The World Wide World: IT Ain't Just the Web ... - Cdn.oreilly.com

Practice Sites designation administered by the National Association of Boards of
Pharmacy and as a brand name affiliated with Amazon.com, drugstore.com looks
like a haven of safety for people who want the convenience or cost savings of buying
online, but who are concerned about the (perceived) risks.
Lonny Reisman, ActiveHealth Management: Leverage in the machine
“I was Jewish growing up in Queens,” says Lonny Reisman, “and so I was supposed
to be a doctor.” He resisted for a while but eventually became a cardiologist.
However, he says, “I wanted leverage. I never wanted 2000 patients who revered me; I
wanted to fix the whole system.”
His experiences as a doctor and, simultaneously, as a health-care consultant for
Mercer Consulting gave him the insights and connections to achieve precisely the
kind of leverage he dreamed of. He founded ActiveHealth Management in 1998 (SEE
RELEASE 1.0, JANUARY 2005). It uses patient-specific information (under HIPAA privacy
guidelines) to provide almost-real-time (same-day) alerts for potentially harmful
situations, such as when a patient fills a prescription for a drug that may be dangerous
or contraindicated for that particular patient. It does this by sifting through the
continuous stream of data on the 8 million-odd patients currently enrolled in its
service by their health plans or employers. For each event for each patient,
ActiveHealth’s CareEngine software assembles the data it has on that patient – drugs
purchased, diagnoses and other information – and runs it through a set of clinical
best-practice rules (what we used to call an expert system before that term became
déclassé). If it discovers any problems – inappropriate treatments for a certain condition
or even lack of treatment – it notifies the relevant physician and (if the patient
is so enrolled) the patient herself.
“We don’t practice medicine,” says Reisman, who like all doctors is sensitive to liability
issues. “These aren’t recommendations; they are ‘care considerations.’ The doctor
may know something we don’t. . .but we do point out things she may not know. The
idea came from my own insecurities as a doctor. Despite my best efforts, I simply
couldn’t keep up with all the literature. And I couldn’t talk to all the other doctors
my patients might have visited. I would have been glad for some help, some actionable
background data on each patient.”
He continues, “Much of the talk now is about assembling all the data on a patient –
dealing with data standards and getting all the data into a single record. But that’s
not enough. What’s the difference if I have piles of paper in a folder, or a fancy Web
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