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A National Universal Health Record (UHR) Database – Doable Any Time Soon?

Could a single, mammoth database solve all our health data needs? Margalit Gur-Arie, whose writing and ideas I greatly admire, has been arguing for one quite passionately on her personal blog in a couple of recent posts (part I, part II).

The crux of her posts is this:
- There should be a single, standardized national database to which physician practises, and ultimately EMR vendors, must submit mandatory data, “in real time”. The requirements will be along the lines of current Meaningful Use requirements.
- This database will be accessible to vendors and entrepreneurs alike, and can have multiple EHRs or apps built atop them.
- Since the patient data is available, and easily accessible (no one “owns” the data, they only own the proprietary bells and whistles they perform on the data), this is a near perfect patient utopia.

It’s a great idea and perfect for an ideal world. Except:
- Massive databases cause massive headaches, as commenter Omowizard pointed out. There is a price to pay for data available at all times, all places, and by everyone. And if I may add, in Gur-Arie’s model, it’s not clear who’s left holding the bag. Presumably the government. Which opens a entirely different can of worms about data ownership.
- Real time updates of data is no joke. At my current place of work, we perform quasi-real time (twice daily) updates of patient visits to client databases from a central repository. The sheer volume is enough to bring down the database servers for a good hour or two.
- We haven’t been able to agree on a standardized schema passed for a healthcare database. What are the odds of this idea ever catching on?
- How are we going to mandate data population? After physicians and care organizations, will EMR vendors be the next recipients of government bribes/largesse/sops to induce them to populate the database?
- Gur-Arie herself points out that American enterprise being what it is, if there are no financial benefits to data ownership, they’re going to be a hard sell.

And while it’s easy for me to write a smart alecky blog post about the infeasibility of the mammoth database idea, I shudder when I think of what we have now: disjoint EHRs that don’t “speak” to one another, walled gardens and proprietary ownership of data that pretty much lock physician office in, PHR offerings from companies like Microsoft who will do God knows what with OUR health data.

I don’t think there are any easy answers. I’m leaning more towards an open source health “OS” platform rather than a single database. But at the very least, Gur-Arie offers some great food for thought.

January 31, 2012 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Microsoft and GE Announce Healthcare Joint Venture

I got suckered into article-hopping on TechCrunch reading Dave Chase’s opinion piece on Microsoft’s recent joint venture with GE Healthcare, only Chase’s headline reads “Microsoft Ends Another Vertical Market Dalliance—This Time In Healthcare”. Two hours later, here I am with the post I should have written right away.

Regarding the joint venture, here’s what the Microsoft spin machine put out, and here’s the original New York Times blogpost that first broke the news.

To summarize: Microsoft and GE will be joining forces in a healthcare joint venture, if and when the deal gets regulatory approval. Some of Microsoft’s healthcare projects like Amalga, Vergence, and expreSSO will now form part of the joint venture. The new company has not been named, but there are plans to hire 750 people, sourced from Microsoft, GE and elsewhere.

- HealthVault still remains with Microsoft.

I’m not a Microsoft fan by any standards but I’m not so sure it’s a bad idea for Microsoft to want to join forces with GE, and keep HealthVault inhouse. And I’m also not sure I’d term the process an end to Microsoft’s healthcare plans. It seems more of a shift in gears. However, Chase, who worked with Microsoft for 12 years, believes it is a sign of an exit given Microsoft’s old exit patterns. (Chase’s list of all the verticals Microsoft has exited from makes for interesting reading. Did you know Expedia used to be a Microsoft company? Me neither.) Posting in the discussion following the Tech Crunch article, Chase also insinuates that there have been layoffs among Amalga employees, though he doesn’t give any numbers.

The NYT post states that the aim for the new company is to provide a Windows like platform which developers can then use to create healthcare related apps and services on. It also rightly points out that EMR vendors like Epic and Cerner are not going to be falling head over heels building products for the new platform.

One of the most trenchant comments (to me at least) on the NYT post comes from a commenter called Manuel Albarracin:

“Also, beyond Epic or Cerner, there will be others who will resist change along these lines, for this resistance comes not only from (legitimately) wanting to protect market positions and commercial interests; it also comes from a subtle but entrenched (and not so legitimate) mentality to reinvent the wheel at every healthcare organization, to ‘control things our way’, thus creating ‘walled-gardens’ in each of them.”

Which is probably what Microsoft has in mind – to provide the framework that the apps are built on. If the Windows experience is anything to go by, we should be in for an interesting ride.

December 12, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

Microsoft Shuts Down Amalga HIS – Lesson for EMR Selection

It’s been a couple weeks since the news came out that Microsoft was shutting down its operations and sales for Amalga HIS. It always felt awkward for me to see Microsoft purchasing a software that was so specific. It just didn’t make sense to me for Microsoft to go after this type of specific product.

John over at Chilmark Research has a good post with his reasons why Amalga didn’t work well for Microsoft. I’m still pondering his comment that the EMR market is mature. However, his take away is a very good one:

Performing a viability assessment on a potential vendor may not reduce one’s risk. Even a big, viable company such as Microsoft may change its mind on occassion and chose to exit a market.

The only clarification I’d make is that a viability assessment does not equal evaluating if the company is big and viable. I cover this topic in my EMR selection e-Book and in these two posts. Not to mention this post on open source (free) EMR software viability.

I think the viability assessment is useful and essential. Just don’t make the simple assumption that large means viable. Ask Misys users about that one.

August 16, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Bill Gates Talks About Electronic Medical Records and Healthcare

From an Interview with Bill Gates of Microsoft. Some of his views about electronic medical records and healthcare. See complete article.

Mr. Gates was also critical of the United States government’s unwillingness to adopt a national identity card, or allow some businesses, like health care, to centralize data-keeping on individuals. “It has always come back to the idea that ‘The computer knows too much about you,’ ” he said. The United States “got off to a bad start” when it comes to using computers to keep data about its citizens, he said. Doctors are not allowed to share records about an individual patient, and virtual doctor visits are banned, he said, which “wastes a lot of money.” The United States “had better come up with a better model” for health care, he said.

I agree and disagree with Mr. Gates. We need more data sharing and more interoperability BUT confidentiality IS an important issue. Just look at how the drug tests became public about Major League Baseball Players when they were PROMISED it would be strictly confidential!!!! I don’t trust big government or big business. Question: How do you tell an attorney or politician or corporate executive are lying? Answer: Their lips or moving or their fingers are typing!

We have to make sure medical information about individuals remains confidential and remains in the control of the individual.

August 20, 2009 I Written By

Mayo Clinic Launches PHR Available to Anyone

Here’s the story from the American Medical News:

The Mayo Clinic announced the launch of a new personal health record system that will be available to anyone, including those who are not Mayo patients. Those involved with the project say the system, powered by Microsoft HealthVault, could also carry benefits for non-Mayo physicians.

Is it just me, or is my headline (which is theirs also) really misleading? When I saw the headline I was really interested to see the type of PHR that Mayo Clinic had created. Instead, all they’re doing is adopting Microsoft HealthVault. That’s a big win for Microsoft HealthVault, but that’s been publicly available for a while. I’m not sure why Mayo Clinic joining HealthVault makes it any more available to those outside of Mayo.

The more interesting part of the article is when they talk about Mayo Clinic moving forward despite Beth Israel Deaconess Medical Center in Boston stopping claims data from being sent to Google Health:

The launch of Mayo’s system came days after Beth Israel Deaconess Medical Center in Boston announced it would stop sending claims data to patients’ Google Health accounts due to the possibility that the data contain errors. The move reignited the debate over whether PHRs can contain too much data that is not useful to physicians, or dangerous for them to rely on.

Mayo’s system will allow the import of claims data through Health Vault, but Mayo’s physicians will likely not use it, the organization said. Other patients and their physicians can choose whether the information is relevant enough to be kept.

I’d still like to see better support for PHR in various EMR and EHR products. However, until there’s a good standard I don’t expect that to happen anytime soon.

May 14, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.