BLOG on IT/IS in Healthcare & Life Sciences Joerg Schwarz on Healthcare [Health + Care]

This is the last entry in my Sun corporate Blog - I will leave Sun and focus entirely on Healthcare Information Security. My new Blog is at WordPress.

On July 1st, we'll celebrate the 4th anniversary of the Sun Healthcare Industry practice. About four years ago now, we started with the preparation for this group and defined in that process five focus areas. We envisioned Sun technologies combined with partner solutions to contribute significant value to the community, by reducing cost and complexity with open-source-based state-of-the art technology:

1. Health Information Exchanges - HIE
2. Secure Data Management for structured and unstructured medical data
3. Caregiver Mobility
4. Regulatory Compliance
5. Consumer Centric Health management

Coming back from the CIO Summit last week and preparing for HIMSS'09 in three, I thought it'd be a good time to review the current state of our healthcare activities and partnerships.

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In the next four weeks there will be a number of opportunities to meet and discuss how we can use open source technology for the digital transformation of Healthcare.

While I'm currently in Miami at the CIO Healthcare Summit, meeting and discussing with many U.S. CIOs and analysts from IDC, Eloy Rodriguez is getting ready for INFORSALUD 2009 in Madrid.  Eloy will talk in the plenary session of Inforsalud about open source "Good Always, Better in Crisis Times". Obviously, open source and open standards are key to interoperability, and interopberability is needed to connect and transform healthcare. Sun wil also feature open storage and Caregiver Mobility at the show. Just before HIMSS, we will address the same topics in a Healthcare Techday in Mexico City.

Along those lines will also be our presence at HIMSS 2009 in Chicago, booth 1210, coming up April 5-8. At our booth you will find partners like ThinIdentity, showing phenomenal Windows integration based on our Caregiver mobility solution. Combined with a MITEL VOIP device, we will demonstrate unprecedented session and voice mobility. If you are the lucky recipient of  a smart card invitation, you will be able to roam with one session between the CSC, Sun and AVNET booth properties - care giver mobility in action. We will also address desktop virtualiztion together with VMWare in a combined VDI solution.

Together with Bridgehead, we will turn up the HEAT for our joint Healthcare Enterprise Data Management solution based on Sun open storage and optional StorageTek Tape Libraries.

Given that the ARRA 2009 includes substantial incentives to build HIE (look at this analysis from AMA), we anticipate a lot of good discussions at HIMSS around HIE. We will showcase the working HIE implementation of the Province of B.C, PLIS, and other HIE implementations and pilots based on our open source HIE stack, such as NHIN. And in this BLOG we discussed already several times the Privacy and Data security provisions in HIPAA that are also part of ARRA 2009, which we will of course address and showcase with our partner FairWarning.

We have discussed on this blog privacy provisions in HIPAA, especially considering new privacy regulation and extensions associated with the increased investment in EMR. Recent articles like this one at The Healthcare Blog demonstrate both importance and urgency of the issue.

We are very excited to offer you in co-operation with our partner  FairWarning® a free, educational webinar exploring privacy regulation and its impact. The webinar was live on March 9th at 2pm Eastern / 11am PST, featuring Deven McGraw, Director of the Privacy Project at the Center for Democracy and Technology.  On January 27th, 2009, Deven testified to the U.S. Senate Committee on the Judiciary regarding privacy in healthcare, and along with others played a pivotal role in finding a workable privacy balance in the American Recovery and Reinvestment Act of 2009 (ARRA of 2009).  Deven is now able to share first-hand insights on the coming healthcare privacy and HIPAA regulatory environment.

If you missed the live event, you can download a pdf version of the presentation with very useful information.

Healthcare data storage requirements keep growing, and regulatory requirements keep changing every year.  The need for fast access to medical images and patient records under any condition remain high.  How can this exponential data growth be managed - while protecting critical data - in an environment where budgets are severely constrained? As discussed earlier, tiered, enterprise wide, consolidated data management is the solution. The question is how to get there.

We prepared an informational webinar to discuss enterprise data management and consolidation for healthcare providers. Join industry leaders from Sun, BridgeHead Software, and IDC for an open discussion of the challenges facing healthcare data management professionals today.  Learn the best practices others have adopted to cost-effectively lower the total cost of ownership of your mission critical data.

This webinar is part of a series of informational web events which we will provide free of charge. If you missed it live, you can go here to listen to the replay.

It's a good thing the Obama administration reads literature about the importance of privacy protection for the acceptance of electronic health records (EHR) (at least it seems so). Not only does the current stimulus plan include funding for the promotion of EHR, it also comes with very strong incentives to keep data private. This will be, based on studies conducted in the e-Commerce space, important for acceptance.

The current discussion about privacy risks caused by pharmaceutical advertising in electronic health record networks is helpful to highlight the difference between privacy regulation in HIPAA controlled institutions, and the uncontrolled Health 2.0 space, which is already very dependent on advertising.

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By Kurt J. Long, all rights reserved FairWarning, Inc.

It should come as no surprise that if the U.S. Federal government jump-starts Electronic Health Record adoption by investing public monies, then appropriate privacy and security safeguards will be asked of the healthcare industry.  The eyes of the world are on the American Recovery and Reinvestment Act of 2009, for the sake of patient privacy, the future of Electronic Health Records, and to some degree, the ability of the western world to compete globally, the world watches with great anticipation.

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Scott McNealy, as I recall, used to say "There are people who would pay extra to get their bicycle delivered in pieces, so they can assemble it themselves". Last week we organized an Industry Solutions review for health care and government at our EBC in Menlo Park - with very positive feedback from attending solution and channel partners, and also some leading Systems Integrators. I want to take this event as an opportunity to share with you which industry offers and architectures we are working on. And spoiling the punch line, I can already tell you that our goal is delivering integrated solutions that provide the fully assembled "bicycle" at the lowest possible cost, so our customers do not have to spend time and effort assembling it on their own. Because if you do have to assemble yourself, you WILL pay extra, if you want it or not.[Read More]

Payers have made tremendous progress in assembling personalized health records based on claims data. They use them, combined with health assessments, educational programs, decision tools and incentives, to create subscriber facing portals as competitive differentiators. Health 2.0, which was characterized by disconnected and fragmented offers, could quickly be superseded by these highly integrated sites. Since the data used in Health 3.0 is quality controlled claims or e-prescribe data, it can also be used by care providers for decision making. While the first generation of Health 3.0 tools seems to be home grown, it is already clear that standardization will further help to re-define ROI and accelerate speed.  [Read More]

Currently the media is full with speculation about the impact of the Obama administration on Healthcare IT. Professional Health IT organizations, like HIMSS, are encouraging Obama to spend more in Health IT, and so far his public appearances and health IT related personell selections seem to confirm that there will indeed be significant investment in health IT. But at the same time, we also read from CIO's like Dr. Halamka and Marc Probst, who face substantial cuts in their IT budgets. So what is going on, and will 2009 be a great, good, or bad year for Health IT?[Read More]

In the last week of October, Sun participated in a health care conference for Latin America in Buenos Aires, Infolac 2008.  Infolac gave us the opportunity to meet health care customers in this dynamically growing part of the world, and to check out if our focus areas for health care apply to the southern hemisphere as much as to the nothern hemisphere. What I didn't expect, was to find the Hospital of the future right there, in the suburbs of Buenos Aires - but that's exactly what happend.[Read More]

Dr. Kolodner invited the medical informatics community to a Town Hall in D.C. last week to discuss medical identity theft. Privacy concerns made it to the front page of the September issue of Healthcare ITNews, a reputable and well read publication. Hoooray!

This is exciting news - selling privacy and security solutions has much of the same feeling as advertising root-canal treatments (I have to guess, being not a Dentist): people know when it has to be done, but nobody is excited about it. Which is why IT security is an unwelcome topic often dealt with by buying Firewall and spam blocker appliances to keep bad people outside.

But those who follow the annual CSI report about computer security know that about 50% of damage caused by security violations is attributed to insiders. Provided that a new set of laws increases liability for record snooping, damages caused by insiders deserve even more attention.

Medical Identity theft, now seriously investigated by the federal government, is also a serious crime. Given the 48 million uninsured and millions more with insufficient insurance coverage, there is a large market for fraudulent access to health benefits. Prevention of medical identity theft is an information security challenge against both insider and outside attackers.

In this context, I posted Friday an invitation to attend a webinar in which you can learn more about a solution provided by our partner FairWarning. Just like a Firewall, the FairWarning solution plugs into different environments and starts to work in the background. Leveraging technology like MySQL, FairWarning detects suspicious access patterns while they occur and can alert IT staff about potential policy violations. This is much better than discovering violations months after the fact in an audit, when liability might already have been triggered. The cool thing about FairWarning is how it can be pre-configured for a specific customer and be deployed in a short time - a true appliance.

So - once more - please register for the webinar to learn more and stay tuned for more IT security solutions for Healthcare from the Sun Industry team.

FairWarning® announced an optimized Healthcare Privacy Surveillance solution that leverages Sun and MySQL technologies, you can read more by clicking here.

We also have a FairWarning® and Sun/MySQL customer webinar scheduled, for which you can register free of charge.

"How to Create a Culture of Privacy and Security while Addressing Core State and Federal Regulations"


Date:  November 5th, 2008
Time:  2:00 Eastern / 11:00 Pacific

Registration Link


Description:   Join us on this webinar to learn how MemorialCare®, a major healthcare provider in Southern California, has executed specific steps toward creating a culture of privacy and compliance while pursuing electronic health record expansion.  On this webinar learn how to:

•  Address crucial state and federal mandates through the use of privacy surveillance
  (e.g. FTC Red Flag Rules, AB 211, AB 541, HIPAA)
• Plan and execute an entity-wide program which ties together privacy surveillance, privacy awareness training and sanctions
• Detect, alert to and deter privacy incidents such as patient snooping and identity theft
• Centralize audit logs from all of your healthcare applications

Registration Link

One of the major challenges in the transformation of health care is managing medical images - massive amounts of data that by law have to be preserved over a long period of time. According to data presented by our partner Carestream Health, only a fraction of the total cost is associated with hardware and software. During the last several years we noticed a trend towards outsourcing of the management component of medical image archiving.

Our partner Carestream Health, based on a number of Sun technologies and services, has developed a comprehensive offer for managed services in eHealth, with a focus on medical image archiving. Medical imaging is a good topic to discuss because it is a big ticket item- Modalities are expensive, so sharing modalities and integrating results across multiple modalities bears great ROI potential.

Not only does it save cost to archive images from multiple modalities into a managed service "cloud" with specified response and availability times, it usually also improves to overall service over a period of time. It becomes for example much easier to share medical images within a health information exchange (HIE or RHIO) if images can be pulled from a central service. Reducing cost by avoinding redunant imaging procedures is a great value proposition for HIE, as discussed in this blog numerous times.

Please listen to a recent Webinar produced  by Carestream Health and the Sun Healthcare team by clicking here.

This webinar is part of a series of webinars with which we provide more in depth information about our solution focus together with our partners.  Upcoming webinars cover Medical Imaging for Siemens PACS customers and solutions for consumer driven health, focussed on payers and health plans. You can register for those seminars and listen live or to the recording. 

The presidential dabate of Senators McCain and Obama covered the topic of health care IT yesterday, so I though it's time for the long overdue continuation of this blog. I reviewed the transscript of yesterday's debate for accurate quotes and comment from the impartial perspective of a healthcare IT professional - this is not a political blog, after all.

Senator Obama, questioned how he would fix healthcare, said "We are going to invest in information technology to eliminate bureaucracy and make the system more efficient." Was he talking about health information exchanges (HIE)? I think so. HIE exchanges have at least the potential to eliminate reduant procedures and improve quality of care by allowing physicians to coordinate care. This is especially important in the context of Senator Obama's next comment: "And we are going to make sure that we manage chronic illnesses, like diabetes and heart disease, that cost a huge amount, but could be prevented. We've got to put more money into preventive care." Disease management and coordination is indeed an important application for HIE, as they allow care coordination and act as a data source for connected PHR, a topic we discussed in this blog many times. Unfortunately, the body of knowledge in medical informatics is full of assertions that these links between HIE exist, but there is little hard evidence. Why?

I think the core problem with HIE is that they are extremely dependent on demand side returns - if HIE don't have a high level of participation, the return and thus value is low. Given that currently only 25% (depending on which study you read that's actually an optimistic approximation) of physicians use electronic medical records (EMR), the probability p to have a doctor with EMR is 0.25. Now, assuming random distribution, and considering the ideal case that every doctor in a region with EMR would be connected, the probability p' to find three pieces of information about a patient would be 0.25 x 0.25 x 0.25 = 0.02. That's a mere 2%. Sorry, that's the rules of probability. Now, once you get to say 80% coverage, p' would be 0.51, 51%. Still not perfect, but much better. Now, I heard at many conferences that up to six doctors are involved in the care of a single Diabetes patient. Once you apply combined probability, chances are infinitesimal to pull all records together unless ALL doctors are online. So realistically, building HIE will only create the value we are all hoping for if coverage is almost universal.

Fortunately, Senator Obama seems to have known this when he said "This will cost some money on the front end, but over the long term this is the only way that not only are we going to make families healthy, but it's also how we're going to save the federal budget, because we can't afford these escalating costs."

Now to Senator McCain. 

Right off the bat he talked about the role of Health IT: "We need to put health care records online. The V.A. does that. That will -- that will reduce costs."

What does he mean by putting health care records online? Could he refer to PHRs? Well, in the context of the V.A. he surely refers to their medical records system, VistA, which is open source, as discussed here many times, and widely considered as being one of the best EMR implementations on the planet. However - the V.A. has an "unfair" advantage. Going back to my previous probability calculation, the V.A. has almost 100% coverage, meaning all V.A. entities are connected and use VistA, so they have a dense, longitudinal medical record. Doing this outside the VA population is difficult - back to our discussion about HIE and curse of combined probability.

Then he really talks about a core topic of PHRs, incentive programs for good life style choices: "we need to have employers reward employees who join health clubs and practice wellness and fitness." We indeed see this as a major opportunity and are actually working on a campaign to provide the right tools to self insured employers, so they can do what Senator McCain suggested. Watch Kumar's blog for more info on this. Right there you will also find more info on a project we're betting on, medical banking. Medical banking is the logical continuation of the policy to empower consumers to direct their health spending based on informed decisions, and combines flexible spending accounts with PHR functionality.

Later in the debate, Obama and McCain quarreled about the cost of health insurance. Senator Obama claimed that "the average policy costs about $12,000". Later, McCain asserted that "The average cost of a health care insurance plan in America today is $5,800."

Who is right? Both. Check the Kaiser Family foundation report on health insurance cost. The average cost for a family is indeed about $12k, while the average cost for an individual is indeed about $5k. Unfortunately, Senator McCain forgot to mention one big advantage of his plan: uninsured or under insured today have to buy health insurance with after tax money, which is pretty unfair compared to the ones who get tax-free insurance benefit from their employer. Kind of a double whammy: first you have the bad fortune of a job without benefits, and adding insult to injury you then have to use after tax money to buy yourself or your family coverage.

But Senator Obama made a good point about under insurance. He reminded us that "The average family is paying an additional $900 a year in higher premiums because of the uninsured", because the public has to pick up cost of emergency room treatments. Again, KFF provides good data on this subject, and solving the problem of un-insurance seems indeed to be a good value proposition. It's questionable if tax incentives really help people at the lower income scale, where tax progression is usually not a top-of-mind issue.

Anyway - conclusion: whoever will be elected President, health IT will play an important role in fixing the issues we face in health care. From my point of view, the team Obama and McCain did a pretty good job covering most of the topics the Sun health care industry team is working on - HIE, PHR, Consumerism. Good job, Senators. Can't we get them both? The problem is certainly big enough....

Update: thanks a lot for the recommendations and applications we received in response to this posting. Much appreciated.

I'm happy to announce that we found two wonderful individuals for the two positions.

Today Sun announced the availability of a major new software release, Java composite application suite 6 (JCAPS 6). As mentioned in several entires, most recently when contrasting Microsoft Amalga and Sun, JCAPS is an essential component of our portfolio in health care. We use JCAPS components to build scalable, inter-operable and open e-Health architectures for our customers, such as the Government of British Columbia. As Jason Baragry comments in his entry about the differences between JCAPS 6 and open ESB, JCAPS 6 is not a superset of open esb. JCAPS is the supported subset with some cool new and improved functionality and full glassfish integration. Mission critical deployment with full support is possible with open source software! We use the exact same model (innovation as part of open source, supported subset in an official release) also with open Solaris. This means that the open source code base is always a good way to predict which features are coming in the next major suported release.

More info can be found here. 

Peter Neupert, VP for health care and as such functionally my counterpart at Microsoft, got to buy some interesting technology after he took his job in 2006. At the Health 2.0 conference last year in San Francisco he announced that they had made 9 sales of the EMR acquired as Ayaxxi and now named Amalga. I was perplexed, as recorded in the blog entry live from the conference. First of all, you would think nine application sales in a multi bilion dollar company like Microsoft are nothing to brag about. Secondly, every major EMR vendor uses Microsft technology for their front end, and in some cases for the back end also, so one could ask why a company would risk trust and partnership with the leading companies in the market for an unimpressive number of sales. And quite frankly, I can't answer that question. I can tell you we, Sun Microsystems, wouldn't. 

This entry contrasts Sun products and policies for health IT to Microsoft's, as a guidance to potential buyers and partners.

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In my blog entry yesterday I contrasted the energy consumption by conventional PCs with the energy consumption of Sun Rays in combination with our SPARC CMT servers. The net result is that a 2.5 kw  photovoltaic installation could provide enough power for 200 clients, enough for a regular community hospital, because a Sun Ray uses less than 1/12th the energy of a PC and our CMT servers can handle many user session in parallel. Today, AHIP-Wire featured this story about the trend of hospitals "going green". The article quotes an architect claiming that "sustainable design can reduce hospitals' energy use by half".  Well - there you go. High energy cost is a good motivation to re-think how to architect things. And it is good that being eco friendly now has a hard ROI in energy cost savings. 

	use as much gas as
	use as much electricity as

Read more about Eco responsibility and economics.

Slightly off topic, but fascinating. Motivated by a comment from Paul Scott, I encourage you to visit the web site "pluginamerica". Great information on electric vehicles. I found through pluginamerica this amazing video on youtube. Must be a year or two old when gas prices of $2.50 were considered astronomically high. Folks - the solutions are out there!

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Last week I was at the Minnesota Health Information Institute in Minneapolis, MN, presenting on how to brave the perfect storm of medical image archiving. In this entry I will explain why the data growth rate in health care is a phenomenon that, if not mitigated by appropriate archive architecture, will become problematic for IT budgets. I will also discuss why tiered archives are the optimal solution for performance and price efficient long term medical archiving. In a second entry I will then discuss why media independence is a key architectural design criteria for medical image archives.[Read More]

President Bush signed yesterday a law about genetic privacy, and that is a good thing for health care and life sciences. The future of health care will look a lot like life science research today - genetic profiling will help to develop better targeted drugs, and in health care delivery physicians can make decisions about treatment options based on genetic analysis.

However, we need to avoid discrimination of people with certain genetic markers, like BRCA1 or BRCA2 or atherogenic lipoprotein phenotypes. They could become victims of discrimination because carriers of certain polymorphisms have known higher risk of cancer or congestive heart disease respectively. The signing of genetic privacy into law is therefore a good reason to discuss how translational research will transform health care.

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As usual, google did a good job. Their hype started before and at the Health 2.0 conference last year in San Francisco, then Dr. Eric Schmidt announced google health in February at HIMSS08 in Orlando, and earlier this week the beta version of the actual service opened its service to users. The hype worked, and google gets lots of attention. This entry discusses Sun's position on PHR in general and Google Health specifically.

 

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The terrible disaster caused by the recent magnitude 7.8 Earthquake in China is a cause of mourning for the victims to many of us.

My wife is from China, and she talks to her family every day in order to get better updates on the emergency response. Pictures of mothers crying for their children, Husbands for their wifes and children for their parents move our hearts. There is little we can do but show our sympathy and try to help the best we can.

Sun has, like many other companies, coordinated a disaster relief drive that allows all of us (Sun employees and everyone else) to help survivors through this difficult situation: 

 

 

 

In Europe and Asia, IHE (Integrating the Health Enterprise) has become an important test set for interoperability and work flow profile. We see more and more demand for IHE compliant products in the U.S. also. IHE does not define technical standards, it provides test profiles and XML document standards that allow exchange of information between different applications. Work flow profiles define which types of information systems have to be connected and exchange information to support clinical processes. IHE profiles therefore are structured around clinical domains, such as Radiology or Cardiology.[Read More]

The 7th annual health technology institute in Minneapolis, MN, will be held next week at the Carlson School of Management of the University of Minnesota in cooperation between the local HIMSS chapter and the School.

I will make my way to Minneapolis to talk at this conference about data storage, specifically of course about medical image archiving.
The talk is titled "Braving the perfect storm: media independent archiving of medical images. How to build scalable, long term archives that satisfy capacity and performance requirements of the medical staff within the budget framework approved by the CFO".

If you are interested to hear this talk live and in color, feel free to register.  I will, however, post the presentation here after coming back from MN.

 

In an earlier blog I described why modern SOA architectures used in Health care are a great match to Sun's SPARC CMT technology. My friend Dr. Stephen Perrenod, who is preparing a talk for a grid conference in Malaysia, was looking for references and dug up this report about Jurong Medical Center in Singapore, which provides a concrete example for CMT in health care. Thank you, Steve!

Returning from the CIO Healthcare Summit in Marina del Rey, CA earlier this week, I review in this entry discussions, contributions to workshops, and one-on-one interviews with C-level executives from small and large hospitals, integrated delivery networks (IDN) and payers.[Read More]

Roger Maduro's Newsletter about VistA and Open Healthcare contains several interesting updates about VistA implementations, and also about the combination of strengths between VistA and Tolven. Medsphere and Tolven reached an agreement to use the Tolven EMR, which was announced at HIMSS, so it looks like we can expect interesting things in the creation of a fully functional clinical application stack for acute care hospitals with a state-of-the art EMR core. And, as I might add, available on a highly scalable SAMP stack.

Finally, we made the last step. After building a legacy in giving away millions of dollars in free, commercial grade software, we now offer free hardware to software developers who port their application to Solaris! Too good to be true? Try it!

Sun Developer Network (SDN) is a free program for the developer community. It might be a well kept secret, but the developer tools SDN members can access for free are state of the art (Netbeans, Sun Studio Tools), not only for Solaris, but for cross platform development. Combine this with a very robust application server (Glassfish) and RDBMS (mySQL), and developing web service based applications  on a SAMP stack (Solaris, Apache, MySQL and PHP) becomes a breeze.

Now, if you need a server or workstation to run the entire stack on Solaris, you can get this for free too, as part of the Partner advantage program, which is of course also free. On top of that, we can help with benchmarks of your Solaris applications, so actual deployment capability can be tested and sized before the actual deployment. And when the first deployment comes around, you can leverage the free try-an-buy program for our CMT servers, both for developers and endusers. These servers are ideal for web services deployments in eHealth applications.