healthy4u: google

Google is shutting down its cloud-based Google Health, a Personal Health Record service

Google is <a href="http://www.examiner.com/web-2-0-in-tampa-bay/google-retires-powermeter-and-health-services-controversy-ensues">shutting down its cloud-based Google Health</a>, a Personal Health Record service, by the end of the year. I wrote: <blockquote>"<a href="http://hcrenewal.blogspot.com/2007/07/personal-health-record-project-with.html">Who'da thunk it? -- Personal Health Record project with big corporate sponsors not working out so well ...</a>" </blockquote> and <blockquote>"<a href="http://hcrenewal.blogspot.com/2007/05/label-me-skeptical-personal-health.html">Label me skeptical: Personal Health Records as healthcare panacea?</a>" </blockquote> both in 2007. Considering the education and expertise one needs to really manage (and comprehend) health records robustly, let me state that I consider the entire concept of the "personal heath record" inane. You heard it here first. -- SS

Google is shutting down its cloud-based Google Health, a Personal Health Record service

Google is shutting down its cloud-based Google Health , a Personal Health Record service, by the end of the year. I wrote: " Who'da...

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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 &quo...

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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 style="font-style: italic; font-weight: bold;" 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">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 style="font-style: italic; font-weight: bold;" href="http://lcs.mgh.harvard.edu/projects/dxplain.html">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 style="font-style: italic;" href="http://en.wikipedia.org/wiki/Reductio_ad_absurdum">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 onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0_5l5d5WTr3rCF1OxYjWQCMZ58U02amoTE7trho8x12NYbR6UPP8JmpwY2E19FcZ4oaBUwNh8lYLp8IolYKq_ve9YohOpipWKEuhjtnh02FzauX2HbebCWl6zID8haXMeDLA3WwmxHjyu/s1600-h/STChangeling.jpg"><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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Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At "<a href="http://hcrenewal.blogspot.com/2009/04/should-google-seek-resignations-of.html">Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?</a>" I expressed great concern about what I term the cross occupational intrusion of the IT industry into healthcare. My major concern in that post was how the information technologists at Google, even with nearly unlimited access to capital (and therefore to the world's informatics expertise) badly mismanaged a Personal Health Records (PHR) project through commission of a most fundamental biomedical information science blunder (quite distinct from IT; most IT technologists and MIS personnel really stink at biomedical information science). They tried to map relatively ungranular, imprecise, and often misused billing codes back to enduser-viewable diagnoses, resulting in easily predictable patient panic and mayhem. As usual in HIT: it's possibly even worse. I am quite concerned about a letter from the consumer education and advocacy organization <a target="blank" href="http://www.consumerwatchdog.org/about/">Consumer Watchdog.org</a> and their allegations that Google has been lobbying Congress to be excluded from HIPAA provisions on privacy and forbidding sales of medical records. The letter, dated April 22, is <a target="blank" href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf">here</a> (<a target="blank" href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf">http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf</a>). Considering that Google is heavily into the PHR space, and even worse, considering they made an Informatics 101 error in attempting to map billing codes into user-viewable diagnostic data, I would (and I'm sure others would as well) view such attempts if they indeed occurred as ominous, a true heavy handed intrusion of the IT industry not only into the affairs of medicine but into what really is another human rights issue. (I'd pointed out another potential HIT-related human rights issue at the post "<a style="font-family: arial;" href="http://hcrenewal.blogspot.com/2009/04/upmc-pioneers-in-health-it-or-pioneers.html">UPMC as Proving Ground for IT Tests On Children</a>".) I would be interested in additional information on the Google lobbying issue, especially from those at Harvard and other academic centers who have been involved in the Google PHR initiative. I have shared these concerns with the American Medical Informatics Association (<a href="http://www.amia.org/">AMIA</a>) clinical information systems workgroup (cis-wg) and the people & organizational issues workgroup (poi-wg) as well. I hope the Consumer Watchdog allegations are not accurate, because if they are valid, the implications of national EHR grow increasingly unsettling.

Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At " Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle? " I expressed great concern about wh...

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Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?

Simply amazing. One of the richest and most "leading edge" IT companies in the world with almost unlimited resources and access to expertise commits one of the most fundamental biomedical information science (a.k.a. informatics) blunders, as in the taxonomy in my post <a href="http://hcrenewal.blogspot.com/2009/03/draft-patient-rights-statement-and.html">here</a>, at the level of "likely to cause patient harm in short term if uncorrected." I have repeatedly written over at least the past ten years that applying the leadership and methodologies of business IT to clinical computing is both ill conceived and dangerous, as business computing and clinical computing are two very different computing subspecialties, the latter requiring quite specialized leadership and approaches. I've written it at <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">academic sites</a>, in magazines, in newspapers, and other venues. Yet, as we have observed at HC Renewal regarding other flavors of healthcare mismanagement and malfeasance, these words seem to <a href="http://hcrenewal.blogspot.com/2006/07/anechoic-effect-explained.html">suffer an anechoic fate</a>. Here we go again with another example of what appears to be gross mismanagement of clinical IT by business IT personnel and organizations. The following type of debacle is sooner or later going to kill patients and must end, immediately: <blockquote> Boston Globe <a style="font-weight: bold;" href="http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt/?page=full">Electronic health records raise doubt</a> Google service's inaccuracies may hold wide lesson ["may?" - ed.] By Lisa Wangsness, Globe Staff April 13, 2009 WASHINGTON - When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found. Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention." "I wondered, 'What are they talking about?' " said deBronkart, who is 59 and lives in Nashua. DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment. </blockquote> (Addendum April 19: a first hand account of this problem is at e-patients.net <a href="http://e-patients.net/archives/2009/04/imagine-if-someone-had-been-managing-your-data-and-then-you-looked.html">here</a>.) What manner of amateurs made and approved the decision to map semantically and often medically imprecise, and often deliberately overstated or misused billing codes to diagnoses, and then display the diagnostic terms to a user - ANY user, patient or "learned intermediary" - in an electronic health record? Not to mention how <a href="http://hcrenewal.blogspot.com/2009/04/masochism-medicine-and-clinical-it-how.html">poorly conceived and implemented</a> many of the HIT billing systems themselves are, making billing data even less trustworthy... <div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinOXLmoUpcH2XE8DCduOm8-bnlZPwBkhOwAAGuhxIX94n-rV4NauiHoaC-UAYsXbSG3kklzXezv6MtRFqj_f9wqUXwwhtzDUA0BNY9jPABeBYPwRajgZdfEMwKnVVFb8Y9azjzxOGH44OQ/s1600-h/doh.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5324254310017454930" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinOXLmoUpcH2XE8DCduOm8-bnlZPwBkhOwAAGuhxIX94n-rV4NauiHoaC-UAYsXbSG3kklzXezv6MtRFqj_f9wqUXwwhtzDUA0BNY9jPABeBYPwRajgZdfEMwKnVVFb8Y9azjzxOGH44OQ/s320/doh.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 115px; height: 146px;" /></a>Injecting humor into a most somber post, Homer succinctly summarizes the situation. </div> It is common knowledge to any competent person in healthcare informatics that doing what was done by Google Health is prone to create exactly the kind of situation that occurred. <blockquote>Insurance data, by contrast, is already computerized and far easier and cheaper to download. But it is also prone to inaccuracies, partly because of the clunky diagnostic coding language used for medical billing, or because doctors sometimes label a test with the disease they hope to rule out, medical technology specialists say.</blockquote> One does not have to be much of a "specialist" to make this realization. Almost anyone who's ever practiced medicine could probably have told Google's designers, developers and programmers this. This raises a number of questions, which also do not require a specialist to raise: <ul><li>What were the designers, implementers and management of this project thinking? </li><li>Who was leading the project? </li><li>What were there backgrounds? </li><li>Who made the decision to implement in this manner?</li></ul> Danny Sands raises the obvious: <blockquote>"The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, said deBronkart's primary care doctor, Daniel Z. Sands, who is also the director of medical informatics at <org idsrc="NASDAQ" value="CSCO">Cisco Systems</org>.</blockquote> Indeed. <blockquote>Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," ["could be?" - ed.] said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum. For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.</blockquote> And when such an event occurs and a patient is harmed or killed, who then is held accountable - and who is held harmless? (Oh wait ... we know the answer to that question thanks to <a href="http://hcrenewal.blogspot.com/2009/03/health-care-information-technology.html">Koppel and Kreda</a>...) This "billing data" issue and other EHR issues like it are not rocket science, they are Medical Informatics 101. I've seen such issues before, such as at "<a href="http://hcrenewal.blogspot.com/2006/08/aol-kerfuffle-information-technology.html">AOL kerfuffle: information technology vs. information science, a distinction lost at industry's peril</a>" and at "<a href="http://hcrenewal.blogspot.com/2006/10/on-intels-and-walmarts-prescription.html">On Intel's and Walmart's prescription for Healthcare IT</a>." I summed the problem up like this at the post "<a href="http://hcrenewal.blogspot.com/2008/12/biomedical-informatics-manifesto.html">A Biomedical Informatics Manifesto</a>": <blockquote style="font-weight: bold;">Biomedical Informatics as a specialty might as well be invisible. Amateurs** rule HIT.</blockquote> (** Amateur in the sense that I am a <a href="http://www.arrl.org/">radio amateur</a>, not a telecommunications professional and would not deem myself appropriate to design and run a critical telecommunications project). Perhaps, though, I should have added "amateurs rule HIT, and even worse are too often managed by incompetents." I believe Google should conduct a top to bottom investigation of the management chain and the decision making process that led to such a fiasco, which can only further erode public confidence in electronic health records at a time of national distrust in Big Business and Big Medicine. Those who made such design and implementation decisions without appropriate input from those who know better, or worse, those who might have overridden or ignored such counsel, should be dealt with appropriately. (If it were me, I'd ask for their resignation, but that's my opinion.) Clinical medicine, Electronic Health Records and patients' well being are not an information technologists' learning lab. Also of concern to me, this is the type of data our government seems to be <a href="http://hcrenewal.blogspot.com/2009/04/have-we-suffered-complete-breakdown-in.html">touting for use in Comparative Effectiveness Research</a>. (It is also of concern to me in this regard that our new Secretary of HHS was the former Kansas commissioner for insurance from 1994 to 2002, and such billing data is likely where the majority of her experience with medical datasets resides.) Finally, like the financial schemes of the past decade, I can only wonder when the computational House of Cards that is being built in healthcare as a result of the quasi-religious Syndrome of Inappropriate Overconfidence in Computing, and worship of its priests, the IT Whiz Kids and consultants to whom domain expertise is optional, will come crashing down. -- SS Addendum: A physician correspondent who wishes to remain anonymous writes (emphases mine): <blockquote style="font-family:arial;">[The Boston Globe article] could not have come at a better time. Just today, a spouse had his "home grown" PHR for his wife who was hospitalized with multiple medical problems, including advanced metastic breast cancer and complex vascular disease. He has an elaborate PHR with history, treatments, allergies, medication lists, etc. It was so impressive that when this 80ish year old patient was admitted, he gave the medication list from the computer to the physicians and nurses. It appeared so reliable that not one health care professional bothered to question it or reconcile it with the labels on the bottles (everyone is so busy nowadays clicking and scrolling the computer silos for information). As it turns out, he left out a decimal point on a dose of a potent medication that should have been 2.5 mg. The computer printed a legible list (with other errors too) stating the dose of this med was 25 mg per day (10 times too much). It was ordered that way by the doctors. It got to the pharmacy, but somewhere in this complex chain, a non physician non nurse individual got the dose to the patient correctly as 2.5 mg [fortunately, the error was caught, this time. What about next time? - ed.] Being a detective with an eye for detail and a stickler for accuracy, I happened to notice the error when the spouse was showing off his PHR to me. Again, this is one case with potentially dangerous consequences of a pervasive error generated in the PHR by flawed data entry. It was not a Google or Health Vault device, but I cannot believe that these companies have garbage filters on their devices to prevent the "garbage in, garbage out" syndrome. Good medical care is being subverted by these experimental devices. Upon scratching the surface of PHR, EMR, and CPOE devices' functional impact on the administration of medical care, the dangers are widespread. This toxicity is covered up from scrutiny by the "non-disclosures" and "hold harmless" contractual obligations described in the Koppel and Kreda report.</blockquote> One wonders how many incidents like this happen every day and are being concealed by the HIT industry and the pundits profiting handsomely from selling defective HIT devices. I am quite concerned that nobody really knows. This is not science. On a final sobering note, as the "hold harmless" and "defects gag" clauses are purged from HIT contracting, which they will most certainly be, I would suggest the many amateurs in HIT obtain some very solid liability insurance covering patient harm related to their systems and their advice. For they may just find themselves as defendants answering questions on the witness stand in front of a hungry plaintiff's attorney, a jury of average citizens, bereaved relatives of patients who were harmed via IT misadventure, and questions composed by people of my background. These questions will place the true nature of their expertise and qualifications to be tooling around with medical care under severe scrutiny. That will likely not be very pretty. -- SS April 22 addendum: In comment #15 to this post <a href="http://www.thehealthcareblog.com/" rel="nofollow" onclick="window.open(this.href);return false;">Matthew Holt</a> issued this filled with absolutes <a href="http://www.nizkor.org/features/fallacies/ad-hominem.html">ad hominem</a> comment ... <blockquote>Seriously, MedInformaticsMD, you are so pissed off with everyone in IT [everyone? - ed.] that you're now part of the problem [problem of vendors creating bad IT? - ed.] Do you seriously think that the people at BIDMC, Google and everyone else in health IT (even Cerner) just dont give a shit? [I cannot read minds. I can only see results - ed.] Or do you think that they might be trying to figure out how to solve these problems [of course they're trying to solve problems, but good intentions without requisite ability and expertise are inadequate in healthcare - ed.], and perhaps could you some constructive help. Rather than a barrage of attacks on anything they try to do. [Anything? You mean, such as <a href="http://hcrenewal.blogspot.com/2009/01/who-can-solve-hits-challenges-part-1.html">in this post praising Google</a> in areas where they do leverage their expertise properly? -ed.] </blockquote>Perhaps my direct Chairman of Medicine-after-patient-mishap tone in offering the most constructive of criticism - i.e., don't embark on medical projects in which you are over your head, find people who do know the domain and let them lead, don't release anything in medicine without appropriate, rigorous premarket trials - upset him. In addition to the inserts above, in the comments section I replied: <blockquote>I'm sorry you feel that way. I'm not sure what "problem" you're referring to, but if it's harming patients due to badly implemented HIT, I'm certainly not part of that problem. As just one example, my <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" rel="nofollow">website on HIT difficulties</a> serves as a resource read <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/content/documents/FINAL_Healthcare%20IT%20Failure_Oct_19_2006.ppt">internationally</a> on how to best avoid HIT errors, has been online for a decade, and is quoted in one of the newest and best books on HIT, specifically "Medical Informatics 20/20." Did anyone at BIDMC, Google or Cerner ever read it? Did you ever read it? If not, why not? It is in fact the first link that comes up on a google search on "healthcare IT failure", for example. Do they take it seriously? If not, why not? I believe they were negligent on this project. This suggests they need to give a bit more of a s--- about their work, expecially since real, live patients are involved and the mistake made was so fundamental. Finally, see my post "<a href="http://hcrenewal.blogspot.com/2009/04/health-it-eloquence-and-software.html" rel="nofollow">A Software Engineer's Eloquence on Health IT</a>" for what I consider an attitude of someone who really does give a s--- about such matters.</blockquote> Finally, I see no links to my decade-old academic <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">website on HIT difficulties</a> over at <a href="http://www.thehealthcareblog.com/">Matthew's blog</a>. One wonders why. It may have to do with a tension between the statement that "the Health Care Blog (THCB) has acquired a reputation as one of the most respected <a href="http://matthewholt.typepad.com/the_health_care_blog/2005/01/about_the_healt.html">independent voices in the healthcare industry</a>" and the post "<a href="http://www.thehealthcareblog.com/the_health_care_blog/2009/04/thcb-would-not-be-possible-without-the-generous-support-of-our-sponsors-thanks-to-our-latest-sponsor-sage-software.html">A Shout out to our sponsors</a>." Healthcare Renewal has no sponsors and does not take advertising. We report, you decide. -- SS

Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?

Simply amazing. One of the richest and most "leading edge" IT companies in the world with almost unlimited resources and access t...

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