Category Archives: PHR

Getting Giga Over Google (Again)

Giga (gĭg ‘ə) n.

  1. Metric prefix denoting multiplication by 109 or 1,000,000,000.
  2. In measuring the capacity of computer disks and RAM, equivalent to X 230 or 1,073,741,824.
  3. In California surf slang for something that is totally gnarlatious.

OK . . . enough already . . . regarding Google, Micro$oft, Privacy, and for sure Deborah Peel. It is a tiresome, circular circus of announcements, concerns from pundits, and hang wringing by the neighsaying yes-crowd (or the “no” crowd as the case may be). The bottom line is that the big boys have been circling this arena for a long time, and after smelling blood all those years, they have decided to take their first bites. While the remoras fight over the irrelevant table scraps, these first bits dig into the whale of a health care problem that we are facing. I for one, think it is pretty cool.

Having watched the inevitable Microsoft vs. Google war taking shape for several years, I find it interesting that a major skirmish line is being drawn in the health care sector. With the recent announcement of Amalga, which as the name implies, is a culmination of several recent acquisitions, Microsoft is fulfilling their promise made last year during the keynote that they are “going to fully apply” all their resources into solving the health care IT problem. Building on that pledge, Microsoft has upped the ante with their still recent HealthVault announcement, and subsequent and surprising announcement that they are going to “open source” their framework, release API’s specifications, and even fund startup projects as part of their Be Well fund.

All of this is prelude, of course, to the real battle which will be in search. We have already seen the troop level increase” with Microsoft’s hostile take over attempt of Yahoo. Get ready for the oncoming battle of the bulge . . . but we can let that simmer because it is “game on” in the health care battle right now. Google vs. Microsoft in PHR right now in prime time. Let’s get ready to ruuuuuuuuuuummmble!

My prediction: Google by a long shot. A really long, interconnected, collaborative, collective intelligence, networked kind of aggregated intelligence kind of a shot.

Look, Microsoft is an application company. As such, they have dominated the computing industry hand over foot for two decades (which could be considered centuries in other industries). Microsoft placed an incredibly profitable bet back in the early 80’s when they understood that by controlling the commodity operating system, they could control all the proprietary applications that would eventually be built. Controlling the applications meant that they could control the dollar flow, the upgrade cycle, and the proverbial versioning game. Ruthlessly, profitably, and in near monopolistic fashion.

However, just as they were late to the internet, they are late to another form of sea change within computing: the NETWORK. I have written about networks frequently recently, having only really understood their potential within the last six months. Sun was rightthe network has become the computer (O’Reilly rocks – this was written in 2000!). No longer do I need applications, in fact, I don’t even care about the applications because I they all reside on the network somewhere. I don’t have any version issues, storage issues, configuration issues – I plug and play; anytime, anywhere. This is incredibly powerful paradigm.

This whole PHR thing sets up an interesting contrast for the larger issue of who would I trust with my health data. Let me start with a few general comparisons in terms of my perceptions in working with these two companies (as it relates to how I think each would manage my personal health information):




Trust Check

Branding Check

Ease of Use Check

Speed to Market Check

Next Order Thinking Check

Make My Life Simpler


My personal analysis of the metrics that matter to me in assessing which platform I would be willing to use for my personal health information.

So after all the hype about the Google PHR, I was actually able to see it and test drive it out yesteday at HIMSS. Congratulation to Roni Zeigler, Missy Krasner, and even Marissa Mayer (who still has not responded to me) for getting this out under extreme market “interest”. The Google PHR has the expected simple but intuitive interface, does exactly what you would expect in terms of functionality with the screen shots you have seen, and with all the seamless integration you would expect: G-mail, Google Calendar, Google Maps, Google Search, Google Alerts, Google Reader, etc. There is medication alerts, built in medical conditions, demographic information, and care coordinator contacts lists. It is currently missing ability to upload images/documents, import laboratory feeds, and several other essential features/functionality. However, as with everything else Google has ever done, you know it is coming in the constant iterations that will inevitably flow.

What an easy, and natural extension, to incorporate my personal health information to an the same entity that already manages the rest of my life. While this has some potential scary undertones, it is far scarier to me to think of the folks in Redmon managing my data and my life in this way. Microsofts bad behavior over the years, the unnecessary bullying, open taunting, stifling of innovation, orientation toward control, and focus on the proprietary, is going to return to haunt them in a very big, and very unfortunate way.

Think about the above for just a minute . . . nearly my entire productive professional life is being managed by Google. On a remote network. For free. Whoa.

So while the hype dust still needs to settle, I remain Giga over Google’s health care prospects.



Filed under Innovation, PHR, Value

Ginormous: Going Gaga over Google

Gaga (gä’gä’) adj.

Afflicted with or exhibiting irrationality and mental unsoundness
2. Completely absorbed, infatuated, or excited

OK, it was bound to happen. After more than a year of dithering, whispering, false (advertising) missteps, and hinting, it looks like we are going to get our first glimpse of “Google Health” (will the real Google Health please stand up). An article that appeared in the New York Times yesterday restoked the fires of possibility for Google’s anticipated tour de force entry into healthcare. My Google Alerts picked up the story, which I then tracked on my Google Reader of top healthcare blogs, which I immediately forwarded to friends via Gmail, before settling in to write this on my Google Blogspot (I hope you are picking up on the theme; kinda scary isn’t it).

Healthcare Symbolism. Google has become the very DNA of the web. Will it do the same in healthcare?

The New Atlantis magazine, in a great 2004 article, documented (Gaga over Google) our collective irrational exhuberance and pervasive adoption of Google technologies, tools, and terse approach to the web. Google is a master of simplicity (I distinctly recall the moment I first saw the Google search page which was so simple compared to the mishmash and noise of my traditional Yahoo home page); and the master of seeing (finding?) the obvious right in front of our eyes. Shortly after this first introduction, I started reading about Sergi and Brin, the “Dont’ Be Evil” Silicon Schlickity stuff, their meterioric rise to entrepreneurial knighthood, the take on the world (M$FT) attitude, the literal beauty of the advertising model, and the triple digit growth quarter after quarter. I mean, man, it is seriously unreal to have witnessed it.

But their pervasiveness comes at a price – particularly as people begin to contemplate their incredible reach into our daily lives and our personal data. I mean, consider all that stuff that I rely on Google for each day to make my life better (as listed above) and how much of my personal information that they already know about me and my behaviors. Every click sends a message to the Google Borg who immediately responds with all kinds of personal, timely, and relevant information back to me. At some point, the convenience and ease and wizardry with which all this happens begins to make you start feeling uncomfortable. I am not a conspiracy theorist, but somebody should turn up the volume on that “Don’t Be Evil” theme song to make me feel better.

It is totally obvious that the democratization of the internet, and all forms of data, will ultimately lead to an effort to democratize the most valuable data of all – your personal health information. I have argued previously that your personal healthcare information will be a form of currency in the future. As such, we all need to begin building equity in the brand by protecting it, defending it, and leveraging these protections to our advantage.

Which brings us to Google Health. I have trusted them with all kinds of my other information – would I trust them with my personal health information? I am still considering it. While I noodle on that, I can observe what they are doing with their concept of a personal health record. As per the Google playbook, the personal health record they are developing is very simple, very plain, and most likely very powerful. The Google PHR has all the right elements, the Sacred 7 of demographics, medications, allergies, diagnosis/problems, medical history/test results, immunizations, and family history.

The Google PHR isn’t really much to look at, and it is certainly not very sexy. However, as Google learned with search, the PHR as a “thing” is irrelevant; it is the PHR as a form of currency (data mining, ad revenue, messaging, analytics, genomics, personalized medicine, etc) that will make it powerful. The more information they have about you, the more valuable it becomes to them and a whole host of other people who will want access to this most personal of all information. The more valuable it becomes to them, the more valuable it should be to you, particularly if you know how to protect your investment.

Reminds me of the movie 1992 move Sneakers, where Ben Kingsley’s character Cosmo, delivers this prescient

There’s a war out there, old friend. A world war. And it’s not about who’s got the most bullets. It’s about who controls the information. What we see and hear, how we work, what we think… it’s all about the information!

That’s a game wherein Google has been pervasively successful. And it is that pervasiveness that will enable the Google Health initiative to be GINORMIS!*

* Yes – it is a real word officially as of 2007 thanks to Merriam-Webster


Filed under Change Agents, Consumerism, PHR

A New Dimension: Introducing the XHR

Dimension (dĭ-mĕn’shən) n.
  1. A measure of spatial extent, especially width, height, or length.
  2. Extent or magnitude; scope.
  3. A physical property, such as mass, length, time, or a combination thereof, regarded as a fundamental measure.

The time has come for a new definition within the world of healthcare information technology (HIT). As many of you know, the debate over the proper use of Electronic Medical Record (EMR), Clinical Information System (CIS), Health Information System (HIS), or Computer Based Record (CBR) ultimately deteriorated into the Acronym of Choice (AOC). To further complicate matters, the National Health Information Infrastructure (NHII) was introduced, complete with the idea of creating a Community Health Information Network (CHIN) as part of a larger Regional Health Information Organization (RHIO). These efforts held the promise of pervasive interoperability, but they too delved into the standards quagmire of Clinical Continuity Record (CCR) versus Clinical Continuity Document (CCD) versus Clinical Documentation Architecture (CDA) concept. Not to mention dealing with the HL7 standard (sure its a standard, its just that everyone has their own), DICOM compliance, and a host of other nauseated bits and bytes that make up the current healthcare information technology alphabet soup.

(Zofran, please!)

This backgrounder leads me to the reason why a new definition is required. The internet is changing the very relationships between all the different players. The old paradigms around the physician-patient, physician-plan, and patient-plan interactions are all evolving in new dimensions as part of the technology explosion and a marked cultural shift to focus on patient value. This is an important shift, one that will take years to complete, but companies who are quick to adapt to the new thinking will reap not only the competitive rewards of first to market, but will build consumer loyalty by providing the best consumer “experience“. These new relationships also mean that information will need to be shared in different ways to accomplish the quality objectives of care, including a health care delivery system and healthcare information technology that is safe, effective, patient centered, timely, efficient, and equitable.

I just spent 5 years of my life laying railroad tracks – putting the information system in place that would serve as the central nervous system or operating system of the hospital organization (the current healthcare aggregation point). We deployed an ENTERPRISE Health Record (my definition of an EHR) which included not only the electronic medical record, but the departmental systems (Rads, Labs, Pharm, Diet, etc) that were integrated into a common system across the continuum of acute care. This was hard work, including ground-breaking, back-breaking efforts to hack through the wilderness in order to leave a solid foundation from which hospital organizations could build their information architecture.

These efforts had natural spillage into the associated clinic market, where a Clinical Health Record (CHR) could be deployed to manage the unique features of this segment. These characteristics included a much more detailed practice management function, scheduling/referral modules, ancillary department interfaces, and billing/financial component. Others have effectively picked up the banner to lay the foundation of electronic medical records in the clinic setting. All this work by all these people, despite its scale and scope and just like it was for all the efforts to create a transcontinental railroad “system”, is just laying the foundation for the future “build out” to come.

Which leads me back to the personal health record (PHR). I have had a few things to say about the PHR recently, because I believe it will be a very important piece in the Health 2.0 world. The market is still very formative, and currently all 5 Bazillion PHR vendors are struggling to come up with a business model that makes sense (even to them). One thing is for sure – having an employer, insurance company, or some other conflicted third party hold your PHR information is not only crazy, it is not smart. As a consumer, you need a trusted, non-conflicted third party that you create a healthy, health-focused relationship with. Someone who can offer valuable Healthcare Advisory Services where, when, and how you would like to receive them. This Health Advisor will have your best interest at heart (literally!), will help you obtain health care prior to it becoming disease care, and will be compensated to help you achieve your objectives for “life, liberty, and the pursuit of health“.

Piecing these concepts together, I see a future where the EHR, CHR, and PHR (as I have defined them) will be a seamless set of information systems, complete with the privacy, security, confidentiality, and interoperability equivalent to the type of efficiency we now enjoy in the financial services industry. Each actor in the healthcare system will have access to the right information, at the right time, with the right degree of control. The XHR will be the inclusive currency of this information exchange and will contain the aggregated information of the EHR, the CHR (subset of EHR), and the PHR (subset of CHR). While the patient will maintain control of the record, the physicians and other providers will also maintain shared custody of the portion that is required for them as professional health advisors. The XHR will be virtual, and will assemble on the fly (in true mash-up form) as needed, for appropriate health care interactions to occur (I’ll provide further definition later). This degree of flexibility, functionality, and efficiency of the XHR will be the required infrastructure to practice the personalized medicine of the future. Truly, a new dimension within healthcare.

Can’t you just hear Rod Serlings voice, “You are about to enter another dimension, a dimension of not only sight and sound but of mind. A journey into a wondrous land of imagination. Next stop, the XHR!”


Filed under Health 2.0, Healthcare, PHR

Custodial Care of the PHR: Controlling the currency of the future?

Custodial (kŭ-stōdē-əl) adj.

  1. Of or relating to the work of guarding or maintaining;
  2. Marked by care and supervision rather than efforts to cure.

The California Health Foundation is a respected and influential healthcare policy organization within the state. They have a research and educational focus which enables to them to occasional commission white papers on various subjects. Having formerly been profiled in a previous issue, and seeing the many positive benefits of such exposure, I keep an eye on their publications. Therefore, it was with interest that I read their most recent report entitled, “Personal Health Records: Employers Proceed with Caution”, which was made available in January 2007. The report was authored by Janlori Goldman JD, the director of Health Privacy Project and a research faculty member at Columbia University College of Physician and Surgeons (what the heck is that? Must be Ivy-league speak for Columbia Medical School), and one of the foremost national advocates of
patient privacy.

Therefore I was surprised to read one of the thought leaders on patient privacy issues discuss the value of an employer owned Personal Health Record (PHR). Essentially it was written as a primer for employers who are considering offering PHR’s freely to their employees. While I appreciate the general assumptions that my employer is interested in my health (aka, my employer wants me to be a healthy happy worker)), I don’t share the Pollyanna perspective that they want my data for altruistic reasons. So while I commend someone of Janlori’s stature for accurately highlighting the potential role and benefits of the PHR, I strongly disagree with the fundamental perspective of the paper.

My employer, by the very nature of having a corporate mission, is interested in reducing costs to increase profits. As an employee, I am a production unit (generating desired outputs) associated with costs (salaries and benefits). My employer is interested in my health insomuch as it can be optimized (like any production input) to maximize my output. If my employer knows that I am a diabetic with strong disposition toward coronary artery disease, or that I suffer from a chronic condition like Crohn’s disease that will ultimately result in significant and sustained expense over time, how will they respond to this information? Will this get incorporate into a decision to hire me? Will it work its way into my annual review? Will my health status now become another mechanism of determining my fitness for corporate advancement, job promotion, or professional opportunity within the company? If this brings shudders, think about what happens when you layer in personalized medicine – do you want your employer knowing your genetic profile, behaviorial predispositions, and predicted intellectual metrics? Do you trust your employer to altruistically use this?

Hate to break it to Janlori, but I don’t have ANY interest in an employer or insurance plan sponsored PHR and neither should you. Matter of fact, I don’t want any part of that world (didn’t you read 1984, or see Gatacca/ Minority Report?)

Conversely, I am interesting in working toward a completely different world. One in which the patient is at the heart and center of the healthcare paradigm. One in which I partner with independent, non-conflicted third party Healthcare Advisory Service companies who help me optimize my own health privately, securely, and personalized uniquely to me. One in which healthcare information is readily available in a human readable format in my own personal health record. One in which my trusted Healthcare Advisor can provide personalized medical information in a relevant, convenient, and through varied customized channels (stream relevant blogs, scientific articles, educational videos, podcasts, multi-media educational production, etc directly to the consumer). This is the patient-centered, timely, effective, efficient, and equitable type of healthcare the Institute of Medicine envisioned when defining the delivery of high quality care.

It is also part of the Health 2.0 world that I see forming even as I write this. This is where company’s like Health Equity, Subimo, Organized Wisdom, Healthgrades, Vimo, Medbillmanager, and the like begin to have influence in shaping the future interactions within healthcare. Healthcare, and quality of care, will continue to be important topics in the future, particularly as human performance begins to be increasingly optimized through technology. This future world is fast approaching.

The PHR will play an essential role in this brave new world by serving as a central repository of patient-centric AND patient-controlled information. For this reason, the concept of PHR data “banking” is not so far fetched. In fact, specific concepts from the financial industry such as banking, security, privacy, transactional interoperability, confidentiality, and the role of financial advisors is directly analogous to what will continue to happen within the Health 2.0 paradigm. And just as you would not trust some shady banking institution with conflicted interests with your financial future, I wouldn’t trust my employer or my insurer with my personal health information. Specifically since I believe that personal health information will become the medium of exchange in this new healthcare marketplace – and if I may be predictive – the essential currency of the future Health 2.0 world.

You can take that to the bank!

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Filed under Health 2.0, PHR