October 4, 2007

Microsoft Rolls Out Personal Health Records - New York Times

HealthVault is a Very Big Deal

This will take a little time to mature and all the privacy wonks will rant about trusting Microsoft (or any company) with important personal information, but I think momentum will build rapidly. It really is time for a rapid move to Electronic Health/Medical Records. If consumers push this option with their health care providers while Microsoft pulls the health care industry into it, we may have a very significant achievement. Meanwhile, a host of others are planning similar services. Uncharacteristically, Microsoft is first in this space. They must believe in a first mover advantage. Perhaps we are on an accelerated path where inertia will not rule.

The really big issue, though is standards. With the critical nature and broad uses of EHR, the standards issue looms very large and is not easy to resolve. Some industry and government groups are surely working on these issues, but I don't know if the process has matured. I doubt that Microsoft has a set of open standards for HealthVault.

Here's a good description of the problem from the Forbes article referenced below:

"There is no shortage of skeptics for a dozen reasons. "The concept behind it is dead on track, but it won't work very well" without a better way to integrate data from local doctors, predicts medical data guru Brent James, vice president for research at Utah's Intermountain Healthcare. The bottleneck, he says, is that there is no universal way to get blood test results, imaging scans and other basic data from thousands of local doctors and labs onto the Web.

"The intercommunications don't exist to get the data from where they now live into this central format and back out again to the physicians and nurses who would use them," James says."



In thinking about our health care conundrum (cost too high; quality not as good as it could be; private vs. public insurance; too many without coverage, etc.), I'm reminded of Milton Friedman's (a world-respected free market advocate and Nobel prize winning economist) answer to a question using health care in the U.S. as an example of the need for more market-based medicine.
Question: Is there an area here in the United States in which we have not been as aggressive as we should in promoting property rights and free markets?

Answer: Yes, in the field of medical care. We have a socialist-communist system of distributing medical care. Instead of letting people hire their own physicians and pay them, no one pays his or her own medical bills. Instead, there's a third party payment system. It is a communist system and it has a communist result. Despite this, we've had numerous miracles in medicine. From the discovery of penicillin, to new surgical techniques, to MRIs and CAT scans, the last 30 or 40 years have been a period of of miraculous change in medical science.

On the other hand, no one is happy: physicians don't like it; patients don't like it. Why? Because none of them are responsible for themselves. You no longer have a situation in which a patient chooses a physician, receives a service, gets charged, and pays for it. There is no direct relation between the patient and the physician. The physician is an employee of an insurance company or an employee of the government. Today a third party pays the bills. As a result no one who visits the doctor asks what the charge is going to be - somebody else is going to take care of that. The end result is third party payment and, worst of all, third party treatment.

Question: Following the recent expansion in prescription drug benefits and Medicare, what hope is there for a return to the free market in medical care?

Answer: It does seem that markets are on the defensive, but there is hope. The expansion of drug benefits was accompanied by the introduction of health savings accounts - HSAs. That's the one hopeful sign in the medical area, because it's a step in the direction of making people responsible for themselves and for their care. No one spends somebody else's money as carefully as he spends his own." *


HealthVault is a step in the direction of 'making people responsible for themselves.' I hope we can absorb this thinking, rather than trot down the gloomy path of 'socialized' medicine.


Update: 10/5/07

More here on HealthVault:

Microsoft: We’re good for your health by ZDNet's Mary Jo Foley -- Microsoft has been signaling its intentions to enter the health-records-management space for more than a year. On October 4, the company finally provided an official game plan of what it's readying on the health care software and services front.

Here is The Economist's take on the announcement.

Forbes has a piece on HealthVault, too.

*quote from Imprimis, a publication of Hillsdale College, July 2006 -Volume 35, Number 7

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