Overshadowed by Giants

MDNG Psychiatry, July 2008, Volume 8, Issue 7

A year later, as we read and watch the breathless coverage devoted to recent moves by Google, Microsoft, and Apple, we are left asking "is healthcare IT worth the hype?"

In the course of covering the latest healthcare information technology news for physicians, there are times we wonder whether it’s all that it’s cracked up to be—whether the products and their capabilities warrant all the hyperbole.

MDNG last visited this issue in our July 2007 cover story, “Healthcare IT: Is it All Hype?” mainly as it pertained to e-prescribing initiatives and lessthan-successful EHR systems. A year later, as we read and watch the breathless coverage devoted to recent moves by Google, Microsoft, and Apple, we are left asking “is healthcare IT worth the hype?”

With healthcare seemingly in permanent crisis mode, there’s a natural tendency for people in the industry to frame every issue in terms of needing a comprehensive solution to avert certain disaster. The more enthusiastic health IT boosters certainly haven’t shied away from casting their favorite applications in the role of healthcare’s savior, confi dently asserting that adoption will lead to thousands of lives saved and billions of dollars recouped. When numbers that large are thrown around, people tend to pay attention. Combine that anticipation with our societal belief in the innate value of technology and unwavering faith in our ability to innovate our way out of any problem, and you have a recipe for runaway hype. Even the merest hint of a rumor that Microsoft, Apple, or Google is planning to unveil “something big” is enough to send the tech industry media on 24-hour alert. So when the news hit that these companies were fi nally making long-anticipated forays into the healthcare market, the health IT community was abuzz with speculation and anticipation. However, at the end of the day, have these companies and their new products really succeeded in introducing ground-breaking ideas to the healthcare industry, and are they worthy of all the hype? And will they hog the spotlight from smaller health IT companies that may be short on notoriety but on the path to creating truly valuable technologies?

The big guns

The past year has seen Microsoft launch the online health record platform HealthVault; Google launch its online health information portal, Google Health; and Apple unveil an iPhonethat supports numerous, new third-party medical applications. A May 2008 MSN article captured the eff ects of the media frenzy surrounding all this, stating that society is “officially in bizarro world when people start lining up at Apple stores for absolutely no reason.” The article even cited an official Apple analyst who said users should not “expect revamped iPhones until 2009.” Th is, predictably, did little to dampen anyone’s enthusiasm. Merely attaching the name “Google” or “Apple” to a product gives it authenticity in many people’s minds, regardless of its merits. Th us, these tech darlings are often given the benefi t of the doubt, with their previous successes (or at least the perception of their success) building up an enormous reservoir of goodwill in observers, making them inclined to assume continued success in all the companies’ endeavors. Th is uncritical embrace only fuels the hype and sets the stage for potential disappointment down the road.

However, some people are already pushing back and challenging the notion that all the hype is justified. Keith Schorsch, founder and CEO of Trusera.com, recently wrote on The Health Care Blog that he thinks Google especially has lost sight of what consumers (healthcare consumers, especially) really want and is focusing too much on user control. However there are companies that haven’t lost sight of what consumers and physicians need, companies whose products are designed to fill more modest but well-defi ned niches. Let’s turn our attention from the Googles and Microsofts and highlight some of the more notable “little guys.”

The up-and-comers

There are many smaller companies that have made great strides in developing truly useful healthcare technology applications that have yet to receive the attention accorded to their larger counterparts. MDNG blogger and editorial board member Nancy Tice, MD, says free EHR platform PracticeFusion is among her favorites. The program allows physicians to integrate

applications without the use of onsite software, relieving practices of the burden of supporting traditional enterprise software products.

“Everything is automated—from scriptwriting to templates for commonly done exams,” Tice says. “One very important feature on PracticeFusion is that after the patients visit, when you close out the note, you may edit it. This is key for malpractice. So key, in fact, that your carrier is supposed to give you a discount if you use an EHR that does this.”

Another success story among the lesser-known tech companies is Hakia.com, a new, still-in-beta-stage semantic search engine designed entirely for the healthcare sector. “We started Hakia in 2004 with the potential to provide the first semantic search technology on the Internet,” says CEO Riza Berkan, PhD. “Search engines provide users with a popularity perspective. What Hakia does is provide credibility without relying on collecting votes. Semantics enables us to harvest databases with full potential (PubMed is one example). Hakia is the first search engine to rely on quality-stamped results.”

Berkan notes that Hakia was able to demonstrate quite a bit of success in semantic searching, even when comparing results to Google, the gold standard of online search in many people’s minds. “We are proud to be instrumental in that vision,” he says. “Popular information is not always correct, and correct information is not always popular. We went to medical associations and picked up their recommended sites for credibility measurement. That list is available on the website at http://company.hakia.com under ‘verticals.’ As an end-user, it’s not your job to determine which is credible information and which is not; the Googles of the world are not providing that to you.”

Between the hype and the reality

So what does this all mean for physicians? Lynn Ho, MD, runs her own micropractice in Kingstown, RI, and claims to not be easily influenced by the hype or media coverage devoted to larger companies, preferring the information that she finds through various e-mail listservs.

“I listen to the technology masters on listservs; word-of-mouth recommendation has worked well for me,” says Ho.

How else can a physician avoid the trap of going for the most-hyped technology versus the most beneficial? Hakia.com beta tester and physician John Boockvar, MD, takes it back to the basics and refuses to be swayed by the charm of the larger, better-known search engines. “From my use of [Hakia], it has shown promising signs of performance,” he says. “The articles it finds are not easily reachable through PubMed’s own search engine, nor with Google’s site search.”

Getting peer feedback is clearly another method for physicians to make the best informed decision about where to obtain their information. “Get personal recommendations from people that have tried the technology you are about to embark on, ask pointed questions, and see if it will fit your needs, not the hyped needs,” says Ho. Small companies aren’t immune to hype and

infl ated expectations. Their products still receive attention from media that focus on their industry, just on a much smaller scale.

So, will the Hakia’s of the world live up to expectations? Berkan says, “It’s too early to make any judgments, but it’s been a bit of a feeding frenzy. Commercialism is okay, I’m not against it, but as with many health sites, I don’t see these kinds of distinctions, and that bothers me.”

On the flip side, even the larger companies themselves appear to be less than enthused by the hype their names often generate. “I’ve always been a bit of a hype skeptic,” says Grad Conn, Senior Director of Product Marketing for Microsoft’s Health Solutions Group. “There’s a lot of energy in healthcare right now in terms of changes that are coming. I don’t want hype to get ahead of itself. People have a tendency to get overanxious, and then we’re disappointed. We’re encouraging everyone to boil the ocean 10 gallons at a time. We shouldn’t be too hard on ourselves if we haven’t completely transformed the healthcare system in a year.”

Optimism with a note of caution

Despite the many triumphant predictions of greatness, it’s still too early to tell whether Microsoft and Google will succeed or fail. The public’s fi nal judgment may not even depend on the actual merits of the technologies themselves, but rather on of the products themselves. Health 2.0 Conference co-founder Matthew Holt is doubtful that health IT will be the solution to the current healthcare crisis. “I think anytime you’re talking about something as complicated as the healthcare system, saying that we’re going to change [it] using health 2.0 is over-ambitious… If you say health 2.0 is going to change healthcare as we know it in every aspect completely, immediately, you’re going to be disappointed. If you say we expect to see health 2.0 as the use of these tools adopted by more and more patients, physicians and healthcare organizations, I’m sure it could slowly change the way healthcare is delivered and the way people manage their health.”

For more thoughts on healthcare IT from Holt, see the June MDNG feature, “5 Questions with…”. The reality is that most of these companies set out to do what they do best, which is create unique technology platforms for home and business that can be built upon and integrated with other existing technologies—not change the American healthcare system.