Google cuts and runs early – The Death knell has sounded for #GoogleHealth

So Google is cutting and running too early from Google Health. In the short term this no doubt makes obvious sense to Google but in the long term I believe this to be a big mistake. 

Health was always a long term play. An industry mired in regulation and conservative approaches, things were never going to change quickly. However, momentum is building. We are seeing a tremendous uptick in innovations that make use of Government Health Data. Just look at the activities at the recent DC Health Innovation Week and people like Tim O’Reilly calling for us to rethink Privacy in Health where “HIPAA has represented the Maginot Line in Health Data protection”. 

Personally, I still use Google Health on a daily basis. My Fitbit and numerous other health related data sources feed in to Google Health and pass data out to other services like I recently moved my Pharmacy because I could have my data automatically piped in to Google Health

Google Health – what we call an untethered Personal Health Record – was NOT a destination in and of itself. Instead it was more useful as a conduit through which we could channel our health data. 

What is ironic is that Google is implementing the Direct Project protocol to make it easier to exchange Google Health Data with other platforms. The Direct Project Protocol is what the Patients 2.0 movement liken to a white button (like the VA’s Blue Button) but one that allows me to send my detailed health data to another site or provider. There is a lot of discussion happening around the Rainbow Button Initiative (Blue, White, Green and Red buttons) in the Patients 2.0 world. 

As Meaningful Use requirements kick in as a result of the implementation of the Affordable Care Act we can expect to see Patient Portals popping up like daisies and consequently a growing need to provide a place that Patients can bring together all these disparate data sources in order to get a comprehensive view of their Health. It is not happening yet, but expect to see changes happening in 2012 and people starting to look for solutions to help them get their arms around their health data. The problem for Google will be that by cutting and running now who will trust them in the future if they decide to come back to the table?

Meainingful Use: Portals, Portals everywhere but not a way to share (#MeaningfulUse #hcdc #healthapps #dchealth)

I was reading an article in Contactless News about “HealthCare Providers seeking convergence” in Identity Management as Meaningful Use criteria come in to play in the HealthCare field. It got me thinking about the future for Patients in a world of Patient Portals.

Meaningful Use

Meaningful use demands that “health care data be kept confidential, private and secure, accurate, shareable with patients as well as providers, mobile and exchangeable, and readily available.” A tall order!

My fear is that we are headed for a situation where patients are tossed in to the sea of meaningful use without a care for the big picture from the patient’s perspective. Why do I fear this?

HealthCare providers, payers and other data handlers in the Industry are still mired in 1990’s technology approaches in how they control their data, or rather; the data that they manage. The emerging interpretation of Meaningful Use is the application of the old style approach – The Patient Portal. 

Don’t get me wrong – there is nothing wrong with a Patient Portal per se. Just look at the level of engagement that Kaiser Permanente have achieved by providing their patients/members with a usable and useful patient portal. But Kaiser Permanente is one of those exceptions – they are an integrated system. For the vast majority of consumers who are not receiving care via an integrated health system the situation is about to become vastly more complicated.

Portals, Portals Everywhere

For Providers to comply with Meaningful Use they will no doubt deliver a Patient Portal. Many of the Practice Management Systems provide the capability almost out of the box. 

But what happens when a patient is needing to visit the Primary Care Physician, a couple of specialists, may be a surgery center, a retail clinic and the local hospital? How many Portals will they have to navigate? How will they get a comprehensive view of their records?

Paranoid Security Reduces Security

In order to comply with HIPAA regulations I can see HealthCare providers implementing complex userid and password requirements. Not letting patients reuse a password, having different rules that prevent the same password being used in multiple systems. Again, don’t get me wrong, these are all commendable steps to secure data. But when a patient is managing multiple systems and user accounts the end result is that if they can’t easily remember a userid and password they will either write it down, or just hit the password reset button and have a new password setup via an email mechanism. 

Is this really better security?

There Is An Alternative

There are two steps that HealthCare Industry system providers can adopt that can dramatically improve this situation:

1. Adopt OpenID/OAuth for Authentication. 
2. Support the Rainbow button Initiative

1. OpenID/OAuth

OpenID/OAuth is broadly the process by which Facebook and Twitter allow users to connect their respective account to another service. The benefit of this is that a user can login to another service using their Facebook or Twitter account credentials – without ever revealing their account password to the new service.  The big advantage of this is that there are fewer password resets because the user is making use of a userid and password combination that they use on a regular basis and therefore are more likely to remember.

OpenID/OAuth is already being adopted by the Federal Government to allow citizens to login to federal websites. If it is good enough for the Government shouldn’t it be good enough for HealthCare. The Twitter Authentication mechanism is also being baked in to the core of Apple’s iOS 5 making it a standard across hundreds of millions of Apple devices.

I urge every HealthCare Portal developer to integrate Single Sign-on using OpenID/OAuth. Development libraries are available from companies like JanRain. I implemented the JanRain Library on in about an hour using a JanRain plugin for WordPress. If you want to be a really proactive developer you can fully implement OpenId/OAuth so that your portal account can act as credentials to connect to other sites. This is something that any Health Care Payer organization should be thinking about.

The big win for the member/patient is that as patient portals proliferate life doesn’t have to get more complicated. When they have to connect to a new Patient Portal they can reuse their account credentials from elsewhere. This can even simplify account setup on a new portal by allowing basic demographic data to be taken from the source account. e.g. Name, Address, Email, Gender, Date of Birth.

2. Support the Rainbow Button Initiative

At Patients 2.0 and we have been supporting the VA/HHS Blue Button Initiative and have promoted an expansion of the concept – The Rainbow Button Initiative. I urge all Patient Portal Providers to implement the Rainbow Button idea:

Blue Button – Download my Health Data to my computer using a standard format

Green Button – Allow me to donate my health data anonymously to another organization 

White Button – Allow me to send/upload my detailed Health Data to another Provider (or copy me when my data is sent between providers)

Red Button – Lock elements of my Health Record I do not want to be shared.

By implementing these simple buttons a Portal provider can give Patients a simple set of tools to manage their Health Records. Allowing them to import and export their data. 

Act Now Before It Gets Too Complicated

If we don’t take steps in these early days of Meaningful Use to provide tools, like single sign-on and data interchange buttons, to simplify life for Patients then we will be creating yet another overly complicated, archaic monster that patients are forced to navigate around. 

Failure to act will chalk up Meaningful Use as yet another great idea that becomes a barrier to better health in it’s implementation. After all, we have been here before. HIPAA was about Portability and yet it became just another form to fill in and an excuse for locking up data from patients while still freely sharing it amongst industry business partners.

#wordpress #meetup at the beehive w/ Roni Noone

This evening is a trip out for a techie event – the Baltimore WordPress meetup group. This is my first time at this meetup, but with running a WordPress network site this seemed like a useful group to attend. Roni Noone shares her story and experience working with WordPress. Her first experience was building a custom site – with all the features of a blog. Eventually went to and downloaded the software and control her website. So the switch was made. Her focus was weight loss. Ended up posting daily. Focus on content and not software. Then the hosting platform crashed. And there were no backups. Switching to blogger saved the day – but eventually went back to WordPress but diversified. Created blogs for specific content then tweaked sites for specific content and purpose. The downside – blog schizophrenia and no one home base.

Roni’s Weigh is oldest blog and home base. Customized version of neoclassical. Not a widget fan – tweak PhP/HTML/CSS instead.

Plugins used: Akismet
Comment email responder
Podcasting plugin by TSG
Subscribe to comments
Wp super cache
Pick giveaway winner

Greenlightbites is food blog. Very tight niche. Mainly recipes and pictures.

You can use WPquery to pull specific content from DB and add that above main loop. then exclude WPquery content from main loop.

Add extra users as authors to allow people to upload and publish their own content. Editor allows people to edit the content of others.

Use categories and tags to allow readers to find content.

Plugins: Post-plugin library
Wp-pagenavi – Navigate by page number
For blogging and tech topics.
outsourced to

Conference site for bloggers in health and fitness. Intensedebate plug in.

Tumblr style in wordpress Clear theme Barebones site

Tool set:
Photoshop / illustrator
iMovie GarageBand Social media:
Fan page for each site on Facebook All sites have autofeed to twitter to secure name.

@RoniNoone for chat on twitter. Personal page on FB for chat too.


iTunes via Linkshare

Regular readers don’t click on ads. They read content so use CPM ads rather than CPC.

A really informative presentation.

Watch for the presentation on

Mark Scrimshire
….Sent from my iPhone

#hipdc @Lostonroute66 talking PillBox

We are here supporting HealthCamp allumni David Hale (@lostonroute66) and Lindsey Hoggle (@lindseybh) who are presenting at Health Informatics Pulse (#HIPDC).

David will be closing the session by telling us about HealthCamp program graduate PillBox going live. This is great news!

Lindsey Hoggle will also be talking about Meaningful Use. I am keen to see what Lindsey has to say as a consultant from the front lines in an adventure in HITECH implementation. Charles Sneiderman kicks off discussing EMRs and clinical decision support tool for post traumatic stress ( no D for disorder because PTS can be considered a normal response to a hyper stressful situation.)

Next up Mones Abu-Asab talking about toxic assets in micro biology. Heterogeneity of rumors occurs at multiple levels. Phylogenetics offers best chance to perform effective analysis using a parsimonious approach. Lindsey Hoggle is up to talk about meaningful use. The legislation HITECH act passed in 2009. Basically meaningful use means implementing EMRs and putting then to use for the benefit of patients.

Markle found 85% of public not familiar with HITECH. Results not much better amongst the medical community. 2011 we are in stage 1. Incentives are available but Penalties start in 2014.

The data follows the patient – electronically.

Now up David Hale talking PillBox 53 slides in 5 minutes.

Getting pill data today is like searching for a meddle in a haystack of haystacks.

Pillbox makes pill data accessible. Vice Le data liberacion.

Mashing multiple data sets makes data accessible and actionable.

The open API Arrives – no key required

David Hale – rock star with the matrix jacket! Mission accomplished. Complete with mention of the roots of pillbox in the public domain at healthCamp DC in 2008.

The sequel to Pillbox? Pillbox 2 is international development incorporating foreign pills.

Question for Lindsey – how can we discover who has implemented EMRs and practice management systems and taken grant money for that purpose. Let’s unleash that data to help the public in their choice of providers. Will accountable care eat the lunch of meaningful use? It is not a competition. It is a crisis. ACOs are part of the solution. We all have to work together. IT is a critical component in achieving interoperability. It was a HealthCamp audience that introduced the data on inactive ingredients (found at pubmed) to pillbox. This is critical info for some allergy sufferers but was information that was previously unavailable.

Mark Scrimshire
….Sent from my iPhone

#health2dev One team wants to merge NCI Thesaurus with VA Blue Button

Use the VA Blue Button and add in a REST interface to LexEVS 6.0 Service

A neat idea. I wonder if the PillBox API would provide the same information. What about then piping the information to SurveyorHealth to check for drug interactions?

The next proposition is: Tackling Prescription drug non-compliance.

Merge EMR data with Pharmacy Benefits Manager the e-prescription and the personal health record. CYNCZ is a proprietary engine that syncs and de-dupes the information from these sources.

This is a problem that is of great interest to the ONC.
@Aviars is proposing a team to develop a solution for a HIV support organization in the District of Columbia. The challenge for today is taking the 7,000 tests performed in 2010 and visualize the information via various libraries.

A number of ideas bubbling up about Elder Care and Aging in Place. e.g. @cristianLiu proposed using the Elder Care Locator.