Correcting Information Asymmetry for patients

Consumer reports is invaluable tool for the purchase of almost anything.

Anytime I am considering a major purchase like a car, or perhaps expensive electronics, I always by temporary access to consumerreports.org. While the Consumer Reports magazine can be interesting to browse, the website is even more valuable. You can access any recent product review done for the magazine in an instant.

The problem that consumer reports addresses is “information asymmetry“.

Consider going to the car lot to buy a car and then comparing two similar car models. Both of the new cars cost about the same amount of money. Both of the cars have the same essential features. Which brand of car should I buy?

The problem here is that there is an asymmetry of information. The car sales man knows much more about the performance of these brands of cars than I do. So there is a danger that he will recommend the worse of the two cars, which he will have over-priced. If I trust the car salesman, I might be doing what is best for him, not best for me. Even if the salesman is honest, he might be making his recommendation based on what the needs of the average car buyer. To the degree that I am different from the average car buyer, my needs might be different.

Consumer reports helps to reduce this asymmetry. I can learn about how the cars perform from an objective source. I might end up taking the car salesman’s recommendation… I might not. My decision will be based on -my priorities- which can be very divergent from both a typical customers and from the salesman’s interests.

This kind of information asymmetry is even more pronounced in healthcare. I could learn what a car salesman knows about cars in about a month of diligent study. But to understand what a doctor does I would have to study for years. If I am trying to make a decision like “Should I have this surgery” I am at the mercy of the doctors much-greater information position. The Surgeon might be recommending surgery because that would generate income. He also might be recommending surgery because he is assuming that my priorities are the same as the “typical patient”.

Rectifying this information deficient for as a patient is much more difficult, because the resources available to patients are often problematic.

The information on WebMD is probably accurate as far as it goes, but it is dumbed-down. You can always spot information that might not go deep enough on the web, because it always ends with “ask your doctor about…”. That is the least helpful thing to say here. It means “This is actually a much more complicated issue, but we are not going to give you any more information, instead go ask the car salesman (the doctor)!”. It is the doctor that I am trying to evaluate here!

Wikipedia has much more accurate information that goes much deeper, but its articles are of sporadic quality (usually very high, sometimes very low… which one are you reading now?) and it may not be updated with the latest information on its more esoteric articles. It was not never intended to be relied upon for medical information that changes very very rapidly.

My boss and collaborator at the Cautious Patient Foundation Dr. Cari Oliver has just written a detailed blog post where she details how patients can use at service called uptodate.com to get around this problem. This service is intended for doctors, but they have recently allowed temporary access rates so that patients can access a topic or two and not pay the expensive yearly access fee. Of course, this service is aimed at doctors. It might be a little over your head. But it is better to have access to accurate, recent information about the risks and benefits of different procedures, from a disinterested third party authority that is too complex than not to have it all!

This type of recommendation excites me as a technologist passionate about social change! This is a classic example of using information to make patients more powerful!!

-FT

Two other Open Source EHRs Meaningful Use certified (partially)

I just found out that at least two other Open Source projects have been meaningful use certified.

OpenEMR has been partially certified.

Medspheres OpenVistA CareVue has been certified.

I hope to get more information about exactly what the partial certification means and what the meaningful use strategies of these organizations mean, but this means that the ClearHealth is no longer alone in certification. (Although from what I can tell, ClearHealth remains the only fully certified Open Source EHR)

I will write more when I know more…

Glen Tullman presents the Chewbacca defense

I have been meaning to write about this for a while.

Glen Tullman and I have pretty different opinions about Health IT. Glen is the CEO of Allscripts, which is the largest proprietary EHR vendor in the country. When ONC called for testimony for the definition of meaningful use, Glen and I sat on the same panel. I testified after him, and I painted a much different picture of the state of Health IT than he did. The summary of his testimony: “The future of EHRs is already here, we are doing meaningful use today”. The summary of my testimony: “There is a market failure in Health IT, no other industry needed to be paid to computerize”. He holds his own software company out as an example of the “right way” where as I generally hold VA VistA, which was developed in a Open Source collaborative fashion as the way forward.

Of course we are both financially biased in this regard. I am an upper-middle income software developer, and Glen got paid $4,072,270 last year. Given the kind of money I make on this Open Source stuff you should probably take everything I say with a grain of salt, and take everything he says with about 45 grains of salt… you know… based on the relative bias involved…

But Glen Tullman got an opportunity to testify again (without me this time), regarding VA VistA. (text, video)

In this testimony, I want to focus on one specific statement, that is particularly galling to me.

While the private sector has been moving forward in light of these incentives, the Government has been investing in their own proprietary systems for many years.  Billions of dollars have been spent to build and implement the VistA/CPRS system within the Veteran Health Administration and the AHLTA system within the Military Health System.

So the VistA/CPRS is “proprietary”, while Glens own software is “private sector”. Wow. The Chewbacca defense at its best.

VistA/CPRS can be run for any purpose, the sourcecode is available for anyone to download without cost, you can redistribute those copies of VistA/CPRS without cost, and you can also redistribute modified versions of the software. That means VistA/CPRS meets the definition of freedom-respecting software, which is the soul of Open Source. Moreover, it was and is developed in a collaborative fashion that is at the heart of every successful Open Source project. If you want to know more, you should read What is VistA Really page that I edit for WorldVistA.

Then, Glen takes credit for accomplishments of Open Source technology:

For example, in Hartford, Connecticut, we have been partners in a project for almost two years that has not only led to widespread health IT adoption but successful implementation of open source health information exchange technologies.

What Glen meant by this is that there are some Allscripts node on an Open Source HIE created by MOSS, Misys Open Source Solutions. In short, Open Source -was- responsible for the exchange, and this had very very little to do with Allscripts software.

He goes on to say:

the fact remains that VistA’s basic platform, which relies on the 25-year old technology called Mumps, cannot support the open, flexible approach needed by those providing care to our nation’s wounded servicemen and women. Rather, the demands of today’s military and veteran healthcare environment necessitate the use of technologies – such as those based on Microsoft’s architecture – that can support an open, shared approach that will not just be desirable, but a fundamental requirement in the near future.

It should be noted that -every- instance of VA VistA inside the VA is capable of communicating with every other instance of VistA inside the VA. The VA was the first and probably still the only large scale organization to achieve this kind of internal data fluidity, which has been happening for more than a decade. Interestingly, the other “large” vendor in Health IT is Epic, a proprietary EHR company that relies heavily on MUMPS. I can think of nothing that Allscripts software can do that either Epic, or VistA is not capable of. Holding out Microsoft technology as a source for peer-to-peer leadership is also pretty ironic, but whatever…

Glen is pretty used to speaking out of both sides of his mouth regarding Open Source. And this testimony is far from the only instance. First there was this article in Forbes, which originally claimed that Allscripts had an Open Source platform, but was then quickly redacted to its current “clearer” status. This was not before it was completely flamed..

most recently, Glen was interviewed in the January 2011 Edition (Vol. 19, No. 1) of HealthData Management Magazine

And Tullman has spent those years (since 1997) being a relentless advocate of the use of open source architecture for health I.T. software and pushed his company to develop tool sets to connect its EHR software with virtually any device or software on the market.

This is was, of course, published in time with the edition of the magazine that would be available during the 2011 HIMSS conference.

This is a very disturbing case of a proprietary EHR CEO being completely intellectually dishonest regarding Open Source. I am on speaking terms with several of the top CEOs of proprietary EHR systems. People like Jonathan Bush of Athenahealth and David Winn (formerly CEO of) eMDs. I have advocated Open Source to these figures on a regular basis. But the remain proprietary companies because they believe that they will make more money as proprietary companies. I believe that Open Source has value that should be more important than profit, and have a friendly disagreement about this with most industry CEO’s. They think my ideas are intriguing and have potential, but see no reason to “bet the farm” on Open Source.

But they also -never- hold themselves out as the “Open” or “Open Source” option. Nor do they malign technologies merely because they are other than those chosen by their own developers. Glen Tullman regularly does both of these. Hell, he did in testimony to Congress.

Look I know that not everyone agrees that Open Source is the way to go, this is not what I am arguing here. I am arguing that we need to have honest and sincere disagreements about licensing and technology issues in Health IT rather than listening to Glen Tullman and his Chewbacca defense.

Direct and CONNECT governance too far from technology

Hi,

I have just submitted a comment to the HITPC governance working group regarding there process for making governance recommendations to ONC. I make the argument that for the most part, comments from HITPC regarding privacy and security architecture have been largely counter-productive because they fail to account for what the chosen NW-HIN (the artist formerly known as NHIN, shortly to be known as the Health Internet) protocols dictate regarding security and privacy architecture. Here is my comment:

Hi,
Thank you for your work on this project. As a minor note, I am pretty sure you mean “governance of the nationwide health information -network-” as opposed to just “nationwide health information”. Your link for “how to participate” does not actually have information about how to submit a comment. I must assume that comments to this post is what you mean, because there does not appear to be any other detectable process for commenting here.

I worked on the Security and Trust Working Group for the Direct Project, which forms one of the two approved protocols on the NHIN. I am somewhat informed regarding the other project CONNECT and the IHE protocols it implements.

In the Direct Project Security and Trust working group, we took -great- care to ensure that our work, would not trample the ability of HITPC or ONC to make reasonable (or for that matter unreasonable) decisions about how trust, security and privacy should be made. However, out of necessity, we did have to choose a technology stack and specific protocol configurations in order to get any kind of working system in place. Those decisions were not intended to limit your ability to make policy decisions, except in one important way; to quote the current version of the introduction to our Direct Project Security Overview: “In some cases, these protocols and technologies will come with specific configuration options that will have policy implications and may also present constraints that Direct Project will force on the trust policies of its users.”

In short, we asked that you implement your policy decisions in terms of the technology choices that we made. Most specifically we chose X.509 as a protocol for managing trust relationships. This is the same underlying trust architecture that is implemented in IHE and CONNECT. Rather than honor this basic request, to speak in relevant technological terms, HITPC has largely decided to recommend ‘in the abstract’. HITPC has ignored the fact that the fundamental designs of both Direct and IHE dictate that certain security and policy issues -must- be answered, and renders other issues irrelevant.

For instance, your document asks: ‘When is exchange not considered NW-HIN and, therefore, not subject to NW-HIN governance? ‘ While this may be a relevant question for those under the IHE protocol, the Direct protocol ‘Circle of Trust’ concept supersedes this questions basic premise. Its not the ‘answers’ the question… it just makes it irrelevant. With Circles of Trust participating in the ‘official NW-HIN’ is a fluid concept. Nodes will float freely in and out of any given definition of what ‘official NW-HIN’ means.

However, in your “what to do plans” you note that you expect to: “Establish technical requirements to assure policy and technical interoperability.” With all due respect, that work is largely done, and what little remains will be finished by participants in the Direct and CONNECT projects. Moreover, any ‘governance’ of these issues, that cannot influence the contents of reference implementations of the IHE and Direct protocols is mostly just blowing smoke. ‘policy and technical interoperability’ will be 100% dictated by what the Direct and CONNECT programmers put into those projects. Which means that for any governance body to get ‘policy and technical interoperability’, that body will need to be deeply linked in with the developers of those projects. So far there has been a substantial breakdown between what we the developers have asked for as far as policy guidance and what we have been given. Most of the advice from the Security and Privacy Tiger Team, while well-intentioned, made extremely poor technical assumptions and did not begin to approach the actual issues that we needed to address. For the most part, HITPC discussions of Security and Privacy have been a distraction to those of us actually deciding how things where going to be implemented.

Which brings me to what I think is the really only relevant issue here: Who should be on the governance board for the NW-HIN.

The answer to that question is pretty straight forward to me: You need to have at least one representatives from the Security and Trust developers from each of the two projects. Preferably the people who are actually involved with the implementation of the relevant portions of the code. (which rules me out sadly).

Moreover, -every- other member of the governance body should be well-versed in X-509. This means that it should be made up -entirely- of people who are both technology and policy fluent. If the members of a governance board are uncomfortable discussing revocation lists, and CA chain of trust or cross-certification intelligently, then they do not belong on the governance body for any portion of the NW-HIN. There are enough clinicians, who are capable of meeting those requirements that we have no reason not to expect this level of competence. Moreover, you should fully expect that the governance body will largely ignore your abstract questions and recommendations, and instead focus on those security and privacy issues that bubble up from our protocol choices, and start to ignore those that issues that are largely handled in-protocol.

Regards,

-FT

Please consider liking this comment if you have felt some of the same frustrations.

Regards,

-FT

The ethics of weight and body fat on Twitter

Update 12-16-2010:

I have just purchased a Withings scale. Indeed, as I discussed in my original article, it will only let me twitter my weight instead of my body fat. How frustrating. But, you can customize the static portion of each tweet. I will be tweeting my weight with a bit.ly link ( http://bit.ly/gS05Nz )to this article and @withings in each post.  Eventually, they will get tired of this and reply to my blog post or otherwise acknowledge this issue.

They also ask for my twitter password, which is no longer the right way to authenticate…

I originally blogged this while hanging out with Alan from videnitity.com ( originally met at health 2.0 ) at an mhealth conference. I should have mentioned videntity before.. they do cool work with Django and python for life streaming. In fact the discussion that I am about to go over prompted him to cover, in detail, some of the work he did using the Wii balance board to lifestream your weight. Hardware hacking for healthcare. Pretty cool stuff.

Almost immediately on seeing Alan again, our conversation turned to our mutual interest in quantified self. We are both interested wifi enabled scales.

But almost immediately I stumbled upon a mutual frustration. The most popular and well-known wifi scale in the space is the withings scale. The withings scale measures both weight and body fat percentage (impedance method). We were both frustrated with the default ability for the device to post to Twitter.

Take a look at the search for http://withings.com on twitter. Notice anything? Thats right folks… the withings scale posts weight. Just weight.

I do not need to bother to tell my readership ( clinicians and health interested IT folks) the problem with this. Our culture continues to have an obsession with weight at runs contrary to health. My own life is a great example. I weigh about 270 pounds. I am overweight, but my relatively high level of physical activity ensures that much of my weight is muscle. If I could manage to lose 10 pounds of fat and gain 10 pounds of muscle it would be better for me long term (as my muscle helped accelerate further weight lose) than just losing 10 pounds of fat. There is some debate about whether BMI or body composition is a better measure, but pretty much everyone agrees that thinking in terms of either BMI or body composition are vastly superior to simple weight measurements, because both take height into account (explicitly or implicitly).

So here we have the basic ethical quandary.

  1. Focusing on weight contributes to an unhealthy obsession with a single number that cripples our ability to compare two people effectively. This obsession can merely be inconvenient for people like me, who are capable of seeing past the number but are frustrated that I have to constantly do that work… Or it can be dangerous for those with certain eating disorders.
  2. The withings scale is capable of publishing both the body fat percentage/BMI and/or weight to Twitter providing social pressure for those who seek to manage their health.
  3. The withings scale chooses to publish only weight to Twitter.
  4. To add insult to injury, salt to the wound, spittle to the slap, and gratuitous cliches to the sentence: Withings knows that its users are requesting body fat percent in the tweet stream, they know they are requesting full templating of tweets, and they are taking a poll on what users want, but the poll does not have full templating (which would allow tweeting of body fat) or simple body fat tweeting as poll options.

Withings is playing “the users are too stupid” card on this one. From the comments of the blog post in question, in response to Paul who suggested a templating system:

Hi Paul, we first wanted to do so but as I said in the post above, we noticed that fully customizable tweets are too confusing for non computer-skilled users.

Moreover, a fully cuztomizable tweet can lead to unrelevant tweets.
Lets say youre trying to lose weight and your tweet is my current weight is %wc% and I only have %wo% to lose to reach my objective.
If ever you pass your objective on a specific weigh-in, the tweet will be unrelevant (it will say you still have -2 lbs to lose for instance) unless you think of changing the default tweet message just before weighing in…

Oh thank you pointy haired bosses at Withings. You have answered a tremendous consumer demand with a technology that further perpetuates fundamental healthcare mythologies. You have given us something at is 95% similar to what we need, but now serves a subtle destructive force instead of what you could have done which would be to apply social pressure to the right problem…and now as your user community suggests methods to allow us to fix your mistake… You tell us that we are not smart enough to do handle the tools we need to do that… Oh thank you from saving ourselves from ourselves!

This is the fundamental problem with Health IT today: we as health IT programmers are constantly making very subtle ethical decisions, and we regularly flub them up. More importantly, we ignore our users when they urge us to fix ourselves…

Withings made an ethical mistake in having the default tweetable data weight instead of body fat. Their UX justifications would be valid if they had made the right ethical decision to start. If I could only get body fat percent… That would be a frustration, but I could deal… As it stands they are just wrong.

But I understand why. Imagine the meeting:

Developer: we should integrate with Twitter
Pointy haired boss: cool do it.
Developer: we do not have time to do a complex integration. We can use weight, body fat percent or BMI…
Pointy haired boss: no one understands body fat percentage or BMI. This is a weight scale. People understand that… Lets go with that….
Developer: but body fat percentage….
Pointy haired boss: would not be as popular. This is a marketing and time question. We only have time for one of the two and most people will want weight…

The pointy haired boss is right. The fact is that people do understand weight better. Withings has probably sold more scales by choosing just to only tweet weight. This is not just a principle vs. profit issue. Assuming scales make a difference for people, more scales equals more difference. Frankly I do not blame Withings for starting with this decision. They were wrong, but their heart was in the right place.

But the arrogant position on templating systems and the fact that the poll they setup on the issues did not even give an option to chose body fat percent as an option is pretty unacceptable.

The other problem that Alan pointed out is that to get at the Withings scale data, you currently had to integrate with the Withings server rather than with the scale itself. So you have a device that records data about you, and then to get at that data, you need the by-your-leave of the device manufacturer… Not OK.

This device should be a “home health appliance”, and it should integrate with the Withings server -as a convenience- not as a requirement. I should be able to point this system anywhere I like. I should be able to easily point the data that the device generates anywhere I want to.

Withings need to take the following steps, and soon.

Support templating as a fundamental method of data export.
Support sending that templated data to any Internet location via simple POST, without going through Withings servers
Support full XML and JSON data export with those posts
Make body fat percentage the default measure sent to Twitter and give users the option to change it back to weight

If you support this idea… Please leave me a comment here, and retweet this article, with the @withings tag. I am pretty sure withings watches twitter.

-ft

Health Internet

For whatever reason people simply do not get what the NHIN is and what its implications are.

This feels like a repeat of what happened to me more than a year ago.

The NHIN (which has been rebranded the “Nationwide Health Information Network” or NWHIN from “National Health Information Network” in response to these silly trademarks) is going to be the foundation of a new Health Internet. The US Government wisely will not call it that, because of the paranoid privacy histrionics that this would induce, but nonetheless it -is- a Health Internet. The definition of the word “Internet” is: Any set of computer networks that communicate using the Internet Protocol. The Internet, the largest global internet

The Health Internet by extension is the “largest Internet devoted to Healthcare Data”.

Here are the basic features of the Health Internet:

  • You will be able to ’email’ your doctor.
  • Your doctor will be able to ’email’ you.
  • Faxing health records will go away.
  • Eventually, your medical records will auto-magically follow you around the country, appearing when they are most needed in a moments notice.
  • All of this will be done securely and in a way that fully supports peoples legitimate need for privacy.
  • New innovative services will appear, that leverage the Health Internet data channel to create applications that were previously unthinkable.

How is this being accomplished? Simple as one two three:

  1. The EHR stimulus money will be given out in response to “meaningful use” standards which include interoperability requirements, which will require connecting and sharing data, without specifying a specific technology stack. These standards will become more and more pronounced as time moves forward.
  2. ONC is supporting the development of two Open Source projects that will serve as reference implementations of the two NHIN protocols: IHE and the newly formed Direct Protocol. Those projects are the IHE projects: (CONNECT Project if your are a federal agency and the Aurion Project if you are anyone else, updated 8-19-11) and the Direct Project (Direct). I recommend you watch this OSCON video for a basic explanation of these two projects.
  3. The Federal Government will expose its considerable health data resources (i.e. DoD and the VA) using these two protocols. Agencies which accept the reporting of meaningful use measures will accept that reporting using one or both of these two protocols.

So are these protocols being mandated? No. But then neither were HTTP, STMP, SSH, SSL, or DNS. Its just what everyone uses. The VA has the single largest pile of detailed health records in the history of mankind. They will be available using either CONNECT-complatible IHE or Direct-compatible Direct protocol. They will probably not be available using your-favorite vendors idea of a proprietary health data exchange protocol.

This is going to happen. Hell, it already is happening. These reference implementations are entirely Open Source. They are designed to eventually handle the cases of communicating across national boundaries. This is going to the start of a international Health Internet. First with Canada and Mexico, and nations promoting Medical Tourism and then everyone else. It will take time. Adoption might be slow. But there will be a Health Internet, it will use these protocols. It is only a question of how long this will take to be adopted, and how long it will take people to stop talking in the abstract about the issues of Health Data Exchange.

This is happening. Adjust.

-FT

Checking with Facebook Places before voting

Hi,

So I wrote a new facebook application that gives you credit for supporting my fathers congressional campaign. My father is running in Texas District 20 (the Alamo District), and I am writing this article as a specific guide to his supporters with iphones/ipads and facebook accounts. (If you do not have a facebook account… now is the time to signup!!)

But no matter where you are this election day, you should use Facebook Places to checkin at your polling station. Why? because anyone building a facebook political applications (like me) will be able to use your checkin to prove that you were at a voting station. This very simple piece of information, where, when and most importantly the -implication- that you actually did vote means that you are a player in what will soon become a very very active political space on facebook.

Remember, there will be a host of facebook applications that check for this data in the coming years. You can be an early adopter of this type of technology even before knowing what application you will be using. This is also good advise no matter who you support politically!!

For many of you, this could be the first time you have used facebook places to check-in anywhere. So I thought I would write you a little guide to checking in. This guide will assume that there is already a location available for you to check-in to, but if there is no such location available, you can follow my instructions to create a Facebook places location to make one for yourself.

First you need to load your Facebook application. These instructions are identical for the iphone and ipad, and should be similar on the Android. If you have not installed the application yet, you need to search for “facebook” in the app store application and download it. Then you should see an application icon like this one on your iphone:

Click the facebook application
Click the facebook application

Next you need to checkin. The simplest way to do this is to click the little geo-tag icon to the right of the text field:

This is where you typically start
This is where you typically start

After you click there you choose which location you want to check-in too. In this example I am checking in to campaign headquarters. If there is a not already a facebook location for your polling station, you should add one.

Choose a place to check-in to
Choose a place to check-in to

Obviously your polling place will not be called “Trotter for Congress Headquarters”. It will be something like “the Smith elementary school”. It does not really matter to much where exactly that you check in to… the application will specifically store your latitude and longitude. Any half-way intelligent facebook application will be able to tell that you were at a voting station, even if you actually check-in at the Burger King across the street. Still better to check in at your actual polling station, even if it means creating a new location in Facebook Places.

Then you will be presented with the check-in interface, which looks like this:

Check in to a given place
Check in to a given place

You can put anything you want in the “What are you doing?” field (including nothing at all). However, while an application can understand the implications of your latitude and longitude, your facebook friends might not. You might give a little context to your check-in by saying “Here to vote” or “Dropping my mom off to vote” or whatever. My facebook social election game, does not attempt to figure out if you actually voted, you can score in the game if you just show up at a polling station on election day. It does not matter if you are under-age, or not voting, or vote for the other guy… I cannot say for sure, but I think other vote-oriented facebook applications that exist to serve a particular political candidate will probably follow suit. Otherwise, someone will try to claim that the application “rewards” voting a particular way, and is somehow illegal/unethical.

However, I imagine that you will also see a large number of facebook applications that are not associated with a particular candidate that will ask about exactly how you voted. These style of applications will turn Facebook places into a kind of real-time location-aware exit polling engine… lots of potential uses for that type of application.

But none of these apps can operate without data. In this election (2010) this will be new, and we will struggle to get the word out… but in 2012 and beyond.. this will be more than normal.

Enjoy!

-FT

MirrorMed, Medical Manager and mm2mm

So originally MirrorMed was a fork of ClearHealth. It was done to satisfy my need to get certain features done… but now ClearHealth has moved far past it… the usefulness of the “fork” part of this has diminished to nothing.

Still there were a few useful things in MirrorMed that have not been replicated in ClearHealth or anywhere else that I know of.

The most useful of these was a tool that I built called mm2mm

mm2mm is a Medical Manager to MirrorMed integration engine. Basically it a php parser for the medical manager data files that allows you to seamlessly move to MySQL. I have used this tool more than any other part of MirrorMed, and so I am now releasing it Open Source (AGPL 3) and completely costless. You can download it from the MirrorMed sourceforge site.

For those who are interested in Medical Manager, you might enjoy reading the history of Medical Manager, which I maintain. Recently someone reminded me that there have now been convictions in the Medical Manager dealership scandal.

Medical Manager was my family business for many years. My Aunt and Uncle still work tirelessly to support clients and my grandfather, now deceased, helped them start the business. The Medical Manager dealership scandal, where Medical Manager ousted small dealerships and apparently accepted bribes to buyout the larger dealerships originally taught me that nothing but Open Source was viable in healthcare informatics.

The release of mm2mm has brought me full circle with Medical Manager. It makes it trivial to use a FOSS EHR like ClearHealth, OpenEMR, OpenVistA or Astronaut VistA on top of an instance of Medical Manager but most of the people who have used mm2mm as beta testers were interested in creating a web-archive of the medical manager database or in entirely migrating away from Medical Manager.

Medical Manager was a great product, but years of neglect and proprietary thinking have doomed it. It might be possible to save if it was released as Open Source now, but it is probably too late.

Oh well…

-FT

betting on quantified self

So I lost the Health Developer challenge to ringful. But they had a pretty good app, so there is no shame in that.

More importantly, I think I really made people think.

Steven Downs of project health design, said this about toeleven.org:

However, instead of using Google Health or HealthVault as a platform, Fred used Twitter. Fred had the notion that people already use Twitter to track what is happening with their lives, so why not track what is happening to their health? That builds upon another key finding from Project HealthDesign: help people track their health information by incorporating the process into their existing daily routine, not adding something new

So basically, while they did not chose me to win the contest, they got the point I was making. If I had time to add some graphical goodness to the app, then I think I might have been able to make a better stab at being more competitive from a user experience standpoint, and I think I might have done better. There is always the next contest.

Still I have made strong headway with the notion that the quantified self movement, is merging with the PHR movement. The quantified self guys are pushing this logging to Twitter thing pretty hard. And toeleven.org is one idea about how to fully move Twitter into the PHR space. We will see how that community reacts to these ideas.

I think it is inevitable that the notions of the “life stream” as per facebook and twitter and the notions of traditional PHR will begin to merge. It is not a question of whether?, but rather when?, and how?

toeleven.org is an Open Source app looking for a project manager.. contact me if you are interested in owning the project…

-FT