healthy4u: Eric Schmidt

Google CEO Eric Schmidt on Healthcare IT Once Again

<div class="commenttxt">At the Jan. 11, 2011 WSJ health blog, in an article entitled "<a href="http://blogs.wsj.com/health/2011/01/11/jp-morgan-healthcare-googles-schmidt-on-open-source-and-health-it/">JP Morgan Healthcare: Google’s Schmidt on Open Source and Health IT</a>", Google CEO Eric Schmidt is cited as saying:<blockquote>... One solution to the problem may be to take the electronic-medical record architecture out of the hands of the corporate world, suggested Google CEO Eric Schmidt at the JP Morgan Healthcare Conference last night. “If I were not doing what I’m doing and I wanted to do something in health care … I would go to all of the research universities and would try to figure out where the best, interesting IT software is that can be open-sourced,” he said at a health-IT panel discussion. “My guess is that a platform like that would be remarkably different from the platforms that we are using today,” he said.</blockquote> First, a comment on language, which perhaps I should more accurately describe as a critique of IT culture:“A platform like that?” As at my post "<a href="http://hcrenewal.blogspot.com/2010/01/does-ceo-of-google-use-google.html">Does the CEO of Google Use Google? - And: Platform, Platform, Who's Got The Platform?</a>" early last year Schmidt also said – <blockquote>“As computer scientists, this [that is, why docs haven’t embraced databases to help them sort through medical information] is a platform database problem, and we do these very, very well, as a general rule. And it befuddles me why medicine hasn’t organized itself around these platform opportunities.”</blockquote>At that post I also pointed out that the successful practice of medicine is not a 'platform database' or any other reductionistic information retrieval problem, and that such a "platform opportunity" was seized upon decades ago:<blockquote>DXplain was developed starting in the mid 1980's by medical informatics researchers who actually know this domain, and which offers this explanation and warning: "DXplain uses an interactive format to collect clinical information and makes use of a modified form of Bayesian logic to derive clinical interpretations ... DXplain does not offer definitive medical consultation and should <a href="http://lcs.mgh.harvard.edu/projects/dxplain.html">not be used</a> as a substitute for physician diagnostic decision making." </blockquote>I note that IT personnel like to refer to “platforms”, “solutions” – a rather presumptuous term – “paradigms”, and other buzzwords to mask the fact that what they’re referring to are more commonly known as “hardware” and “software” and arrangements thereof. It is a word that implies lack of knowledge about the complexities and realities of medicine – including that health IT problems will not be solved via a “platform.” I wrote more on “platformania” <a href="http://hcrenewal.blogspot.com/2010/01/does-ceo-of-google-use-google.html" rel="nofollow">at this link</a>.I do agree strongly with Schmidt on the following from the recent WSJ posting: <blockquote>Schmidt said that using such an open-source strategy — giving programmers the freedom to modify and distribute software [an agile computing methodology - essential to health IT development and lifecycle - ed.] — is a proven way to fix disparate software architectures. It’s the same development strategy that brought about the modern internet and “all the other technologies that you use every day.” ... Part of the problem in designing and discussing a new standard is that the current focus is on the companies involved rather than the patients.</blockquote>That's been done, too, as in the <a href="http://worldvista.sourceforge.net/openvista/index.html">OpenVista /WorldVista</a> efforts. I merely add that an erroneous approach to "focusing on the patients" (and the clinicians using the IT, i.e., a user-centric approach in the terminology of Social Informatics) will have results just as suboptimal as the current designer-centric approach to health IT. Designing health IT that "focuses on the patients" and that eliminates unintended consequences - i.e., "doing health IT well" - is <a href="http://en.wikipedia.org/wiki/Wicked_problem">wickedly harder</a> than it sounds. Most importantly with regards to Mr. Schmidt's most recent thoughts on academia:The National Research Council did study a number of the best academic centers and in a 2009 report found quite clearly that even there, “Current Approaches to U.S. Health Care Information Technology are Insufficient.” See <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572" rel="nofollow">http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572</a> They did recommend the solution, and it's not a "platform": <blockquote>“In the long term, [Health IT] success will depend upon accelerating interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering.”</blockquote> That means forgoing the current national rush to EHR, which is decidedly a medical experiment without patient consent.In any case, I am impressed that a major information technology CEO has recommended a patient centered approach to health IT, agile methodologies, open source, etc. - true sacrilege towards today's <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=ecosystem">health IT ecosystem</a>. (Note to Google and Mr. Schmidt: In "<a href="http://hcrenewal.blogspot.com/2009/01/who-can-solve-hits-challenges-part-1.html">Who Can Solve Healthcare IT's Challenges? Part 1 - Google</a>" I wrote that: <blockquote>... This [HIT] dysfunction takes the form of corporatization of HIT, creation of myths about its magic bullet capabilities in "revolutionizing healthcare" ... In "<a href="http://hcrenewal.blogspot.com/2008/12/biomedical-informatics-manifesto.html">A Biomedical Informatics Manifesto</a>" I addressed the domain expertise I feel is most needed. I did not, however, address the "who" as in "what organization(s)." What organizations, that is, have the resources (e.g., financial and infrastructure) to make useful, usable, national, interoperational HIT happen? What organizations have the innovative track record to effectively engage the best specialists to make it happen? One example comes to mind immediately. It was suggested by an expert in IT and bioinformatics I correspond with, Felix Fulmer. <a href="http://www.google.com/">Google</a>. These folks are innovative. Their services are reliable, fast (when is the last time Google was down or took a long time to provide query results?), widely available, cost effective (many services available for free!), and a true technological tour de force.</blockquote> Google, I am available should you seek true competitive advantage, and avoidance of paths that lead to <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">health care IT failure</a> such as you once attempted <a href="http://hcrenewal.blogspot.com/2009/04/should-google-seek-resignations-of.html">here</a>. However, somehow I am sure your HR department would probably find my sometimes "edgy", critical-thinking approach to matters of national import "disruptive." Disruptive to what, exactly, I'm not sure, but disruptive to - something - is good enough in today's "PC", outcomes-be-damned corporate culture.) -- SS</div>

Google CEO Eric Schmidt on Healthcare IT Once Again

At the Jan. 11, 2011 WSJ health blog, in an article entitled " JP Morgan Healthcare: Google’s Schmidt on Open Source and Health IT ...

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Does the CEO of Google Use Google? - And: Platform, Platform, Who's Got The Platform?

<div style="text-align: left;">Over at the WSJ health blog, reporter Jacob Goldstein's Jan. 8, 2010 post "<a href="http://blogs.wsj.com/health/2010/01/08/google-ceo-harvard-surgeon-talk-health-it/">Google CEO & Harvard Surgeon Talk Health IT</a>" quotes Google's CEO:</div><blockquote> "Google’s CEO Eric Schmidt doesn’t know why docs haven’t embraced databases to help them sort through medical information." [Schmidt said] ... So when you show up at the doctor with some set of symptoms, in my ideal world what would happen is that the doctor would type in the symptoms he or she also observes, and it would be matched against the data in this repository [such as <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&source=hp&q=dxplain&btnG=Google+Search" style="font-style: italic; font-weight: bold;">DXplain</a>? -- which we learn from a - er, um, Google search - was developed starting in the mid 1980's by medical informatics researchers who actually know this domain, and which offers this explanation and warning: "DXplain uses an interactive format to collect clinical information and makes use of a modified form of Bayesian logic to derive clinical interpretations ... DXplain does not offer definitive medical consultation and should <a href="http://lcs.mgh.harvard.edu/projects/dxplain.html" style="font-style: italic; font-weight: bold;">not be used</a> as a substitute for physician diagnostic decision making"? - ed.] ... Then this knowledge engine would use best practices, and all the knowledge in the world to give physicians some sort of standardized guidance. This is a generalized form of the checklists that you’re talking about … As computer scientists, this is a platform database problem, and we do these very, very well, as a general rule. And it befuddles me why medicine hasn’t organized itself around these platform opportunities. [No - the successful practice of medicine is not a 'platform database' or any other reductionistic information retrieval problem - ed.]</blockquote> I note that IT personnel like to refer to "<a href="http://en.wikipedia.org/wiki/Computing_platform">platforms</a>", "solutions" - a rather presumptuous term, "paradigms", and other buzzwords to mask the fact that what they're referring to are more commonly known as "hardware" and "software" and arrangements thereof. Does this "platform opportunity" view reflect naïveté about the complexities of medicine and medical decision making, or does it reflect something else? Could this "befuddlement" be construed as calling physicians obtuse? Is this yet another example of what I referred to in my post "<a href="http://hcrenewal.blogspot.com/2009/12/utter-arrogance-of-it-industry.html">Healthcare IT Failure and The Arrogance of the IT Industry</a>" and other writings as a cross-occupational invasion of medicine by IT? IT personnel seem to have a propensity to offer healthcare-related opinions far outside their own areas of expertise -- or if in healthcare organizations, edicts - based upon the narrow view of their own relatively linear and deterministic fields. The risk is, especially when coming from high perches, that such opinions and edicts can result in deleterious actions (e.g., government initiatives). In an absurdist <a href="http://en.wikipedia.org/wiki/Reductio_ad_absurdum" style="font-style: italic;">reductio ad absurdum</a>, deliberately made absurdist due to many years of exposure to equally absurd (to those with actual domain experience) "who needs medical school/residency/patient care experience to profess on medical matters?" attitudes: Why don't physicians offer the advice that Google could improve its search algorithms, or Intel and AMD their microprocessors, by utilizing intelligent psittacine platforms <a href="http://www.youtube.com/watch?v=O_Fpad20Zbk">as in this British Broadcasting Company (BBC) video</a> narrated by a true technology expert, Captain James T. Kirk? <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0_5l5d5WTr3rCF1OxYjWQCMZ58U02amoTE7trho8x12NYbR6UPP8JmpwY2E19FcZ4oaBUwNh8lYLp8IolYKq_ve9YohOpipWKEuhjtnh02FzauX2HbebCWl6zID8haXMeDLA3WwmxHjyu/s1600-h/STChangeling.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5424782084411649186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0_5l5d5WTr3rCF1OxYjWQCMZ58U02amoTE7trho8x12NYbR6UPP8JmpwY2E19FcZ4oaBUwNh8lYLp8IolYKq_ve9YohOpipWKEuhjtnh02FzauX2HbebCWl6zID8haXMeDLA3WwmxHjyu/s320/STChangeling.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 157px; height: 112px;" /></a>Kirk did have a (computerized) physician son: <a href="http://en.wikipedia.org/wiki/Nomad_%28Star_Trek%29">Nomad</a>! </div> ---------------- Quite seriously, physician reluctance to "embracing databases" and health IT in general is not about database platforms. I only wish it were so simple. The WSJ seems to understand this. In a Jan. 12, 2009 article by reporter Bret Stephens entitled "<a href="http://online.wsj.com/article/SB10001424052748703652104574652002740167932.html">Can Intelligence be Intelligent?</a>", the observation is made that technology is a mere facilitator, and intelligent, well trained, experienced, critical-thinking people are the enablers of any complex field that requires human judgment. They must be unfettered by machine and bureaucrat: <blockquote> ... Terrifying as the thought may be to many of its current practitioners, the true art of intelligence requires, well, intelligence. That is a function neither of technology nor of "systems" [a.k.a. "platforms" - ed.], which begin as efforts to supplement and enhance the work of intelligence and typically wind up as substitutes for it. It is, instead, a matter of experience, intellect, initiative and judgment, nurtured within institutions that welcome gadflies in their midst.</blockquote> I've left the following comment at the WSJ health blog: <blockquote>Mr Schmidt, If you’d like to learn more about why many physicians are reluctant to embrace clinical IT, you might also do a Google search on “<a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&source=hp&q=healthcare+IT+failure">healthcare IT failure</a>” and similar terms.</blockquote> Need I say anything more about the irony of that advice? I'd also noted a fixation on "platforms" as solutions to biomedical problems (best when they come in shrinkwrapped, off the shelf, "on the IT roadmap" packages!) in my June 2008 post "<a href="http://www.bio-itworld.com/issues/2008/may/cover-story-merck-informatics.html">An Open Letter to Merck CEO Richard Clark on Merck's Mission to Rediscover the Wheel.</a>" A nonmedical research IT leader, who'd found a move from basic research to clinical IT "quite an eye opening experience" (i.e., a domain in which she had little or no experience but was paradoxically appointed to lead) talked all about "platforms" in <a href="http://www.bio-itworld.com/issues/2008/may/cover-story-merck-informatics.html">Bio-IT World</a>: <blockquote>... We've invested a lot in some core platforms; we need to start translating that into results in the clinic at some point. And so having people who have an understanding of what does that really take to help inform the earlier research directions, the platform directions [i.e., research direction = platform direction - ed.], is a key theme...We already have siloed platforms to show that data, we need to integrate it more than it is... combining the results data from clinical samples with the associated patient data, what's that platform?</blockquote> Platform, platform, platform. Who's got the platform? My comments to that CEO in my Open Letter were that this was the wrong mindset and question, based upon an IT person's focus on information technology. This is as opposed to a focus on information science and on facilitating people in interacting with data and information in order to gain actionable knowledge, i.e., an information science and human-computer interaction-based approach that those in medical informatics thought about long ago. In line with the conclusions of <a href="http://hcrenewal.blogspot.com/2009/12/healthcare-it-as-cybernetic-miracle.html">Greenhalgh et al</a>. [1] who called for "eschewing sanitized accounts of successful projects" and instead recommending studies of clinical IT in organizations that “tell it like it is” using the de-identified critical fiction technique, I'd written on how conflation of information technology and information science impaired R&D in pharma at my essay "<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=pharma">Sure path to R&D failure: Conflation of IT with information science in the pharmaceutical industry</a>." That piece and the aforementioned Open Letter were written before Merck sold itself to Schering-Plough in a "<a href="http://www.biojobblog.com/2009/03/articles/ideas-and-indulgences/the-merckschering-plough-deal-under-the-microscope-why-a-reverse-merger/">reverse merger</a>" due to the <a href="http://www.forbes.com/2009/04/21/merck-schering-earnings-business-healthcare-merck.html">unsustainability of doing business from an empty wagon</a> of new products, a sign of just how well this IT-centric "platformania" has been working out for R&D. In the information science-centered view and approach, the "platform," a.k.a. computer technology, is merely a canvas and facilitator, the artist (clinician or scientist) and the brush wielded by them being the primary enabler of and contributor to the masterpiece. Unfortunately, I don't think anyone is "home" in pharma or in the HIT sector anymore to parse these ideas; in fact I've only recently learned that the people I did work with who could parse these ideas into creative reality were laid off by the very IT people making such statements and asking such questions. IT personnel perhaps need to move away from their reductionist platformania. (Perhaps they are confusing "platforms" with "pixie dust.") Rather, they need to start thinking in terms of facilitating clinicians and scientists through domain specific and individualized-to-need information science and HCI innovation that arises of true cross-disciplinary expertise. They need to leave creation of cybernetic miracles to people such as <a href="http://en.wikipedia.org/wiki/Irwin_Allen">Irwin Allen</a> and <a href="http://en.wikipedia.org/wiki/George_Lucas">George Lucas</a>. And platforms to carpenters. -- SS [1] Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method. Greenhalgh, Potts, Wong, Bark, Swinglehurst, University College London. Milbank Quarterly, Dec. 2009. Available at: <a href="http://eprints.ucl.ac.uk/18821/">http://eprints.ucl.ac.uk/18821/</a>

Does the CEO of Google Use Google? - And: Platform, Platform, Who's Got The Platform?

Over at the WSJ health blog, reporter Jacob Goldstein's Jan. 8, 2010 post " Google CEO & Harvard Surgeon Talk Health IT " ...

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