1 What is Flower?
Right now Flower is in flux, it’s early days and people are only beginning to outline the goals for Flower. What has been decided is that…
- Flower will provide the mechanism that health care organizations use to transmit medical data between each other.
- Flower will provide an interface that people will use to ensure that they have control over who has access (or has accessed) their medical data.
- Flower will provide an easy-to-use and intuitive mechanism that will enable health care professionals to ask a patient for access to some or all of their data as well as a mechanism for people grant or deny that access.
Flower isn’t trying to provide a personal health or electronic medical record. What they are trying to do is sketch out how an emergency room physician at your hospital might reach out to your primary care physician to find out more about you, and how this can be done in such a way that you feel in control and your privacy is protected while at the same time ensuring that you get the best care possible. It is no small feat! If you look around for other products that are working to meet this need, you won’t find much. Flower looks to be the trailblazer, in fact, they may be the only people trying to address this very real need.
The concept of Flower was first articulated in *public* on this blog as part of the threaded comments which followed a phenomenal discussion (for those who haven’t followed along) on EHRs and *Meaningful Use*.
The FLOWER team is highly motivated for a number of reasons… most of us are practicing physicians… we deal with the glaring HIT flaws present in health care everyday. We are forced to rely, as the primary means of information transfer in medicine, on the fax machine. — It was not difficult for us to recognize the overwhelming need for FLOWER.
Many are HIT professionals as well and are capable of articulating the engineering, design, privacy issues we will face. Two of the participants are the ultimate e-patients, and their input is invaluable. Lastly we have a physician, e-patient, and disruptive innovator with tremendous proven talents in refining objectives and bringing concepts to fruition.
Flower will be free, useful, meaningful, easy to use, elegant, and non threatening to those unfamiliar with technologies
We have no idea whether or not we will be successful… but I assure you, it will not be for lack of trying, lack of effort or lack of talent…. the core team is pushing on… because, in the end— WE ARE ALL PATIENTS!
The Orthopedic Adventure 
Very Cool, Howard, There are a few Silicon Valley People I have spoken with who have considered that the biggest problems to be solved in HIT ( after getting every provider on some paperless platform or another) are these interconnections that the #flower crew is speaking of… they are mostly in the Health 2.0 space, mostly consumer internet folks… I am excited to see PRACTICING PHYSICIANS on board with this.. in contrast to 95% of the health 2.0 consumer internet space… keep me posted as to how our network of house call docs can help, as well as development priorities… You know how I feel about the third party payors, the more we consider physicians and patients and move away from HOW TO GET PAID by the third parties, the better. Did you all figure out who is your customer yet?? Best, Natalie
We are the customers… The motto being— we are all Patients. The *product* planning lies ahead… First comes definition, guiding principles, framework, concept, teams, etc,etc… Then product and engineering. Fun stuff. About time docs *sieze* control with the goal of better health for all…period. HJL914.715.9598hjluks@vzw.blackberry.nethjluks@gmail.com
Late to party; but hear you & affirm the mission. Will catch up with thread!
I’ve explained Flower to others as something of a missing link in terms of effective communication between patients and physicians. Currently, there is no good way for digital information in EMRs and PHRs to communicate. Most importantly, there is no intuitive way for a patient to access and control this information in a way that also allows her physician to optimally have necessary data.For the physician, Flower has the potential to improve efficiency by bringing liberation from the (analog) fax machine in the digital age. For the patient it holds out the promise of facilitating individualized care by allowing meaningful interaction and cooperation between herself and her providers.If we are successful, Flower will be disintermediation at it’s best. Removing the technological middlemen that currently hinder the patient-physician relationship.I’m excited. Thanks again, Howard for the summary and for all of your work in this regard.
Howard, Great discussion as always but what is the difference between Flower and HealthVault?The three main point that you mentioned are solved with A HealthVault connection for both the patient and the provider.Jeff Brandtwww.comsi.com
Google Health and Microsoft Healthvault can still continue to exist – Flower is essentially a “brand” for a healthcare protocol to bring medical data into a PHR. So we are working just to develop a standard way for data to flow into a PHR. Flower, I believe, solves a bunch of political issues with standardizing this process. (If you read Howards prior blog and read the “Wilford Brimley” part of this, you will understand how introducing a concept like Flower changes the way people think about their medical data, and so Flower helps meet that need.) (Essentially it was born out of a late night discussion where the question was asked, “Why don’t patients demand an IT standard in healthcare?”As I thought about this with two of my colleagues, we realized it’s because the patient doesn’t know to ask, and the rest of healthcare is too busy competing to worry about the patient. So we thought of a way for the patient to ask for a standard. The idea mostly sat dormant until Howards page and voilà! A healthcare revolution is born!) 🙂
Last point ; this could finally make PHRs much more ubiquitous and ultimately empower patients and even change the financial dynamics of healthcare delivery (you don’t like a hospital? If you have all of your medical data following you, it makes it much easier to go to another hospital), so this has the potential to open up a lot of markets. As one of the chief landscapers in Flower right now, we are wondering how Google and Microsoft may react to this, since it could possibly help drive patients to their PHRs. In the end, my last thought about your question : Flower might spin off it’s own PHR, because we are hoping that by having heavy patient involvement, the brand “Flower” may give a person confidence that it’s not run by some big conglomerate. In the end, patients and front-line medical staff have good ideas about what healthcare needs. Flower is the result of the two.
“Flower will be free, useful, meaningful, easy to use, elegant, and non threatening to those unfamiliar with technologies” #hcflower
I get it, any phr!Sent from my Verizon Wireless BlackBerry
YES 🙂 !!!
interesting, might be time 4 stealth if taking on the big boys… Sent from my Verizon Wireless BlackBerry
Drikstanley thanks for the update.
After thinking about this for a while, I guess I am still missing something. HealthVault provides what you say you are looking for? FreetransportablePublished standard (CCR, CCD) to move dataall PHR/EMR can connect easy but not necessarily cheapHV provides the free storage to facilitate store and forward.Patient controls access It is not Peer-to-Peer, HV is the gate keeper Published SOAP interface (technical stuff to facilitate)simple interfaceThe tech is not the problem, whatever you provide the Health facility will have to buy in. The will have to stop thinking about owning the patient and their data. The same old problem.On the subject of why patient don’t revolt; confusion misunderstanding, complacency. Jeff Brandtwww.comsi.com
JeffI would agree with your statement, vis-a-via HealthVault, and the notion that Flower may not offer anything if it is competing at that level. I agree that technology, or even standards, are not the issues. Take those issues off the table, where the significant residual lies I believe is in the areas where HV (and GH) are doing a carve-out. Specifically, HV/GH I believe fails as a complete model/solution in at least two areas.First, there is a wherewithal to participate as an individual (access, nominal cost of technology: computer, internet, etc., some degree of healthcare savvy/interest either their own or on the behalf of another) and those that participate because their providers are offering this service. This is a very small niche — it offers no solution for those that providers don’t participate, where there exists financial barriers (the poor), or where the “payer” is self (indigent) or Medicaid.Second, there is the legacy problem (significant within HC) and the need for interoperability (a palliation for a technological disease state). If a goal is to have a near universal accessibilty to whole and total personal health information (PHI, here broadly construed) then adoption/implementation will require very low thresholds. You point out well that its not technology (and not standards by extension) — it has to be cost! The unit cost for a unit of interoperability (however construed) is high in our present system — because by-in-large it entails the very costly vendor produced hardware/software installs + the creation of a multitude of partial/complete siloing of PHI. This would includes those siloings of PHI with HV/GH as well.Can we reduce the unit cost of interoperability sufficiently to spur massive adoption now AND cover all those that may disenfranchised from the PHR-movements to date (poor, indigent, without proper access). I believe we can drive that cost down with existing tech/standards, but we must leverage what we already know works. I would use the trivial examples of email and movie downloads — not that their content is important compared with PHI, but rather as examples of dropping the cost of a unit service (or a unit of participation) to near zero.Flower, perhaps, is not about addressing the technology/standards directly, but rather about how we can use that which we have better by changing the focus from maintaining the current structure to more look like other content-driven web services. We have the technology, we have the standards, and in many respects we have the bandwidth and storage as well. What’s missing is the platform and the device (may be the same) and the wherewithal to minimize the siloing of PHI to one or a few. Interoperability (and its unit cost) is the problem — both the lack of and perhaps the current course towards both vertical and horizontal hierachies of HIEs.
Here’s to data liquidity! HL7 InfoButton can deliver contextually relevant decision support content to #hcflower