November 24th, 2009

What open source can teach medical practice

Posted by Dana Blankenhorn @ 7:34 am

Categories: Consumer Information, Ethics, General, IT Management, Internet, Medical Office IT, Medical Records, Networking, Open Source, Research

Tags: Gender And Diversity, E-health, Open Source, Human Resources, Healthcare, Dana Blankenhorn

It is frustrating whenever personal medical questions become political questions.

This happens all the time. Example A, ripped from the headlines, is the kerfluffle over mammograms.

Women, doctors and politicians who hate having to go through the procedure are now screaming bloody murder over the non-existent “threat” to halt access to it.

Let’s go back to where this started. It was a population study, done on behalf of the U.S. Preventive Services Task Force,  which concluded that the risk of unnecessary treatment exceeds the risk of death from annual screenings for the disease.

It was a science paper, and it was complicated, couched in the words scientists use to describe their work with precision.

Every profession has its version of this language. Engineers do, lawyers do, even software developers do. Learning the language gives a journalist entree into these professional worlds, but it’s not an exercise most of us will, or should, go through.

Thus this study, like so many, was filtered through the lens of journalism. A flood of words failed to answer the questions women wanted answered

• What are the chances I will die from a late diagnosis?
• What are the chances I will suffer from over-diagnosis and over-treatment?

Calculate the threat to me so I can make a rational choice.

This is where technology comes into play. An Electronic Health Record (EHRs) can show you your own history, we can take your family history, we can analyze your genetic history, and we can estimate based on that.

If, that is, we have access to the larger pool of data. That’s our baseline. It’s what we need to compare your own data to before we can give you the answer you seek.

In scientific studies like this one we don’t have access. The data is locked away somewhere. Mass adoption of EHRs is going to unleash a firehose of data, and the question should occur, very soon, what to do with it.

I’m not talking here about your record. I’m talking about the gross data, this warehouse of numbers describing everyone’s condition, what is being done for us, and what the results are.

An open source attitude toward that data, within the realm of science and throughout the medical community, can help patients gain access to the benefits of that data and answer the question they ask — what should I do?

Unfortunately medicine, health IT, and medical data all suffer from a proprietary attitude born of paranoia, the fear that you may be identified in this data mountain, that your needle will appear in this haystack, and that giving everyone access to data means giving them access to you.

A database, stripped of personal information, consisting of millions of records, is safe for use by software code. The data, and the code, are what we need to provide real answers.

We are collecting the data. We need to unlock it. We are writing the code. We need to share it.

This is what open source can teach the practice of medicine.

August 28th, 2009

Health IT start-ups can avoid the political minefield

Posted by Dana Blankenhorn @ 7:51 am

Categories: Always On, Assistive Technology, Consumer Information, Finance, General, Government, Home Health Care, Home Health Care Equipment, Internet, Networking, U.S.

Tags: Health Care, AthenaHealth, Wireless Health Care Application, Vertical Industries, Benefits, Healthcare, Human Resources, Dana Blankenhorn

Venture capitalists are suddenly getting all dewy-eyed over the potential for health IT start-ups, pointing to the success of AthenaHealth.

One reason is that sweet, sweet stimulus cash, Michael Greeley of Flybridge General Partners told The Wall Street Journal.

Trouble is that cash will be tough to come by. The definitions for meaningful use under which the cash will be doled-out are functional, with the first kicking in less than two years from now. That’s an eyeblink in health IT.

One reason this field does not move in Internet time is HIPAA, for which the late Sen. Edward Kennedy is being lionized today. It has had the unintended side-effect of layering regulatory compliance on top of any innovation or marketing plan, leading to an industry mired in the architectures of the 1970s.

It can take enormous effort to break through this regulatory stranglehold, as witness AthenaHealth itself. Co-founder Todd Park was criticized as a partisan when nominated recently to be CTO for the Department of Health and Human Services.

But Athena’s other co-founder is Jonathan Bush. First cousin to George W. Bush, and nephew of George H.W. Bush. AthenaHealth is nothing if not bipartisan.

If it takes that much political pull to make a health IT success, why bother?

Rather than focus on the stimulus money, perhaps start-ups would be better advised looking to what FCC chair Julius Genachowski said in his notice of inquiry into the wireless market. Wireless health care applications are of particular interest to the agency, which seems dedicated to opening the market so these can thrive.

Back in 2003 I spent much time studying what I called “the world of always-on,” applications that live in the air and deliver value not just for health care but home automation and inventory.

In health care such “killer apps” would include heart and glucose monitors that use wireless networks to give patients, caregivers or doctors alerts when the wearer starts fibrillating or going into hypoglycemic shock.

These devices are starting to come to market, and the agency has reassured the market that connecting them should not be a problem.

To me that sounds a lot more promising than hoping stimulus money will fall from the sky. Especially if, like most of us, you don’t have friends or relatives in high places.

July 21st, 2009

Open source to power Connecticut HIE

Posted by Dana Blankenhorn @ 6:00 am

Categories: General, Government, Hospital IT, IT Management, Medical IT, Medical Office IT, Medical Records, Networking, Open Source, Physician Information, state government

Tags: Misys, Health Care, Vertical Industries, Healthcare, Benefits, Open Source, Human Resources, Dana Blankenhorn

Connecticut is building a Health Information Exchange (HIE) based at least in part on open source software.

Hartford Healthcare, which provides rehabilitation, long term care, and hospice facilities in central Connecticut, said today it will combine Misys’ open source connectivity technology with Allscripts EHR systems, a health record built on software as a service, to create Transforming Healthcare In Connecticut Communities (THICC), a regional system linking hospitals, clinics and facilities statewide.

THICC, in turn, will be connected to the National Healthcare Information Network, built on Sun software.

Stephen O’Neill, a Hartford vice president, said he was sold on Misys after seeing its software in action at a ConnectaThon sponsored by existing HIEs in Chicago early this year.

“Their HIE governance framework is designed to help us drive toward a
consensus with all of our stakeholders from the beginning of the project. It is just what we
needed to provide us with the best chance for success.”

Those wondering what the connection between the two companies is should know they are, in fact, one company. Misys acquired Allscripts in what one commenter called a “shotgun wedding” back in March, 2008. Seems they had their first baby, and it’s a state.

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

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.

May 7th, 2009

GE putting $6 billion into proprietary health IT push

Posted by Dana Blankenhorn @ 8:07 am

Categories: Finance, General, Government, Hospital Equipment, Hospital IT, IT Management, Medical IT, Medical Office Equipment, Medical Office IT, Medical Records, Networking, Research

Tags:

General Electric chairman Jeff Immelt is just finishing his Washington Newseum road show and it’s the most blatant combination of lobbying, marketing, and circus seen since the Obama Administration blew into town.

The headline number is $6 billion, but the real number is $3 billion, its total research commitment over the next six years. Some of that has already been committed to a joint venture with Intel. I wrote about the “embrace and extend” strategy behind all this in November.

While Immelt touted lower costs, wider access and innovation in its HealthyImagination campaign, this is mainly marketing with a political aim, evidenced by creation of a Health Advisory Board featuring former Senators Bill Frist and Tom Daschle.

If you think this is going to lower the cost of health care, here or anywhere else, then you do indeed have a healthy imagination.

What I didn’t see, nor hear, in the whole hype-filled event (The Rwandan ambassador? The head of Campbell Soup? The president of NBC News? A General Mills brand developer?) was a serious commitment to open standards, to transparency, to making certain GE gear works with the IT systems of every other vendor.

This is especially important in GE’s case, because it leads the market for scanners, for diagnostic gear, for the equivalent of a standard PC network’s printers and input tablets.

If their stuff won’t work with other IT vendors’ stuff, or if it won’t work simply and transparently, the whole industry is in terrible, terrible trouble. Too many doctors in the past have wasted too many millions of dollars on IT systems that didn’t work with their diagnostic gear. Once burned, twice shy.

Instead, what I saw was an attempt to define “synergies” that could have been written by Jack Donaghy, the GE executive Alec Baldwin plans in “30 Rock.” (That’s Alec above, from his cast page on the show’s site.)

Health IT doesn’t need more lobbying, it doesn’t need more marketing hype, it doesn’t need more political promises. What it needs are commitments, written in plain English and followed up on, to open standards.

May 5th, 2009

Is our health coordination better than in Malawi

Posted by Dana Blankenhorn @ 7:42 am

Categories: Assistive Technology, Consumer Information, Curioisities, Ethics, General, Home Health Care, Networking

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

Last time I visited my doctor she was still working on paper.

The chart she used contained scribbles from another doctor. The analysis she made of my condition was mostly guesswork.

It’s true that, if we were in Malawi, she might not be a doctor. But she might be carrying a mobile phone she could use to text message a database, and if I had the flu follow a standard regimen to not only get me well but keep my family from getting sick.

She might have been able to warn every health professional within 100 miles if I had an infectious disease, and just that quickly protect everyone in the Atlanta metro area.

Frontline SMS is delivering this coordination now, with Josh Nesbit its man on the ground. He is being joined by other college graduates, and having success with a tech platform consisting of a donated laptop and 100 recycled phones.

(The picture above is from a collection Nesbit loaded to Picasa of his work in Malawi.)

Nesbit got started after learning the hospital he was volunteering at had to serve 250,000 people in a 100 mile radius, and most of the community health workers actually working in villages had no contact back to base.

The point here isn’t that Malawian care is the best anywhere, but merely to point out that technologies we take for granted here are still miracles, and if these can be applied with effectiveness then the failures we have with health IT here are not due to our platforms, but our lack of imagination and reluctance to try.

April 24th, 2009

The spectrum and the stimulus

Posted by Dana Blankenhorn @ 8:58 am

Categories: Finance, General, Government, Hospital IT, Medical IT, Medical Office IT, Medical Records, Networking, Open Source, U.S.

Tags: Health Care, Spectrum, Wireless LANs, Wi-Fi, Wireless And Mobility, Dana Blankenhorn

David Kibbe and Brian Klepper are developing a fascinating series at The Health Care Blog concerning the HITECH bill and how deep standards should be for systems which get aid.

HITECH, you will recall, is the health IT portion of the Obama stimulus, with as much as $19 billion in subsidies for those who buy certified Electronic Health Record (EHR) systems over the next five years.

(To the right, a WiFi aerial being installed in Nepal.)

In Part I they note there is, as yet, no standard definition of what an EHR must contain. It’s subject to change and thus, they suggest, only the power to create such a record should be specified.

In Part II they go deeper, describing the various layers of technology — physical, device, application, connection — and what should be done by regulators in terms of history.

Breaking AT&T’s monopoly on phone devices and Apple’s hold on iPhone applications were critical to the growth of the Internet and the iPhone App store, they argue. Standards can bind as well as loose. Standards should describe what works and not specify how to make it work.

This brings them to the heart of the matter, the CCHIT certification process that threatens to bind the industry to vendor-specific technology, creating not just monopoly rents but bottlenecks to advancement. What is at issue?

It is the potential linkage of incentive payments to a certification process that would require specific applications to manage health data.

In thinking about these insights I could not stop myself from thinking of wireless data, a beat I have covered for a decade now.

Most of our frequency spectrum is “owned,” most of it by a very few companies. This not only gives them monopoly rents but control over wireless devices. Phones must be “certified” to run on the Verizon, AT&T, Sprint or T-Mobile networks. The carriers are in control. Thus you can only buy an iPhone from AT&T.

Some slices of the spectrum are outside this control, the so-called “unlicensed” frequencies used most notably by the WiFi router on your desk. Here control lies not in ownership of the spectrum but in approval of the equipment. WiFi gear has strict power limits to reduce interference on the spectrum, which can be used and re-used from house to house to house.

The result of all this is that most of our spectrum is very underused, while WiFi spectrum is heavily used. When buying a new Netbook recently I found that all my neighbors now have WiFi routers installed, all of them secured with at least a password.

There is far more data moving on my street using WiFi than there is on all other frequencies combined, and this is probably true where you live. By endorsing an open standards-making process, and regulating only the power output of devices, government let the bit market flourish.

Consider your average general hospital. How many now have extensive WiFi networks installed? How much data are they running using licensed cellular frequencies? From which do they gain the most benefit?

Of course critics may then ask, what about the market? After all, each of the major cellular carriers brings in far more revenue, per hertz of spectrum, than the folks making WiFi routers. It’s the vendors who benefit from the closed system, users who benefit from the open one.

This is at the heart of our present dilemma. Vendors know they can’t compete with open source, the equivalent in this case of the WiFi standard. Thus they will naturally seek to define as much as they can, maybe define open source out entirely, and thereby protect their cash flow.

The public interest lies with WiFi, the private interest with cellular monopolies, but guess which side has the money to control what happens in Washington? Seen much new unlicensed spectrum lately?  Last time I checked folks were still fighting for slivers of white space while the rest of the old TV spectrum has already been sold to monopolists.

So there is a clear difference between the “market interest” here and the “public interest.”  If the “market interest” controls what systems HITECH subsidizes the “public interest” will be left fighting for crumbs.

April 21st, 2009

What Obama promised open source health IT

Posted by Dana Blankenhorn @ 6:45 am

Categories: Finance, General, Government, IT Management, Medical IT, Medical Records, Networking, Open Source, SaaS, U.S., Windows

Tags: Information Technology, Microsoft Windows Vista, Health Care, Open Source, Dana Blankenhorn

So far as I can tell, the President has promised open source a shot at health IT stimulus and government contracts.

He has not guaranteed anything.

George Lauer of iHealthBeat wrote last week that the President “chose” VistA and open source Connect for its military records program.

That is not the case.

Sun’s work on the NHIN-CONNECT system was contracted for under the Bush Administration. The President promised to “link” the VA’s current VistA system with the military’s AHLTA system, and he promised our heroes interoperability, but that is all.

The same is true in the larger health IT stimulus plan, HITECH. CCHIT still controls functional requirements needed for certification, which in turn is needed to get paid. But as Fred Trotter notes, whether CCHIT will actually certify open source solutions remains unclear.

Important questions remain unanswered:

1. Will VistA be upgraded or replaced with a proprietary system?
2. Will AHLTA be moved to the VistA platform or just connect with it?
3. What hoops will open source have to jump through in order to participate in HITECH?

So far, under the Obama Administration, open source has been riding momentum generated during the second Bush Administration.

Its acceptance by the military is based on performance under past contracts. VistA’s survival seems to have depended more on Dr. Robert Kolodner, a Bush appointee, than anyone on the Obama team.

What open source seems to be getting from the Obama Administration is a shot, a chance, a foot in the door. But there is a big distance between being allowed to present and being given a contract.

Proprietary vendors, especially in the health care space, are experts at creating Fear, Uncertainty and Doubt (FUD) concerning open source. They will offer government “proven solutions” while open source advocates will offer tools the government might build on.

If this now becomes a standard contracting process, in other words, open source can still be shut out. The other guys have more salesmen. They can schmooze whoever needs schmoozing, and grease whatever palms need greasing to get what they want.

What we need are policy statements favoring a “build” process over a “buy” process, and demanding open standards, preferably royalty-free standards, for government contracts.

We don’t have them yet, so the jury is still out on the Obama Administration and open source in health IT.

April 8th, 2009

Another WiFi health scare breaks out

Posted by Dana Blankenhorn @ 10:01 am

Categories: General, Government, Internet, Mental Health, Networking, Wellness

Tags: Health Care, WiFi Signal, Wireless LANs, Wi-Fi, Wireless And Mobility, Dana Blankenhorn

Another WiFi health scare has broken out, this time in England, where a teacher’s group is demanding it be ripped out of schools.

Scientists and journalists have been investigating WiFi for years, repeatedly calling claims against it unproven, yet the fearmongers appear every spring with the flowers.

WiFi signals are very low power, but because they run on microwave frequencies some people think they’re living in ovens.

The controversy is important because WiFi has become an important feature in hospital campus networks, allowing the transfer of voice and data to doctors at the point of care.

This can create a dramatic increase in productivity, which is why some hospital networks are saturated and being upgraded.

Yet the continuing repetition that WiFi is dangerous, especially to children, continues going around the world faster than it can be put down.

Why should WiFi be more dangerous than other services which run on similar frequencies, often at higher power? And if electromagnetic waves are truly dangerous, why aren’t the cranks going after cell phone companies, or TV and radio stations?

The more this lie is told, just as with any big lie, the more people believe it. If electromagnetic signals are dangerous we’re all doomed. If WiFi is dangerous so are all types of mobile communication.

It is well past time we got to the root of this nonsense and stomped it out, once and for all. Before someone really is hurt.

How would you do that?