Thursday, January 13, 2011

Google CEO Eric Schmidt on Healthcare IT Once Again

At the Jan. 11, 2011 WSJ health blog, in an article entitled "JP Morgan Healthcare: Google’s Schmidt on Open Source and Health IT", Google CEO Eric Schmidt is cited as saying:

... One solution to the problem may be to take the electronic-medical record architecture out of the hands of the corporate world, suggested Google CEO Eric Schmidt at the JP Morgan Healthcare Conference last night.

“If I were not doing what I’m doing and I wanted to do something in health care … I would go to all of the research universities and would try to figure out where the best, interesting IT software is that can be open-sourced,” he said at a health-IT panel discussion. “My guess is that a platform like that would be remarkably different from the platforms that we are using today,” he said.

First, a comment on language, which perhaps I should more accurately describe as a critique of IT culture:

“A platform like that?”

As at my post "Does the CEO of Google Use Google? - And: Platform, Platform, Who's Got The Platform?" early last year Schmidt also said

“As computer scientists, this [that is, why docs haven’t embraced databases to help them sort through medical information] is a platform database problem, and we do these very, very well, as a general rule. And it befuddles me why medicine hasn’t organized itself around these platform opportunities.”

At that post I also pointed out that the successful practice of medicine is not a 'platform database' or any other reductionistic information retrieval problem, and that such a "platform opportunity" was seized upon decades ago:

DXplain was developed starting in the mid 1980's by medical informatics researchers who actually know this domain, and which offers this explanation and warning: "DXplain uses an interactive format to collect clinical information and makes use of a modified form of Bayesian logic to derive clinical interpretations ... DXplain does not offer definitive medical consultation and should not be used as a substitute for physician diagnostic decision making."

I note that IT personnel like to refer to “platforms”, “solutions” – a rather presumptuous term – “paradigms”, and other buzzwords to mask the fact that what they’re referring to are more commonly known as “hardware” and “software” and arrangements thereof.

It is a word that implies lack of knowledge about the complexities and realities of medicine – including that health IT problems will not be solved via a “platform.”

I wrote more on “platformania” at this link.

I do agree strongly with Schmidt on the following from the recent WSJ posting:

Schmidt said that using such an open-source strategy — giving programmers the freedom to modify and distribute software [an agile computing methodology - essential to health IT development and lifecycle - ed.] — is a proven way to fix disparate software architectures. It’s the same development strategy that brought about the modern internet and “all the other technologies that you use every day.” ... Part of the problem in designing and discussing a new standard is that the current focus is on the companies involved rather than the patients.

That's been done, too, as in the OpenVista /WorldVista efforts.

I merely add that an erroneous approach to "focusing on the patients" (and the clinicians using the IT, i.e., a user-centric approach in the terminology of Social Informatics) will have results just as suboptimal as the current designer-centric approach to health IT. Designing health IT that "focuses on the patients" and that eliminates unintended consequences - i.e., "doing health IT well" - is wickedly harder than it sounds.

Most importantly with regards to Mr. Schmidt's most recent thoughts on academia:

The National Research Council did study a number of the best academic centers and in a 2009 report found quite clearly that even there, “Current Approaches to U.S. Health Care Information Technology are Insufficient.” See

They did recommend the solution, and it's not a "platform":

“In the long term, [Health IT] success will depend upon accelerating interdisciplinary research in biomedical informatics, computer science, social science, and health care engineering.”

That means forgoing the current national rush to EHR, which is decidedly a medical experiment without patient consent.

In any case, I am impressed that a major information technology CEO has recommended a patient centered approach to health IT, agile methodologies, open source, etc. - true sacrilege towards today's health IT ecosystem.

(Note to Google and Mr. Schmidt: In "Who Can Solve Healthcare IT's Challenges? Part 1 - Google" I wrote that:

... This [HIT] dysfunction takes the form of corporatization of HIT, creation of myths about its magic bullet capabilities in "revolutionizing healthcare" ... In "A Biomedical Informatics Manifesto" I addressed the domain expertise I feel is most needed.

I did not, however, address the "who" as in "what organization(s)." What organizations, that is, have the resources (e.g., financial and infrastructure) to make useful, usable, national, interoperational HIT happen? What organizations have the innovative track record to effectively engage the best specialists to make it happen?

One example comes to mind immediately. It was suggested by an expert in IT and bioinformatics I correspond with, Felix Fulmer.


These folks are innovative. Their services are reliable, fast (when is the last time Google was down or took a long time to provide query results?), widely available, cost effective (many services available for free!), and a true technological tour de force.

Google, I am available should you seek true competitive advantage, and avoidance of paths that lead to health care IT failure such as you once attempted here. However, somehow I am sure your HR department would probably find my sometimes "edgy", critical-thinking approach to matters of national import "disruptive."

Disruptive to what, exactly, I'm not sure, but disruptive to - something - is good enough in today's "PC", outcomes-be-damned corporate culture.)

-- SS

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