As is often common at the end of the year, a lot of companies have started putting together their “Top 10″ (or some similar number) lists for 2011. In fact, some of them have posted these lists a little bit earlier than usual. This week as people are often off work or on vacation, I thought it might be fun to take one list each day and comment on the various items people have on their lists.

The first list comes from Booz Allen Hamilton and is Booz Allen’s Top 9 ways IT is Transforming healthcare. Here’s their list of 9 items with my own commentary after each item.

Reduces medical errors. I prefer to say that Health IT has the potential to reduce medical errors. I also think long term that health IT and EMR will reduce medical errors. However, in the interim it will depend on how people actually use these systems. Used improperly, it can actually cause more medical errors. There have been studies out that show both an improvement in medical errors and an increase in medical errors.

My take on this is that EMR and health IT improves certain areas and hurts other areas. However, as we improve these systems and use of these systems, then over all medical errors will go down. However, remember that even once these systems are perfect they’re still going to be run be imperfect humans that are just trying to do their best (at least most of them). Even so, long term health IT and EMR software will be something that will benefit healthcare as far as reducing medical errors.

Improves collaboration throughout the health care system. I’m a little torn as we consider whether health IT improves collaboration. The biggest argument you can make for this is that it’s really hard to be truly interoperable in really meaningful and quick ways without technology. Sure, we’ve been able to fax over medical records which no one would doubt has improved health care. However, those faxes often get their too late since they take time to process. Technology will be the solution to solving this problem.

The real conundrum here is the value that could be achieved by sending specific data. A fax is basically a mass of data which can’t be processed by a computer in any meaningful way. How much nicer would it be to have an allergy passed from one system to another. No request for information was made. No waiting for a response from a medical records department. Just a notification on the new doctor’s screen that the patient is allergic to something or is taking a drug that might have contraindications with the one the new doctor is trying to prescribe. This sort of seamless exchange of data is where we should and could be if it weren’t for data silos and economics.

Ensures better patient-care transition. This year there was a whole conference dedicated to this idea. No doubt there is merit in what’s possible. The problems here are similar to those mentioned above in the care collaboration section. Sadly, the technology is there and ready to be deployed. It’s connecting the bureaucratic and financial dots to make it a reality.

Enables faster, better emergency care. I’m not sure why, but the emergency room gets lots of interesting technology that no one else in healthcare gets. I imagine it’s because emergency rooms can easily argue that they’re a little bit “different” from the rest of the hospital and so they are able to often embark on neat technology projects without the weight of the whole hospital around their neck.

One of the technologies I love in emergency care is connecting the emergency rooms with the ambulances. There are so many cool options out there and with 3G finally coming into its own, connectivity isn’t nearly the problem that it use to be. Plus, there are even consumer apps like MyCrisisRecords that are trying to make an in road in emergency care. I’d like to see broader adoption of these apps in emergency rooms, but you can see the promise.

Empowers patients and their families to participate in care decisions. Many might argue that with Google Health Failing and Microsoft HealthVault not making much noise, that the idea of empowering patients might not be as strong. Turns out that the reality is quite the opposite.

Patients and families are participating more and more in care decisions. There just isn’t one dominant market leader that facilitates this interaction. Patients and families are using an amalgamation of technologies and the all powerful Google to participate in their care. This trend will continue to become more popular. We’ll see if any company can really capture the energy of this movement in a way that they become the dominant market leader or whether it will remain a really fluid environment.

Makes care more convenient for patients. I believe we’re starting to see the inklings of this happening. At the core of this for me is patient online scheduling and patient online visits. Maybe it could more simply be identified as: patient communication with providers.

I don’t think 2011 has been the watershed year for convenient access to doctors by patients. However, we’re starting to see inroads made which will open up the doors for the flood of patients that want to have these types of interactions.

Helps care for the warfighter. This is an area where I also don’t have a lot of experience. Although, I do remember one visit with someone from the Army at a conference. In that short chat we had, he talked about all the issues the Army had been dealing with for decades: patient record standards, patient identifiers, multiple locations (see Iraq and Afghanistan), multiple systems, etc. The problem he identified was that much of it was classified and so it couldn’t be shared. I hope health IT does help our warriors. It should!

Enhances ability to respond to public health emergencies and disasters. I’ve been to quite a few presentations where people have talked about the benefits and challenges associated with electronic medical records and natural disasters. They’ve always been really insightful since they almost always have 5-6 “I hadn’t thought of that” moments that make you realize that we’re not as secure and prepared for disasters as we think we are.

It is worth noting that moving 100,000 patient records electronically to an off site location is much easier in the electronic world than it is in paper. With paper charts we can’t even really discuss the idea of remote access to the record in the case of a natural disaster.

Possibly even more interesting is the idea of EMR and health IT supporting public health emergencies. We’re just beginning to aggregate health data from EMR software that could help us identify and mitigate the impact of a public health emergency. Certainly none of these systems are going to be perfect. Many of these systems are going to miss things we wish they’d seen. However, there’s real potential benefit in them helping is identify public health emergencies before they become catastrophes.

Enables discovery in new medical breakthroughs and provides a platform for innovation. Most of the medical breakthroughs we’ve experienced in the last 20 years would likely have been impossible without technology. Plus, I don’t think we’ve even started to tap the power that could be available from the mounds of healthcare data that we have available to us. This is why I’m so excited about the Health.Data.Gov health data sharing program that Priya wrote about on EMR and EHR. There’s so many more medical discoveries that will be facilitated by healthcare data.

There you have it. What do you think of these 9 items? Are there other things that you see happening that will impact the above items? Are there trends that we should be watching in health IT in 2012?

Be sure to read the rest of my Health IT Top 10 as they’re posted.

Let’s face it, I haven’t actually been nice to Google of late when it comes to healthcare (or maybe I have, just once). While I believe the criticisms are justified, I can see why some people might think I’m beating a dead horse, namely Google Health. But there are some unresolved questions in the area of privacy that Google really should answer.

Google’s ill-fated attempt at a PHR isn’t completely dead. The company won’t “retire” the online service until January, and will allow users to download their data through Jan. 1, 2013. Naturally, others have stepped up to try to fill the (tiny) void left by Google Health’s demise. To nobody’s surprise, Microsoft is helping the remarkably small number of Google Health users transition their accounts to HealthVault, Microsoft’s own overly hyped, underutilized PHR platform.

What concerns me is what will happen to data already on Google’s servers. Will records be archived? Will sensitive patient health data stay on Google’s servers in perpetuity? Nobody has said for sure.

Are records safe from Google’s data-mining juggernaut? Google has consistently said that it would not use health records for anything other than to steer traffic to its core search engine, but let’s face it, Google’s primary source of revenue is from algorithm-driven advertising.

But, you say, HIPAA protects patients from unauthorized uses of their data, right? Well, remember back to 2009, when the American Recovery and Reinvestment Act expressly made third-party data repositories, health information networks and, yes, personal health records, into HIPAA business associates, effectively holding them to the same rules as covered entities under HIPAA.

Wouldn’t you know, both Google and Microsoft came out and said they were not subject to this provision. No less an insider than former national health IT coordinator Dr. David Brailer, who was a part of the legislative negotiations, told me then that lawmakers had Google Health and HealthVault specifically in mind when they crafted the ARRA language. As far as I know, there haven’t been any reported data breaches involving either PHR platform, so there’s been no need to test whether ARRA actually does apply to them, but if I had my data on Google’s or Microsoft’s servers, I’d be concerned. I’d particularly want to know what Google plans on doing with the data it’s been holding once Google Health does shut down.

Perhaps it’s time for me to make some phone calls.

There’s a pretty fierce battle going on right now between all the various stakeholders interested in exchanging patient data. The stakeholders range from very large companies to government initiatives to startup companies. One of the major problems that I see is that it’s not completely clear which model of patient data exchange will win out. In fact, let’s not be surprised if a number of different options take hold.

With this said, I found it interesting that my favorite open source healthcare IT advocate, Fred Trotter, has chosen to get behind the Direct Project. In Fred’s post describing the challenges with the IHE-protocol HIE model approach is flawed and that the direct exchange of healthcare information is the way to go. In fact, he provides the following two illustrations in his post to show the difference:

HIE Model (click on the image to see it full size)

Direct Model (click on the image to see it full size)

Fred then offers this incredibly interesting conclusion:

At every level, organizations are deciding whether to invest in Direct or IHE-based exchange. At this point, I believe the only viable option is for a local exchange to either support Direct only, or both Direct and IHE. IHE is simply going to be too heavy weight for early adoption. Eventually, IHE may become dominate but for now Direct is much simpler, and puts the patient right in the center of everything. If you are a policy maker, you should be asking anyone involved with an HIE process to detail what their Direct-strategy is. If any effort is ignoring Direct and going with IHE-only I would lay odds that they will be broke and defunct before the decade is out.

Moreover, an IHE-only strategy is going to exclude direct participation from patients at this stage. If you care about patient empowerment, I recommend that you advocate for the Direct project at every level, including in your local HIE and REC.

Lots to consider with this complex challenge.

I guess you could say that the direct model is the patient centric model. Although, one could easily argue that the direct model doesn’t have the patient as the center of the model, but instead is a PHR centric model. So, the direct model will be a patient centered model only as much as the PHR software allows the patient to be involved.

Thus, it makes since why Microsoft HealthVault and Google Health are heavily involved in the Direct Project. Of course, they want to be involved in a project that puts them at the center of the communication.

The real question even with the direct model is what incentive do the various PHR vendors have to make this interaction happen? What will be the “cost” that PHR vendors pass on to consumers and/or doctors that use the PHR centric model? Basically, what’s the business model of the PHR vendors?

Unless we can find a PHR centric business model that works for the PHR vendor while still empowering the patient, even the direct model will fail or have adverse outcomes.

I recently sat down with Jeff Donnell from NoMoreClipboard. We had a fascinating all around conversation, but one of the most fascinating things he told me was the story of his last visit to his doctor’s office. I’ll do my best to recount what he told me.

When he decided he needed to go see the doctor for a visit his wife suggested that he call the doctor to make an appointment. Of course, Jeff “eats his own dog food” and decided that instead of calling for an appointment, he’d request an appointment through NoMoreClipboard. So, he logged into his account and sent off the request for an appointment with his PHR attached. Pretty interesting idea no?

Don’t ask me why, but when possible I’d much rather request something through my computer. Maybe it’s sitting on hold while you wait to talk to someone that’s turned me off to the phone call, but the idea that I could request an appointment online even if the doctor isn’t on NoMoreClipboard is a pretty attractive feature for a PHR.

Of course, since Jeff’s doctor wasn’t on NoMoreClipboard, his appointment request and health record were faxed to his doctor’s office. He got a call from the doctor and scheduled his appointment. The story certainly doesn’t end there.

When he arrived at the doctor’s office he wondered if they’d have his record or not. They handed him the standard clipboard to fill out all the paperwork. He still said nothing and dutifully filled out the paperwork. No one said anything about the record he’d sent until he was with the doctor and the doctor realized that Jeff was the one that sent in his PHR. I guess it was the talk of the office when that fax came in.

Obviously, the idea of requesting an appointment and faxing in your health record using a PHR still has a ways to go. In fact, NoMoreClipboard’s goal is to work with doctor’s offices like these so that the office gets the person’s health record on the forms that the doctor’s are use to getting it on. I think that’s a smart strategy. Not to mention the idea of the patients driving their doctors to use and work with a PHR provider. I think they call that Word of Mouth advertising right?

I’ve been thinking about this for a while when I recently talked with someone from Microsoft’s HealthVault division. I quite frankly asked this gentleman why I should use a PHR. Obviously, if I was a patient with a chronic or complicated illness I could see a compelling use case. However, what’s the use case that will drive and motivate healthy individuals to use a PHR. So far I really haven’t heard a good answer.

Requesting an appointment and not having to fill out that same lengthy cumbersome paperwork is the closest I’ve thought of.

My very first meeting with a vendor at HIMSS was with NoMoreClipboard. I’d known of them for quite a while, but never really took them seriously before. After meeting with them, I was really impressed with what they’re trying to do in the PHR space. I was particularly interested in them since they have a PHR implementation in a university health center, but they go well beyond that.

In fact, I think the greatest potential for NoMoreClipboard is likely in partnerships with smart EMR vendors that want to integrate with a great PHR rather than putting up some half baked piece of junk software that they call a PHR. Yes, if you’re an EMR vendor you likely know what I’m talking about. It’s really hard to focus on creating a great EMR software and a great PHR software. Oh yes, and you have to do a Practice Management system too. It’s no wonder that PHR often gets set to the side.

That’s why it makes so much sense for smart EMR vendors to become channel partners with someone like NoMoreClipboard. Then, they can offer their users a PHR without having to build all of the features in house. Plus, NoMoreClipboard seems to have a nice set of API’s available so it almost seems like it is your PHR and not a third party PHR.

Sure, this has been around for a while, but I think that it’s taken a while for NoMoreClipboard to really build out the tools and features for doing this type of integration. The other key is that integrating with a PHR like NoMoreClipboard can also satisfy a number of the Meaningful Use requirements if it’s done right.

Of course, I had to also ask them what their take was on their “competitors” Google Health and Microsoft HealthVault. They are the 2 behemoths in the PHR space and so the question was certainly no surprise. What was interesting was NoMoreClipboard’s response to competition. They’ve basically decided to partner with them and integrate NoMoreClipboard with Google Health and Microsoft HealthVault. Yep, that’s right. You can import and export between the three PHR systems. That’s pretty unique if I do say so myself.

Now I’m not saying that NoMoreClipboard is perfect. There’s plenty they still have to work on, but I was impressed how far they’ve come since I last looked at them.

I’d love to here what other EMR vendors are doing as far as providing their users the PHR capability. Are you building your own or integrating with some other PHR vendor?