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New? Really?

Friday’s AHIP Solutions SmartBrief had this item:

New AHRQ campaign focuses on patient empowerment
The U.S. Agency for Healthcare Research and Quality is rolling out a new campaign called “Questions Are the Answer,” designed to help patients be more involved in their care to avoid preventable harm. The program offers a Web site that includes video, checklists and advice for patients and providers on asking and answering questions. The Boston Globe (6/26)

The Boston Globe story from Thursday didn’t make mention of this being a new campaign; only the Spanish component is new. And that’s accurate. Readers of this blog would know that “Questions Are the Answer” is not new. I wrote about it on April 23, 2007.

On another subject, last week’s Health Wonk Review was one of the best I’ve seen to date—and not just because health IT got top billing. Kudos to Jaan Sidorov of the Disease Management Care Blog for his excellent and detailed commentary.

The link to the “Ultimate Guide to Google Health” was particularly useful. It’s nice to have time to put together such a comprehensive list. Or so I’m told.

June 30, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

And they ask me why I drink

Here’s a recent e-mail exchange I had:
I have redacted the name of the other person to protect the ignorant.

—– Original Message —–
From: [redacted]
Sent: Monday, May 12, 2008 9:42 AM
Subject: Link to’s recent article heart stints research

Thought you and your readers might be interested in’s recent article on a report that 72% of journal articles on heart stints in 2006 failed to note who funded the research draws sharp criticism of disclosure practices:

Feel free to link to this and let me know if you need anything else.


[name redacted]


From: “Neil Versel”
Sent: Monday, May 12, 2008 10:45 AM
To: [redacted]
Subject: Re: Link to’s recent article heart stints research

Why exactly would I be interested in a story like this?

From: [redacted]
To: Neil Versel
Sent: Monday, May 12, 2008 10:48 AM
Subject: RE: Link to’s recent article heart stints research

I just thought you might want to link to it on your Healthcare blog.

From: “Neil Versel”
To: [redacted]
Subject: Re: Link to’s recent article heart stints research
Date: Monday, May 12, 2008 10:53 AM

You mean my blog about health IT?
This is about a clinical trial. When have I ever covered that. And FYI, the word is “stents.”
You haven’t been doing this very long, have you?

I didn’t get a response to the last message.

Oh, and by the way, you didn’t hear this from me, but Ricoh will be building some of the underlying PHR technology for Google Health. Oh wait, you did hear that from me. But you won’t hear that from Google. In fact, try asking them simply for the name of their Google Health partners and you’ll get a link to a YouTube video of Eric Schmidt’s speech (the same one I posted at to the HIMSS conference and instructions to fast-forward to about 28 minutes to try to read the logos on the screen from Schmidt’s PowerPoint presentation. The company’s reasoning? They haven’t launched the product yet.

Yeah, their CEO showed the product to thousands of people at the largest health IT meeting of the year, but the company hasn’t introduced it.

The story gets worse, but if I say any more, the situation turns personal between myself an a Google employee I shall not name.

And they ask me why I drink!

P.S., Marissa Mayer, please call me. Your press people are not very cooperative. You are not the Google employee I shall not name.

Addendum, 5/20/08:
I just realized the unnamed pitch-person has won, since I did indeed link to the BW article on my blog. Know anyone in Fort Lauderdale who delivers crow to hotel rooms?

May 18, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Eric Schmidt’s HIMSS speech

Lots of people have found this site while searching for information on Google‘s presence at the recent HIMSS conference. I wrote up a couple of short pieces about Eric Schmidt’s keynote address and subsequent press conference, but time is of the essence for me over the next month and a half. I therefore present the full video of Schmidt’s address, which includes some Q&A. Feel free to draw your own conclusions. Or just go to the original YouTube page for some bizarre comments.

March 10, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Pre-HIMSS scuttlebutt

ORLANDO, Fla.—Congress, are you listening? Steroids have hit health IT.

National Coordinator for Health Information Technology Robert Kolodner, M.D., admitted to me this morning that he’s juicing. He even showed me the pills, surreptitiously hidden in the inside pocket of his suit jacket.

Yeah, so what if he had a prescription, and he was using the ’roids to cure his laryngitis before he has to deliver a keynote address Tuesday morning to thousands of HIMSS conference attendees? If other media can hype steroid use in baseball, why can’t I do it in health IT?

One person I mentioned this to today said he would support the use of performance-enhancing substances for anyone promoting greater adoption of health IT. So I guess the consensus is to take the Bud Selig approach and look the other way as long as it’s for the good of the game.

(Full disclosure: I took prednisone last year to treat a rash that resulted from an allergic reaction to the antibiotic Bactrim. I guess that makes me a juicer, too.)

Keep reading, I’ve got all the pre-HIMSS dirt right here.

Peter Basch, M.D., medical director for eHealth at MedStar Health in Washington, D.C., is the HIMSS physician of the year, and will be honored at the HIMSS Awards Dinner on Tuesday.. The Davies Award winners have been public for several months, and I don’t have word on other award winners.

The HIMSS partnership with the Association of Medical Directors of Information Systems has produced data showing that an increasing number of chief medical information officers are reporting to executives other than chief information officers, often the CMO, CFO or even CEO.

E-prescribing vendor DrFirst is remaining independent, but has agreed to add Meditech to its roster of EHR partners it promotes to e-prescribing customers.

News of Google’s long-awaited health product got out last week, so it’s widely known the Cleveland Clinic will test a personal health record with 1,500 to 10,000 patients. (The leak, of course, came from the Cleveland Clinic, and not from tight-lipped Google.) However, I have learned that the public launch of the product likely will come near the end of the first quarter. Google CEO Eric Schmidt likely will make it official when he delivers a keynote here on Thursday morning.

Note to skeptics: I have learned that Patient Privacy Rights Foundation founder Deborah Peel, M.D., has not been paid by Microsoft to tout the privacy benefits of HealthVault. I understand that the only financial gain she will receive is from the fee Microsoft will pay her organization to certify HealthVault against privacy standards Peel is developing.

The annual, midyear HIMSS Summit will run concurrently with National Health IT Week this year, in Washington, D.C. The summit is set for June 9-10. HIMSS Advocacy Day will take place June 11 on Capitol Hill. The week ends with the seventh-annual Center for Information Therapy conference on June 12-13. I believe this is the first time the Ix conference has been held anywhere besides Park City, Utah.

Also, if you aren’t registered for HIMSS, you still can participate in several public meetings here staged by the federal government:

American Health Information Community meeting, Tuesday, 10 am to 4 p.m.
Establishing the AHIC Successor, Tuesday, 3:30 to 5:30 p.m.
HIT Terms Project: Network Workgroup Public Forum, Tuesday, 4 to 6 p.m.
HIT Terms Project: Records Workgroup Public Forum, Wednesday, 11 a.m. to 1 p.m.

All times are Eastern, and all meetings take place in the Orange County Convention Center, Orlando, Fla.

February 24, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Dude, this sucks!

Paper medical records suck. You and I have known this for a long time. But it’s confirmed this month in “Wired,” which has a cover story called, “Why Things Suck! 33 Things That Drive Us Crazy.”

Among them is this entry:

Why Things Suck: Medical Records
By Erin Biba Email 01.18.08 | 6:00 PM

Most medical records are about as orderly as an ER on Saturday night. Because they’re mainly confined to paper, they can’t be easily transferred from one physician or hospital to another. And because they’re not subject to any standards (or even legibility requirements), they’re nearly impossible to compare and combine.

Improving the system is possible, but it would take the cooperation of a bunch of interest groups that have no interest in working together. The Health Insurance Portability and Accountability Act, passed by the federal government in 1996, was supposed to fix things, but massive lobbying turned it into porridge. For example, HIPAA lets states make their own rules; now some states say doctors should keep records for 20 years, some for two.

You’d think electronic records would solve the problem, but no. Because the software vendors selling electronic record-keeping systems are competing, their systems are proprietary and incompatible. Oddly, that’s OK with many physicians. Another name for an all-knowing, all-seeing, all-compatible electronic system is database, and physicians don’t want people mining theirs — not because of patient-privacy concerns, but because the info could be used for doctor-on-doctor performance stats. Plus, docs already hate filling out charts; you think they want to learn data entry?

A fix may be on the way. Google and Microsoft are both working on software that will appeal to physicians and patients alike. (Kind of gives new meaning to “blue screen of death,” don’t it?) But a word of advice: Pressure your docs into accepting a more transparent system. If you don’t understand your chart, ask. You want some surgeon to cut the wrong leg off of you someday?

So finally a publication that fancies itself as cutting-edge gets it. Are Microsoft and Google the fix? Well, that remains to be seen. Last week, Microsoft re-branded its healthcare products as Amalga, replacing the Azyxxi and Hospital 2000 names. Today, the Redmond Empire announced plans to publish the source code for HealthVault XML interface protocols and other open-source projects.

HealthVault chief architect Sean Nolan explains the open-source initiative on his blog. Michael Zimmer, the 2007-08 Microsoft Resident Fellow at Yale Law School’s Information Society Project talks about some of the privacy issues HealthVault is trying to address on his blog today, while open-source guru and Microsoft critic Fred Trotter cautiously lauds Zimmer for a fair assessment of the issues.

As for Google, CEO Eric Schmidt is delivering a keynote at next week’s HIMSS conference, and actually is holding a 30-minute press conference afterwards. The Internet search giant also is throwing a cocktail party next Tuesday, with the theme, “Home is Where the Heart Is.” The invite says, “Come meet the health team at Google and learn more about what we’re working on.” About all I expect to learn from the secretive company is who actually works for Google (I know a couple of people already) and whether the bartender can mix a dry vodka martini.

Back to the “Wired” spread. Medical records are not the only “things that suck” in healthcare. The list also includes prescription drugs, hearing aids, infertility treatments and knees and backs, not to mention the all-encompassing science itself.

I can’t say for certain that personal health records suck, but that could be an addition to the list if someone doesn’t figure out a way to make someone other than health plans use them. You may recall that back in December I declared a personal moratorium on PHR stories until I saw proof that doctors and patients were actually using PHRs in any sort of volume.

After I got a pitch from one payer-owned PHR vendor on Jan. 29, I wrote back with a terse, “I’m not doing any more PHR stories until someone shows me evidence that more than a handful of patients and doctors are actually using the things.” I’m still awaiting a response.

February 20, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Google’s health plans, and more on CMIOs

BRISBANE, Australia—I’m at the other end of the world this week for the 12th World Congress on Health (Medical) Informatics, otherwise known as MedInfo, so things have been a bit nutso, what with the travel, the change of 15 time zones and the acclimation to a rainy winter in a region that’s had drought conditions for several years, at least until I arrived Sunday.

That said, I have a couple of things to share that I carried with me for some 9,000 miles. Yeah, so what if I carried them on a tiny USB drive? I still brought them to Australia.

First off, thanks to Fred Trotter and Dr. Scott Shreeve for cluing me in to a sneak peek at Google Health, allegedly code named “Weaver.” See this post at Google Blogoscoped, complete with screen shots. Happy scoping.

Secondly, a story I wrote for Digital HealthCare & Productivity late last month caught the attention of Dr. Scot Silverstein, director of the Institute for Healthcare Informatics at Drexel University in Philadelphia. Dr. Silverstein agreed with the quote from Gartner‘s Vi Shaffer about chief medical information officers: “Direct report to the CIO is a wedge of separation from the medical staff.”

Silverstein e-mailed me to say he e-mailed the story to members of the AMIA clinical information systems workgroup. “We’ve been discussing how to empower the CMIO role and trying to organize a workshop on same, although the proposal was rejected for November,” he wrote.

Silverstein also referred me to an essay he wrote several years ago, entitled, “Ten critical rules for applied informatics positions: What every Chief Medical Informatics Officer (CMIO) should know,” which he said was still relevant.

From that essay:

Rule 6 : Reporting should preferably be to senior medical leadership or medical records (health information management).

Physicians and other clinicians, being the primary enablers of healthcare, should report to personnel who understand clinical issues, matrixing with those who facilitate care. Reporting to non-medical personnel should be done only if the chemistry between the two parties is very good, and the senior party is well-rounded and has experience in working as a direct supervisor to medical personnel. Unfortunately, this is not very common.

Rule 9 : Have a direct, open channel to organization’s CEO.

Also make sure the CEO and other senior executives understand what medical informatics is about, and its strategic value. Direct them to this web site, for example … Medical informaticists may unfortunately be viewed by healthcare executives as “clinical consultants who know a little about computers”, as opposed to leaders in clinical computing.

I then referred Silverstein to a Digital HealthCare & Productivity editor to submit a commentary, which ran Aug. 7. Click here to read.

August 22, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Time for WebMD and Google to panic?

This is one of the most interesting M&A bits to hit my inbox in a long time: Health-specific search engine Healia has just announced a takeover by Des Moines, Iowa-based publishing company Meredith Corp.

That’s right, the publisher of such titles as Fitness, Ladies’ Home Journal, Family Circle, Better Homes & Gardens and Successful Farming has bought itself a healthcare search engine. I bet Wall Street didn’t see that one coming, and I wonder if they’re sweating over at WebMD, Google, Microsoft and Yahoo.

By the way, Dr. Tom Eng, Healia’s president and founder, says that Healia is hiring a CTO and Web designers at company headquarters in Bellevue, Wash., and VPs for online marketing and advertising sales to work in New York, where Meredith has a large presence. Eng is keeping his job.

June 18, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

On Google

Is it the worst-kept secret in healthcare, the idea that Google wants to offer some sort of consumer-centric product in the near future? Google VP Adam Bosworth has made a few speeches in recent months on the need for better health information to empower consumers, but the company isn’t talking otherwise. In fact, every healthcare person I’ve talked to that’s had any contact with Google personnel is under some sort of non-disclosure agreement.

Lucky for us, the notes in the program from last month’s World Health Care Congress offered this: “As Google’s architect of the soon-to-be-unveiled health vertical, Mr. Bosworth imparts his compelling vision for providing timely, relevant information to consumers via content providers and health care institutions to create a robust solution.” (Emphasis mine.)

If you have a copy of the full program—the thick, spiral-bound one—it’s on page 14.

May 4, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

My ‘Red Herring’ story

At long last, I have a copy of my story from the April 23 issue of Red Herring. I’ll post a PDF version later for easy downloading and printing, but for now, here’s the text.

Google, then Gargle
America’s sorry performance on personal health records could soon change.

By Neil Versel

With names like GlobalPatientRecord, NoMoreClipboard, HealthKey, and HealthCard, the U.S. marketplace for electronic personal health records, so-called PHRs, is getting crowded. And yet the public has barely noticed that the era of people tracking their own medical history has arrived.

Dr. David Kibbe, a former director of the Center for Health Information Technology of the American Academy of Family Physicians, estimates that perhaps 10 percent of adults in the United States will have access to PHRs by the end of 2007, though only 2 percent will actually be using the records.

Now senior advisor to the academy, he expects that figure to double in 2008.

Those numbers won’t blow anyone away, but today’s sleepy calm could change once a few tech heavyweights enter the PHR arena. Steve Aylward, Microsoft’s U.S. general manager for healthcare, says, “It’s not an if, it’s when we’ll do that and how we’ll play.”

Google also is preparing its much-anticipated entry into the healthcare arena.

Internet scuttlebutt suggests that a simplified PHR called Google Scrapbook could surface sometime this year, perhaps as an outgrowth of Google Co-op.

Naturally, Googleplex mouthpieces are on lockdown, but Vice President Adam Bosworth dropped some hints in a speech to a Washington, D.C., audience in December.

In describing how his mother died of cancer, Mr. Bosworth said, “For lack of an easy way to find the right specialist and for lack of comprehensive medical information about her that could have been shared between her doctors and caregivers, she ended up being sicker than she should have been and dying sooner than she should have.”

The solution, according to Mr. Bosworth, is for sick people to have a “health URL” for caregivers to share information and discuss treatment options. “This isn’t rocket science. It is Online Web Applications 101,” he said.

Indeed, a three-year-old Watertown, Massachusetts-based company called MedCommons already offers health URLs, secure web pages summarizing basic health status, including diagnoses, medication lists, and allergies, all under the control of patients. “It’s a patient-centered view of the world,” says Chief Science Officer Dr. Adrian Gropper.

AOL co-founder Steve Case is also putting his time and bankroll behind Revolution Health, a company that is offering free online “personal health homes” to the public.

“It’s really a dynamic and interactive concept,” Dr. Kibbe says of the URL system. It moves the focus from software to the control of information, says Dr. Kibbe, a contributor to Google Co-op for Health. A health URL would provide access to basic health data, as well as relevant documents, images, and video, he says. “All of those things might be useful in taking more control of your health and healthcare.”

A Measure of Control
An oft-stated problem in healthcare is that records are scattered and otherwise unavailable when doctors and patients need them most. Personal health records are meant to address the situation by centralizing health information and giving consumers a measure of control, with the goal of cutting out some of the administrative waste and improving the quality of care.

That is the idea behind Dossia, a project bankrolled by some of the nation’s largest employers, including Intel, Wal-Mart Stores, Applied Materials, and Pitney Bowes. Announced in December and scheduled to debut in the second half of the year, Dossia is a nonprofit effort to provide “lifelong” PHRs to employees of each participating company, records that people will be allowed to take with them even if they change jobs or retire.

Much of the impetus for Dossia came from Intel Chairman Craig Barrett, who thinks businesses should expect better results for the billions of dollars they spend on employee health insurance, and the best way to do that is through information technology. “The people with the purchasing power have to provide the incentives because, frankly, I don’t think the [healthcare] industry is capable of modifying itself,” Mr. Barrett said in a speech last September.

According to Dr. Kibbe, “That’s exactly the kind of national dialogue we need to be having about healthcare.” But reform needs to involve consumers, be patient-centric, and focus on preventive care, he says. “It is unlikely to come from those incumbent interests—disruption will come from outside the healthcare system.”

Omid Moghadam, director of PHR programs at Intel, says that the chip maker looked at many of the 200 or so PHR options out in the marketplace, but nearly all were “tethered” to a single vendor, health system, insurer, or employer—and information was all over the place. “You have to go through nine or 10 different sources and you can’t take it with you when you change jobs,” he says.

“Fragmentation is what we realized is the big problem,” Mr. Moghadam adds. “What that requires is for the individuals to gather and enter all the information themselves.”

Users of Dossia PHRs will have the option of keying in their own information, but the system also will aggregate data from billing claims, pharmacy records, and, where they exist, electronic medical records. (Perhaps a quarter of all U.S. hospitals keep patient records electronically, and even fewer independent doctor’s offices do, according to most estimates.)

“There is enough electronic data to make a pretty good record,” Mr. Moghadam says. “The combination of claims and pharmacy data will get you about 80 percent there.”

Health insurers are thinking along the same lines, working through national associations to develop a standard for a “payer-based” PHR, a standard that may or may not be compatible with the one Dossia is creating. Some of the larger insurers, including Cigna, Aetna, and Blue Cross and Blue Shield, offer a form of PHR through their web portals.

Predictably, many are skeptical about the notion of insurance companies building clinical records from billing claims. “There has to be a Chinese wall between the record and the health plan,” asserts W. Ob Soonthornsima, CIO of Blue Cross and Blue Shield of Louisiana.

“I don’t think people realize how much data the insurers have,” says Dr. William A. Yasnoff, a former senior federal health IT official who now consults on the interoperability of health information. “Do patients trust the insurance companies to
have this information?”

Trust is a big deal in the PHR arena. “Doctors are not that interested in claims data. They are interested in clinical data,” says Dr. R. Daniel Claud III, an emergency physician at Chicago’s Northwestern Memorial Hospital. But today, much more electronic information exists on the payer side than anywhere else in healthcare.

Dr. Claud also runs HealthCapable, a small firm that just introduced an ATM-like system called HealthCard in Illinois after running a test in Colorado last year. A swipe of the card in a standard magnetic-stripe reader “unlocks” secure patient information stored online—currently limited to medication lists—when the holder shows up at a doctor’s office or hospital. The provider then can update the information when the patient leaves.

Whether on a card, CD-ROM, USB drive, secure web site, or even a piece of paper, the advantage of a consumer-controlled PHR is that it is more portable than one tied to a specific health plan, job, or hospital system.

The sponsors of Dossia are promising that all records created on that platform will be fully portable when employees leave. Louisiana Blue Cross and Blue Shield, for example, is developing a claims-derived PHR that people will be allowed to keep—for a fee—if they switch insurers. “We want to advocate the ownership of the record,” Mr. Soonthornsima says. “We want it to be portable.”
Red Herring 04.23.07

April 21, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

The whole truth?

Health IT vendor Practice Fusion grabbed headlines a couple of weeks ago with the news, first reported March 16 in the San Francisco Chronicle, that it would offer a free EMR to physician practices, thanks to a “deal” with Google.

Publications nationwide jumped on this story, which some interpreted as Google’s long-anticipated entry into the world of healthcare. As of this morning, Practice Fusion’s own Web site lists no less than 17 instances of media coverage the company has received since then, including my story in Digital HealthCare & Productivity last week.

Thanks to the publication schedule, my story didn’t appear until March 20, which gave me time to put in a call to Google and get spokesman Brandon McCormick to say, “This shouldn’t be interpreted as a product move on Google’s part.”

Further, an e-mailed official statement from Google read as following: “Practice Fusion has recently joined Google’s AdSense program to place ads on their Web pages. AdSense helps hundreds of thousands of publishers effectively monetize online content in just about every vertical category that exists on the Web. Practice Fusion’s participation in our AdSense program is not exclusive and should not be read as an indication of any product plans by Google.”


That makes it sound like Practice Fusion’s invocation of the G word was little more than a publicity stunt. I guess it worked, since so many publications—the Wall Street Journal included—took the bait.

The news also lit up the blogosphere.

Fred Trotter’s post called the news “snake oil” and “bunk”—and that was just in his headline.

A new blog called e-CareManagement took issue with the business model and raised the obvious privacy concerns about an ad-supported EMR. That blog’s writer, Vince Kuraitis, e-mailed me twice last week.

The first message questoned both Practice Fusion’s ethics and the wisdom of publicizing the supposed business connection to Google. The second message, sent exactly nine minutes later, said the following:

…one more thing that doesn’t fit…

Google AdSense revenue is peanuts, see, e.g.,

certainly not enough to sustain an EHR.

On the other hand, you would think that PF would have negotiated a special
click thru rate with AdSense knowing that doctor eyeballs poised on an EHR
at the point of care would be worth a lot more that an average eyeball.

….which would suggest that indeed there is a special deal with Google

…but which Google now denies ????

This thing stinks.

I don’t know if anything stinks or not, but I can vouch for the ad revenue being peanuts. Google doesn’t cut a check unless you have at least $100 in your account. I’ve had AdSense ads on this site since July 2005, and I haven’t seen a dime yet. But I never expected to make a profit from blogging.

On the other hand, Practice Fusion finally updated its blog on Tuesday, the first post since March 6. Perhaps the phones were ringing off the hook there for the past three weeks?

Stay tuned to this story and to my blog. I have at least two more posts in me, and hopefully I’ll have them up in the next day or two.

March 29, 2007 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.