A possible sea change on how to share health data

Boston July 22, 2008 002 I'm writing today from Boston, Massachusetts, where I just delivered the opening keynote at the World Congress Leadership Summit.  The conference is being held at the new and very lovely Renaissance Waterfront Hotel.

If you've noticed a nautical theme on HealthBlog from time to time there's a very good reason for it.  I grew up in the Pacific Northwest in a fishing village on the waters of Puget Sound.  The sea is very much in my blood. I find that whenever I'm near a seaport and can smell the ocean air or hear the cry of a gull, I not only get nostalgic about my boyhood but I have an almost uncontrollable desire to get down to the water.  So after my keynote this morning, I took a long walk.  That's when it hit me; the connection (at least metaphorically) between today's topic on HealthBlog and the sea.

Boston July 22, 2008 004

The theme at this year's Leadership Summit is "The Road to Interoperability".  My keynote on global healthcare industry trends was followed by a "reactor panel" moderated by Janet Marchibroda, CEO of the eHealth Initiative.  Panelists included Bill Beighe, CIO of Physicians Medical Group of Santa Cruz; Barbara Blakeney, RN, Innovation Specialist at Mass General Hospital and Past President of the American Nurses Association; and G. Daniel Martich, MD, CMIO and Associate CMO, at the University of Pittsburgh Medical Center.  In my presentation I had discussed the 5 global trends; increasing personal responsibility, "retailization" of health services, "commoditization" of services and providers, information everywhere, and globalization.  The panel reacted to my keynote by giving examples of how their organizations are being impacted by these global trends and what they are doing to address them.  The conference continued with a number of other presentations and breakout sessions on how to achieve interoperability in our health system, and what it will take to get us there.

Boston July 22, 2008 007 In 2004, George Bush proclaimed that most Americans would have an electronic health record by 2014.  So here we are 4 years later, and despite a lot of focus on establishing the Office of the National Coordinator for Health IT, promoting the concept of a National Health Information Network and seeding Regional Health Information Organizations with millions of dollars in federal and foundation grants, one could argue that we aren't much closer to getting where we need to be than we were four years ago.  However, in those four years something else has emerged that is proving to be truly disruptive.  It's the idea of aggregating health information around the consumer as perhaps a better and certainly less costly solution than trying to interconnect every hospital, clinic, doctor's office, imaging center, lab, payer and other player in our complex ecosystem of care.  And what is at the center of this change?  It is patients and healthcare consumers themselves and the emergence of new technology models such as HealthVault, Google Health, Medical Record Banks, Dossia, and other solutions that appear to be leapfrogging the need for NHIN, RHIO's, or other efforts to hard wire a connection between every health facility.  If there is a buzz in the air at this conference it is that bow wave of new ideas.  This truly represents a "sea change" in our thinking on how to achieve a portable, always available, and interoperable "electronic record" for most Americans by 2014.  In fact, I now believe we may get there well before that date rolls around.

Bill Crounse, MD   Senior Director, Worldwide Health   Microsoft Corporation

Comments (5)
  1. This week the Congress meeting is in Boston.   I referenced in a earlier post that PHR's, (personal

  2. Joe McDonald says:

    Very interesting piece. I too grew up in a fishing village and  I too am now involved in health IT as National Clinical Lead for IT Mental Health in the NHS. Although I agree that clustering information around the patient holds promise, we have made significant progress in developing Electronic Patient Records in Mental Health Services in the UK. We have learnt significant lessons which could usefully be applied elsewhwere. It is difficult to join things up but not impossible.


  3. hlthblog says:


    Thanks for writing.  I agree that in centrally managed, public health systems such as the UK’s NHS it is possible (although still challenging and expensive) to connect everyone in the health ecosystem.  America’s public-private system is not as amenable to this solution.  Hospitals and clinics are often reluctant to share information with each other due to competitive or other business concerns.  Although there are some great examples of community or regionally sponsored information exchanges, a sustainable business model for such exchanges is lacking.  That’s why I believe the solution may very well be in aggregating data around patients and consumers themselves in order to reach our goal of an "electronic health record for most Americans by 2014".

    Bill Crounse, MD    

  4. Bill says:

    Nice article, thanks.  It would seem to me that consumers are looking at these electronic health records (in the U.S. anyway) with a wary eye.  The perception seems to be that this tool won’t help the consumer that much in cost reductions.  But does open some scary doors for insurance companies to deny coverage with ever greater ease.

  5. hlthblog says:


    Thanks for writing.  I don’t know that the movement toward personal health records is so much about lowering costs as it is about greater personal control, improved service, greater satisfaction, and the potential to reduce medical errors and miscommunications.  While privacy and security are important considerations in selecting a PHR service, believe me, your insurance company already has all of your health information.

    Bill Crounse, MD

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