Healthy debate on electronic health records

By Steve Johnson

Mercury News
Article Launched: 10/31/2008 07:00:00 PM PDT

Backed by both presidential candidates, Silicon Valley tech giants and
other companies are leading an effort to create electronic health
records containing data about your most intimate health conditions —
from your bunions and bad back to your chronic hemorrhoids and
psychiatric history — so the information can be easily shared with
doctors, insurers and others.

Proponents of electronic health records believe they can dramatically
cut medical costs and lessen the likelihood of patients being
improperly treated. As a result, voluntary programs to test the
concept recently have been launched by major corporations, from
Silicon Valley tech titans Google and Intel to Microsoft.

But despite assurances the records will be kept confidential and
patients will control who sees them, consumer advocates fear the trend
will lead to widespread privacy violations and relentless marketing by
hucksters misusing the data.

"Increasingly, consumers will be receiving an array of pitches and
promotions and product offerings based on very sophisticated
analytical assessments of their health information," said Jeff
Chester, executive director of the Center for Digital Democracy. "This
is an area rife with problems."

Saying the paper records used by most doctors are inefficient, waste
money and make it hard for health professionals to exchange vital
information about patients, President Bush in 2004 ordered the federal
government to begin planning
for the nationwide adoption of electronic health records. And that
goal is being enthusiastically pushed by his would-be successors.

Computerizing such records makes sense "instead of you filling out
forms in triplicate when you go to the hospital, that will reduce
medical errors and reduce costs," said Barack Obama during the
candidate's second debate Oct. 7.

"Let's put health records online," replied John McCain.

Major corporations are promoting the concept, as well.

In May, Google set up an area on its Web site, dubbed Google Health,
where people can place their health records and share the information
with doctors and others. Patients now can exchange health data with
only a few doctors participating with Google Health, but Google plans
to broaden its record-sharing features.

Not to be outdone, Microsoft in June announced a deal to let Kaiser
Permanente's 159,000 employees store their medical data on Microsoft's
HealthVault site. Late last month, Microsoft unveiled a similar
arrangement for patients covered by insurer Aetna.

In addition, Santa Clara computer-chip maker Intel has teamed with
several large companies, including Applied Materials, Wal-Mart and
Pitney Bowes, to create an independent Web-based entity, called
Dossia, where the companies' employees can manage their health data.

The services are free for patients and the companies involved insist
they're not in it for the money.

"None of us are approaching this because we think we can create a new
product line," said Colin Evans, an Intel manager who is Dossia's
chief executive, insisting Intel's interest is to help improve its
workers' health.

"Most doctors keep their data on paper. That's dangerous. If doctors
can't exchange information or have an incomplete view of the patients
because they don't have the records," he said, it can have serious
consequences and has even led to some patients' deaths.

As Microsoft has promised, Google won't pepper patients with unwanted
ads, said Dr. Roni Zeiger, product manager for Google Health. Instead,
he added, the Internet search giant believes it can benefit indirectly
by providing a vital consumer service.

"We think that when people are signed in to applications they trust
and appreciate, they will tend to use other Google products,"
including Google's main search site, which does have ads.

So far, just 13 percent of U.S. doctors use some computerized records
and 4 percent do so extensively, according to a New England Journal of
Medicine national survey of nearly 3,000 physicians in July. But if
the adoption of such records becomes widespread, it could open up a
huge business opportunity. Research firm Kalorama Information
estimates the annual market for products related to such systems could
hit $4 billion by 2015.

Much of the equipment needed to link the network would have to be
powered by computer chips, for example, a potential big plus for
Intel. Google also might be able to charge businesses such as
weight-loss services to put their nutritional or other medical tips on
Google Health, said Andrew Rocklin, a health expert at Diamond
Management & Technology Consultants in Chicago.

But the concept has run into resistance.

Of 1,003 Americans surveyed two years ago by the New York-based Markle
Foundation, which promotes new communication technologies, 77 percent
suspected their information could get into the hands of marketers and
80 percent feared they could be exposed to identify theft and fraud.

Those worries are warranted, consumer advocates say. "One of the
ongoing concerns I think with both Microsoft and Google is these
business models are constantly in flux," said Marc Rotenberg,
executive director of the Electronic Privacy Information Center in
Washington. "They may say today there is no advertising. Once they are
in possession of the medical data, they can change the business
model."

Recent medical-data breaches also have contributed to the misgivings.
In April, federal prosecutors in New York charged a former hospital
employee with improperly accessing nearly 50,000 computerized health
records of patients so he could sell the information to others.

Contact Steve Johnson at sjohnson@mercurynews.com or (408) 920-5043.

Google Health Launches Non-Profit Patient Assistance Web Site

November 03, 2008

by Becky Jacoby, Reporter

Information on thousands of patient assistance programs can be found online at PatientAssistant.com, Inc. (PatientAssistant), a new nonprofit organization and integrated service launched by Google Health.

A patient assistance program is a service offered by pharmaceutical companies to help low-income, underinsured or uninsured individuals or families procure medications for free or low cost. Based on medications listed in the patient's Google Health profile, the application facilitates a search for eligible patient assistant drug programs. PatientAssistant helps users to identify affordable pricing, thus saving money on the prescription drugs that they need.

"The more medications a patient is required to take, the longer and more difficult it can become for them to find patience assistance programs that meet all of their needs," stated Rex Bowden, President, PatienceAssistance.com, Inc. "Our new integrated service on the Google Health platform is designed to make that process much easier by allowing users to search for programs on multiple medications at once, while using existing information to save time in searching for eligible programs that meet all, or most, of the patient's needs," he said.

How does Google Health work? Users create a Google account, register their medical records and health information then log in to www.google.com/health and "Explore Online Health Services." A walk-through of the program's features is available prior to sign-up.

PatientAssistant also shows users the costs of their prescriptions within their geographic area. It also offers related tools such as the ability to send reminders to patients to submit enrollment forms.

Aetna Teams Up With Microsoft For Health Records Storage

Submitted by Piyush Diwan on Thu, 10/23/2008 - 08:13.

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In a first of its kind, health insurer Aetna Inc. teaming up with Microsoft Corp. is offering clients medical record storage, allowing them to access the Internet-based vault, even if they change jobs or replace their health plan for another.  According to Wall Street Journal, beginning next month, all Aetna clients will be able to transfer information from their Aetna 'personal health record', an online repository of data, such as, claims, diagnoses, test results and prescriptions, to HealthVault.  Patients will be allowed to choose what they want to transfer between Aetna and Microsoft.

A recent trend, of late, several firms like Google Inc., have created web sites that allow people to store health information e.g. doctors, hospitals and pharmacy records at one place.  Not to be left behind, even IBM and Duke University have set up a web site, specifically for allowing people to pay medical bills, schedule doctor appointments and store medical records, amongst other things.

The customer retains total control over access of his /her health data, including information that can be seen.  No one, not even doctors or care providers, not even Microsoft officials can access the information, unless and until they have been permitted to do so by the patient.  A highly advantageous system, it not only gives clients continued access, but also helps improve communication with care and service providers.

Launched just about a year ago, Microsoft's free HealthVault has about 40 firms that currently allow customers to store information on it, including hospitals and CVS Caremark's Minute Clinic.  A cost effective measure for both the insurer and its customers, Health Vault is not only free, it will also help the insurer save tens of thousands of dollars it currently spends on answering benefit queries over the phone.  As soon as, the electronic personal health records of 6-million Aetna customers transfer online, there will be little need to pick up the phone.

	THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING

Subjects' DNA secrets to be revealed Web postings may boost research By Carey Goldberg, Globe Staff  |  October 20, 2008 The human ability to let it all hang out is about to reach a whole new level. Ten genome-era explorers assembled by a Harvard Medical School genetics professor are expected to announce today that they will post their medical records and the DNA sequence of about one-fifth of their genes on the Web for all to see. The 10 include the genetics professor himself, George Church; Harvard psychology professor Steven Pinker; and technology investor Esther Dyson - and they are leading the way for a hoped-for crowd. In April, Church's "Personal Genome Project" received approval from the university's ethical review board to sequence and post the genes and records of 100,000 willing subjects. The project aims to advance genome research by tapping volunteers who have a Facebook-mentality sense of privacy - minimal - and enough excitement about genomic science that they are willing to lay out their genetic and medical information so any researcher can sift through it for links between genes and traits.  (Personally I would like to be able to recognize the DNA of the Facebook mentality.) "There's a hope that by making these data public, you can harness crowd-sourcing power in the same way that Wikipedia and YouTube and Google and Linux all emerged from cooperative, distributed efforts," Pinker said. The project's approach - its sense that genetic self-disclosure is not necessarily scary - contrasts sharply with the concerns about genetic privacy that recently prompted Congress to pass the Genetic Information Non-Discrimination Act, which bars insurers or employers from holding people's genes against them. Personal Genome Project participants voluntarily relinquish their genetic privacy for the sake of research - and out of curiosity about what will emerge. The idea, Church said, is that researchers need to explore how genes and environment interact to produce everything from disease to personality, and for that, they need both faster, cheaper DNA sequencing and great databanks of people's characteristics. "As far as I know," he said, "this is the first time an attempt has been made to put a collection of all those together in a way that anyone can access it." Interviewed by phone last week, several of the project's participants said they were committed to disclosing their gene information, even though they will have a last-minute chance to decline. They plan to talk about their results and decisions at a press conference this afternoon. They said they believed deeply in others' rights to genetic privacy, but they had good reasons to let go of theirs, and had the luxury of holding positions in life that left them unworried about potential discrimination. ( Thieves very rarely discriminate against individuals of position, when they choose to steal their identities. ) "I'm a physician and a chief information officer, and I believe in the rich tradition of self-experimentation," said Dr. John Halamka of Beth Israel Deaconess Medical Center. "What we have to learn as a society is: What does this data show, how do we use it, how do we protect it, what are the pitfalls?" Halamka got his initial results yesterday, and said they suggested he could be at heightened risk for several diseases that have not in fact affected him, including a paralyzing neurological disease and tuberculosis. He also carries a single mutation that, if a person has two of them, doubles the risk of prostate cancer. So "today's disclosure changes the way, for the rest of my life, I relate to doctors in that if I have a change in PSA [Prostate Specific Antigen] or prostate exam, I'll be much more likely to follow it up. Doctors can be the worst patients." Halamka had a preparatory talk with his 16-year-old daughter, he said, telling her that his genes would be posted publicly and reminding her that half of her genes came from him. A future suitor of hers, he said, "could look at my data on the Web and say, 'You know, I just don't think this is a suitable life mate because look at the risk for this and the risk for that.' And her response was very mature, which was, 'If a prospective boyfriend evaluated me based on your genome, I wouldn't want him as a boyfriend anyway!' " Along similar lines, Rosalynn Gill, a founder of Sciona, a Colorado-based personal genetics company, said that part of her motivation for baring her genes was to make the point that "it's not just your genes that determine who you are." The project at this point, Church said, has sequenced only about 20 percent of the participants' genome regions that instruct cells how to make proteins, the tiny machines that make the body run. But it will ultimately scan all their genes, he said, and at a cost of $1,000 or $2,000 per person. It would be hard to calculate the sequencing cost for current volunteers, Church said, because the technology is still in the development stage. Attaining a "$1,000 genome" is the focus of hot competition in the DNA technology field, and Church co-founded a Cambridge company, Knome Inc., that offers to sequence a person's complete genome for $350,000. Many predict the $1,000 genome will be possible within a few years. Personal genome companies that already offer consumers data on hundreds of genes of interest currently charge about $1,000 or less, but they examine only myriad small chunks of their customers' genomes.  There may be significant downsides to posting your genetic data on the Web, said Dr. David Altshuler, a leading genomics researcher at the Broad Institute and Massachusetts General Hospital. Would you really want your DNA and medical records to come up when a date or prospective employer Googles you? What if, in the future, an enemy can synthesize your DNA and plant it at a crime scene? But Altshuler said he welcomed the public debate that the Personal Genome Project will surely spark. "The project is forcing a societal discussion of what it would mean to put up your data - what uses it could be put to, and what limits it would have, and that's a very useful discussion to have," he said. To see the postings: http://www.personalgenomes.org Carey Goldberg can be reached at goldberg@globe.com.

© Copyright 2008 The New York Times Company
 

Remember when it is on the web, it is there forever. 
And there is no guarantee of security for your identity.

This free offer may be the most expensive choice you make in your entire life.

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October 12, 2008

Novelties

Keeping Your Own Health Chart, Online

By ANNE EISENBERG

BUSY people can easily forget to take their medications, or to write down symptoms or reactions during a course of treatment — information that could later be meaningful to a doctor.

New tools are being developed that may help harried patients, including those with chronic health conditions, monitor their medications, home tests and other details. The information can then be posted to a Web page that the patient can choose to share with a doctor, pharmacist, friend or caregiver.

Zume Life, of San Jose, Calif., for example, is testing a small hand-held device, the Zuri, that prompts users to take their pills on schedule and to keep track of health-related matters like diet and exercise.

"We're going after users who are mobile, social, active people" who need to follow a health routine in the midst of busy lives, said Rajiv Mehta, the chief executive of Zume Life.

All of the data from this pocket-size electronic minder, which beeps or flashes when it's time to take a pill, are uploaded to a Web portal. There, users can inspect, for example, graphs or charts of their exercise or other activities of the last few days or week. And, if the users wish, a caregiver can do so, too.

The Zuri will cost about $200 when it is released in the spring, Mr. Mehta said. Users will also pay about $40 to $50 a month for Web services. A software version of the device that will run on an iPhone is also in the works.

Kathleen Weaver, a high school teacher of computer science in the Dallas Independent School District, is testing a Zuri, using it to keep track of symptoms as well as medication related to diabetes, cardiovascular complications and a persistent cough.

"If I had to write all of this down, I don't think I could," she said. "I'm busy all day taking care of other people."

People who are monitoring their health at home may also take advantage of new online data-storage services being developed by Google, Microsoft and other companies. HealthVault (www.healthvault.com) by Microsoft lets users upload data directly to their account from about 50 devices, including many blood pressure and heart rate monitors, blood glucose meters and weight scales, said Sean Nolan, a computer scientist and chief architect of the Microsoft Health Solutions Group in Redmond, Wash.

Owners of the account can then share the data with, say, a nurse or case manager who is tracking how they are responding to a new medication. They can also share information with compatible applications — for example, a free blood pressure manager program from the American Heart Association (www.americanheart.org).

The number of applications that can exchange information with HealthVault is growing, Mr. Nolan said. NoMoreClipboard (www.nomoreclipboard.com), for instance, can draw data from HealthVault to fill in information in medical forms typically required for an initial visit to a doctor. (The basic service is free.)

TrialX (www.Trialx.org) matches patients to relevant clinical trials based on their health information (no charge for patients).

Users of HealthVault can even arrange to have faxes sent directly to their accounts through a number arranged with MaxEmail (www.maxemail.com). All faxes sent to the number, like those for immunization records and lab results, are automatically uploaded to the account ($8.95 a year).

Until recently, there was no easy way for most people to make their health information available to others on the Web, said David Lansky, president and chief executive of the Pacific Business Group on Health, in San Francisco, a coalition of health care buyers.

But people will use the new sites being developed by Google, Microsoft and others as they now use online tools to manage their finances, travel and shopping, Mr. Lansky said.

"This is part of a shift toward a medical system that is more centered on and directed by patients themselves," he said.

First, however, patients will have to become comfortable placing medical data like readings from home tests online.

Mr. Nolan of Microsoft said that with HealthVault, "you, the account holder, control your health information" and can decide whether and what to share.

If people's concerns about confidentiality and security are addressed successfully, online repositories could have advantages, said Dr. Robert Steinbrook, a national correspondent for The New England Journal of Medicine.

For example, Dr. Steinbrook said, "a nurse could review information about weight on a daily basis sent directly from a scale to a repository, and not necessarily have to send out someone to weigh a patient."

But such programs are still under development, he said, and "all of this remains to be seen."

E-mail: novelties@nytimes.com

Medicare and Medicaid: What's the Difference?

Medicare and Medicaid coverage explained.

Medicare and Medicaid are very different. Medicaid is a federal program for low-income, financially needy people, set up by the federal government and administered differently in each state. (This program is called Medi-Cal in California.)

Eligibility for Medicare, also a federal program, is not tied to individual need. Rather, it is an entitlement program; you are entitled to it because you or your spouse paid for it through employment or self-employment taxes. Medicare was created in an attempt to address the fact that many older citizens have medical bills significantly higher than the rest of the population, while it is much more difficult for most seniors to continue to earn enough money to cover those bills.

Although you may qualify for and receive coverage from both Medicare and Medicaid, there are separate eligibility requirements for each program -- being eligible for one program does not necessarily mean you are eligible for the other. Also, Medicaid pays for some services for which Medicare does not. If you are eligible for Medicaid, Medicaid may pay Medicare deductibles and the Medicare premium.

Do you know where your medical records are?

IBM Launches Cloud Computing Center in India Date Submitted: Thu Oct 02, 2008

BANGALORE: IBM has unveiled a cloud computing center in Bangalore. The center will give enterprise customers including mid-market, universities and government bodies in India immediate access to the resources they need to pilot cloud infrastructures and applications, and deliver new and innovative services to their customers. The center in Bangalore joins other new Cloud Computing centers in Korea, Vietnam and Brazil. These centers will cater to an increasing demand in emerging markets such as India for Internet-based new computing models and skills.

IBM Cloud Computing Centers host computing activities for clients or provide access to expertise and infrastructures for clients to design and deploy their own cloud environments. This computing model allows businesses and consumers alike to remotely access a vast computing resource that can be tapped on-demand to deliver next-generation services that consumers demand, like online medical records or mobile stock portfolio management. It also improves energy efficiency because of its principle as a shared infrastructure, and allows organizations to better track information, pay for what they use and access more computing, storage, services or applications on demand.

IBM is already collaborating with partners, government and academia in other emerging countries to facilitate innovation supported by a Cloud infrastructure. In India, clients such as mid-market vendors, academic institutions, telecommunications companies and government bodies will be able to access the center for the resources they need to pilot cloud infrastructures and applications, and deliver new services to their customers.

"Cloud computing enables server centric virtualization which helps IT ecosystem to achieve smaller footprint, efficient resource utilization and server consolidation. Enterprises are looking at alternate ways to support their dramatically increasing computing needs, one that will allow for massive scalability while providing an energy efficient and resilient infrastructure. Technology collaboration between IIT Kanpur and IBM India will drive new developments in computing to support academic advancement and economic development in India," Said, Prof. Sanjay G. Dhande, Director, Indian Institute of Technology, Kanpur.

Dr. Ponani Gopalakrishnan, Vice President, India Software Lab, said, "The convergence of personally empowering technologies into the hands of the consumer is fundamentally changing consumer behavior and expectations. Cloud computing offers an answer for many of these needs and allows an organization to further reduce costs through improved utilization, reduced administration and infrastructure costs, and faster deployment cycles."

One of the prime agendas for the center in India will be to help enterprises looking to transform their data center for service delivery and innovation, as well as startup businesses or organizations that do not have or cannot afford to build an entirely new infrastructure. There will be a special focus on the fast growing communications industry including content providers, internet service providers and telecom companies.