Future of Health IT: Trends and Scenarios

More on Microsoft's HealthVault Strategy

Sean Nolan, chief architect of Microsoft HealthVault, commented on my post of a few days ago regarding Microsoft's HealthVault strategy. He gave me a pointer to an entry on his own blog to clarify how they are tracking the the provenance of data, or its "pedigree" as he refers to it (And Now for a Little Usability, April 17, 2008).  One of the comments on the post got me looking more closely at HealthVault, and thinking about how it can help with the current dismal state of the art regarding the search for consumer health information on the Web.

My thesis work tapped into a huge body of server log data  that accompanied a Microsoft Research grant to my thesis advisors, Lada Adamic and Suresh Bhavnani,  as part of the research program leading up to last summer's Microsoft Live Search Summit. The data set provided a remarkably clear picture of search behavior "in the wild". The bottom line: the quality of the result sets returned by major search engines from the queries of consumer health information seekers was questionable at best.

This came as no surprise, for two reasons. First, consumers seeking any kind of information, even about a subject as critical as a mortal illness, tend to submit terse, vague queries. Search engines are hard put to discern the user's intent. Their general-purpose algorithms do a pretty good job of bringing relevant information into view, but it is not uncommon for outdated or unscientific information to appear in the midst of (or even ahead of) authoritative results.

Challenges facing translational biomedical research

I was at two different meetings last week at the NIH in Bethesda, MD, both of which were related to the fostering of clinical research networks. The first meeting, called "Clinical Research Networks: Building the Foundation for Health Care Transformation", was the culmination of the NIH Roadmap "Re-Engineering the Clinical Research Enterprise" program, in which a dozen academic health centers and other research institutions fulfilled contracts to do research and develop tools and techniques for the creation, care and feeding of clinical research networks.

The network concept was defined broadly to include disease-focused networks, practice-based research networks (PBRNs), transplant donor/recipient networks, and others. There were keynote speakers from the NIH leadership, but the bulk of the meeting consisted of panels composed of principal investigators discussing the lessons learned in the fulfillment of their contractual obligations. While each contract produced some sort of intellectual property, but the lessons learned were the primary goal of the program, and the lessons were rich and diverse.

Microsoft Explains HealthVault Strategy

I didn't get around to writing about this at the time, but a couple weeks ago I read in eWeek about how Microsoft Explains [its] HealthVault Strategy. There are a couple of analogies I wouldn't have made myself: MS compares HealthVault to XBox and PayPal.

The goal was to provide ways for consumers to better understand their health and health information and manage that information for themselves.

Conn [Grad Conn, Healthcare and Life Sciences senior director for global consumer strategy] explained that with consumers as the aggregators and the controllers of to whom, how and when their information can be shared, the traditional health information model is turned on its head.

"Right now, the mechanism for this is through HIPAA, which dictates how to control patient privacy when patients don't control the records," Conn said. HIPAA, he said, has very clear rules that patients can request to see, copy, add to or delete any piece of health information in their record, and HealthVault uses those same procedures, but in a digital format.

So far so good. This (when properly implemented, whether by Microsoft, Google, or some other "fourth party") will accomplish in nimble form what is already one of the clumsiest and least effective of the HIPAA provisions, the portability requirements. Your health records are indeed available to you as a patient, but the care provider has the option of charging you for the cost of making a copy, and in virtually all cases will only supply the records in hard-copy format, even when an underlying EMR or EHR is in use.

Now, on to the first of the startling analogies:

Web 2.0 Can Give Consumers More Control over Health Care

The closing keynote at Microsoft's Health & Life Sciences Developer and Solutions Conference, held April 22 through 24 in Atlantic City, N.J., got a write-up in eWeek: Web 2.0 Can Give Consumers More Control over Health Care.

Ben Flock, a Microsoft Healthcare & Life Sciences Industry advisor, told attendees during his closing keynote... that Web 2.0 technologies moved information out of isolated silos and into interlinked community computing platforms that function like software for users.

Flock said applying those same concepts to the health care industry would provide tools that would allow for better and more relevant information sharing, collaboration, and ultimately better care as consumers gained more control over their information and, ultimately, their health.

Web 2.0 features like product and service ratings, information search, social communities, and tools are a natural evolution of health care technology, Flock said, and represent a new business paradigm that companies and institutions will have to adopt in order to remain competitive and relevant.

"The social relevance factor is a moving target, especially in health care, because it's in such an early stage," Flock said. The key is successfully reaching out to partners, customers and consumers, he said, and Flock cited HealthVault as one way Microsoft was reaching health care consumers.

The clinical professions are ambivalent at best concerning online consumer health information. The message here is that the horse is out of the barn. It's too easy to create social networking applications that leverage Web 2.0 technologies like wikis, blogs, and podcasts, and exploit their synergies with Web 1.0 technologies like forums and mailing lists, and now with Web 3.0 technologies like Microsoft's HealthVault and the nascent Google Health. These applications will interconnect health information consumers with birds of a feather, but also with commercial entities bent on exploiting the opportunities the social media make possible.

Clinicians can either get on the speeding train now, or get run over. It's probably possible to do both, which is part of their hesitation in making the leap. But the inevitable is, to put it redundantly, inevitable.

The IT community's greatest challenge

This is another one of those posts that has taken me a while to write - a little over a month, in fact. Today I added a few final sentences and feel it is finally good to go. Whew! I feel the subject was important enough to be worth the effort. I hope you feel that way too.

Back at the end of March, I read an online article by Bill Snyder at the Infoworld site called Multi-core to leave developers in dust?. It concerned the looming challenge of leveraging the parallel processing resources being made possible by the emergence of inexpensive, soon-to-be-utterly-ubiquitous multiple-core CPUs.  Snyder feels the IT industry is not ready for the challenge. I agree. I first wrote about the problem last December in a post entitled The Landscape of Parallel Computing Research: the NY Times and Berkeley EECS. In many ways this post is a continuation of that thread.

Here's a bit of what Snyder has to say:

That's not to say that the IT industry is scoffing at the potential benefits of multi-core processing. But the mountain between IT and some future multi-core promise land -- namely, the task of developing parallelized apps that keep pace with continual core advances -- is huge, says David Patterson, the Pardee Professor of Computing Science at UC Berkeley and director of the parallel computing lab. "It's the biggest challenge in 50 years of computing. If we do this, it's a chance to reset the foundation of computing."

In the short run, Patterson says, we can parallelize legacy software and gamble on getting value out of eight cores. But that would be only an interim solution, as such apps would not scale to 32 or 64 cores, he adds.

What is frustrating is that this problem didn't exactly sneak up on the industry. Chip development cycles are very long, and key software developers are well aware of what's moving through the pipeline. Sure, software always lags hardware. Many of us complained that we didn't have software that would take advantage of 500MHz back in the '90s. But what Patterson and others call the multi-core revolution poses problems for developers that are qualitatively different than the problems of the past. Why wait so long to get serious about solving them?

The answer to the last question is, in my opinion, a personality characteristic common among IT personnel, which is the always-incorrect belief that my current technology - architectural model, operating system, hardware platform, programming language, integrated development environment, application framework, or what-have-you - is the be-all and end-all of IT evolution.

Case in point: Not long ago I was indirectly involved in the port of an application from Ingres on a Vax to a Java/J2EE platform on Windows 2003 Server (web container) and JBoss/Oracle on Linux (EJB container and DBMS).  A single programmer had worked on the system for almost 20 years, was not far from retirement, and had much fear of and no interest in learning the new technologies. What was sad about the situation is not the programmer's mindset, but the fact that her managers had allowed the situation to devolve into the state it was in at the time of the need for conversion. If the leaders don't lead, the followers oftentimes don't follow.  This was by no means the only time I have encountered this mindset malaise.