brown2020

This year, the US will spend $2.5 trillion on healthcare, and no one really understands where the money will go. All we know is that we will spend twice as much as the rest of the modern world and we apparently will get worse results. We also know that there are wide variations in how medicine is practiced within this country, and there seems to be no clear correlation between spending and quality.

Escalating healthcare costs and the current crisis in the healthcare system has something in common with the recent financial meltdown. Both crises are rooted in information challenges: The underlying systems have not been transparent, with too many opportunities to game the system, until eventually the inevitable crisis hits.

Much like subprime mortgage applications, the underlying healthcare data that might reveal the true status and risks of the system are buried on paper and in silos. As a result, the risk is misunderstood, mismanaged, mispriced and ultimately shifted to the next sucker, the last one always being the taxpayer.

Just as the mortgage crisis has its roots in policies designed to help more Americans buy a home, healthcare also is full of good intentions gone awry. The fact is, the system has become far too complex for our old information technologies and methods to handle. Without a new information model we will continue to fly blind.

New Models for Linked Data

In 1998, Tim Berners-Lee, the architect of the web standards that enabled the Internet to fundamentally change the way the world is wired, described his vision for the web:

The Web was designed as an information space, with the goal that it should be useful not only for human-human communication, but also that machines would be able to participate and help. One of the major obstacles to this has been the fact that most information on the Web is designed for human consumption, and even if it was derived from a database with well defined meanings (in at least some terms) for its columns, that the structure of the data is not evident to a robot browsing the web.

The original web enabled the documents of the world to be linked together, and now we can find the world’s smallest needle in the worlds largest haystack in milliseconds. The next generation of the web, as envisioned by Tim Berners-Lee, is about linking data and meaning in much the same way we have already linked documents. This web of linked data enables a marketplace of ideas competing to create smarter and more useful services – without needing loads of capital to redevelop or integrate the old systems. (more…)

Here is the rough transcript of Today’s Healthcare IT Policy Committee Meeting. One of the active Twitterers on #hitpol asked someone with a blog to post it, and since I have been following these meetings on Twitter and via the webcast, here it is.

First, here is what the Health IT Policy Committee does:

The Health IT Policy Committee will make recommendations to the National Coordinator for Health Information Technology (HIT) on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information. The American Recovery and Reinvestment Act of 2009 (ARRA) provides that the HIT Policy Committee shall at least make recommendations on standards, implementation specifications, and certifications criteria in eight specific areas.

What might look like mundane details in this work actually will determine the infrastructure of our future healthcare system, and we are about to spend a lot of money on it.

The biggest urgency is that if we don’t transform healthcare, our current approach will bankrupt our country. The biggest concerns are that if we act too quickly, we will lock in legacy approaches that have failed us already, and we will miss the opportunity for truly transformative approaches coming out of the Semantic Web and Open Source communities.

Here is the transcript, courtesy of  @cascadia on Twitter:

Event ID: 1364976
Event Started: 7/16/2009 9:50:16 AM ET
Please stand by for realtime captioning.

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You’d — you’dJudy, you’re all set.

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Judy, you’re all set.

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Good morning, everybody. Welcome to the third meeting of the health information technology policy committee. This is a federal advisory committee which means it is being operated in public. We have an audience in the room, telephone lines are open if you care to listen to the meeting, and it is being webcast. Minutes of the meeting will be put on our website in about a week following the meeting. Members of the committee, please remember to identify yourself when you’re speaking so we have proper attributes in the transcript. Let me go around the room and you can introduce yiewrgs beginning with la ton I can’t. (more…)

Last week, a healthcare executive asked me “What is social media”? I point out that it was a healthcare executive because many people in the $2.6 trillion US healthcare field are having intense debates right now about how to make better use of information technology and possibly how to use Web 2.0 technologies to support patients, accelerate research, and improve care. Most people in the healthcare field, however, know they are coming from behind and they are not sure where to start.

Nevertheless, I was taken aback by the question. Working one block from Twitter in the South Park area of San Francisco, I had taken it for granted that social media has become part of everyday life. When I tried to describe the idea that sharing more of yourself on the web can make life richer and more interesting, the good doctor looked at me with confusion and maybe a tinge of disgust. Sharing in healthcare is not social, and to a lot of healthcare people, “social media” sounds more like a communicable disease than a great new idea or solution.

Sharing in healthcare has always been, and probably for most of us should remain, an intensely personal and private act. It is not surprising that social media and healthcare haven’t come together, at least not under the auspices of major health care institutions. Despite some forward thinking efforts of a few pioneers like Mayo Clinic, which recently even sponsored a “Tweetcamp”, most of the use of social media in health has come from grass roots efforts as people find information and support from other people who share similar needs, experiences and circumstances.

Sharing through social media is an act of faith that the benefits of being “out there” with your ideas and content will outweigh the risks to your privacy and personal space. Millions of people have already gotten over than hurdle and have determined that social media makes life richer and more interesting. Social media is about people having a conversation online. For many, this already includes health. (more…)