Thursday, May 1, 2008

Electronic medical records - Kibitzing with Kibbe, or How to Unravel the Health Care Hairball

I spoke last week to David Kibbe, MD, MBA, e-health consultant extraordinaire. Kibbe, who served for years at the e-point man for the American Academy of Family Physicians, now independently consults with the Kings and Queens of the e-health realm, such as Microsoft and Google.

Although his job for a decade or so was to encourage physicians to enter the e-health arena, these days his main schtick is e-consumer-empowerment. He believes Microsoft, Google, Dossia (a consortium that includes Walmart and Intel), and others will turn health care on its head in a few short years, rather than a few long decades.

The tool of these a-giants will be consumer-owned personal health records, bearing information on their medical histories, medications, allergies, lab tests, x-rays, even images of EKGs, CTs, and MRIs. Another arrow in the consumer empowerment quiver will be web sites such as,,, and, which seem to be popping up everywhere..

Rather than blog you down with the details of our discussion, let me share with you with excerpts of some of Kibbe’s recent comments in a September 24, 2007 e-caremanagement blog.

Health 2.0 Deserves Careful Watching

By David Kibbe, MD, MBA

Thursday I attended a wonderful one day conference, entitled “Health 2.0 — User Generated Health Care .” One of the most interesting events of 2007. Held in San Francisco. I had a chance to talk with Adam Bosworth and Missy Krasner of Google, with Peter Neuport of Microsoft, and with David Brailer, among many others.
How to describe this event?

Imagine it’s 1995, and you spend 8 long hours with 500 other people looking at demonstrations, very brief, of about 40 companies who want to use the Internet and Web for e-commerce and other businesses aimed directly at the consumer. There is lots of enthusiasm, and lots of venture capital attention.

Imagine that in the mix of companies demo’ing their Web-based applications are four tiny firms: Google, Yahoo, Expedia, and . Along with 36 other companies and products. But remember, it’s 1995, and so you have no way to know which company or product will grow and go on to be successful businesses in 2000. (A lot of people in the audience don’t think Google will do very well, by the way.)

That’s what this was, except that the companies and products at Health 2.0 were all aimed at consumer health activities that offer interactive benefits to the user, and in some cases to providers. I saw some amazing products and services, but I have no way of knowing which ones will ultimately succeed and move into the mainstream.

There were several categories of panels for the demonstrations.

• The Role of the Consumer Aggregators, which included Google, Microsoft, WebMD, and Yahoo.
• Search in Healthcare, including Webstory and Kosmix.
• Social Media and Networking for Patients, including PatientsLikeMe and Sophia’s Garden
• Tools for Consumer Health, e.g. Vimo, which offers a way to purchase health care insurance online, and DNA Direct.
• Provider and Social Networks. e.g Sermo and Within3

It will take me some time to digest all of this. Here are some first impressions:

1) What I really, really liked was the way in which so many of these companies and applications helped the patient/consumer help himself/herself — to be better informed, to know their options, to take better actions, to hope and act in their own best interests. This is exciting, and very necessary, as physicians in primary care are already unable to meet the demands upon them for care delivery, and this imbalance/shortage is only going to get worse in the future. And it’s exciting because empowerment is the key to saving the individual out-of-pocket spending. As health costs continue to shift to the individual, Health 2.0 can really be helfpful.
Healing without information is indistinguishable from magic…..And magic in health care today is unsafe and very expensive!
We need an informed (empowered) health nation. Health 2.0 is leading that potential.

2) There are two issues that I would focus upon:

• We need to help people discover, collect, store, and utilize the relevant health information in digital (computable) format, e.g. the CCR and XML. Until we do that, none of these wonderful applications can be invoked at will without having to type in medications, diagnoses, or family history, etc. And that is going to impact adoption.

• We need to find ways to share the task of personal health data discovery and use — including all the repurposing of that data — between the individual and his/her providers. These applications and networks pose wonderful opportunities for patients and physicians to work together in completely NEW and DIFFERENT ways, some of which we saw yesterday, but for the most part hasn’t yet occurred

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