Content and Technology: A Love-Hate Relationship

In late October I participated in a couple of conferences that underscored how information technology (IT) has changed business publishing.  The first event, e-Patient Connections 2009, had a diverse audience comprised of Pharma marketers, medical communications agencies, health literacy experts, and health care publishers.  Special guests included e-Patients who spoke about their use of community, content, medical expertise, drugs and devices to manage their conditions to allow them to live life as ordinarily (or extraordinarily) as they would if they didn’t have their disease or condition. 

The second event, Data Content09, was the InfoCommerce Group’s 17th annual event for b2b directory and data publishers.  Themes ranged from improving lead-generation applications of directories, the importance of understanding the workflow needs of your customers, and the overarching theme of how over time technology is commoditizing content.

The keynote speaker at Data Content09, Sharon Rowlands, CEO of Penton Media, described how she has aligned Penton by markets and is undertaking a thorough customer analysis to understand how the company’s information can be integrated into customer workflow and improve productivity.  Sharon described why in today’s economy, in order to rise above commodity status, publishers need to offer point-of-need solutions that are tailored to each segment of their user base.   Standalone reference works and print publications may still play a role, but it is an increasingly marginal one.   

The final session of Data Content09 presented four examples of companies that are employing IT to their advantage.  These companies (Capterra, KnowWho , Skyscape, and EDA)  effectively use technology to move up the value chain.  Publishers need to ask themselves how their data can be put to use to make their customers more productive: for example, can their data be integrated into the customer’s supply chain process or sales pipeline process?  Or can technology and Web 2.0 tools help improve the quality of the data that are provided, through reviews and ratings, deeper verification, or mash-ups with related content?  In some cases, it’s as simple as offering a mobile version or including video or interactive quizzes to enhance the experience for the user. 

Forward-looking publishers recognize the inevitability of commoditization of information due to better, cheaper, and faster IT and digital distribution.  These leaders use the commoditization trend (“the race to the bottom” in the words of Barry Graubart from Alacra) to their advantage by scouting more and more free inputs for their higher value information packages,  and they know how to use commodity-level information as a marketing tool.

For more on the topic of content commoditization and the importance of moving up the content value chain, see the slides from my e-Patient Connections 2009 presentation (esp. slides 7-11).  Although focused on the opportunities in the health content sector, these slides apply to all types of information. 

Google Health: PHRs Still Need Human Touch

Google has been very good at establishing a broad-based platform for search and search advertising.  However, they’ve always taken a “hands-off” approach when it comes to content.  Google doesn’t get involved in the dirty work of “data cleansing”, especially when it requires domain-specific knowledge and human intervention. Instead, Google focuses its resources where they can rely on existing metadata to fuel their engineering powerhouse. 

Therein lies the problem that came to light this week when the Boston Globe ran an article that detailed the experience of e-Patient Dave (Dave deBronkart) in transferring his medical record info from Boston’s Beth Israel  Deaconess Medical Center (BIDMC) hospital to Google Health, the highly anticipated personal health record (PHR) utility from Google.  Dave described in the Globe article and on the E-Patient.net blog some of the unacceptable outcomes that occurred when Google inferred information from content that was imported into his Google Health PHR from electronic records at BIDMC.   For instance, dates did not accompany most of the information, so Google Health issued alerts that assumed all of the conditions and meds listed in his record were occurring simultaneously. 

The article also highlights serious flaws in using medical billing codes to infer information about medical conditions.  E-Patient Dave delves more deeply into the medical coding issue on his blog and offers a good round-up of the various codes used by medical providers.  These billing codes are imperfect for their primary purpose; using them as the primary metadata to infer a patient’s medical history is a fatal flaw.

So, should we conclude that Google Health is a DOA as some have suggested?  Not necessarily.  But, I think it may be fair to say that Google Health isn’t ready for the average patient/consumer and won’t be until more progress is made in harmonizing the codes and terminology used by various stakeholders in the healthcare economy. 

One conclusion is clear:  given the current stage of development of PHRs, there are opportunities for content intermediaries in healthcare to solve some of the data inconsistency problems.  One new company,  Zweena Health, added its voice to the Google Health bashing to promote its own service that creates PHRs for individuals.  According to their site, they “do all the work” to convert information from providers into a usable information resource. 

Traditional healthcare publishers represent another group that is well-positioned to help solve the data translation and transfer problem for patient records.  Healthcare publishers like Elsevier, ThomsonReuters, and Wolters Kluwer have been combining content with technology to create clinical and workflow tools for years.  Their expertise in understanding content, technology and workflow of healthcare professionals should be included in efforts to develop electronic records for providers and patients.

Finally, medical librarians have expertise and hands-on experience in translating medical information for consumer audiences.  Perhaps it is time for Google to fund medical librarians to take on the work of creating taxonomies and harmonization schemes that would better serve multiple stakeholders.  I’ll forward this post to David Rothman and other medical librarians who blog to get their feedback.

One final thought.  Google likes to aim high and target projects that reach large numbers of people where Google can add value through low-touch high-tech projects that leverage their computing and coding resources.   In the case of digital health records, perhaps Google should take the approach that CMS has used and tackle a smaller piece of the puzzle first, starting with drug information.  Digital drug databases have evolved to a state where they are more reliable and CMS is advancing e-prescribing by providers through financial incentives and promotions.   This week’s announcement that Express Scripts is acquiring Wellpoint’s NextRx pharmacy benefits management (PBM) unit for $4.68 billion is another sign of progress in this arena.  The market apparently approves of the acquisition:  Express Scripts’ stock price has risen since the announcement and has been upgraded to a buy by UBS.

As we wrote last month on the subject of health IT, it is imperative that architects of the health IT software systems understand the content that will flow through their systems and how it will be used.   The same imperative applies to developers of PHR software and tools to an even greater extent, because of the need to translate or explain medical terminology for consumer audiences.