Transforming Healthcare through Information Technology

Back on November 20, I attended a seminar at the Reagan Building on how healthcare in the U.S. could be improved through information technology.  As an alumnus of the business school, and someone who’d worked in healthcare IT before, I wanted to learn about a part of the healthcare debate that I hadn’t seen much coverage lately.  Dr. Ritu Agarwal gave the talk and answered questions during and after her presentation.

The main problem with healthcare in the U.S. could probably be summed up this way:

Despite spending more on healthcare than any other country in the world, our clinical outcomes are no better than in countries that spend far less.

Even more disturbing, of the 30 countries in the OECD, the U.S. has the highest infant mortality rate.

In the past 10 years, premiums for employer-based health insurance have risen 120%.  Over the same period, inflation grew 44%, while salaries grew only 29%.  So healthcare costs are increasing far faster than inflation (and our ability to pay for it with our salaries).

As far as healthcare IT goes, Dr. Agarwal gave the following reasons for the slow pace of adoption by healthcare providers:

  • inertia
  • it’s a public good–patients get the benefits–not the healthcare providers
  • lack of common standards

Adding to the inertia point is the fact that healthcare in the U.S. has many stakeholders–patients, medical professionals, hospitals, pharmaceutical companies, insurance companies, and more.

Dr. Agarwal pointed to a number of countries with successful implementations of healthcare IT.  They included Canada, Australia, and the United Kingdom.  Australia in particular was singled out as being 5-10 years ahead of the U.S.

One thing I didn’t expect was that the Veterans Administration and the Department of Defense would be held up as native models of successful healthcare IT implementations.  One key factor noted by one of the other seminar participants was that the VA and DOD systems were closed.  Providers, specialists, hospitals, etc were all part of the government.  This enables them to enforce standards, in patient records and other areas.  Another point I considered later (which didn’t come up in the Q & A) was that the government model is non-profit as well.

Dr. Agarwal’s proposed solution to improving the current state of IT use in healthcare (as I recall it) was an regional exchange model.  Healthcare providers in a particular region of the U.S. would choose a standard for electronic health records (EHR) and other protocols.  Connections between these regional exchanges would ultimately form a national health information exchange.  Building on existing protocols and technologies (instead of attempting to build a national exchange from scratch) would be the most practical choice.

For more information, check out the slides from the presentation.

Unit testing strong-named assemblies in .NET

It’s been a couple of years since I first learned about the InternalsVisibleTo attribute.  It took until this afternoon to discover a problem with it.  This issue only occurs when you attempt to unit test internal classes of signed assemblies with an unsigned test assembly.  If you attempt to compile a Visual Studio solution in this case, the compiler will return the following complaint (among others):

Strong-name signed assemblies must specify a public key intheir InternalsVisibleTo declarations.

Thankfully, this blog post gives a great walk-through of how to get this working.  The instructions in brief:

  1. Sign your test assembly.
  2. Extract the public key.
  3. Update your InternalsVisibleTo argument to include the public key.

Figuring Out Google Wave

I recently received an invite to Google Wave (thanks Rory).  From the few minutes I’ve played with it so far, it seems to be Google’s next offering in collaboration (Google Docs is probably their first).  I’ve still got some spare invites, so send me an e-mail if you’re interested in trying it out.

One of my bosses from a previous company came across a couple of links that explain Google Wave:

I’ll probably be checking these out when I have time (if I’m not distracted by other “oooo shiny” toys, or life in general).

A visit to Iowa City

Last weekend, I visited my cousin Kevin at the University of Iowa to sit on his Ph. D defense.  For the past five years, he’s been working in pharmaceutical chemistry figuring out how to create vaccines that can be delivered directly to human genes.  I’m no chemist, so the bulk of his talk was way over my head, but it was very cool to see his command of the material and how well he presented.  When he came back from the private portion of his defense, we knew he’d succeeded.

After a celebratory lunch, Kevin took his brother Richard, sister Michelle, and me to a firing range to shoot.  By firing range, I don’t mean some shiny building with paper targets on motorized tracks.  We drove about an hour from Iowa City to a fenced-in area outdoors with some metal stands and a big pit.  You bring your own guns, ammo, and targets.  When other people are around, you have to signal them that you’re going to put targets out so they stop shooting.  We turned our fire on some empty steel solvent containers with four different weapons: a Ruger pistol (.22 LR ammunition), a Ruger rifle, a Springfield 1911 (.45 ammunition), and an M1 Garand (7.62mm rounds).  After spending a couple hours shooting, I will never look at Hollywood shoot-em-ups the same way again.  Movies seem totally fake compared with the noise and recoil of large-caliber weapons.  We had fun, and we turned out to be half-decent shots (for rookies).