterday’s piece about WellAWARE is a good example of what’s possible.

Short-haul wireless links monitor patients without their having to wear anything. Cellular phone calls can alert caregivers to problems, and wireless data links can offer specifics.

Without wireless technologies such miracles would not be possible. But paranoia over security could kill such applications in the crib.

Frost & Sullivan’s wireless analysts can come up with all the scary scenarios they want, but where is the real danger?

The real danger is you’re raising the cost of care. The report by Jayashree Rajagopal and Luke Thomas are especially wary of such technologies as Bluetooth and WiFi, which they insist must get expensive security upgrades before being trialed:

“Such security features will enable cellular technology to gain a competitive advantage over various wireless alternatives as cellular technologies operate in the licensed band providing guaranteed quality of service,” remarks Thomas. “This is not the case with unlicensed technologies such as WiFi, Bluetooth, Digital Enhanced Cordless Telecommunications (DECT) and RFID.”

Nonsense. Having carriers capture and up-sell all wireless medical data transfers is not going to provide real quality improvements. It’s just going to price them out of the range of many patients.

For someone like the late, great Karl Malden (who passed away yesterday at 97) there might be value in a TMZ seeing the late alerts of his failure. It might be a scoop to know about the problems of the rich and/or famous.

But what would they be getting and how would they get it? Let’s get real. Intercept a data call and all you get is data, without context. Intercepting and decoding a digital phone call (and all cell calls are digital) is more difficult, and you have to pick out just the right needle in an awfully large haystack.

That’s because we start getting fancy with security and proof of concept through Quality of Service (QoS) agreements.

The plain fact is that most of the people with motive to snoop on our medical conditions remain insurers and employers. Both have the same motive, limiting exposure by cutting off needed care, in the present or in the future.

Insurers have already offered to stop running risk pools and denying coverage to people with pre-existing conditions, part of their effort to prevent government competition.

Most fears, in other words, are becoming groundless. The rest can be treated as the exceptions they are, and punished accordingly.

Paranoia is no longer necessary

July 1st, 2009

WellAWARE of watching grandma

Posted by Dana Blankenhorn @ 11:43 am

Categories: Aging, Always On, General, Home Health Care, Home Health Care Equipment, Internet, SaaS, Wellness

Tags: Woman, Sensor, WellAWARE, VOA, Dana Blankenhorn

Working with two of the largest faith-based nursing charities, WellAWARE  of Charlottesville, VA has begun delivering on the promise of passive monitoring just weeks after its official launch

That is partly because the company has been in the development and trial for nearly five years, said CEO Jeff Noce. But it’s also because its two key customer-partners can deliver significant market share quite quickly.

At this writing, 60 facilities have the WellAWARE system, company officials told ZDNet.

WellAWARE is offering a system of sensors that track a patient’s movement throughout their residence, comparing their activities to a baseline of normality, and alert caregivers to changes.

Noce explained how this worked recently with an 81 year old client aging-in-place in Hastings, NE:

There was an alert that the woman had not slept for 26 hours. The woman was evasive, but we were able to be proactive, and the nurse was able to visit, knowing she hadn’t slept.

The woman finally admitted she’d been hallucinating. The nurse asked about medication, the woman said she had some, and the nurse found that one of the side effects of one medicine was hallucination. She was able to fix the situation in a day.

The patient didn’t have to do anything. The care giver was then able to provide an interaction that got correction.

The Hastings case was detailed at a recent forum sponsored by Volunteers of America, one of the company’s key customers, featuring Newt Gingrich, Tom Daschle, and Donna Brazile. VOA serves over 500 government housing and hospice communities, where it believes it can cut costs substantially through WellAWARE and improve care.

The other key customer is the Evangelical Lutheran Good Samaritan Society, known as Good Sam. Between them the two have a fair share of the faith-based care market. (The other two segments are profit and non-profit care groups.)

From a technical standpoint, the offering features a proprietary wireless sensor array, a SaaS Care Engine that collects and analyzes data from the sensors, and screens for care givers’ mobile devices that offer alerts.

Proprietary sensors were developed, Noce said, so that WellAWARE can run up to 6 months on a battery. Components running on the Zigbee standard are being evaluated, he said, especially as the company prepares to look into active systems that might feature blood pressure or glucose monitoring.

Noce said the company is also buoyed by the pending entry of GE and Intel into the market, believing it will legitimize what WellAWARE is doing.

June 30th, 2009

Can a Virginia hack scuttle health IT reform?

Posted by Dana Blankenhorn @ 8:10 am

Categories: General, Government, IT Management, Medical IT, Medical Records, Networking, Open Source, U.S., state government

Tags: Database, Information Technology, Health Care, Virginia, Vertical Industries, Benefits, Healthcare, Storage, Strategy, Human Resources

An April hack attack against a Virginia database managed by Northrop-Grumman is giving health IT a black eye right when it doesn’t need it.

The Associated Press reports that prescriptions for powerful painkillers are not being given by some doctors who can’t check the database, whose aim is to prevent drug abuse.

The 35 million name database was accessed illegally in late April.

The Virginia hack is important because the Northrop-Grumman agreement compromised by it was negotiated by Aneesh Chopra, then the state’s secretary of technology, now President Obama’s CTO.

The idea behind the $2 billion, 10-year agreement is to create a “cloud” environment for all the state’s computing needs, centralizing all functions under one department.

In an interview with The New York Times after his appointment Chopra emphasized his support for entrepreneurship, and did not mention the centralized contract, which seems in spirit to be more akin to the Bush technology policy than the Obama Administration’s.

But the Obama team has warmed to several Bush-era policies, and maybe all this talk about open source and modular systems, too, is just rhetoric.

In any case Virginia officials are now asking hard questions about the Northrop-Grumman contract, and perhaps national reporters should too.

There is a basic philosophical difference between the closed world of a single-source government contract and the open, competitive environment health IT needs. We need to know on which side of the divide the CTO stands.

June 29th, 2009

Do security and privacy make health IT reform impossible?

Posted by Dana Blankenhorn @ 8:34 am

Categories: General, Hospital IT, IT Management, Insurance IT, Medical IT, Medical Office IT, Medical Records, Payment Processing

Tags: Information Technology, Privacy, Health Care, Vertical Industries, Benefits, Healthcare, Strategy, Security, Human Resources, Management

An ongoing series on health IT reform by Ann Carnes over at Kaiser Health News has a subtext worth discussing here. (Picture from Allscripts.)

To what extent are fears of privacy and security preventing health IT reform?

In her latest piece she profiles a doctor who stopped using an eprescribing pilot because of security and policy problems. The system automatically logged out when inactive, and would not support the full range of medicines being prescribed.

An eprescribing system can cut costs by eliminating paperwork, but it must support what paper is already doing or it’s worthless. And if it’s a pain to use doctors will give up and go back to their pads.

These are reasonable objections. There is a need for security, privacy and procedure in any health IT implementation. But it must be balanced against the need for simplicity, with its ease of use constantly compared with paper alternatives, to be effective.

The hardest thing to be is simple. This is true in story-telling. It’s true in science. It’s also true in software.

Any requirement that gets in the way of simplicity needs to be carefully considered, and pared down to its simplest form, before being tossed at an industry with a lot on its plate.

June 26th, 2009

Can contractors be part of health IT reform?

Posted by Dana Blankenhorn @ 6:02 am

Categories: General, Government, IT Management, Medical IT, U.S.

Tags: Information Technology, Health Care, Standards, John Loonsk, Vertical Industries, Benefits, Healthcare, Quality, Human Resources, Business Operations

In covering efforts to reform health IT based on open standards most reformers I have spoken with have reserved a special disdain for federal contractors.

Contractors got us into this mess, they sneer, with proprietary models and cost overruns.

John Loonsk (right) is trying to change that.

A longtime advocate for a national healthcare network while at the Department of Health and Human Services, Loonsk joined CGI Group, a major federal contractor based in Montreal in April, and wrote at Government Health IT this week as an advocate of standards-based reform.

But what kind of reform? Carefully-engineered reform, he says.

Now that there are funds, the national health IT agenda is no longer emphasizing proactive engineering. Instead, the focus is more narrowly on getting electronic medical records into practice settings, supporting the general idea of health information exchange, and hoping that the organic growth of the two solves the many needs of a nationwide infrastructure.

The administration should reconsider this plan.

Instead, he suggests, standards need to be engineered that all vendors would meet and connect to.

Doubtless, a contractor such as CGI Group could be hired to engineer those standards. But would that speed or slow the pace of health IT reform?

Loonsk argues his case based partly on the development of Internet standards. But those standards were negotiated, not imposed. And they developed organically along with the network, in an open, transparent process.

Of course, while the Internet standards door was always open, few other than engineers walked in for nearly a quarter century. The Web was overlain on a set of standards that were engineered, but also negotiated, and existed before it was spun.

Is that possible with health IT, given the large number of vendors already serving the market and the urgency of the task?

June 25th, 2009

PARP inhibitors working against inherited cancers

Posted by Dana Blankenhorn @ 6:29 am

Categories: Drugs, General, Research, genetics

Tags: Cancer, Dana Blankenhorn

If a genetic condition leads to cancer there is new hope in a class of drugs called PARP inhibitors.

Poly (ADP-Ribose) Polymerase (PARP) is a protein cells use to repair genetic injuries naturally. But cancer cells also use this protein to repair their own DNA damage. Inhibiting this action allows chemotherapy and radiation to do its job against cancers resulting from genetic mutation.

In a study causing much excitement in the cancer-fighting world (CBS called this the “holy grail” of cancer research, thus the French Taunter above) scientists at the Institute of Cancer Research in Sutton, England gave 19 patients with advanced cancers caused by mutations in the BRCA1 and BRCA2 genes a PARP inhibitor and over half saw their tumors shrink or stop growing.

The drug had no effect on 41 patients whose tumors were not the result of the genetic defect.

The big excitement is that PARP inhibitors can be designed against other forms of inherited cancer. They are already being tested against a form of breast cancer. And there are few side effects — you take a pill twice a day and may get some indigestion.

The new drug has the name olaparib. The full article is now in front of the New England Journal of Medicine firewall.

The Royal Marsden NHS Foundation Trust, which worked with the Netherlands Cancer Institute and drug maker KuDOS Pharmaceuticals, now owned by AstraZeneca, is a charitable group affiliated with that nation’s National Health Service. They would welcome your contribution.

June 24th, 2009

Steve Jobs nearly died and lied about it

Posted by Dana Blankenhorn @ 8:30 am

Categories: Ethics, General, Hospital Equipment

Tags: Steve Jobs, Stock Options, Investment, Benefits, Personal Finance, Financial Accounting, Human Resources, Stock Options & Grants, Finance, Dana Blankenhorn

NOTE: This may be the most controversial post I have done at ZDNet.

I did not intend to offend anyone, and I admit to a bias in favor of Steve Jobs. I thought long and hard before posting. But what if this had happened to Warren Buffett 25 years ago? Serious attention to disclosure rules could have limited the Bernie Madoff scandal, and prevented other harms against investors, including earlier accusations of back-dating options against Apple itself, many involving Jobs.

We can’t have one law for those we don’t know and another for people we like.

---

For daring to steal fire from the Gods, it is said, Prometheus was chained to a rock and sentenced to having his liver pecked out by birds.

Steve Jobs can relate.

Not only did Apple come awfully close to losing Jobs over the last few months, but he will never be truly out of the woods.

The bottom line is that Jobs is very lucky to be alive following a liver transplant. The first successful liver transplant took place in 1967, but it did not become common until the 1980s, with the introduction of cyclosporine.

About 6,000 liver transplants are now done each year in the U.S., but the waiting list for organs averages 17,000. Those waiting lists could be reduced as more donors can now survive having part of their liver removed for transplant.

How and why did Jobs jump the queue? He was dying dieing faster than others, the company now admits.

Paul Argenti of Dartmouth’s business school says Apple deserves to face SEC action for lying about failing to disclose Jobs’ condition, which is the outgrowth of his 2004 pancreatic cancer.

I hate to be one of those birds pecking at Prometheus, but I agree.

This would not be the first time for Jobs on the SEC’s operating table. He was questioned in a scandal over the backdating of stock options, with Jobs later telling Forbes “nobody loves me.”

That’s not true at all. What we don’t like, and what we shouldn’t be made to like, is a lie material to our investment. Apple is as dependent on Jobs as any U.S. company since Walt Disney, and he spent months denying he was knock, knock, knockin on heaven’s door.

Jobs’ January letter, calling his condition a “nutritional problem,” was a lie from beginning to end. A straight-out, bald-faced lie. I complained about this possibility a year ago, and repeat the complaint.

Why, Steve? Were you embarrassed? Not want us to make a fuss? Don’t like get well cards? Or were you trying to boost your own fortunes in case the liver didn’t come and you actually did die?

It’s hard to have to ask these questions, even though Jobs is reportedly back at work, because he is, and will remain, a very sick man.  Jobs will have to take drugs that suppress his immune system for the rest of his life. He’s got a 9 in 10 chance of still being with us in 2014.

But a bird’s got to peck where a bird’s got to peck. And if the journalism gods tell you to peck at Prometheus’ liver, that’s what you do.

June 23rd, 2009

A new push for health data rights

Posted by Dana Blankenhorn @ 12:00 am

Categories: Consumer Information, Ethics, General, Government, U.S.

Tags: Health Care, Health Data, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

A coalition of health IT reformers today offers a Bill of Heath Data Rights aimed at moving the heart of the health IT debate away from doctors and insurance companies, toward patients.

This is the brainchild of former Google Health executive Adam Bosworth and Patientslikeme co-founder James Heywood. My copy was forwarded by David Kibbe.

The actual proposal is postcard simple:

In an era when technology is allowing personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. All people:

• Have the right to their own health data.
• Have the right to know the source of each health data element.
• Have the right to take possession of a complete copy of their individual health data, without delay, at minimal or no cost. If records exist in computable form, they must be made available in that form, without delay, at minimal or no cost.
• Have the right to share their health data with others as they see fit.

These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

The expected reaction from the industry is “yeah, but.” Yeah, but it’s not that simple. Yeah, but most people don’t care. Yeah, but how do you express that in software.

The hope is that the principles behind HIPAA can be maintained while the costs of HIPAA, and the use of it as a smokescreen for luddism by the health IT industry, can be foregone.

That’s a big hope for such a short document.

I’m afraid that if this became part of some law passed by Congress it certainly would become a new HIPAA law. But if NCHIT David Blumenthal can convince the President to make this part of an executive order, something that exists in spirit and is defined on-the-fly, it might be worthwhile.

June 22nd, 2009

Supplements make everyone a beta tester

Posted by Dana Blankenhorn @ 11:38 am

Categories: Aging, Consumer Information, Curioisities, Drugs, Ethics, General, Home Health Care, Internet, U.S., Wellness

Tags: Supplement, Beta Tester, Federal Government, Vertical Industries, Benefits, Healthcare, Government, Human Resources, Dana Blankenhorn

Everyone in tech knows how products get to market.

Once coding is done you have an alpha test, with friends and family checking the code. Then comes the beta test, where volunteers are allowed in. Finally comes what I call the “gamma test,” or the general market release.

For most of what we put into our bodies the process is pretty similar. Beta testing is the way we roll.

Few companies push cures through the full FDA approval process. If you’ll settle for sales, not just prescriptions, you call what you offer a supplement and bypass the government entirely.

Few object to that. My health food store might not have gotten through the 1980s without that kind of forebearance. But in the last decade all kinds of quack cures have used the supplement exception to make us all beta testers.

I have written before about one such substance, revasterol. Following its mention on Oprah by Dr. Oz Mehmet of RealAge, the doc’s face has been all over the Net pushing an anti-aging elixir made of acai berry, which is said to contain lots of the stuff.

It might be great. But wouldn’t you like to know first?

The latest supplement to hit public consciousness is Sensa, which claims to stimulate the sense of smell so you will eat less. (That’s Sensa “creator” Dr. Alan Hirsch at the top.) It’s not the only such product. A pen-based version called SlimScents is making similar claims.

Never mind that the only company in the field taking the pharmacology route, Compellis Pharmaceuticals, is going in the opposite direction, with a compound that actually makes things harder to smell.

As Richard Doty, who heads the smell and taste center at the University of Pennsylvania (go Quakers), put it to The New York Times, “more research needs to be done.” Amen to that.

As I noted at SmartPlanet recently, companies have been using loopholes in the law to push some really dangerous stuff on people. I asked last week, “How many more Zicams are out there?” and the more I learn the more urgent the question becomes.

Sensa may be the best thing since sliced cheese. It may be as benign as salt or MSG. The truth is I don’t know.

Are you happy being a beta tester? Is it OK that the FDA has to wake up and get its shoes on before even looking at what you put in your body, based on the “endorsement” of some guy in a white coat?

How big a scandal do we require before we start asking the question seriously?

June 19th, 2009

Will smartphones make us healthier?

Posted by Dana Blankenhorn @ 7:38 am

Categories: Aging, Consumer Information, Gadgets, General, Mental Health, Sports Medicine, Wellness

Tags: Smart Phone, Health Care, Smart Phones, Cellular Phones, Handhelds, Consumer Electronics, Personal Technology, Hardware, Dana Blankenhorn

Smartphones, led by the iPhone, continue their march into the heart of the mobility market.

They bring with them a host of health applications, some useful, others just silly.

We are still at the start of the evolution but it’s time to ask the question. Will smartphones help make us healthier?

Right now the fitness-obsessed and hypochondriac are getting some serious help. Many doctors have a new toy. But is anything really happening?

I argue that it is. As smartphones become a platform as important as desktops they change the way we live in subtle ways.

I noticed this on my recent trip to China. Lacking a phone of any kind, I felt naked. Lacking a smartphone I felt lost. Especially so since everyone around me had one.

That’s because smartphone makers have broken the U.S. carrier monopoly on SIM cards, those plug-in chips that define services. The AT&T monopoly on the iPhone is now a local monopoly. Every American I saw at CompuTex with an iPhone had simply changed-out their SIM for one with a local carrier and gone back to work.

Another reason is that the “touch” interface is becoming ubiquitous. Everything next year will be a touchscreen, and not just that but every new interface will be a touch interface. It’s the first real advance in computing since the mouse.

A third reason is that smartphones are, thanks to the Web, gathering some unity of purpose. Widget sites like Plusmo support a variety of smartphones, and it’s no longer unusual to see widgets and apps that work on multiple devices.

All of which means we’re gradually gaining a more intimate relationship with the data defining our life and work. This includes health data. Whether you’re a medical professional or a layman, you will benefit from this intimacy in many, unexpected ways.

Agree or disagree?