Recently in Health Care Category

...in reporting on the total scariness of Google Health. 

In an article in The New England Journal of Medicine, two leading researchers warn that the entry of big companies like Microsoft and Google into the field of personal health records could drastically alter the practice of clinical research and raise new challenges to the privacy of patient records.

The authors, Dr. Kenneth D. Mandl and Dr. Isaac S. Kohane, are longtime proponents of the benefits of electronic patient records to improve care and help individuals make smarter health decisions.

Did the good doctors read my story from over a month ago called Google Health is Frightening?People's medical records contain all kinds of things that are nobody's business but their own. Any doctor or hospital that would outsource their record-keeping, which is one of the most important things that a doctor can do for a patient (keep a good chart), is abdicating their responsibility and calls into question whether they value convenience over ethics. The doctor-patient relationship, including medical records, has long been considered sacrosanct. For a company like Google to actually want to offer this as a service says more about their arrogance than the system itself does about their capacity to innovate, and for any doctor or hospital to buy or use it would, to me, be a violation of trust.

There are those in Washington and around the country (Paul Krugman is one) who believe that electronic, portable charts are the key to universal health care. Krugman regular cites the Veterans Administration as an example, since they use some electronic records. The big difference is a) they keep it in-house, and b) they are a single organization. If I wanted to send my VA records to a private doctor, I would have to jump through way more hoops than just telling Google it's OK...and I should have to. Hillary Clinton regularly throws out "e-charts" as the solution to all our problems, and more centralization of records was a big part of her failed 1993 "Hillarycare" plan that she is so loathe to discuss now.

This should not be easy.

Google should be commended for trying to simplify health care record keeping, but this is an arena where they should keep their mitts off. If they want to sell a "black box" turnkey solution for internal record keeping, go for it, but I will still insist on paper. Host my records for me? Go away.

How many times do I have to repeat myself?

The "27 hour" reference at the top of this page, is of course a reference to the fact that Alex and I live in two different time zones, but working with a partner across the country writing on technology and politics, which both move at incredible speeds these days, can take its toll. Now, the NYT says that blogging can kill.

Other bloggers complain of weight loss or gain, sleep disorders, exhaustion and other maladies born of the nonstop strain of producing for a news and information cycle that is as always-on as the Internet.

True, it's compulsive. I see things and post, even when I should be sleeping or working or whatever. The travel and the events take their toll. Even Michael Arrington realizes that "this is not sustainable"

London's Sunday Independent reports that a yet another mobile phone study has found that using one of those helpful little gadgets will kill more people than smoking or asbestos.

Mobile phones could kill far more people than smoking or asbestos, a study by an award-winning cancer expert has concluded. He says people should avoid using them wherever possible and that governments and the mobile phone industry must take "immediate steps" to reduce exposure to their radiation.

The study, by Dr Vini Khurana, is the most devastating indictment yet published of the health risks.

It draws on growing evidence - exclusively reported in the IoS in October - that using handsets for 10 years or more can double the risk of brain cancer. Cancers take at least a decade to develop, invalidating official safety assurances based on earlier studies which included few, if any, people who had used the phones for that long.

I guess if they're right, the answer to "where you at" will be "in the hospital, fool!"

The Washington Post reports today that a laptop containing "sensitive medical information" on more than 2,500 patients in a NIH study was stolen last month, potentially exposing seven years worth of data, including names, diagnoses and heart scans to...people who would want to bore themselves to death reading that kind of thing.

What is more interesting is that the Post reports that the data on the laptop was not encrypted, a clear violation of Government security policies. And to think I was worried about Google Health. 

Here's a question. Why is this data, which is supposed to be encrypted and kept under the highest confidentiality and security, kept on a laptop computer which any bloke could simply walk away with? I don't know about you, but if I wanted to keep data secure, I'd keep it on an encrypted external hard disk, which I'd disconnect and keep under lock and key when not in use, with the keys on a separate flash drive under separate lock and key.

It's great that the Government requires patient data to be encrypted, but that doesn't do me much good if the machine it is encrypted on is readily accessable, and the keys aren't secured somewhere else.

At least they're learning...

Nabel, in her statement, said that since the NIH incident, "we are ensuring" that all the institute's laptop computers are encrypted and that staff members will be required to take regular computer security training. She also said "patient names, other identifying information, or identifiable medical information" will no longer be stored on laptop computers

The Hill prints some truly idiotic ideas from DC people sometimes. Every single proponent of "health care reform" agrees that better patient record-keeping is a good idea. It's a centerpiece of every presidential candidate's proposal, as if digital health records are some kind of magic way to cut costs. As expected, everyone wants to get in on this next federally mandated gravy train. I've already written about Google Health in these pages, and Microsoft has introduced their HealthVault software, but did you know that Steve Case, the man who built AOL (and watched it become worthless) has his own great idea for keeping your most intimate information in a computer?

The vice president of the American College of Physicians , Michael Barr, agreed that the government still has a role to play even as these companies are positioning themselves in the market for electronic medical records.

Uniform standards for sharing medical information still need to be established because healthcare providers are responsible for maintaining complete "medical legal records" for their patients, Barr said. "They're working on one end of it and not the other," he said of Google, Microsoft and the other technology companies.

While useful to patients, "these [personal health records] that Microsoft and Google are providing will not replace the medical charts ... for documentation purposes," Barr added.

So, these things are pretty much useless except from a data mining point of view. Your doctor is going to have to keep his own records, so why would you give them to Google or Microsoft, or anyone, for that matter? Keep in mind that these third-party companies are not covered by the Health Insurance Portability and Accountability Act. Once you give them your records, you've given them your records. Their rights are defined by terms of service. Of course, they'll tell you that they have no reason to hurt your privacy, that there is a "market force" behind keeping your data secret. 

The Health Information Trust Alliance, a private cooperative led by representatives of healthcare and technology companies, released a survey of health IT executives on Monday showing widespread concern about the absence of a uniform, HIPAA-compliant information security framework that medical providers and companies can employ.

Update - they're back up on the Google Blog, but it seems like they aren't letting us link to them from here. Also, the trackbacks are still disabled. Here's the same cut-and-paste as earlier. The images come up now, but they don't come up in the post from yesterday Now click on the link to the entry...still no trackbacks!

Here is a screenshot deeper in the application:



We're proud of the product that we've designed and are continuing to build, but recognize that we are just at the initial stages of our "launch early and iterate" strategy. We look forward to the feedback we will receive from our Cleveland Clinic pilot, from all of you, and from the initial users of our service when we make it publicly available in the coming months.

Did anyone notice that they've disappeared from the Google Blog? Only the original press-releasish blog post remains. Did they put it down the memory hole? Have they invented one?

Are they backtracking now that people have heard about this privacy nightmare of a product? They should know you can't just make it go away.

Still waiting, Google...

So one of my regular reads is the Google Blog. Recently, I've been writing about some of their entries, and it's been driving some traffic this way since they link to posts that link back to them.

Today around 10:30 am I read a post on Google Blog about their new Google Health product that described it and showed some screen shots. I thought "wow, that's a bad idea" and I so I took a lunch break, threw together my thoughts and posted them here on this site. The post went live at 12:00pm EST.

Now, I had been busy at work, but earlier (around 9:45am EST) I had checked the Google Analytics for the site and the visitor count was low since neither Alex nor myself had posted anything new since last night (2/27/07). Maybe an hour after I posted I went back and was a bit shocked, the visitor count had gone through the roof. I looked at the Google Blog, and out of all the links shown on the "Links to This Post" list, mine was the only one with a remotely critical title, "Google Health is Frightening." The rest were either simply linking or re-reporting with various degrees of fawning and praise going on. Yet, there was my post on how I thought it's a horrible idea, and that any doctor would be insane to use it, and that there were probably legal issues that hadn't properly been considered.  It was maybe the 5th link in the list.

Around 4:00PM EST I noticed the hit count slowing. I went back to the source (the original Google Blog post), and lo and behold, the post had every single link/trackback deleted.

Not only that, but they turned off the trackbacks for every single post on the blog, but didn't remove the presence of the feature from their front page template! Look! Straight-up cut-and-paste job from their front page as of 10:30PM EST:

Here is a screenshot deeper in the application:

We're proud of the product that we've designed and are continuing to build, but recognize that we are just at the initial stages of our "launch early and iterate" strategy. We look forward to the feedback we will receive from our Cleveland Clinic pilot, from all of you, and from the initial users of our service when we make it publicly available in the coming months.

Permalink Links to this post

Labels: healthcare

Now, when I went to click on the "Links to this post" link, I got a blank space. Nothing. All the  trackbacks are kaput.

So, it's ok to link to the Google Blog in order to shower them with praises and talk about how revolutionary and wonderful they are...but criticize them or suggest they are heading down a dark path? They'll make you disappear. At least that's what it looks like. Now, I know a lot of tech types don't get Washington, but us Beltway locals have a saying: "the coverup is worse than the crime." You may have heard that before.

Hey, Google Bloggers: want to tell me why you turned off trackbacks? If you give me a real reason, I'll even apologize to you. Heck, I'll fly out to California and buy you all a round of your preferred beer.

But only if you can prove to me that you're not so scared of criticism based on your own blog that the second someone does, you stop linking back.

Your corporate motto is "do no evil" but honestly, this looks like something Steve Ballmer would do. I'm just too far away from the Googleplex for you to throw chairs at me.

So come on, Google Bloggers. Turn them back on, or explain on your blog why they are gone.

I'll be reading. And I'll be writing, too.

That's right. Google wants to host your medical records. Last week they announced a partnership with a clinic in Cleveland, OH. Now they're talking more about the product itself. Here's the scoop from Google Blog:

 

• Platform - One of the most exciting and innovative parts of Google Health is our platform strategy. We're assembling a directory of third-party services that interoperate with Google Health. Right now, this means you'll be able to automatically import information such as your doctors' records, your prescription history, and your test results into Google Health in order to easily access and and control your data. Later, this platform strategy will mean that you will be able to interact with services and tools easily, and will be able to do things like schedule appointments, refill prescriptions, and start using new wellness tools.

• Portability - Our Internet presence ultimately means that through Google Health, you will be able to have access and control over your health data from anywhere. Through the Cleveland Clinic pilot, we have already found great use-cases in which, for example, people spend 6 months of the year in Ohio, and 6 months of the year in Florida or Arizona, and will now be able to move their health data between their various health providers seamlessly and with total control. Previously, this would have required carrying paper records back and forth. With Google Health, the user can simply import the data from each medical facility and then choose to share it with the other facilities. It's advances in data portability like this that we think can really make a difference in the quality of healthcare. The clearer and more comprehensive the information regarding your health becomes, the better your care will be.

I'll be clear. I like Google. I think they mean well. They've got a ton of smart people there. On the other hand, the idea that my medical records are stored somewhere central, indexed and made available to anyone who can get access to the machine (as opposed to my doctor keeping his own records and sharing them when I tell him to) goes completely counter to my sense of privacy. Some things are best kept difficult. Sharing confidential records of any short should be one of them. To be honest, I think anything you want to keep secret or confidential should be on paper. My doctor, who is a pretty young, tech-savvy individual, uses a tablet PC to take his charts, and he's been kind enough to print his notes and stick them in a paper file.

Why do I ask him to do this when I don't have anything to hide? When there is no paper, there is no paper trail. If I know that only my doctor has my records, if they show up anywhere else, I have a pretty good idea of where they came from. If they're hosted on Google's machines, I have no idea who is doing what with my data.

Would this extend to mental health records? Imagine if you went to a therapist, marriage counselor, rehab, whatever, and those notes and records were online for "easy access." I want it to be a total pain in the neck for anyone to get them. I want it to be difficult for me to get them sent to anyone.

I switched Dentists this year. To transfer my charts and X-Rays, I had to call my old dentist, have them fax my new dentist a release form, which I signed in their presence, which they faxed back to my old dentist, who put my charts and X-Rays in a tracked, signed for FedEx envelope. It took some time and it was annoying, but my privacy was protected. Remember, there are many medical conditions that are illegal to disclose in the U.S. Imagine if a misplaced setting on this Google Health inadvertantly released people's genetic records or HIV status? I wonder what Andrew Sullivan, the Internet's favorite HIV+ pundit has to say about this.

People's medical records contain all kinds of things that are nobody's business but their own. Any doctor or hospital that would outsource their record-keeping, which is one of the most important things that a doctor can do for a patient (keep a good chart), is abdicating their responsibility and calls into question whether they value convenience over ethics. The doctor-patient relationship, including medical records, has long been considered sacrosanct. For a company like Google to actually want to offer this as a service says more about their arrogance than the system itself does about their capacity to innovate, and for any doctor or hospital to buy or use it would, to me, be a violation of trust.

There are those in Washington and around the country (Paul Krugman is one) who believe that electronic, portable charts are the key to universal health care. Krugman regular cites the Veterans Administration as an example, since they use some electronic records. The big difference is a) they keep it in-house, and b) they are a single organization. If I wanted to send my VA records to a private doctor, I would have to jump through way more hoops than just telling Google it's OK...and I should have to. Hillary Clinton regularly throws out "e-charts" as the solution to all our problems, and more centralization of records was a big part of her failed 1993 "Hillarycare" plan that she is so loathe to discuss now.

This should not be easy.

Google should be commended for trying to simplify health care record keeping, but this is an arena where they should keep their mitts off. If they want to sell a "black box" turnkey solution for internal record keeping, go for it, but I will still insist on paper. Host my records for me? Go away.