Google cuts and runs early - The Death knell has sounded for #GoogleHealth

So Google is cutting and running too early from Google Health. In the short term this no doubt makes obvious sense to Google but in the long term I believe this to be a big mistake. 

Health was always a long term play. An industry mired in regulation and conservative approaches, things were never going to change quickly. However, momentum is building. We are seeing a tremendous uptick in innovations that make use of Government Health Data. Just look at the activities at the recent DC Health Innovation Week and people like Tim O'Reilly calling for us to rethink Privacy in Health where "HIPAA has represented the Maginot Line in Health Data protection". 

Personally, I still use Google Health on a daily basis. My Fitbit and numerous other health related data sources feed in to Google Health and pass data out to other services like Keas.com. I recently moved my Pharmacy because I could have my data automatically piped in to Google Health. 

Google Health - what we call an untethered Personal Health Record - was NOT a destination in and of itself. Instead it was more useful as a conduit through which we could channel our health data. 

What is ironic is that Google is implementing the Direct Project protocol to make it easier to exchange Google Health Data with other platforms. The Direct Project Protocol is what the Patients 2.0 movement liken to a white button (like the VA's Blue Button) but one that allows me to send my detailed health data to another site or provider. There is a lot of discussion happening around the Rainbow Button Initiative (Blue, White, Green and Red buttons) in the Patients 2.0 world. 

As Meaningful Use requirements kick in as a result of the implementation of the Affordable Care Act we can expect to see Patient Portals popping up like daisies and consequently a growing need to provide a place that Patients can bring together all these disparate data sources in order to get a comprehensive view of their Health. It is not happening yet, but expect to see changes happening in 2012 and people starting to look for solutions to help them get their arms around their health data. The problem for Google will be that by cutting and running now who will trust them in the future if they decide to come back to the table?

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Meainingful Use: Portals, Portals everywhere but not a way to share (#MeaningfulUse #hcdc #healthapps #dchealth)

I was reading an article in Contactless News about "HealthCare Providers seeking convergence" in Identity Management as Meaningful Use criteria come in to play in the HealthCare field. It got me thinking about the future for Patients in a world of Patient Portals.

Meaningful Use

Meaningful use demands that "health care data be kept confidential, private and secure, accurate, shareable with patients as well as providers, mobile and exchangeable, and readily available." A tall order!

My fear is that we are headed for a situation where patients are tossed in to the sea of meaningful use without a care for the big picture from the patient's perspective. Why do I fear this?

HealthCare providers, payers and other data handlers in the Industry are still mired in 1990's technology approaches in how they control their data, or rather; the data that they manage. The emerging interpretation of Meaningful Use is the application of the old style approach - The Patient Portal. 

Don't get me wrong - there is nothing wrong with a Patient Portal per se. Just look at the level of engagement that Kaiser Permanente have achieved by providing their patients/members with a usable and useful patient portal. But Kaiser Permanente is one of those exceptions - they are an integrated system. For the vast majority of consumers who are not receiving care via an integrated health system the situation is about to become vastly more complicated.

Portals, Portals Everywhere

For Providers to comply with Meaningful Use they will no doubt deliver a Patient Portal. Many of the Practice Management Systems provide the capability almost out of the box. 

But what happens when a patient is needing to visit the Primary Care Physician, a couple of specialists, may be a surgery center, a retail clinic and the local hospital? How many Portals will they have to navigate? How will they get a comprehensive view of their records?

Paranoid Security Reduces Security

In order to comply with HIPAA regulations I can see HealthCare providers implementing complex userid and password requirements. Not letting patients reuse a password, having different rules that prevent the same password being used in multiple systems. Again, don't get me wrong, these are all commendable steps to secure data. But when a patient is managing multiple systems and user accounts the end result is that if they can't easily remember a userid and password they will either write it down, or just hit the password reset button and have a new password setup via an email mechanism. 

Is this really better security?

There Is An Alternative

There are two steps that HealthCare Industry system providers can adopt that can dramatically improve this situation:

1. Adopt OpenID/OAuth for Authentication. 

2. Support the Rainbow button Initiative

1. OpenID/OAuth

OpenID/OAuth is broadly the process by which Facebook and Twitter allow users to connect their respective account to another service. The benefit of this is that a user can login to another service using their Facebook or Twitter account credentials - without ever revealing their account password to the new service.  The big advantage of this is that there are fewer password resets because the user is making use of a userid and password combination that they use on a regular basis and therefore are more likely to remember.

OpenID/OAuth is already being adopted by the Federal Government to allow citizens to login to federal websites. If it is good enough for the Government shouldn't it be good enough for HealthCare. The Twitter Authentication mechanism is also being baked in to the core of Apple's iOS 5 making it a standard across hundreds of millions of Apple devices.

I urge every HealthCare Portal developer to integrate Single Sign-on using OpenID/OAuth. Development libraries are available from companies like JanRain. I implemented the JanRain Library on HealthCa.mp in about an hour using a JanRain plugin for Wordpress. If you want to be a really proactive developer you can fully implement OpenId/OAuth so that your portal account can act as credentials to connect to other sites. This is something that any Health Care Payer organization should be thinking about.

The big win for the member/patient is that as patient portals proliferate life doesn't have to get more complicated. When they have to connect to a new Patient Portal they can reuse their account credentials from elsewhere. This can even simplify account setup on a new portal by allowing basic demographic data to be taken from the source account. e.g. Name, Address, Email, Gender, Date of Birth.

2. Support the Rainbow Button Initiative

At Patients 2.0 and 

HealthCa.mp we have been supporting the VA/HHS Blue Button Initiative and have promoted an expansion of the concept - The Rainbow Button Initiative. I urge all Patient Portal Providers to implement the Rainbow Button idea:

Blue Button - Download my Health Data to my computer using a standard format

Green Button - Allow me to donate my health data anonymously to another organization 

White Button - Allow me to send/upload my detailed Health Data to another Provider (or copy me when my data is sent between providers)

Red Button - Lock elements of my Health Record I do not want to be shared.

By implementing these simple buttons a Portal provider can give Patients a simple set of tools to manage their Health Records. Allowing them to import and export their data. 

Act Now Before It Gets Too Complicated

If we don't take steps in these early days of Meaningful Use to provide tools, like single sign-on and data interchange buttons, to simplify life for Patients then we will be creating yet another overly complicated, archaic monster that patients are forced to navigate around. 

Failure to act will chalk up Meaningful Use as yet another great idea that becomes a barrier to better health in it's implementation. After all, we have been here before. HIPAA was about Portability and yet it became just another form to fill in and an excuse for locking up data from patients while still freely sharing it amongst industry business partners.

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@roniNoone presenting at the baltimore wordpress user group

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#wordpress #meetup at the beehive w/ Roni Noone

This evening is a trip out for a techie event - the Baltimore Wordpress meetup group. This is my first time at this meetup, but with HealthCa.mp running a Wordpress network site this seemed like a useful group to attend. Roni Noone shares her story and experience working with Wordpress. Her first experience was building a custom site - with all the features of a blog. Eventually went to wordpress.org and downloaded the software and control her website. So the switch was made. Her focus was weight loss. Ended up posting daily. Focus on content and not software. Then the hosting platform crashed. And there were no backups. Switching to blogger saved the day - but eventually went back to Wordpress but diversified. Created blogs for specific content then tweaked sites for specific content and purpose. The downside - blog schizophrenia and no one home base.

Roni's Weigh is oldest blog and home base. Customized version of neoclassical. Not a widget fan - tweak PhP/HTML/CSS instead.

Plugins used: Akismet
Comment email responder
Podcasting plugin by TSG
Subscribe to comments
Wp super cache
Pick giveaway winner

Greenlightbites is food blog. Very tight niche. Mainly recipes and pictures.

You can use WPquery to pull specific content from DB and add that above main loop. then exclude WPquery content from main loop.

Add extra users as authors to allow people to upload and publish their own content. Editor allows people to edit the content of others.

Use categories and tags to allow readers to find content.

Plugins: Post-plugin library
Wp-pagenavi - Navigate by page number

RoniNoone.com
For blogging and tech topics.
outsourced to http://makemyblogpretty.com

Fit.blogging.com

Conference site for bloggers in health and fitness. Intensedebate plug in.

Poopbutterflies.com

Tumblr style in wordpress Clear theme Barebones site

Tool set:
Dreamweaver
Photoshop / illustrator
iMovie GarageBand Social media:
Fan page for each site on Facebook All sites have autofeed to twitter to secure name.

@RoniNoone for chat on twitter. Personal page on FB for chat too.

Monetization:
Affiliates:

Amazon
iTunes via Linkshare

Regular readers don't click on ads. They read content so use CPM ads rather than CPC.

A really informative presentation.

Watch for the presentation on RoniNoone.com

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#hipdc The Meaningful Yoose Rap

This was the video shown

Check out this video on YouTube:

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#hipdc @Lostonroute66 talking PillBox

We are here supporting HealthCamp allumni David Hale (@lostonroute66) and Lindsey Hoggle (@lindseybh) who are presenting at Health Informatics Pulse (#HIPDC).

David will be closing the session by telling us about HealthCamp program graduate PillBox going live. This is great news!

Lindsey Hoggle will also be talking about Meaningful Use. I am keen to see what Lindsey has to say as a consultant from the front lines in an adventure in HITECH implementation. Charles Sneiderman kicks off discussing EMRs and clinical decision support tool for post traumatic stress ( no D for disorder because PTS can be considered a normal response to a hyper stressful situation.)

Next up Mones Abu-Asab talking about toxic assets in micro biology. Heterogeneity of rumors occurs at multiple levels. Phylogenetics offers best chance to perform effective analysis using a parsimonious approach. Lindsey Hoggle is up to talk about meaningful use. The legislation HITECH act passed in 2009. Basically meaningful use means implementing EMRs and putting then to use for the benefit of patients.

Markle found 85% of public not familiar with HITECH. Results not much better amongst the medical community. 2011 we are in stage 1. Incentives are available but Penalties start in 2014.

The data follows the patient - electronically.

Now up David Hale talking PillBox 53 slides in 5 minutes.

Getting pill data today is like searching for a meddle in a haystack of haystacks.

Pillbox makes pill data accessible. Vice Le data liberacion.

Mashing multiple data sets makes data accessible and actionable.

The open API Arrives - no key required

David Hale - rock star with the matrix jacket! Mission accomplished. Complete with mention of the roots of pillbox in the public domain at healthCamp DC in 2008.

The sequel to Pillbox? Pillbox 2 is international development incorporating foreign pills.

Question for Lindsey - how can we discover who has implemented EMRs and practice management systems and taken grant money for that purpose. Let's unleash that data to help the public in their choice of providers. Will accountable care eat the lunch of meaningful use? It is not a competition. It is a crisis. ACOs are part of the solution. We all have to work together. IT is a critical component in achieving interoperability. It was a HealthCamp audience that introduced the data on inactive ingredients (found at pubmed) to pillbox. This is critical info for some allergy sufferers but was information that was previously unavailable.

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#health2dev One team wants to merge NCI Thesaurus with VA Blue Button

Use the VA Blue Button and add in a REST interface to LexEVS 6.0 Service

A neat idea. I wonder if the PillBox API would provide the same information. What about then piping the information to SurveyorHealth to check for drug interactions?

The next proposition is: Tackling Prescription drug non-compliance.

Merge EMR data with Pharmacy Benefits Manager the e-prescription and the personal health record. CYNCZ is a proprietary engine that syncs and de-dupes the information from these sources.

This is a problem that is of great interest to the ONC.
@Aviars is proposing a team to develop a solution for a HIV support organization in the District of Columbia. The challenge for today is taking the 7,000 tests performed in 2010 and visualize the information via various libraries.

A number of ideas bubbling up about Elder Care and Aging in Place. e.g. @cristianLiu proposed using the Elder Care Locator.

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#HealthApps insightful @TimOReilly hits the spot,again.This time on Privacy and how it relates to the Rainbow button initiative. #hcdc

It has been an incredible DC Health Innovation Week. First @TheWalkingGallery then a busy day on Wednesday with an incredibly vibrant HealthCa.mp/dc at the beautiful and inspirational Kaiser Permanente Center For Total Health (#kpcth). Yesterday (Thursday) saw me visiting The National Institutes of Health for the 2nd annual DataPalozza that was organized by Todd Park's team at the Department of Health and Human Services. Ahman Bhandari, Cristian Liu, Julie Eisenman and others put on an incredible event. The Nacher building was at the Epicenter of Health Trending Topics on Twitter and the spirit of innovation was bubbling over for the entire day.

The day wrapped up with a discussion that included Aneesh Chopra and Tim O'Reilly and, as ever, It was Tim that left an indelible mark in my consciousness. His comments still have me thinking because they resonate with ideas I have been having about Health data privacy for some time. 

Tim talked about the need to rethink Health Data Privacy. He pointed out that "All data is known or knowable via triangulation". Going on to say that we need to rethink legislation so that rather than focusing on penalizing people for having health information, instead focus on applying penalties for inappropriate USE of health data. 

While HIPAA was necessary to place some controls around Health Data use by the industry the Act has been seized upon as the greatest excuse for stifling innovation yet in the title of the Act the "P" stands for Portability and not Privacy!

The most prophetic comment from Tim O'Reilly was that we have built a Maginot Line for Health Data. For those who are not History buffs, the Maginot Line was a defensive wall erected by the French after World War 1. The problem was that the Germans simply went around the wall. The point is that data can be triangulated in such a way that it is effectively impossible to anonymize data. The gaps can be filled in through data mining other sources. 

Just as we have norms of social behavior we need the same in the world of Health data. If we accept that we can't keep Health Data private, indeed there are massive advantages to be gained by making it easier for an individual to share their data, then it is a fool's errand to police organizations and apply penalties  when failures occur. This is a case of shutting the stable door after the horse has bolted. 

No, we need to switch to applying severe penalties for inappropriate use and/or lax management of health data.

When you look at HIPAA rules I keep coming back to the fact that when we put the patient at the center, and in control of their data, much of the regulation and controls in the Act are set aside. While an organization has strict controls, once in the hands of the patient they can decide whatever they want to do with their data.

Putting the patient at the center in Health Care is the essential step in moving health care forward and really powering innovation. This is why I am a big proponent of the "Rainbow button Initiative" and the growing use of the Blue Button. The simple button metaphor will make it easier for patients to get hold of, and manage, their data. We want to expand the metaphor with the Green button to be able to anonymously donate our data to an organization, the White button to send our data to someone else (this is Jamie Haywood and PatientsLikeMe's reverse blue button) and a Red button to lock down our data.

The Green button concept was the subject of a great discussion at HealthCa.mp/dc. One idea that surfaced was to put forward the idea that our Health Data should be classified as an organ and therefore covered by the Organ Donation process at the DMV. Imagine if we made it that easy to donate our lifelong health data to science when we pass on.

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#healthApps Harvey Fineberg - We are lost in a sea of data. We need to make this actionable information

Todd Park can be proud of the Health Data Initiative Forum. The forum is building a partnership mentality in Health. Government is providing large data sets and entrepreneurs are rising to the challenge to make sense of that data and mix it with other data sources to create actionable information that creates the potential to improve health care.

Secretary Sebelious points out that we have a triple loss in the USA. Our Government spends more on Health Care than other Governments. Our Private Health Care industry is the most expensive in the world and we still have 50M uninsured people. [Ed: That is almost the size of the entire UK population!]

The biggest news of the day so far has to be AETNa's announcement that they will be implementing Blue Button functionality for their 10M members in 2011. This is great news! Back in March I posted an article saying we need a campaign "Blues - give me my button!"     ... Well AETNA just raised the stakes and creates more pressure for the rest of the Private HealthCare industry to follow the great example set by the VA thanks to Todd Park and his team's instigation of new ways of sharing health data.

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Dr Maurice Cates talking to participants - make something happen #hcdc #dchealth at #kpcth HealthCa.mp/dc

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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#hcdc HealthCa.mp/dc kicks off at 9am at #KPCTH DC Health Innovation Week gathers speed

HealthCa.mp/dc kicks off this morning with a great group of participants. Building on the buzz from a fabulous #TheWalkingGallery event on Tuesday evening. Today the theme is "Vitality Through Data" - but at the end of the day HealthCamp is driven by the participants.

http://youtu.be/p8-GyA4jCUA

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@daniellecass and @tedeytan admiring @cristianliu's jacket at #thewalkinggallery

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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Preparations for #thewalkinggallery

Mark Scrimshire
B: http://ekive.blogspot.com
....Sent from my iPhone

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DC Health Innovation Week - The press conference at #KPCTH

This week is DC Health Innovation Week. The Mayor of Washington DC proclaimed it as such. So here we are sitting in the mission orientation room at the Center For Total Health. Conversations are breaking out as people wait for the official announcement. 

The week of Innovation centers around The incredible Kaiser Permanente Center For Total Health and the activities that have been generated out of the office of the "Entrepreneur In Residence" at the Department of Health and Human Services - Todd Park. The HealthCare Blog had a great post from Todd today. Calling All Health Innovators: Health Data Palooza. The 2nd Annual Health Data Initiative Forum takes place at the National Institutes of Health on Thursday but it is preceded by two great events:

This evening starts the series of events with #TheWalkingGallery. Around 30 passionate Health Transformation Advocates will be wearing their change message on their backs. I will be among those wearing an amazing jacket that was created by @ReginaHolliday. Check out Regina's blog to see the wonderful change creations. 

On Wednesday we have HealthCa.mp/dc an incredible group of participants are gathering to explore the issue of "Vitality through Data." This ties in with the Health Data Initiatives that HHS is promoting through Open Health Data. 

On Saturday, June 11th, I will also be taking part in the Health 2.0 Code-a-Thon Developer Challenge at the Center For Total Health. This will be the first time I have had opportunity to take part directly in a Code-A-Thon. I am looking forward to it immensely.

There are plenty of other events happening during the week. In Clay Shirky's words - we will have a significant "Cognitive Surplus" circling the National Capital Area this week. Let's put it to great use, by making connections and creating new tools and services that use data to create vitality and promote patient/consumer/citizen engagement in health.

If you are around town come and say hi. I will be the one wearing this jacket:

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