Bosworth wants you to take charge of your health

Adam Bosworth is asking you to take your health into your own hands (or at least into your computer). The former head of Google Health, Bosworth is now working on a new start-up, Keas Inc., which is dedicated to helping consumers take charge of their own health data. His work focuses on making individual health records easily accessible, thus preventing overtreatment and overspending through proper patient education.

While attending the Aspen Health Forum this summer, he took a few minutes to explain the importance of public access to health data.

Let's talk a little bit about how you got to where you are today. I worked for Citicorp in the distant past, Borland building Quattro, Microsoft for 10 long years building what I now call Lego blocks for adults, BEA Systems for three years, Google, and three of my own start-ups.

I decided about five years ago that I'd spend the next 25 trying to improve health care and help bring it into the 21st century. I went to Google with that in mind and got sidetracked for 18 months running and building what are generally called Google Apps today before getting to work on Google Health. Keas, my current company, is in some way the culmination of everything I've learned in computing, applied to how to improve health care.

What rights do we, the public, have with our health records, and why is the demand for online health technology increasing? I helped start the HealthDataRights.org site with some friends, and I believe passionately in it. The Internet is an incredible communication and computing device. It can deliver any information and communication to anyone, anywhere. And every industry takes advantage of this except health care.

Dossier

Name: Adam Bosworth

Title: CEO and co-founder

Organization: Keas Inc.

Most interesting technology: Machine learning

Philosophy in a nutshell: "Really two: Carpe diem and KISS -- keep it simple and stupid where possible; life is complicated enough."

Three defining personality traits: "Lazy (I need downtime and work/life balance), passionate (what I do, I really care about or I don't do it), and simplistic (I look for simple solutions to hard problems)."

Favorite vices: "I don't think of what I do as vices, just living life to the full."

People are trying to get the personalized relevant information and communication they need -- What meds should I be on? When can my doctor see me? -- and are stymied. Once it is understood that we all have the right to our health data online to use as we see fit, we will see a rapid emergence of companies like Keas that help people take charge of their health.

Can you tell me a little bit about Keas? We give people a personalized and tailored understanding of their health data: How are they doing? What matters? And for those things that matter, are they [flagged in the system] in red, yellow or green? If not in the green, we give them personalized and tailored health plans and a support community to get into the green. We help people track their lab results -- cholesterol, HDL, LDL and so on. We give them reminders that they need to stay on top of their health.

It is a simple idea, but hard to execute. What makes us somewhat unique is that any health and wellness experts, without needing to be programmers or hire IT, can author these plans. Instead of helping 100 people a year, they can help 100,000.

What are some of the benefits of having our health care records accessible at all times? Does it help cut costs, for example? Giving consumers tools for taking charge of their health will absolutely cut costs. We have a completely broken system today. It is a "sick care" system, not a health care system.

Think of disease as a slope over time, where it takes years of bad behavior to get sick enough to actually get Type 2 diabetes or lung cancer or coronary disease. Once you are this sick, you cost a fortune to treat. Even more so in the U.S., where tests are frequently done redundantly, and expensive procedures are followed even though evidence suggests that diet and exercise would be far more effective.

But if people have the early warning signs and the knowledge and support, and they take responsibility, then these diseases, which cause over 50% of our care costs, will drastically abate.

What are some mistakes that have been made, and how has the health care IT world learned from them? A canonical mistake in the IT world is to define standards without people trying to use them as they build them. In the end, such standards normally fail due to market imperatives. But in the health care market, imperatives don't work well because there are no rewards for doing it more cost-effectively.

We have seen this in the huge HL7 health care standards, which are like using a supertanker to deliver milk to your house. Also, most health care software in the doctor's office is 20 years out of date. We know how to build good, fast, scalable on-demand software cheaply. But health care is still sold client/server.

There has been some talk that open source is the key to advancing 21st century health care reform. Do you find this to be true? It depends. I believe in the profit model. I worry about things that are free because it is so easy to fall into the tragedy of the commons. I think a lot of problems in health care stem from the fact that the consumer doesn't pay the doctor. If we did, I'm confident that health care would be far more user-friendly. So I think it depends on the circumstances.

What does the future of health and technology look like? Will everyone be e-prescribing and self-diagnosing online? I think everyone will work together with a team. Care will be continuous, not episodic. Computing power will ensure that the right people are alerted before problems become intractable, and the team plus the community will help to rally everyone on.

E-prescribing will not always be online. Some routine escalations of medicines may be, but doctors will still use hands-on judgment before prescribing or changing medicines in many cases. Consumers will have tools to learn which issues may be the reason for their symptoms and with what likelihood -- something doctors often don't know on a statistical basis.

That, for example, would have saved my mother's life; [she] died from ovarian cancer. But doctors again will partner online with consumers to practice participatory medicine. I do think a lot of visits, like psychological ones, will harness the power of videoconferencing to cut down on unnecessary travel and deliver maximum flexibility.

-- Interview by Sara Forrest, a freelance photographer and writer in New York (studio@saraforrestphoto.com)