Do-It-Yourself Health Care?

Given that Google has been mucking up health care reform since 2007 by trying to turn the whole affair into an enterprise software problem, the only question from today's news should be "What took Microsoft so long to get into this game?" Actually, Microsoft was in the game. The problem was that reality was interfering too much with how they wanted to play it. Following up on the Google everything-can-be-reduced-to-search philosophy, Microsoft researchers discovered that health-related Web searches could induce a new form of hypochondria (which BBC News was quick to dub "cyberchondria" when they reported these results in December of 2008). Still, fundamental misunderstandings of the nature of health care (particularly its social dimension) continue to march forward like an army of those pink bunnies with their drums; and that brings us to today's news.

This morning Dana Blankenhorn posted the following report on the ZDNet Healthcare Web site:

Microsoft’s vision of health reform is simple. Connect systems so patients can participate in their own care.

That’s the idea behind HealthVault, which corporate vice president Peter Neupert insisted at HIMSS yesterday is not a Personal Health Record (PHR) at all but a secure method for creating them, and allowing data patients create to be combined with what their doctors have.

He said this while standing in a small conference room next to incoming HIMSS president C. Martin Harris who delivered results from a project the Cleveland Clinic performed on over 250 people with chronic conditions like hypertension and diabetes.

Some 75% of the nation’s health care dollars are going to such chronic conditions, said Harris, who is also CIO of the Clinic.

The Clinic gave patients simple devices to measure their ongoing condition — scales, blood pressure cuffs, blood sugar monitors — and taught them their use. This data was combined through HealthVault with what their own Electronic Medical Records (EMR) showed, and alarm conditions were monitored. When called for, doctors called patients and adjusted medications or instructions.

“The process measures were the biggest change we saw,” said Harris. “We increased the time between visits 35-50%,” with no reduction in care quality.

Let's begin with the "bottom line" results. The most dangerous misconception of health care (which, as I have observed, is a consequence of trying to view it as an industry) is that it is all about throughput. In the best of all possible worlds, health care would be about maintaining a healthy condition in the body of every citizen of the United States. Unfortunately, since "health maintenance organizations" have thoroughly fouled up the semantics of "maintenance" by folding it into the industrialization worldview, we can no longer use the word in a meaningful way; and, as a result, our very expectations for a better health care system have been corrupted.

Worse than the bottom line, however, is the hypothesis it purports to warrant. This is that a significant portion of health care is a matter of monitoring bodies, providing data that can then be dispatched to a records system from which they may be filtered for "alarm conditions." This does not deny the role of conversations between doctors and their patients; but it purports to "tune the workflow" in such a way that only "conversations that really matter" take place.

The good news is that, perhaps as a result of all of those decades of experience with Windows, Microsoft is will to admit that there are still a few bugs in the system:

Neupert admitted that some work needs to be done on client devices. Monitors need to become small enough to be worn comfortably, so patients aren’t just checking themselves at home but doing it automatically through the day.

Well, yes, you do not want your data acquisition to intrude on an individual's day-to-day activities; but this overlooks a higher-level issue of whether or not the "immutable" day-to-day practices of the patient are compatible with data acquisition in the first place. After all, if technology innovation can screw up a previously smoothly running ATM operation (as I recently reported), what can it do for a process that covers all of an individual's waking and sleeping hours? It all comes down to whether or not we are willing to heed messages from those like Doctor Jerome Groopman that medical care can only succeed on the basis of its fundamentally human nature. Unfortunately, it is difficult (impossible?) to find anyone who might shape the future of our health care system who not only comprehends those messages but is committed to doing something about them.