Future of Health IT: Trends and Scenarios

Using crowdsourced librarians to outsmart Google

Thanks to Ian Jones, I found a very interesting article on Ars Technica entitled Using crowdsourced librarians to outsmart Google. It's about a project that aims to "out-Google Google" using the collective brainpower of librarians in crowdsourcing mode. It's based on what the project leaders say is sound science. There is a growing body of research on the credibility of online material, so their claims may be valid, but I haven't had time to vet them yet, so I am making no claims of my own here.

Still, the idea is very interesting. I've been hyperfocused on the problematic findability of quality consumer health information via the commercial search engines. If there is a better way of building an online search engine in terms of returning credible results, I'm all for it, and who knows? This could be it.

The Reference Extract project hopes to turn all of this credibility research into something practical. The team consists of professors like Lankes and the OCLC, an academic technology organization that counts more than 60,000 (!) libraries among its members. The initial work is funded by the MacArthur Foundation. Their first goal is certainly ambitious: use the web sites that librarians suggest most often as the basis of a more credible search engine that can return reliable results.

Reference Extract already believes that it can best Google, even before work has begun in earnest. That's because it has already used librarian-recommended sites to populate a custom Google search engine. Simply doing this produced search results that testers ranked as "more credible" than searches run on the main Google index, even when the testers had no idea that one of the searches was based only on librarian-approved sites.

I don't have time to think about this much at the moment, much less write intelligently about it at any length, being in crunch mode on a couple of projects all at once. Still, I wanted to pass it along. Others with a similar passion out there may find this very useful.

Red herrings swimming around Google and Microsoft PHRs

I spent three days last week at the American Medical Informatics Association (AMIA) Spring Congress. I was there to present lessons learned from Michigan's $3.2M NIH Roadmap contract funded under the 2003 "Re-Engineering the Clinical Research Enterprise" Broad Agency Announcement (BAA) in the Clinical Research Informatics track, but I spent a few of the sessions in the Personal Health Records (PHR) track.

Unsurprisingly, there was a lot of buzz in the PHR track about Google Health, and to a lesser degree, Microsoft HealthVault. Google Health was more prominent for several reasons, not all of which are enduringly pertinent: its public debut happened more recently; Google does not suffer from the Borg-like "Evil Empire" image from which Microsoft suffers; and Dr. Roni Zeiger, MD, Google Health Product Manager, was an eloquent and well-received speaker at one of the sessions.

That was Thursday. My presentations were on Friday right after lunch, so I was a bit distracted that morning and missed a couple of breakout sessions. After my time in the limelight, I spent a very inspiring hour talking with Bob DiLaura of Cleveland Clinic, during which we speculated about the future of PHRs. One assertion with which I believe we both agree is that the entry of these two major players is going to revolutionize the healthcare records "marketplace".

I put "marketplace" in quotes because in the USA a market implies exchange of value that can be represented in monetary terms. HealthVault and Google Health are free, and as FasterCures CEO Greg Simon said in one of the keynotes, "Free is the new money". Google and Microsoft will aim for volume, and monetization will come later. It's not terribly difficult to imagine a variety of ways huge volumes of consumer health records could be monetized without violating patient privacy. But there are a lot of red herrings in these waters. Let's look through the glass window in the bottom of the boat here and see what these red herrings look like.

The Healthcare IT Guy (again): Is e-Health An illusion?

I just can't keep up with him. I sit here drinking my morning coffee, and I see that Shahid Shah, the Healthcare IT Guy, has done it again. Yesterday he posted an interesting article from guest writer Dennis de Champeau of Ontooo called Is e-Health An illusion?. It raises an issue I've discussed before - our healthcare system costs way more than any other developed nation and delivers a coin-toss level of quality (e.g., in eWeek: Digital Health Coming to Grandma's House). He looks at a solution that may or may not be the answer, but is certainly a component of one - telehealth or telemedicine. I think it's a great idea, but I'm not so sure it'll be adopted here.

Upgrade Your Baby

I'm swamped at work, so I only have a few minutes while I drink my midmorning coffee, but this was too good to pass up. eWeek's daily healthcare newsletter yesterday included a link to an article on VeriChip's Baby Protection System, from which I drew the following teaser text:

VeriChip's infant protection system is really two separate above-the-skin solutions, one a band similar to a standard hospital bracelet that has an embedded RFID chip. The second option, called the Halo skin-sensing system, is similar to an electronic key fob for a car that can be attached to an infant's ankle or a patient's wrist. Another key fob-type device can be worn around the neck of staff members to use as a personal panic button.

Now you can deterministically identify your toddlers among all those others in the daycare center that look just like him or her. One more problem solved for the busy moms and dads out there.

More on Clinical Care Informatics vs. Research Informatics

While I was off in Idaho, Bob DiLaura of Cleveland Clinic left a very insightful response to an earlier post of mine, Clinical Care Informatics vs. Research Informatics. Comments often go overlooked by blog readers, especially on older posts, and this one deserves a better fate.  I'm copying it here along with my response to his insights.

CCHIT Town Call brings out the dogs and ponies

I really want to believe in ONCHIT's and CCHIT's efforts. When the first round of certified systems was announced a week or so ago, I looked at the CCHIT documents, especially those arising from the process leading to the certification benchmarks, and they have been very thorough. This is a tremendously difficult technical challenge and their efforts are a laudable first step. However, as I wrote at that time, the real challenges are not technical, but political at the macro and micro levels, in fact at every level.

Shahid Shah posted a very informative entry about a CCHIT dog and pony show he attended, with links to yet more detailed information. It is well worth your time.

US Healthcare: The Best in the World! | The Medical Blog Network

I was reading an entry in the TMBN blog aggregator entitled US Healthcare: The Best in the World! by a blogger who, like me, is a patient rather than a professional when it comes to the world of medicine. I do clinical research informatics but have nothing to do with patient care, except for sitting on the table in the examining room being poked and prodded and hopefully diagnosed, and hopefully correctly diagnosed at that.

Marc's post cited several articles in the news recently that illustrate why you should "be afraid, be very afraid" when you are in serious need of healthcare. Although he didn't cite it, Rand's report entitled The First National Report Card on Quality of Health Care in America documents the failings he describes in a frighteningly detailed and empirical manner.

I wrote about the Rand report a while ago in a post in my own blog entitled The Killer App of 21st Century Healthcare.  I find myself believing ever more fervently that evidence-based medicine, and in particular prompt and reminder systems, are our best hope for improving outcomes in our healthcare system.  If we can get EMRs implemented, use P&R systems to mine them for key information, and get that information in front of the care provider and the patient at the right time and place, we may yet make Marc's sarcastic post title come true.

eWeek: Digital Health Coming to Grandma's House

eWeek has an article that just came out entitled Digital Health Coming to Grandma's House. It paints a potentially rosy picture of a future in which health IT reaches into people's homes to propagate preventive care and facilitate remote intervention when necessary. There is, however, an 800-pound fly in the ointment: America's fragmented, bloated, overpriced and underserving healthcare system. Providers and payers face a Prisoner's Dilemma problem that isn't going to go away anytime soon.

More on the Linux Wearable Computer

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Yesterday I put up a quickie about a post in The Positive Technology Journal regarding a wearable Linux computer targeted at the healthcare market. I took a look last night at the Web page describing this new toy, the Zypad WL 1000 from Parvus Corporation. I have mixed feelings about it - I love new gadgets as much as anyone, am enjoying learning to hack Linux, but feel like this may be a bit ahead of its time, at least in the healthcare market.

Core Values, Innovation and Outsourcing

Recent entries in two blogs I follow regularly addressed the effects of IT outsourcing, coming at it from different angles. Shahid Shah, the Heathcare IT Guy, speculated on the future effects of offshore outsourcing on the US jobmarket, based on insights his recent trip to India. His warnings apply to IT professionals in all fields, not just his (and my) field of health IT. The EDS Fellows' blog post reviewed some insights from Geoffrey Moore's latest book, bringing into focus some of the reason why outsourcing sometimes fails, onshore or off. These are must-reads for IT professionals: for managers, for whom outsourcing either already is or will soon be a fact of life; and for us worker bees, who wonder what we can do to make sure we still have jobs five or ten years from now.