Lab Soft News

Radiology Groups Begin to Develop Their Own "Nighthawk" Service Model

Nighthawk Radiology Services has filled an important niche for hospital-based radiology groups in the past. As the name implies, the company offers the services of its own radiologists to interpret studies performed at night. Some of these personnel are located in countries with different time zones than the U.S. such as Australia to facilitate this process. This was viewed as a desirable alternative to having the associates of the local hospital-based radiology groups perform this night work. I have posted a number of notes about various aspect of the "Nighthawk" business model. Unfortunately for the radiology groups involved, some hospital administrators have asked the following question: If we use the Nighthawk services during off-hours, why not "disassociate" from our own radiology group and use the same company to interpret our cases during the day? This approach is sometimes referred to as the "dayhawk" model (Dayhawk Radiology and the Decline of the General Radiologist). Needless to say, this competitive threat presented a dilemma for the hospital-based radiologists.

I have just picked up on a rumor that one Ohio hospital-based radiology group has decided to fight back against Nighthawk, the company, by creating its own in-house version of nighthawk services. The group is pursuing this goal by buying a condominium in Honolulu with a five-hour time difference from Ohio. As described to me, the group offers its members the "hardship duty" of spending two-month stints in Honolulu, interpreting studies sent to them across the web from Ohio. In this way, members of the group can manage the studies generated in their hospital during the nighttime hours without missing much sleep.

As I was trying to run down this rumor, I encountered a web site that lists some 88 teleradiology jobs. It provides some idea of the shift to this service model. One advertisement, in particular, caught my attention. I list it below:

Alaska: General Diagnostic, 26 weeks vacation, $500K (nighthawk): Two member private practice primarily serving outpatient clinic seeks a [third] General Diagnostic Radiologist. All digital environment with new McKesson PACS to be installed in March 2008. Night service begins at 5pm with minimal weekend call. At least 2 weeks off per month, and after a year to Partner, vacation could possibly increase to 3 weeks per month. First year income is approximately $350K to $400K, increasing to about $500K at partner.

This job is described as "no longer active" and I can understand why. How many jobs in America pay this kind of money for half-time work?

Digital Pathology Offered as a Service Rather Than a Product

For a few years, an evolution has been occurring in the field of information technology whereby software is provided as a service rather than as a purchased product. This is approach has been referred to in the past as SaaS (software as a service). In parallel with this development has been the transition to cloud computing whereby applications and data storage are managed by a network of servers accessed via the web rather than on servers located within the enterprise. It's clear to me, that digital pathology, at some time in the near future, will be provided as a service rather than as a product. As evidence for this statement, here's what BioImagene has to say on its web site about Virtuoso, its software product, and its pricing strategy:

BioImagene’s Virtuoso digital pathology application software works with BioImagene’s iScan family of slide scanners to provide an end-to-end digital pathology solution. The total digital pathology solution allows users to view, manage, archive, and analyze digital images. Virtuoso also allows users to produce customized digital reports and collaborate with other pathologists or oncologists in real-time....Virtuoso is a web-based application that enables the various users, e.g.: pathologists histotechnologists, lab administrators, and clinicians, to improve their efficiency within the anatomical pathology workflow....BioImagene’s digital pathology solutions require no upfront capital expenditure due to its comprehensive pay-per-click pricing model that makes it easy for pathologists and laboratories to acquire them..

Note the reference to a web-based solution and also to a pricing model based on pay-per-click. This is sometimes referred to as the "taxi-meter" approach. A ride in a taxi is a service and not a product. However, when considering digital pathology as an end-to-end pathology solution, there is a key component that is not now provided by vendors: inexpensive storage of the large image files that are the byproduct of any digital pathology system. Look for a total basket-of-services to be offered by digital pathology vendors such as BioImagene and Aperio at some time in the near future including storage of image files.

In a previous post, I discussed the possibility of healthcare carving out its own unique remote storage capabilities that I referred to as a "vertical cloud" (see: A Closer Look at the Vertical Cloud in Healthcare Computing). The digital pathology cloud storage would be an important component of this vertical cloud. There is currently at least one company, Insite One, that offers remote cloud storage for PACS files as well as other healthcare data. The company describes its archiving and storage services in the following way on its web site:

InSite One's patented InDex storage management services deliver a powerful suite of intelligent, standards-based solutions that adhere to DICOM, HL7 and XDS (cross enterprise document sharing) IHE standards and protocols. This on-demand, vendor neutral object repository ensures rapid retrieval of your clinical information throughout the enterprise. Data is retained for legal-life in a HIPAA enabled environment and archived in Tier-4 mirrored geographically dispersed datacenters.

It's Time for the FDA to Prohibit Direct-to-Consumer Advertising by Pharmaceutical Companies

I have generally been suspicious about direct-to-consumer (DTC) advertising by pharmaceutical companies on TV and in glossy magazines. This type of advertising provides the drug companies with an opportunity to manipulate the viewing public with brief, slick messages. I expressed my reservations in a previous blog note (see: Effectiveness of "Direct-to-Consumer" Drug Advertisements). A recent article emphasizes how these ads may not boost sales and also that the taxpayers may actually be funding them. Below is an excerpt from it (see: Drug ads ineffective for boosting sales, could cost taxpayers: UBC-Harvard study):

US Taxpayers may be on the hook for the high cost of drug advertising that does little to boost sales, according to a new study led by a University of British Columbia health policy researcher. The study...examined the US sales patterns of clopidogrel, a top-selling drug also known by the trade name Plavix used to prevent blood clots after heart attack or stroke. The drug was selected to study the impact of advertising on sales because it was sold for more than three years before the launch of its first direct-to-consumer advertising (DTCA) campaign in 2001. "While clopidogrel use has been increasing for some time, we found advertising it to consumers didn't make use rise any faster," says [one of the authors of the study] The researchers found a significant jump in the drug's price that coincided with the launch of its DTCA campaign. This higher price added US $207 million to the pharmacy bill for Medicaid, a publicly funded health program in the US for individuals and families with low incomes...."The key issue is whether advertising to consumers, which has risen 330 per cent in the last 10 years in the US, contributes to the significant cost increases in publicly funded health insurance programs such as Medicaid," says [another author of the study].

This news comes at the same time that the FDA is holding hearings about whether pharmaceutical companies should be allowed to use social media such as Twitter to promote their products (see: FDA Begins to Shape Rules for Online Drug, Device Ads). My reaction to this latter issue was instantly negative, given the fact that Tweets are limited to 140 characters. In such a setting, the contraindications to the use of a drug cannot be adequately covered. Moreover and at least in my mind, there is the distinct possibility that the less ethical pharmaceutical companies could pay individuals to post glowing reports about their products on social media as a form of viral marketing. There is no way that the FDA could police such underhanded activities on Twitter with a current daily volume of about 25 million message.

Let's put an end to all DTC advertising by pharmaceutical companies on TV and magazines. These companies should, of course, be allowed to communicate with physicians via the web and printed materials. As I noted above, the web, but not web-based social media like Twitter, is the most appropriate communication channel for healthcare consumers who want to acquire detailed information about drugs. In essence, they would be looking over the shoulders of the doctors. Web advertisements and reports by these companies, of course, can easily be scrutinized by the FDA. Consumers browsing the web can also get ready access to medical journal articles about the effectiveness of drugs and also adverse reactions, achieving a balance not available on TV or consumer magazines.

Science-Driven Medicine Bumps Up Against Perception of Risk with Mammography

The recent recommendation of a panel of experts that routine mammography is no longer necessary for women in their 40's was greeted by widespread skepticism and will probably be ignored by most physicians and patients. My personal interpretation of these events is that most women viewed early detection of breast cancer as trumping the "problems" associated with false positive reports. For those with health insurance, the cost of care for many does not play a large part in this decision process. The New York Times published a short but excellent analytical piece about this issue with a look at the future (see: Medical Science and Practice in Conflict). Below is an excerpt from the it:

This week, the science of medicine bumped up against the foundations of American medical consumerism: that more is better, that saving a life is worth any sacrifice, that health care is a birthright....The backers of science-driven medicine, with its dual focus on risks and benefits, have cheered the elevation of data in the setting of standards. But many patients — and organizations of doctors and disease specialists — find themselves unready to accept the counterintuitive notion that more testing can be bad for your health....For decades, the medical establishment, the government and the news media have preached the mantra of early detection, spending untold millions of dollars to spread the word. Now, the hypothesis that screening is vital to health and longevity is being turned on its head, with researchers asserting that mammograms and Pap smears can cause more harm than good for women of certain ages....The challenge of persuading patients and doctors to accept such standards requires a transformational shift in thinking, particularly when the disease involved is as prevalent, as deadly, and as potentially curable as cancer. How do you convince them that it is in their best interest to play the odds when they have been conditioned for so long to not gamble on health? After all, for the one in 1,904 women in their 40s whose life would be saved by early detection of breast cancer, taking the risk would in retrospect seem a bad choice.

I was fascinated by the author's use of the term "science-driven medicine" -- I will take it to be largely synonymous with evidence-based medicine (EBM) with some overlap with comparative effectiveness. I have an image of a panel of experts poring over research articles, weighing the data, and concluding that the earlier screening was not cost-effective. Organizations with the most financial skin in the game such as the American Cancer Society and the American College of Radiology were the first out of the gate, decrying the evidence and the conclusions of the panel. The women of America as the consumers of the service then weighed in aggressively in favor of the earlier screening -- whatever evidence was present to support the conclusion was left in the dust.

So the question for health and lab professionals is whether this is a general vote in favor of early screening and against EBM and comparative effectiveness as tools and analytic methods for the future. I think that the answer to this question is probably no because of some of the unique aspects of mammography in particular and women's breast health in particular. Breast screening in so ingrained in our culture through long-standing practice that it will be nearly impossible to alter in any substantial fashion. However, any health panel recommendations in the future may need to take the individual wishes and perception of healthcare consumers into consideration. For me, this is the major lesson that has now been learned.

A Quick Look at Cardiovascular Information and Imaging Systems (CVIS)

I must have been sleeping at the switch. Outside of my lab/LIS world, a new category of integrated clinical information systems has arisen -- the CVIS or cardiovascular imaging and information system. McKesson provides a CVIS web site promoting the McKesson product. Listed below and copied from the "comparing solutions" tab of this web site is a summary of the functionality of their system:

• Reporting: (1) Real-time reporting; (2) Remote report creation and signing; and (3) Automated rules-based report distribution
• A single, coordinated image display, to view all medical images
• Single sign-on for clinicians to access multiple systems
• Patient-centric workflow
• Robust digital archiving (efficient access to historical images and data, including echocardiograms, and ECGs and hemodynamic waveforms)
• Web access for clinicians and referring physicians

Readers of this blog will undoubtedly be familiar with the major "ancillary" information systems: LISs, RISs, and pharmacy information systems. In addition, we now have the PACS variants in both radiology and pathology. They are used for archiving the digital images acquired in both departments. The CVIS is a very interesting variant on this theme of specialty-oriented systems because, it combines workflow, reporting, and digital archiving similar to LISs, RISs, and PACSs. Note the reference above to a "single sign-on for clinicians to access multiple systems." Cardiologists, the major users of CVISs, obviously need access to the hospital EMR to integrate various streams of clinical data such as current medications and nursing progress notes.

I have suggested in previous notes that hospital EMRs are not adequately designed to hold the text and image files generated in diagnostic departments such as the clinical labs, pathology, radiology, and cardiology. Here are two quotes from a previous note discussing the superiority of "ancillary department automation" over EMRs and the goals of EMR vendors (see: EMR Failures and a Recipe for Their Avoidance in the Future):

• ....Mr. HIStalk's proposed solution [for managing hospital information systems]: stick with ancillary department task automation. I will take his definition of ancillary information systems to primarily involve LISs, RISs, PACs, and pharmacy information systems. Unfortunately, few CIOs and CMIOs have in-depth knowledge about the lab, radiology, or pharmacy systems. They are managed by the knowledge and process domain experts in the specific hospital departments, frequently with hosting by the central IT departments.

• For their part, EMR vendors continue to pursue their short-term strategy of selling inadequate and poorly designed systems that that are difficult to install, don't scale up, or perform inadequately. CIOs and CMIOs keep buying inadequate EMRs, despite the long  history of failure of these systems, because they are paid to deploy "modern" systems and there are few if any in the market that respond to their wish lists. You have two sets of players that are pursuing a flawed business model in concert.

So what is the take-home lesson from all of this. Pretty simple, really. The "departmental diagnostic systems" continue to evolve, frequently integrating images with reporting information. Moreover, they also manage patient and physician mission-critical workflow for the various specialties. This is in contrast to hospital EMRs that more frequently serve as data repositories relating to clinical care. The LISs, RISs, radiology/pathology PACS, and now CVISs are thus on a different development trajectory than EMRs. I am not exactly sure of the future relationship of the EMRs to these ancillary systems but the "integration" challenges will be formidable.

Wal-Mart Launches Co-Branded Walk-In Medical Clinics in Three Cities

Up to this point, walk-in clinics in retail drug stores and big-box stores have not lived up to their expectations. In my opinion, they have enjoyed several key advantages over competing medical offices such as convenience, posted price lists, and relatively low costs for routine procedures. For many of them, however, major liabilities were the absence of a referral network for patients with more complex problems and a lack of integration of their health records with regional physician office and hospital records. This latter problem, of course, is not unique to them. It seems that Wal-Mart has reworked its business model to address at least one of these deficiencies with a co-branding strategy as described in a recent article (see: "The Clinic At Wal-Mart" To Open In Atlanta, Little Rock And Dallas Supercenters). Below is an excerpt from it:

Wal-Mart today announced that its first co-branded in-store clinics will open in Atlanta, Little Rock and Dallas under “The Clinic at Wal-Mart” brand. These clinics – the first of which is expected to open in April – will be connected to their communities via local hospitals that Wal-Mart’s customers already know and respect. Today’s announcement is the first step towards opening 400 co-branded convenient clinics ....Wal-Mart has signed a letter of intent to work with RediClinic...and local hospital systems to open co-branded walk-in clinics in 200 Wal-Mart Supercenters. Wal-Mart has also signed a letter of intent to partner directly with St. Vincent Health System, a part of the Catholic Healthcare Initiatives system, to open four co-branded clinics in Little Rock....“The Clinic at Wal-Mart, owned and operated by St. Vincent Health System” is expected to open in Little Rock by the end of April, as will “The Clinic at Wal-Mart owned and operated by RediClinic” in association with a local hospital system in Atlanta [according to a Wal-Mart executive]. By the summer of 2008, Wal-Mart also expects to open co-branded clinics with RediClinic and a local hospital system in Dallas....The Clinics at Wal-Mart will offer a limited set of affordably-priced Get Well and Stay Well services. Each clinic will operate seven days a week and feature a consistent, innovative design. They will also feature prominent signage in keeping with Wal-Mart’s price transparency promise -- a key aspect that requires operators to post pricing for the services and treatments offered so patients know what their costs will be up front.

The notion of co-branding walk-in clinics with local hospital partners makes perfect sense to me. A previous post discussed how Cleveland Clinic was partnering with Minute Clinic for walk-in facilities in the Cleveland area (see; Cleveland Clinic Partners with Minute Clinic in Retail Health Services). The story above presents two different business models for the Wal-Mart initiative -- direct partnership with the hospital and a three-way relationship including RediClinic and the hospital. I suspect that the latter will appeal to hospitals with little experience or interest in the walk-in model for minor problems but are anxious for the referral of more complex cases. It should not be surprising that one of the first partnerships announced by Wal-Mart was with a hospital system in Little Rock. Regardless of the business model, the idea of posting prices for office visits may have infectious qualities. If it's appropriate for co-branded walk-in clinic facilities, it be also be relevant for those directly owned and managed by a hospital system.

IMS Provides Access to Physician Prescription Information

When a representative of a pharmaceutical company calls on a physician in the office, he or she will generally know how many prescriptions that physician writes per month for the drugs that the rep is promoting. How can this be? Welcome to the world of IMS and PBMs. A recent story in the WSJ and a blog followup below provides the answers (see: What Does IMS Health Do, Anyway?).

IMS Health is nearing a deal to sell itself for nearly $4 billion, the WSJ reports. That raises a simple question: What does IMS Health do, anyway? Drug companies pay IMS for information about the prescribing habits of individual doctors. This, of course, is very valuable stuff for the drug company sales reps who make calls at doctors’ offices. IMS buys the raw prescription data — which doesn’t identify patients — from pharmacies. Maine, New Hampshire and Vermont have all passed laws banning the sale of information that identifies individual doctors’ prescribing habits, with proponents arguing that the business interferes with the doctor-patient relationship. IMS and other companies in the business have challenged those laws, arguing that they violate the first amendment. The courts have gone back and forth on the issue. Last year, a federal appeals court upheld the New Hampshire law, overturning a lower court’s ruling. The Supreme Court refused to hear the case. Through the AMA, individual doctors can choose to restrict companies’ access to their prescribing data. IMS’s business isn’t limited to selling prescription information about individual doctors. The company also does consulting work and big-picture analyses of trends in the drug business, among other things.

I have posted a previous note in which I make the case that much of what the public perceives as the confidentiality of medical information is largely a myth (see: Despite HIPAA, the Privacy of Our Health Records Is Largely a Myth, On the Privacy of Health Information: The Horse Is Already Out of the Barn). One of the biggest cracks in the confidentiality wall consists of the pharmaceutical benefit managers (PBMs). IMS Health is a little cagey about the source of its information. Here is a cut-and-paste from its web site listed under market measurement. Note that they "assess" billions of transactions but they don't indicate where they obtain their data.

We don’t just track information at IMS; we evaluate it, test it, understand it. We take a vast array of healthcare data and facts and transform them into actionable intelligence. By assessing billions of transactions involving more than a million products from 3,000+ pharmaceutical manufacturers, we remain the go-to company for clients seeking to make faster, smarter decisions.

The pharmaceutical companies don't have prescription-level information -- it must originate from doctor offices, retail pharmacies, hospital pharmacies, and PBMs. Even if companies like IMS block the names of patients from the drug profile data that they sell, much can be learned from it on the basis of other parameters. Here a quote from Mr. HIStalk from one of the notes referenced above dealing, in this case, with clinical data peddling by HIT vendors (see: Despite HIPAA, the Privacy of Our Health Records Is Largely a Myth). Think joinable fields and loyalty card databases.

I think that [HIT vendors selling hospital clients' ‘de-identified’ clinical data] conveniently [hide] behind the concept of “anonymization” as an absolute; a simple technique of magically rendering highly sensitive personal data untraceable. Sounds good to a lay person, right? It even sounds technically reasonable as long as you’re thinking of someone having only one data element (just your birth date) instead of multiples (your birth date and ZIP code) and one database (a prescription file) instead of multiples containing joinable fields (prescriptions plus driver’s license records plus a grocery store loyalty card database). It’s like security in general: rarely absolute, secure only if there’s not enough incentive for someone to go to the trouble to crack the code.

Continuing Discussion About Citrix as a Critical Component of EMRs and LISs

In response to my recent note about the role of Citrix in prolonging the lifespan of obsolete fat-client EMRs and LISs (see: Citrix Has Become a Barrier to Improvements in Healthcare Software), Dr. Ulysses Balis has responded with a comment. He is Director of the Division of Informatics in the Department of Pathology, University of Michigan Medical School. In this interest of continuing this discussion, I quote it in its entirety below with boldface emphasis mine:

I couldn't agree with you more, Bruce. With the continued insistence of many vendors to push thick client applications, Citrix is often the only effective methodology to purvey support for 100's of concurrent users. As an example, our informatics division looked at the Cellavision product about a month ago. It's a big, bloated thick client app that REQUIRES Open GL. Does that run on Citrix? Nope. Given that our department does not want to support this as a native application on a myriad of hematologist’s PC's that aren't even under our [guidance and control because they are managed by central IT], the answer is simple: Cellavision is a non-starter. There is only one long-term solution to this present slow-burning fiasco, and that is web-based applications, which make use of open architectures whenever possible. Hence, my take is that in the end, Citrix is dead. Epic is dead. Eclipsys is dead. Cerner is dead. I expect a new breed of web-based solutions to replace these Mumps and Cobol-based clunkers within the decade. And when that finally happens, it won't be a minute too soon. So, in summary, I would offer the friendly amendment to your thesis statement that it is not only Citrix that is a barrier to improvement in healthcare software, so too are the myriad of poorly-written thick-client applications that continue to fuel the demand for Citrix. Both need to go.

So here is an interesting question based on Ul's comment. Why are the shares of Cerner, a major vendor of EMRs, at historic highs, reaching about $85 per share in October if their products are dead, to quote Dr. Balis. Let's put aside for the moment some of the bad publicity that Cerner has continued to receive in the U.K. (see: Another Saga of "Blame the Vendor" Leaks Out of the UK). I am sure that most of this tends to be discounted by American investors. Let's also put aside the fact that most of the EMR purchases by major health systems have gone to Epic lately (see: Forbes.com Puts Some Numbers to the Epic Systems Success Story). Everyone agrees that this latter system is the EMR clunker du jour.

Answering my own question, I am sure that the success of the Cerner shares is based on its most recent quarterly financial performance and the infusion of federal money into hospital EMRs (see: CCHIT Certification and "Meaningful Use" of EMRs). I certainly agree that the days of our obsolete EMRs are numbered. "Within the decade" is a rather long span of time, however. The key question at hand is whether the incumbents in the EMR field are investing some of their capital in developing the "next-gen" web-based systems. New EMR market entrants face the formidable task of confronting the computerization of complex healthcare transactions using new tools and with severe penalties for errors. The will also confront very risk averse buyers of their systems who may not be that sophisticated technically.

Citrix Has Become a Barrier to Improvements in Healthcare Software

In my opinion, many EMR and LIS systems have become outdated in terms of their architecture (see: Possible Adverse Consequences of Increased Federal Investment in HIT). I have attributed this in the past to the fact that hospital and lab executives keep purchasing them so there is no rush by the vendors to convert them to a more modern design. A recent note by Mr. HIStalk on the use of Citrix in the healthcare industry provides another view of this problem. Here is his note:

...[S]omeone lists the five companies Dell should take over, all of them in healthcare IT. They are Allscripts, Quality Systems (NextGen), CSC, Cognizant, and Citrix Systems. Citrix isn’t technically a healthcare IT vendor, but [healthcare is] probably [the company's] biggest vertical since the industry is dominated by 1970s time capsule applications that won’t run efficiently and securely without it....Actually I use Citrix a fair amount at work and it’s pretty cool – poorly architected fat client apps run a heck of a lot better over wireless or VPN when you’re only painting screens and not slinging massive data packets back and forth.

His observation is very interesting and hits the mark. I am reminded of a LIS vendor many years ago which was reluctant to admit that the use of Citrix was absolutely essential in order for its product to function adequately. The company did not want current clients to understand its fat-client problem nor potential clients to add the cost of the Citrix software to the total cost of ownership (TCO). This need for Citrix as companion software for many LISs and EMRs also places an additional work burden on the lab and hospital IT support staff. As noted above by Mr HIStalk, the success of Citrix in the vertical healthcare market is a function of the inadequate design of the EMRs and LISs that we continue to buy and operate. Citrix is cool but there is a big price to be paid in order to see it work on a daily basis.

G.E. Jumps into the Hospital Connectivity Space

As someone who spent a lot of time in the past thinking about community health information networks (CHINs), the recent news about G.E. entering the HIE (health information exchange) space made me laugh out loud. The amount of money lost on healthcare connectivity endeavors such as CHINs and regional health information exchanges, a later incarnation of the same concept, has been enormous (see: A Quick Look at CalRHIO). So here we go for one more bite at the apple (see: G.E.’s Bid to Connect Computerized Health Records).

There are all sorts of obstacles to moving the nation’s health care system, choking on paper records, into the computer age. The cost and complexity of making the transition are daunting, though the government’s $19 billion in incentives for doctors and hospitals to adopt electronic health records should help. But the hoped-for benefits of digital health records ...will not really materialize unless information flows seamlessly and securely among labs, clinics, hospitals, doctors’ offices and patients. General Electric’s big health care division is introducing on Thursday a new unit, eHealth, to pursue the business opportunity presented by this challenge. The main target for G.E.’s new business unit is in providing the technology and expertise to build regional and statewide Health Information Exchanges [HIEs], as these planned data-sharing hubs are now being called. An initial $564 million grant from federal government to the states will provide seed money to get things started. Over the last two decades, there have been efforts to set up such health information-sharing networks. They were first called Community Health Information Networks and later Regional Health Information Organizations. Mostly, they failed. Hospitals and physician groups had no incentive to make the investment to share patient information, since they were not paid for doing so. But to qualify for incentive payments from the government, doctors and hospitals need to adopt electronic health records that share information across networks....G.E. said it was investing $90 million to get the new eHealth unit going. Its offerings include software for securely storing and sharing patient information, a Web portal that can pull patient information from various sources and present it to doctor, and a Web-based personal health record, called LifeSensor. It was built by a G.E. partner, InterComponentWare. So is G.E. going head-to-head in the emerging field of personal health records — controlled by individuals, not a doctor, hospital or insurer — with the likes of Google and Microsoft?

I do take issue with the statement above that hospitals lacked an incentive to share patient information and paying them for doing so will provide sufficient motivation. My view has always been that hospital executives view patient information as proprietary and providing some small payment for them to pursue a connectivity goal will be insufficient. The problem is that they will never state their true objection but rather moan about the complexity of medical information and the challenges of clinical data exchange. Incidentally, hospitals have had no problem sharing financial information because this is how they are reimbursed (see: CCHIT Certification and "Meaningful Use" of EMRs).

I have covered both the Microsoft and Google forays into the PHR development and, of late, Google's partial withdrawal from this field. I have come to the personal conclusion that the Google executives have decided either that they have bigger fish to fry (e.g., the cell phone market with Android) and/or the healthcare market poses too many risks and too little profit for a technically innovative and adroit company (see: Google Health Running Out of Steam, According to Experts). For Microsoft, working several years behind the curve and having power lunches with hospital executives probably feels just about right (see: Microsoft's Cell Phone Operating System Lacks Key Functionality). I suspect that G.E. decided to hold its nose and jump into the HIE fray. After all, McKesson, a serious competitor, has had success linking physician offices and office EMRs with its RelayHealth product (see: Developing an Electronic Medical Record Ecosystem (Network).