Google, Microsoft demand place at medical stimulus table

Google, Microsoft demand place at medical stimulus table

Summary: Given the outright lies being told right now concerning the main health care plan -- Obama does not want to kill your grandma -- it's hard to see how subtle differences between EHRs and PHRs can be explained so that 300 million people can access their data and be counted on to keep it secure.

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TOPICS: Health, Google, Microsoft
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Google and Microsoft are demanding Web access to electronic medical records and took their complaints right to the top this week.

Google chairman Eric Schmidt and Microsoft chief strategy officer Craig Mundie both hammered NCHIT David Blumenthal on the issue during an advisory committee meeting Thursday.

What's most interesting is that both Blumenthal and U.S. Chief Technology Officer Aneesh Chopra pushed back.

The HITECH stimulus money goes to hospitals that automate records and deliver the functional requirements of a recently-passed plan on meaningful use.

The resulting Electronic Health Records (EHRs) are covered by the HIPAA law, in terms of how they can be shared. What Schmidt and Mundie want is that EHRs respond to Web standards so the records can be turned into Personal Health Records (PHRs) controlled by patients.

Here's the difference. If the wrong person looks at your EHR, they could be fined heavily by the government. If you give your PHR to someone who then distributes it to the world, neither government nor your doctor has any liability -- that was your decision.

Schmidt and Mundie based their arguments on the efficiency of Web standards and the need for patient control over their health records.

Blumenthal pointed out that the HITECH stimulus is about EHRs, not PHRs. But what was most interesting was the active pushback by Chopra, who suggested patients could be given "summaries" of their records.

At this point, Nextgov reports, Schmidt came close to losing his temper. "Giving me a summary...is not the same as giving me the record," he said.

He's right. But the Google-Microsoft challenge is one the Administration needs to address far more directly than it has:

  • On the one hand, forcing vendors to cooperate with Google and Microsoft has all sorts of nasty privacy implications, since Google Health and Microsoft HealthVault are not subject to HIPAA.
  • On the other hand, denying Google and Microsoft access to the full records leaves the data under the proprietary control of doctors and hospitals, and keeps people from gaining the full value of PHRs and personalized health.

Given the outright lies being told right now concerning the main health care plan -- Obama does not want to kill your grandma -- it's hard to see how subtle differences between EHRs and PHRs can be explained so that 300 million people can access their data and be counted on to keep it secure.

So it seems to me that Google and Microsoft are barking up the wrong tree. Rather than addressing their questions to Blumenthal and Chopra, they should be creating a public education campaign on PHRs that will create demand for access to records from the bottom up.

As a first step, perhaps Microsoft could explain on its main HealthVault page what a PHR is, and the difference between that and an EHR.

As a second step, perhaps Microsoft and Google could both get on board the health reform train. That would add weight to their words in any future meetings with Administration officials.

Topics: Health, Google, Microsoft

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28 comments
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  • No, of course not

    No, Obama doesn't want to kill your grandma. But he DOES want her to wait in the back of the line for that hip transplant while other, younger, patients get higher priority. If she dies while waiting, well, that's a shame, but there's limits to what we can do, right?
    Dorkyman
    • That is a lie and you know it.

      When caught in an obvious lie, the technique of
      the liar is to develop what seems like a more
      plausible lie.

      But just because a lie sounds plausible (because
      there are waits for care in Canada) does not
      make it so.

      The President has said no such thing about
      having people wait for needed care. There is
      nothing about it in the legislation before
      Congress.
      DanaBlankenhorn
      • Wow... are you serious?

        [i]But just because a lie sounds plausible (because there are waits for care in Canada) does not make it so.[/i]

        And you think because we aren't Canada and create the same system it won't end up the same way? Last time I checked Canada's economy was actually better then ours, so how do you propose we pay for all this extra care that Canada can't?

        [i]The President has said no such thing about
        having people wait for needed care. There is
        nothing about it in the legislation before
        Congress.[/i]

        Because the president would never lie to us. It has never happened before right? Are you telling me you believe all the crap legislature dreams up? Because if you have actually watched the news... no, not MSNBC where their worship liberals like they are gods... actual news, you might would see the whole picture.

        You can live in that dream world if you want, but it will not last forever.

        Also, I'm curious if you have read the entire bill you speak of. Because it seems few congressman actually have, and the ones that do say it is hard to understand. These bills tend to be hundreds of pages long, and the average person would have a hard time following it from front to back.
        ShadowGIATL
        • Its horses for courses

          There are waits in the UK too but then alot of people dont get treated in a private system so you cant realy judge either way.

          jdbukis@...
          • Health Reform in Canada, Australia and the UK

            Most efforts to reform the health care systems
            in Canada, the UK and Australia come down to
            bringing more private enterprise into the
            picture, in one way or another.

            I have no argument against it.

            What we need is balance, options, competition.
            Most people don't have any choice in their
            insurance right now. A public option offers
            competition.

            It lets you buy from the people who give your
            parents Medicare. Most Medicare patients like
            Medicare.

            For that matter, most Republican Congresspeople
            seem to like the coverage they're getting as
            well.

            I think I'm as good as a Republican
            Congresscritter and should have the option of
            getting what they take for granted.

            DanaBlankenhorn
          • off the track?

            Aren't you guys a little of the track in this so called discussion? Even the author?
            How all this is relevant to M$ and G$$gle wanting the piece of the taxpayer pie to fund their little garage projects? Who cares that their want it? Just because they are so big they should be allowed to participate in helping with the standards but they should not be allowed in the healthcare system. Just because they have big mouths does not entitle them to swallow the largest piece of pie. My health records are just fine on a piece of paper. I do not need some half-a$$ed software companies to hold them for me.
            pupkin_z
          • EHRs

            There is $19 billion going into creating incentives for doctors and hospitals to create Electronic Health Records under the HITECH Act passed by Congress.

            What Google and Microsoft want is for the standards under which those records are written to include Web standards, so that people can, if they choose, gain access to their records, storing them at Google or Microsoft (or at other online locations) as Personal Health Records (PHRs), under their personal control.

            Thanks for writing.
            DanaBlankenhorn
          • Open Standards

            All of this focus on EHRs is good, but it scares me as well. I worry about private companies creating closed proprietary systems that shut out open source options.

            I want open standards for all it so that we as a small medical clinic have some options. I also want it for *me*. I want to be able to have *my* records in a form that *I* can use and store without having to pay some proprietary gatekeeper for the privilege.
            mosborne
          • In reference to Dana's comment.

            [i]What Google and Microsoft want is for the standards under which those records are written to include Web standards, so that people can, if they choose, gain access to their records, storing them at Google or Microsoft (or at other online locations) as Personal Health Records (PHRs), under their personal control.[/i]

            While I can see the benefit to this for the people, I don't agree with letting either MS or Google have control of them. That kind of control over personal information is dangerous, especially in the hands of a large companies.

            Kind of negates the HIPPAA law alltogether, and brings on all new privacy issues.
            ShadowGIATL
          • "My health records are just fine on a piece of paper"

            Until you are a patient with a complex history who winds up in an emergency room with doctors completely unfamiliar with your case. That is when doctors unaware of your conditions and medications following normal protocols can kill you.

            That is what happened in this case, for example:

            http://talkback.zdnet.com/5208-13593-0.html?forumID=1&threadID=39777&messageID=810267

            As far back as 1999, avoidable medical errors cost America $17 billion per year:

            http://www.ahrq.gov/qual/errback.htm

            Fromm 2000-2002, avoidable medical errors were killing an average of 195,000 people per year in American hospitals:

            http://www.medicalnewstoday.com/articles/11856.php

            MedAlert bracelets and pocket cards can only carry a tiny fraction of a patient's history. We really need electronic medical records with secure data sharing to put vital life-saving information in the hands of doctors who need it when they need it.

            The issue drawing Microsoft and Google into this discussion is "who should own the data?" Tradition has always placed medical information in the hands and file shelves of attending physicians. The issue being debated now is whether or not patient information should really be the property of patients and, if so, how to safeguard patient data from unauthorized distribution.
            Cardhu
        • The lies continue

          The present bill doesn't create anything like
          the Canadian system. Anyone who claims it does
          is a liar. They are deliberately and willfully
          telling you something that simply isn't true.

          The record of this President in terms of honest
          truth-telling is, so far, much better than that
          of his predecessor. Just because Bush lied
          doesn't make Obama a liar.

          It is a problem when news organizations lie
          routinely. But that's an old problem. What we
          need are more organizations that tell the truth.
          I try to tell the truth, honestly, without
          propaganda.

          Of course, those who believe in bias will say
          that fairness is bias. I can't help them. All I
          can do is my job.

          As a private citizen, on the other hand, I can
          do more.
          DanaBlankenhorn
          • You can call your opposition liars if you want to...

            But it only serves to show how far to the left you lean, and how biased you are.

            You call yourself unbiased based on what? Your strong political view that suggests anyone that opposes this legistation is a liar? That makes you the most biased of all.

            Using your blog as a political medium to spread your far left, liberal propaganda is worse then the fanboys from all sides of the OS spectrum.
            ShadowGIATL
          • A difference between argument and lies

            Lies followed by projection. Is that all the opponents of reform have?

            America deserves better. The present system rations care, it costs twice what citizens elsewhere pay, and rather than deal honestly with the question of reform all I read are personal attacks.

            Real Americans are neither impressed nor intimidated.

            I notice you signed in as ShadowGIAtl. Were you a veteran? Is that what the GI stands for? If you are you enjoy a single payer health care system that costs less, per patient and procedure, than any other in the nation. And you deserve it.

            The rest of us deserve better too. We deserve the kind of health care Republican Congresspeople get.

            That should be the benchmark. Care as good as Congress, nothing less.
            DanaBlankenhorn
          • Eh...

            [i]Lies followed by projection. Is that all the opponents of reform have?[/i]

            I hear it from both sides. People on the far extremes have a hard time understanding that the people in the middle don't want one extreme or the other. That is where I'm at... the middle.

            [i]America deserves better. The present system rations care, it costs twice what citizens elsewhere pay, and rather than deal honestly with the question of reform all I read are personal attacks.[/i]

            This is true that America deserves better. The present system costs more because everyone let them get away with overcharging for way to long. Instead of asking everyone to pay higher taxes in a time when few can afford it, why not punish the medical supply companies that charge $3000 for bandages? This is where the real problem is at. If a gas station charges over $4 a gallon they get in trouble for jacking the price, but medical supply companies get away with it. Why? Because they line the pockets of congress, not just republicans, but democrats as well.

            [i]I notice you signed in as ShadowGIAtl. Were you a veteran? Is that what the GI stands for? If you are you enjoy a single payer health care system that costs less, per patient and procedure, than any other in the nation. And you deserve it.[/i]

            My signon name has nothing to do with military, but I have worked with and for several levels of government. Yes, my healthcare during those times was pretty good. However, it was group insurance plan provided by a company that provides the same plans to companies outside of government.

            [i]The rest of us deserve better too. We deserve the kind of health care Republican Congresspeople get.[/i]

            And this is where your bias shines through Dana. You suggest that republicans get better healthcare then democrats? You think only republican congressman get good healthcare plans? If you meant congress as a whole, then just say congress.

            Personally, up until lately I have had no political opinion past voting for who I felt was best for the job. Now, I have a lot of discontent with republicans and democrats. You are all behaving like there is only one side... your side. When did it become wrong to be in the middle of the road. When did it become wrong to think that there can be a milder, more subtle solution that will sit better with both sides?

            This nation was built on balance, and now everyone wants it their way and no other. People need to read a book. This is what has destroyed republics time after time. The fight for power is the evil that needs to be stopped here.

            Maybe you think all it cozy from your chair at the house, but for those that have worked closely in the government know better. I watched two congressmen nearly destroy the one part of the Hurricane Katrina Recovery Project that was actually functioning the way it was supposed to. Why? Greed. The whole reason it took so long to do anything down there, was because you had to tip toe around the red tape designed to guide you to their districts and their companies.

            Companies they aren't supposed to have control of, but do. These same companies that the pork projects fund. The pork projects that Obama claimed would no longer be funded once he was in office. Lie number one.

            Don't tell me Obama has a good track record of not lying. What he has, is a good track record of weaseling his way out by twisting words. I give him credit for being a great speaker. But what good is it if hardly anything he says comes true. Not sure about where you live, but here where I am, unemplyment is still on the rise. Yet Obama claims for the 4th week in a row that things are getting better. How?

            You can preach all day that Obama is great and he never lies, but that won't change the reality for millions of Americans without jobs.

            More then 700 billion dollars wasted on banks that didn't need help, two auto companies that can't learn how to manage money and is still laying off people left and right, and no telling how much of it is wasted on BS projects for certain democrat congressmen's districts. The economy would have been better off if they have split that money up and gave it to the people. They then could have invested in companies and brought thier stock up. That would have stimulated the economy more.

            In reality, printing all that money has only further devalued our currency in the name of what? Government Motors, and a couple taxpayer financed banks? What do we get from it? Do we get dividends from them? No. That moeny is gone. But it's ok, cause they can just print more.

            And now you want everyone to pitch in and have the government run our healthcare? And what makes you think that a government run healthcare for the people will be the same as for congressmen? Because they say so?

            How gullible can you be.
            ShadowGIATL
  • RE: Google, Microsoft demand place at medical stimulus table

    I think this discussion would be better if Dana kept out
    his political beliefs. Calling those who believe that
    the rationing in the Congressional health care proposals
    would curtail the availability of some procedures for
    elderly patients liars has nothing to do with the
    Microsoft/Google involvement. All it does is stir up a
    political firestorm which he is not qualified to quell.
    He is not here for his political opinions.
    NolaOwl
    • I responded to a falsehood

      I can't let falsehoods go by in this forum. When lies are told I call people on them. The biggest problem in our current debate is that lies aren't being challenged, and so are believed.
      DanaBlankenhorn
  • RE: Google, Microsoft demand place at medical stimulus table

    There are approx 450 congressmen and senators in the US. 250 million Americans all put in a little bit to allot of tax money to pay for the healthcare and salaries for these 450 people.

    When someone says "I just want the same care that Congressmen have" who do you think is going to pay for that? There are 45 million uninsured (20 million of those illegal aliens). Who is supposed to pay for this? And GM? And bank bailouts? And all the PORK? This country will be broke soon and go down in history as a ONCE powerful nation.

    We need to:
    1.) Have term limits on congress and the senate. 2 terms max (just like our president).
    2.) Implement a fair tax so everyone contributes to the tax pie not just the top 50% wage earners.
    3.) Pass a law forbidding special interest and lobbyist.
    4.) Wake up the American public to what is going on in Washington and inspire them to do something (regardless of party)
    5.) Have everyone move to the center a bit. Watch CNN and Fox News. Read the Drudge Report and The Huffington Post. See what these media sources are saying and learn to identify the BS.

    p.s. In regards to the original post. I work as an IT tech in the Healthcare sector and I?m all for letting Google and MS create a standard for PHR. I predict most patients will NOT go down this road but it will be there for those that want it. It will take years for EMR vendors to implement this technology into their EMR for easy import and export to/from their systems. When it comes down to it with a standard developed there will hundreds of vendors offering services to store your healthcare data.
    launchsbs
    • Control

      The issue Google and Microsoft are responding to is a control issue.

      Gatekeepers - insurers and hospital groups -- with control of EHR data want to avoid open Web standards so they can force patients to use the PHRs they want them to use.

      That's the way Google and Microsoft view things.

      From the point of view of the government, PHRs aren't their business. The stimulus is for EHRs, files under which HIPAA laws control. So what Google and Microsoft are talking about, to them, is irrelevant.
      DanaBlankenhorn
  • RE: Google, Microsoft demand place at medical stimulus table

    Great Blog Post - you nailed it!

    An EHR is like your bank - you can view it but not change the data only your doctor can.. a PHR is like Quicken which imports data from numerous banks (docs) and you can add your own information but it doesn't flow back into the bank (clinical record).

    To be honest web based applications are last years technology and most people will move their records around via mobile health technology with a web backup.

    Besides, without the clinical records (EHR) from your doctor to import into your PHR they are pretty worthless and that is what the stimulus money targets. We all know that no one is going to hand enter the data. Do you have a PHR? Does your doc have an EHR? Is there any clinical evidence that a PHR is more effective then a consumer portal to their EHR is? Should we have PHR's - YES but we don't need the government to mandate them nor fund them do we?

    Most of the largest EHR's (including the VA, Kaiser, Group Health with millions of patients) have patient facing portals. In addition both Google and Microsoft have announced partnerships with clients like the Cleveland clinic and Kaiser that use Epic which actually has its one PHR (Lucy).

    When you leave a system like Kaiser it can be frustrating that you can't easily export your records but 90% of all docs don't even have a record to export so it is a pretty small segment of people (like me) who are impacted by this. It really isn't the lack of consumer facing data that accounts for people's health problems, and only in rare cases do most doc's need more data to make a decision.

    There are also plenty of web based EHR applications out there like eClinical works so let the market decide. Get all of the vendors to sit down and simply agree on interoperability (which they have failed to do for 20 years). Of course if you have interoperability would you even need an external PHR?

    The stimulus money is seed money targeted to encourage doctors and clinics (especially those that have populations who are undeserved) to get online and was never meant for a consumer facing applications like a PHR.

    Since neither Google nor Microsoft have an EHR it makes perfect business sense that they would want to redirect some of the money to their products or want to make it easier to benefit but they both have what is essentially a consumer product and they need a sustainable business model.

    I am curious, can you exchange your PHR from Google Health to HealthVault? nope

    I am a hard core consumer advocate who believes we need to empower consumers but I also know that people like my parents have no desire to see their lab results, nor do most doctors want patients looking up all of their tests and showing up with computer print outs.This argument is a canard and is sounds like nothing more then an attempt to build up their business (which is fine).

    The bigger concern for consumers is what private firms do with our data. Cerner (a large EHR) for example sells it as do all of the pharmacies 3rd parties to large drug companies at the rate of a couple of billion a year. Both Microsoft and HealthVault are free and have great privacy protections but honestly I am sure they both have a business plan to moniterize our data.

    The solution is not either or. We need government, business and most of all providers and consumers to sit down and work to come up with a solution instead of demanding anything.
    eHealthAdvocate
    • Great post. Recommended

      I would like everyone who has posted here, regardless of their politics, to look carefully (and maybe even respond) to what eHealthAdvocate has written here.

      This adds tremendous value to the post, by laying out the economic issues on both sides of the divide.

      Thanks so much.
      DanaBlankenhorn