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Of my last post about open source food, Jeff Jarvis commented:

I wasn’t suggesting that the kitchen should be turned over. I’m exploring the ideas of openness even in restaurants. For example, I’d like to know which dishes get ordered more so I can use that in my decision. Or perhaps diners can suggest improvements in recipes. And so on.

Next I’m tackling health. Since that’s your expertise, how do you think Googlethink could come to health care? Could it? Can doctors and health institutions be more transparent? What would we learn from aggregated and open data? Would there be value in a social relationship among patients? And so on. I have some ideas but I’d love to hear your thoughts.

From my point of view, the biggest challenge in healthcare institutions is the institutional thinking that goes on behind the scenes. Many good hospitals are trying to keep it all together, given the unfair hand they’ve been dealt: price-setting from insurance payors, even lower price-setting from the government, and the legal responsibility to treat anyone sick enoug to walk through their ER doors. Add in overall costs of service delivery increasing at a time when the costs of insurance are biting Joe Q. American’s pocketbook and Michael Moore’s Sicko… well, it’s a rough time right now in healthcare.

This leads to institutional thinking: how do we keep this boat together? And the simplest answer is command and control leadership. Don’t take risks, don’t innovate, trim costs wherever possible, etc. That’s not a critique — I’m sympathetic to the challenges here — but it does mean that providing patient access to data inside of a hospital is risky because it opens the hospital up to more risk.  Patient benefits be hanged!

I have been point-blank told, at more than one hospital, how much they’d like to get rid of system X or software Y, but they can’t. Even though it doesn’t work and there are better products available, they just can’t. It would be too costly — politically or capital-wise.

From an infrastructure standpoint, most hospital software is cumbersome, expensive, and (let’s face it) old. The sales cycle for a hospital engagement is often 18-24 months — contrast that to a Google service: free, immediately available, updates whenever you want! As good as the technology is, each hospital technology infrastructure is a jigsaw puzzle that barely fits together as is, never mind inviting a behemoth like Google into the mix.

A typical patient experience, from a hospital standpoint, goes as follows:

1. I’m healthy.
2. I’m worried I’m sick and go online to get health information.
3. I see a doctor/RN for diagnosis.
4. I go to a hospital for treatment.
5. I am discharged.

Being a patient in a hospital is a terminal experience: it ends in discharge or death! The medical systems were created long before Starbucks convinced every industry that consumer relationships were what mattered (thank you, SB, for getting the stinky breakfast sandwiches out; here’s a to a $30 stock price again.)

Google Health might end up being a great tool for diagnosis but hospitals can’t embrace it… unless so many the physicians demand it for their patients.

The churn and noise about hospital transparency is basically saying, “Here’s proof we don’t kill that many people.” Transparency = quality of outcomes for a hospital. But in 5 years, that won’t matter. Once the measures of quality are open to the public, the payors and Medicaid/Medicare will use it as an excuse to stop paying hospitals with lousy outcomes. So, overall, the healthcare experience should get better. But that doesn’t mean we’ll know any more or less about the process.

I place much more faith in the power of patients to self-organize in a way that wasn’t possible even two years ago. With sites like PatientsLikeMe, patients in recovery — discharged, perhaps from a hospital — are about to connect about their quality of treatment in a real-time, clinic study fashion. Sites that provide disease/condition/treatment communities will be where hospitals can knock it out of the park. Imagine if every cancer patient in your town heard that XYZ Hospital was the best — from the site moderator!

That’s where the openness will come from: empowering patients who had great experiences to market the hospital with a level of authenticity not possible any other way. We just ran a few webinars on this topic — so popular, agencies and competitors showed up in droves to hear what we had to say. That tells me we’re striking a chord.

But, as I always say, the nice thing about talking about the future is that it’s difficult to be proven wrong.

And by way of continuing the conversation from yesterday, Jeff Jarvis wonders if Google ran a restaurant, who would do the cooking?

Besides the silliness of open source restaurants as a concept — technique matters far more than recipe — the NY Times contrasted that notion with the need for efficiency in dining, noting that too many choices killed the Manhattan diner.

But art demands risk and taking a step forward into the unknown.   Asking your customers to make all the choices — which, one might argue, is an artistic choice in and of itself — is not the same thing as crowdsourcing.  For example, Threadless.com has plenty of folks vote on the best designs, but still maintains final creative control on which t-shirts to send into production. 

Even Wikipedia, famed for its “wisdom of crowds,” has become more bookish and patroling than in the past.  Giving an example at a client site, we created a page for their hospital… and then they got banned.   For copyright infringement. 

I think the point of the restaurant was “Can we imagine Google mashups working in a world outside of technology?” 

Sure, go to any jam band or jazz pickup group.  The improvisational talent is found plenty of places.   But if you don’t share a common level of expertise, you can’t play along.

Remember when Cerner dissed Google Health?  This news came out today in the Globe about Google Health and BCBS of Mass:

Come this fall, members of Blue Cross and Blue Shield of Massachusetts will be able to go online to look up their healthcare claims and some medical records, which the insurer says will help patients manage their medical care and have more productive discussions with doctors.

The feature is being offered through Google Health, the new healthcare Web portal recently opened by the Internet search giant based in Mountain View, Calif. Blue Cross-Blue Shield said it is the first health insurer to sign on to the service.

Since Cerner sells its goods to hospitals and hospitals are reimbursed by health plans and those health plans are demanding more up-to-date, quality information on patient outcomes…  Hmmm.  Seems like those patients are going to want to use their Google Health accounts — backed by their health plans — when they show up for a doctor’s visit.

And kudos again to the great state of Massachusetts, the right in the center of healthcare innovation.  (Did we mention we had an office here?)

Cerner Disses Google Health. Surprised?

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Comment:

It would make sense for Cerner to partner with both Google and Microsoft, because it is in the best interest of the patient. People are wanting and needing more control over their health records, and this would be one more way for them to get control. It would behoove hospitals to ask for this service, because it would be one more service they could offer to their patients. The product could be white labeled through Cerner. It is a win-win, Cerner just needs to realize it is not 1999, and that people will get their electronic health information either way. They might as well make it easier for themselves and for the patient.

I was fascinated by this article about the challenges of healthcare content startups. No so much about why such companies exist, but in hearing about how the general market views “patients” and “consumers” and what implications that has for healthcare institutions.

After an afternoon discussing the challenges of establishing a health content startup, the final panel at EconHealth got to deals: who’s buying and who’s investing in what. ContentNext publisher Rafat Ali moderated a discussion among a group of dealmakers, from the perspective of investors, bankers and would-be buyers.

– Interest areas: Esther Dyson: “The way I divide the market is into the arms merchants and the establishment… what’s been missing: there’s been professional content and there’s user generated content, which may or may not be valuable or reliable… and then the third thing is the content about the users.” It’s the third thing that’s exciting to Dyson, who is an investor in 23andMe, the know-your-own-genes startup. “I think it’s this area that’s so exciting… Microsoft (NSDQ: MSFT) is really, really well positioned, as is Google.” With all these things, there’s a question on whether users are aware of these new tools. Morris R. Levitt, Managing Director-Life Sciences, Desilva+Phillips, noted that the big buyers of these startups are either PE-backed platforms or major consumer media firms, like MSO. The problem: “When I listen to a lot of these specialty things, I find that a very low percentage of things are of interest to these organizations.” Most of them aren’t up to scale. Women are particularly valuable, since in many households, said Levitt: “women are the chief medical officers.”

I know many hospital CMOs who might bristle at the last conclusion, but it underscores a complete lack of thinking about providers in this conversation. Are we the only company in the US who is looking at the issue this way?

Follow the link for more above.

Here is an excellent blog post about HealthVault vs. Google Health.

It’s worth a read-through, but the thing that’s clear to us is that neither Microsoft or Google is thinking too much yet about how the hospital institution will interact with the data they collect. Since they’re more in the PHR model — well, Google’s is squarely; HealthVault is just a storage space, but that’s surprisingly useful for reasons you’ll read about in coming weeks — you still have the problem of another stream of care-related data.

Most hospitals are still struggling to connect the dots and collect everything that happens inside their walls, never mind deal with information a patient may have. So while both of these applications might help the physician/patient face-to-face interaction become a more informed experience, they don’t do much to address the operational failure in healthcare of how data is distributed in a system.

In other words, nurses will still be answering phones from referring docs, scratching down notes, and flagging paper files with sticky notes for some time.

(And hey, that’s more an observation than a complaint.)

Google is one step closer to organizing the world’s information. It has announced in the Wall Street Journal this week that it will begin to allow people to put their health records on the web. Actually within Google, which really isn’t the web. On the web would probably be a little too broad since that usually means it can be searched for and viewed by everyone. Google is developing a new health record initiative that will allow people to upload and manage their health information on the Google platform. I refer to it as a platform and not a web site, because Google technically is not a web site. More on that below. Google much like Microsoft, and its HealthVault program, are entrenching themselves more and more into our lives. They are no longer just search engines indexing sites; they are becoming huge depositories of information that will eventually know more about you and friends and family than you do. This is not a bad thing, and you shouldn’t complain about it because you agreed to it when you signed up for your Gmail, Hotmail or Yahoo! account. You gave up your “privacy” when you clicked on the terms of service agreement checkbox. I find it interesting when people complain about privacy on the Internet. The Internet is a public space that is completely voluntary; nobody makes you put your information out there. Actually, nobody makes you go online and search for stuff or read email, so the arguments about privacy are weak. It is a risk you take when you venture into a public forum.

A Google Spokesman in the WSJ stated that:

“For us trust between Google and our users is one of the absolute cornerstones of our business. And we are absolutely committed to continuing that dedication in all of our efforts.”

Can your credit card company say that?

A fact that some have realized but most have not is that the Internet is not just about web sites. People use the Internet for almost everything, a lot of it no longer focused on someone going to a web site and reading about an organization and its products. It is about interacting with others, forming communities and organizing our crazy lives. The most popular sites are not ExxonMobil, GE, Coke and other very large organizations. They are sites such as Reddit, Zulu, Furl, Digg, FaceBook, YouTube, Ebay, LinkedIn, Google and other sites that are interactive and form community. Google has been more than a search engine for quite some time it offers Gmail, office applications, video, blogging services, instant messaging, photos… The idea of providing health records is just a logical step in its progression of filling its corporate mission of gathering the information of the world. You are in the world, and your health record is information…

Hospitals and other health organizations need to take off their 1999 hat, and realize that people really don’t care about your facility or no smoking policy. People want to take control of their health and the way they are treated when they interact with a hospital. This will be done through hospital sites becoming more interactive and community focused through video, blogs, forums, and hospitals working with organizations such as Google, Revolution Health and Microsoft in creating portable electronic health records. Hospitals talk about being patient centric, here is one more way to do that.

Cleveland Clinic seems to have figured it out, we wrote about it earlier this week…

• Google and Cleveland Clinic Join Forces to Organize Your Health
• More on Google’s Partnership with Cleveland Clinic

I was in the midst of the great towers of GE, Cerner, Microsoft, and the other glittering HIMSS palaces and there was one player out of place: Google.

It had such a modest footprint and has been so quiet about the partnership with Cleveland Clinic, you’d never know they launched a major initiative. There were no banners advertising Google was even at the show, nevermind they were entering the PHR space.

But I can tell you one thing: from my unofficial poll, PHR vendors seemed a lot more concerned about Google than they did about Microsoft’s Health Vault. (”Health Vault is just a place to store stuff,” is what was more or less repeated back to me — which is more or less the official party line.)

In show full of massive overstatement — I know of several companies in the financial dumps who made significant booth investments — Google’s presence was, for a soon-to-be major player, oddly understated.

Last week Google and Cleveland Clinic announced that they will be working together to give patients better access and flexibility to their health records. What an idea! People “in charge of their own health information.” Wow! Why did Google have to revolutionize this? Aren’t they just a search engine? Yes, they are a search engine, but they are quickly turning into the largest collection of all things on the web, and now not on the web. For instance, Google has worked with universities for the past couple of years to digitize entire libraries, and now they are digitizing health records.

Here is Google’s mission: Google’s mission is to organize the world’s information and make it universally accessible and useful.

See more than a search engine. Google will continue to organize data yours and mine until they either run out of server space or things to index. This will be interesting to watch.

And this is why it is exciting:

By integrating with the Google platform, Cleveland Clinic is helping create national access to electronic medical records at no cost to the user or provider. The integration between the two systems will help deliver:

• National Access — A more efficient and effective healthcare system driven by a working interoperability model that moves electronic medical records from a closed model to one that is open and connected.
• Consumer Empowerment — A secure patient-centric, consumer-driven tool that will provide each consumer increased control of their medical care, without compromising their privacy. This will empower patients to actively manage their overall health.
• 24/7 Access/Portability — A web portal with 24/7 access, capable of providing the consumer with an opportunity to actively engage in their health care, heightening the importance of quality care and service by providers.

You can see the press release on the Cleveland Clinic web site.

Update:

The Health Care Blog has posted a great post on the Google and Cleveland Clinic discussion.

I am NOT saying that there shouldn’t be privacy protections and there is no reason in my mind why, for all HIPAA’s flaws, it cannot be extended to PHR providers as covered entities.

However, as far as I can tell nothing that is happening here violates HIPAA. Showing you keyword based advertising may not to everyone’s taste, but it does not mean your private health data is being transferred to anyone. And presumably your data will only end up in these services if you give them permission to accept it, which will include consent to provide whatever services and advertising you’ll see.