Don’t ever tell me online relationships can’t be strong. On Sunday, I had a premonition that drove me to “catch up” with a blogger whose site I hadn’t been to for a while. When I got there, the last post began this way:

– A conversation with my husband, shortly after arriving home this afternoon with fresh oxygen tanks, spots on my liver, fluid pushing around my lungs (likely filled with cancer, as are the tumors inside) and at least one broken vertebra that must be healed before we resume any kind of treatment. –

How did we get here? I asked my love, across the bed strewn with children’s toys, books, and an oxygen tank.

The post goes on to admit that Susan Neibur,  a woman we all knew as @whymommy, the author of the truly magnificent blog Toddler Planet, had asked for in-home hospice “at least for a while.”

The post is dated January 22. It encouraged me to keep checking back, and today I am grieving today for a woman I met in person only once, at a BlogHer conference, which she struggled to attend so she could give a keynote presentation.

Susan was a planetary scientist, and she was diagnosed with inflammatory breast cancer, a rare and aggressive form of breast cancer that doesn’t get talked about much ( the news covers things like whether women should have mammograms at 40 or 50.) But it kills young women, and now it has killed Susan. It is undignified to say that sucks.

I met Susan BlogHer and Twitter, where she actively shared all her experiences — sometimes with the clinical detachment of the scientists. I tried hard to engage with her in the only way I could, by writing encouraging comments on her blog and offering to introduce her to EmpowHer, a network of women interested in women’s health headed by a friend of mine who is a fierce patient advocate.

But, like all the women who read her posts and somehow believed she would defeat this terrible disease, there wasn’t anything I could do in her individual case. So now, I raise my voice: perhaps too late for her, but not for other women, and indeed not for other men as well, who suffer and died way too young.

And here is what her husband says about all of us here online, where some still doubt that relationships are “real”:

 I can’t begin to describe how her friends, those physically nearby and those she knew only on the internet, enabled her to carry on through five years of treatment and recurrence.  Many of you have commented on Susan’s strength and grace, but these were traits that she pulled from all of you.

Related articles

• Goodbye, WhyMommy (betterinbulk.net)
• Goodbye (toddlerplanet.wordpress.com)
• What. A. Wonderful. World. (theyearofwhatif.com)

Image by mariachily via Flickr

I was fortunate enough to be able to attend the Rock HealthHealth Innovation Summit onJan.20th. It was the third day of a conference that highlighteddevelopment, design, and business issues around the potential for health care transformation through technology. The room was full, and the audience stayed until the end, even on a Friday afternoon.

Why? Because they knew something big was up. What’s up is the awareness of the Rock Health accelerator and the move to change a system only a young person from outside the industry could even hope to change. For three days, enthusiastic developers listened to cynics like me talk about business models, chasms, and challenges. I hope our doubts didn’t make a dent in their drive.

A year ago, there was no Rock Health, but more important, there was no community pulled together around the cause of health care innovation brought about by young people largely focused on digital and mobile technologies. A scant one year later, there is a vibrant health tech community in San Francisco, supported by large hospital systems, insurance providers, VCs, angels, entrepreneurs and mentors. The need is recognized, but until Rock Health, there hasn’t been a community. Health 2.0, another wonderful step in the direction of change, focused more on showcasing change than on financing or mentoring change.

The second class in the Rock Health program kicks off this week. Some of the grads from the first have already received additional funding or gotten to revenue.

They won’t all succeed. They have no concept of how complicated this industry is. But here’s the most important point: Rock Health has drawn together all the people inside and outside the system who want it to change, who are willing to take chances, and willing to support the effort to move the needle.

And thus I feel like 2011 was a tipping point for health care as an industry. After last year, for many reasons, it can’t remain the same. The larger providers and payers have already begun to circle the wagons around Obama’s health care reform law, because they are realists and know it’s not going to be repealed completely no matter who gets elected. So they’ve begun the journey toward bundled payments, Accountable Care Organizations, medical practice acquisitions, and better electronic health records. The battleships are slowly changing direction.

And the best part, Rock Health was founded and is run by women — the very people who make most of the health care decisions anyway.

Related articles

• A Dozen New Health Care Startups at Rock Health (ushealthcrisis.com)
• Rock Health Gathers Healthcare & Technology Stars: A Photo Gallery (xconomy.com)

The difficulties that health technology innovators will have breaking into the health care industry were no more clearly illustrated than by the talk given by Dr. Sam Ho, Chief Medical Officer of United Health Benefits Group, on the third day of San Francisco-based health incubator Rock Health’s  Health Innovation Summit. After two days of exciting stuff about design and development, CEO day presented the cruel reality of the market .

Dr. Ho began by admitting the system was broken. Payments, he admitted,  didn’t align with objectives, and outcomes were an afterthought.  But now things are in the process of change, partly because of the passage of Obamacare (although he didn’t mention it by name), partly because of the too-temporary tenure of  Dr. Donald Berwick at CMS, and partly because in a worldwide recession, we can’t afford our health care costs any longer.

So the big players, fearing innovation from without, have decided to try to innovate from within, and came up with a slogan called “The “Triple Aim:”  a slogan that embraces how to improve the individual experience, improve population health, and control inflation of per capita costs. Dr. Ho believes these three aims are separate now, but they must be aligned  to succeed.

For United Health, this means Care Management Programs, Transparency and Premium Designation Programs, Hi Performing Preferred Networks, Value-Based Benefits, and Value-Based Contracting. These can be read as forms of rationing and cost shifting by the more cynical among us. However, for him,  it mans developing more and more incentives for changing consumer behavior. For example, patent premiums will get lower and benefits richer if consumers enroll in a diabetes plan and stick to it. If they manage their blood pressure or lipid levels, they will also have richer benefits. But what if they try and fail? I’m all for outcomes-based medicine, but we have to be careful we are measuring things that are within the control of either patient or provider. And how do we judge?

Five years ago, I lost a dear friend to a situation that never should have
happened. Although, if I were to ask him, he would tell me otherwise.
He would say his life’s journey was over. I would say the ignorance
and arrogance of his adopted country’s medical system killed him.  I am writing about this five years later because I was reminded of him this week by the Dalai Lama’s presence in Bodh Gaya, India. Things in American medicine have not improved since Sri’s death;if anything, they are quickly devolving.

N.S. (Sri) Sidharan was a retired technologist from Intel who devoted
his life to peaceful causes. He travelled frequently to and from Bodh
Gaya, India (the place where Buddha received enlightenment) to visit
Dwarko Sundrani, one of the last active followers of Ghandi. Dwarko
runs the Samanway Ashram, a school for village childen in the Bihar
province of India, far from the Bangalores and Hyderabads. Bihar is
poor. Not only can’t people afford to educate their children; they
don’t even understand why education is necessary. Some of the children
Dwarko-ji cares for are tribal. They only come to school because he
feeds them, and he teaches them only farming. With oxen.

Dwarko-ji was 85, and had no succession plan for the Ashram. Sri spent
his retirement years trying to raise money for the school and figure
out a way for it to go on after Dwarko-ji passed. Between trips to
India, he helped a bunch of start-up companies in Arizona, including
one that has a new method for diagnosing heart disease, participated
in several meditation groups, and began a business called Technology
Initiatives for Peace. He was a big proponent of trust.

Sri was my friend, and I admired him. I went to India with Sri twice, the first time
when Dwarko-ji was travelling from Bodh Gaya to Dharamshala
for an audience with the Dalai Lama. We flew to Delhi, took an
overnight train to Pathamkot, stayed in an ashram that served as a
retreat center for the people who run other, more public ashrams, and
then went to Dharamsala, the seat of the Tibetan government in exile.
Not one touristy thing did I see.

Although I didn’t personally meet His Holiness, I did meet Dwarko-ji,
and see the Dalai Lama and the chanting monks from afar. It was a
life-changing experience. Sri took incredible care of me.

I went back to India, to meet Sri in Bodh Gaya for
Dwarko-ji’s “eye camp”, an annual event in which tens of thousands of
blind Indians are restored to vision by cataract surgery in a
week-long surgical marathon that takes place in tents on a dirt field.
In the years since the eye camp began, they have never had a fatality,
and rarely an infection, despite the sheer numbers of surgeries and
the dusty, hot, crowded conditions. Volunteer doctors come from all
over to participate.

Sri wanted to spread the good will of the eye camp from India to
Africa, and in July 2006 he went to Ghana to try to scope out the
situation and set things up. He was very excited.

And then I never heard from him again. One day I awoke in the
morning, opened my email, and saw this message: “NS Sidharan died last
evening in Good Samaritan Hospital. He had recently returned from
Ghana. Details to follow.”

I freaked. It doesn’t take a rocket scientist to figure out what
happened. Sri returned from Ghana with a fever. He went to the
hospital. They diagnosed flu. He told them he had come back from
Africa. They suspected malaria. But they didn’t begin treatment.
They kept sending him home while they did tests. Some of the tests
were “inconclusive” (meaning the pathologist probably didn’t know how
to read for malaria).

By the time they got the diagnosis and admitted him to Banner Good Samaritan Hospital

Image via Wikipedi

his body was overwhelmed by the bacteria. Then they had to use drugs
so powerful that he died.

The friends who were with him told me he got good medical care. I beg
to differ. I googled malaria. Here’s the CDC web site: “Malaria should
be considered a potential medical emergency and should be treated
accordingly. Delay in diagnosis and treatment is a leading cause of
death in malaria patients in the United States.”

More: “Where malaria is not endemic any more (such as the United
States), health care providers are not familiar with the disease.
Clinicians seeing a malaria patient may forget to consider malaria
among the potential diagnoses and not order the needed diagnostic
tests. Laboratorians may lack experience with malaria and fail to
detect parasites when examining blood smears under the microscope.”

And the last quote: “This sometimes fatal disease can be prevented and
cured. Bednets, insecticides, and antimalarial drugs are effective
tools to fight malaria in areas where it is transmitted.”

In other words, if Sri had stayed in Ghana, or any underdeveloped
country, he’d probably be alive today. Only in America, where we think
we know everything about how everyone “should” live, from what they
should eat to how they should vote, is he dead. This teaches me
humility. And I grieve

Related articles

• Ngondro interrupted – Bodh Gaya, India (travelpod.com)

Until you have gone off the deep end on nutritional therapy as I have, a Western medicine aficionado has every reason to doubt its effectiveness. Thr only people who know how useful it is to tightly control the toxins, vitamins, and foods that go into their bodies are the people who MUST know: very sick people, usually with cancer or diseases that can’t be diagnosed and are chronically debilitating, people who sell supplements, and wackos like me who want to live long and prosper.

When I undertook my journey to better health, it was for many reasons. First, the US health care system is broken; it is costly and access is limited by a critical doctor shortage. Second, I have two young grandsons, for one of whom I will soon be the only surviving grandparent. Third, two former husbands, a former lover, and my daughter’s inlaws all suffered from cancer. Fourth, I was on anti-depressants since the death of my last husband almost fifteen years ago.

I wasn’t a bad eater to start with: no fast food, little processed food, organic fruits and vegetables, limited amounts of meat.

But then I went to the nutritionist/pharmacist in North Scottsdale, where wealthy people have access to treatments the ret of us lack. They pay out of pocket, as I did.

The nutritionist (http://www.time4health.com) administered an IGC panel for food sensitivities and then prescribed fish oil, immune support, digestive enzymes, probiotics, and a multi-vitamin high in B Complex.

He also told me to eat only grass fed beef if at all, only Wild fish, no gluten, and for me especially no dairy of any kind and no Lima,kidney, or navy beans. (the blood test showed I have intolerances to them).

He also told me to get off frappacinos and start the day with protein rather than a banana, get off the single Diet Coke I drank a day, and stick to a pretty much plant based diet.

I balked. So would you. After all, I am a healthy person. I didn’t feel bad to begin with, although I did have a little joint pain and some digestive bubbles, which I thought normal for my age.

But I am now six weeks into the program. I can stand at a cocktail party without feeling my back. I easily gave up Diet Coke and Frappacinos, without even missing them. I have ten times the energy I had before.

But the most important result so far: I am off Lexapro. Those SSRIs are supposedly very difficult to get off, with major withdrawal. I, However, cut my pills in half for a few weeks, then went to half a pill every day, and then to nothing. With no withdrawal that I noticed.

One of my best friends is an MD. He kept asking me for the “literature.” My family doctor called me “meshuga,” Yiddish for crazy. But he did agree to order another series of blood tests to find out even more about me. Trust me, there is literature being written about this every day at major medical centers as a result of new clinical trials– trials that were forced into existence by patients who demanded them, patients who offered their own experiences online, and patients simply desperate for remedies for chronic conditions. Oh, and by a health care system staggering under the costs of treating these conditions– conditions that could be halted or prevented by proper nutrition.

Don’t let the American food-industrial complex maim you. Do your own research.

Food, Inc. (Image via RottenTomatoes.com)

As the widow of a doctor, I have devoted a lot of energy to thinking how to live to a healthy old age. Life extension theory has changed radically over the course of my life.

When I was a kid, there was not much processed food, and we ate meat, vegetables, and potatoes, along with dreadful stuff like jello. Yes, we ate cookies and cake,but my mother went to a butcher and a bakery, and our foods were fresh. Calories were the main concern. You had to limit the number of calories.

Oh, and drugs were just being discovered. My doctor put me cheerfully on amphetamines to lose weight, barbiturates to sleep, and tranquilizers for anxiety. We thought they were all good for you. We now know they are as addictive as “street drugs.” Indeed, the current wave of addiction is to prescription drugs, not street drugs. Even then, I hated the side effects of those drugs and quit taking them as soon as I could.

Things changed in the 70s. When I met my mother-in-law, she had just turned 65, she was concerned with longevity, and she followed Adele Davis, who believed in high protein diets and B-12 shots. She took those. At the time, they were called “liver shots.” Those of us who didn’t take shots ate liver, because it was high in vitamin B, protein, and iron. Only later, when they began to put cows on hormones, did people become afraid to eat liver because that’s where the toxins accumulated in the cow.

When I got pregnant with my daughters, I stayed on a very high protein-and-vegetable diet because it was supposedly brain food. Pregnancy taught me about salt: cans of tuna made my ankles swell. Excessive salt, which is put into our depleted processed food to make it taste better, causes high blood pressure. So does smoking.

I had already given up smoking, because the very first inkling about the relationship of lifestyle to disease was the Surgeon General’s report in 1964 that linked smoking to heart disease.

In the 80′s, Diet for a Small Planet came out and we all became vegetarians. I grew vegetables in the 70s as well. Even then I stayed away from fast and processed food.

All the while, food processing has become more and more a chemical affair, and most food chemists and nutrition scientists trace heart disease, diabetes, and cancer to food processing: the addition of chemical preservatives, the leaching out of vital minerals and vitamins by pesticide depleted soil, and so on.

I’ve seen “Food, Inc“., in addition to “Forks Over Knives” and “Fat Sick and Nearly Dead.” The agricultural products that are subsidized (corn, dairy, beef) have ginormous PR campaigns that tell you what to eat. Then the government puts it in the school lunches and the food pyramid.

Bottom line: stay as pure as you can. I have read the medical studies. “It’s the toxins, stupid.”

You can eat beef and chicken as long as they are free range and grass-fed, and not injected with hormones, steroids, etc. Or fed wheat and corn, because those crops are now toxic because of the pesticides and the soils they are grown in. And as long as they make up less than 20% of the calories in your diet (and they have more calories than plant-based foods). My nutritionist says to prefer grass-fed beef (if eating out) to farmed fish, because farmed fish is fed toxic grains and hormones. Wild fish is best, but even it is polluted with mercury.

Stick to green leafy vegetables and fruits like berries and watermelon and citrus that don’t have much sugar. Sugar creates havoc in the blood, because it causes your energy to fluctuate wildly even if you aren’t diabetic. Protein evens out the blood sugar, which is why you need it. Nuts and seeds are also good, although you have to be careful what chemicals they are prepared with (barbecued or honey roasted nuts can be full of chemicals). Starch, by the way, becomes sugar during the digestive process, so forget potatoes and anything but whole grain bread.

Wheat free is desirable, but not necessary. I am now wheat free, and have more energy. I am also dairy free, which probably IS necessary because of the toxins in the feed our cows are given. And in my case, I’m intolerant of dairy.

Which brings me to my final step of how to fine tune: I went for a series of blood tests, including an IGC panel. That panel told me what foods I was sensitive to, which means which foods cause inflammation in my particular body. I eliminated them.

The current scientific thinking is that most disease is caused by inflammation. Cholesterol doesn’t necessarily cause heart attacks; inflammation does. It breaks the cholesterol loose and sends it through the blood. Cancer is also thought to be inflammation, which weakens the immune system so it doesn’t automatically just kill the cells that become aberrant.

And here’s where stress comes in: stress also weakens the immune system. Anything that causes the immune system, which weakens anyway with age, to weaken further could be a cause of disease. For example, stress causes the blood to pump harder against the walls of the heart, which causes high blood pressure,
which in turn causes thickening and enlarging, which in turn causes less efficient pumping, which can cause heart failure.

The health care system has known all this for a while, but has chosen to address it with technological fixes (surgery) rather than root causes (change the way you live). Now that we can’t afford ourselves as a sickly nation, you will see the preventive measures come into play. They are our “austerity program,” but they should have been our program all along, IMHO.

On balance, I feel great. My arthritis and high blood pressure, caused by excessive exercise and stress, are now controlled. What have I given up? Dairy, wheat, and processed food (which I never ate anyway). What haven’t I given up? Red wine and dark chocolate. I haven’t found any articles that tell me they aren’t good for me.

I am listening to the story of a woman who had malignant mesothelioma eleven years ago, was given 8-14 month prognosis, and is alive because her best friend is a specialist in personalized medicine at the University of Arizona. He found through tumor tissue analysis that her markekers were the same as those of someone with chronic myelogenous leukemia, which is treatable.

So there she is, up on the stage, a living example of why Arizona has committed itself to the Biomedical Roadmap to develop personalized medicine and customized care as a special industry for Arizona.

But here is the problem.

Right now, personalized medicine is for the rich, and most of us won’t be able to afford it. The speaker I heard admitted that her health insurance has paid millions over the years to keep her alive.

We MUST figure out a way to make these advances available to people at less cost to both the health care system and the individual patient. Ironically.personalized medicine and especially molecular profiling may end up saving, rather than costing, the system money, because we will be able to stop offering chemotherapy to people it won’t help.

Right now, one of the reasons the last six months of life cost so much is that we spray these expensive medicines at people without knowing whether they can really help. I’m the process, we ruin the patient’s quality of life and literally waste billions.

I found it eye-opening to learn that the same expensive interventions, done only where they are truly going to be worthwhile, could actually help save our health care system.

This post came to us from Anthony Lopez at E-Health Insurance.

Educate employees about health insurance costs: According to recent numbers from the Kaiser Family Foundation , the cost of employer-sponsored health insurance increased 9% for family coverage and 8% for single coverage in 2011. But the fact is that most employees don’t have a good understanding of how much employers pay toward their coverage. If you’re facing increased costs and need to ask your employees to contribute more toward their premiums, it’s time to sit down and have a frank discussion. If employees better understand the challenges increased costs present to your business, they may be more willing to accept necessary adjustments to their coverage or contributions.

Consider that employees prefer cuts in benefits to rate hikes: A recent survey sponsored by eHealthInsurance and conducted by Kelton Research shows that employees are more likely to be upset by increases in their monthly premiums than by changes to their benefits. Keep that in mind when deciding how to adjust your health insurance offerings for next year.

Conduct an employee poll to find out which benefits matter most: If you find that you must cut benefits from your health plan in order to make ends meet, ask your employees to complete an anonymous poll. Don’t ask about their health or their medical history – that’s illegal – but ask them which types of benefits matter most to them: robust preventive care, prescription drugs, chiropractic, maternity care, low copayments, vision or dental coverage, etc. This can give you some guidance when choosing which kinds of plans to offer.

Consider ALL options available from your carrier, and new carriers too: When open enrollment season comes around, many employers get notices from their insurance company suggesting a few coverage alternatives, but there’s usually more to choose from. Contact your agent or broker to explore other options that might be available through your current carrier. A licensed agent representing multiple carriers can also provide you with fresh quotes from other insurers in your area. It’s all part of doing your homework if you want to make sure and get the most for your health insurance dollars.

Offer employees more than one coverage option: Smaller businesses tend to offer fewer coverage alternatives, but there may be benefits to offering more. If you’re currently offering your workers only one health plan, consider adding a second or third to the mix. For example, you might offer a high-deductible Health Savings Account-eligible plan, and then another plan from the same carrier with a lower deductible. The dollar amount you contribute toward employee coverage need not change, but it gives employees who want it the chance to start a Health Savings Account or to pay a little more from their own pockets for a plan with a lower deductible or more robust benefits.

Get that new tax credit while it lasts: Not all small businesses can afford to offer health insurance. But until 2014 tax credits are available for small businesses with 25 or fewer employees with average annual wages of less than $50,000. You may qualify for a credit of up to 35 percent of the premiums you pay toward employee coverage. Talk to your accountant to learn more.

Discourage employees from going uninsured: Some businesses will find that they’re unable to provide employer-sponsored health insurance in the coming year, or that their employees can no longer afford rising rates and opt not to enroll. If that’s the case, encourage your employees to do what they can to make sure they have some form of coverage. It gets them better access to medical care when they need it and helps keep them financially sound, which can only be good for your business. If their spouse works, they may be able to enroll in his or her plan. If they’re under age 26, they may qualify to re-enroll in a parent’s health insurance plan. To explore government-sponsored options, they can also contact the non-profit Foundation for Health Coverage Education at coverageforall.org.

Image via Wikipedia

Are poor Medicare recipients drug addicts, or are they selling their drugs on the street?  The stereotype out of the Government Acocunting Office says they are addicts defrauding the government.  Looking at the same study with an open mind, I think it’s just as easy to say they are trying to make ends meet by buying and selling drugs, just like most of the other residents of ghettos and barrios where the 99% live:

In 600 cases revealed in the audit, Medicare beneficiaries received prescriptions from as many as 87 different doctors in the same year indicating, the report said, that the patients shopped around to find as many providers as possible to write prescriptions for drugs in those 14 categories — mostly controlled substances and primarily hydrocodone and oxycodone.

“In these situations, there is heightened concern that these Medicare beneficiaries may be seeking several medical practitioners to support and disguise an addiction,” Kutz told the Senate Homeland Security and Governmental Affairs Subcommittee on Federal Financial Managment, Government Information, Federal Services and International Security on Tuesday.

The people who received multiple prescriptions accounted for $148 million in loss to Medicare, according to the Government Accounting Office, which conducted the audit. GAO believes that most of the “doctor shoppers,” who are disabled or elderly, are addicted to the drugs they’re buying.

I would like to challenge GAO: I would bet otherwise. I bet they are selling their excess drugs on the street to get money to live on. In this nation of haves and have-nots, Medicare is one of the last remaining sources of safety.

I looked this up on the internet. Here’s what Yahoo Answers says is the prevailing rate for oxycontin on the street: “usually the cardinal rule for all recreational pills is a buck a milligram.” In Palm Beach County Florida, where many elderly people live, recreational pain killers go for $8-$10 a pill.

Before we assume the Medicare beneficiaries themselves are the addicts, let’s look at who they are:

One barrier to spotting fraud among Medicare beneficiaries with low incomes is that they are a special group that can switch Medicare plans monthly, making it difficult to spot excessive prescriptions or excessive visits to the doctor, Kutz noted. Traditional Medicare beneficiaries can only switch Medicare plans once a year.

Doesn’t it make more sense that these people, who probably lack other necessities in life, have put their disabilities to work for them in the only way they can — to use them to procure drugs and re-sell them on the street. Of course looking at it that way would mean taking a systemic view of poverty, disability, social problems, and drug addiction. Prescription drug addiction is just as prevalent among the rich as among the poor, only the rich can afford to pay the $10 a pill.

Here at Health 2.0 there is definitely an air of transformation. Several initiatives that I had been following have come to fruition, or at least to critical mass, among them implementation of EMRs and patient communities. MedHelp now has over 12 million visitors a month, while millions of women annually visit the women’s social health site EmpowHER.com

On the electronic medical records side,  physicians have finally begun to implement EMRs in large numbers, because they are now subsidized by ARRA, the stimulus bill (you remember, the one that didn’t work?) to do so. In order to receive $50,000 to deploy an EMR, a physician need only buy one and demonstrate its “meaningful use” in his practice. For this year, to qualify for the Medicaid meaningful use incentive, all you had to do was purchase the software and go live in your practice. In the future, there will be other, more important qualifiers, such as the health outcomes of your patients. But for this year, just buy the product and begin to use it.

As a result, companies like Practice Fusion, which always made its software free, and is a (private) cloud-based platform have begun to grow by leaps and bounds. Founded in 2005, Practice Fusion grew by 400% in 2009 with the passage of ARRA now has 100,000 users and 21,000,000 patient records online. Next year, it is projected to have  100,000,000 records. Its iPhone app will launch soon, and its iPad app is being designed by one of the country’s top designers, who will speak at Practice Fusion’s user conference in November.

As part of an “exclusive” interview  with Practice Fusion’s founder and CEO, Ryan Howard, in which we took a pedicab ride around downtown San Francisco, I found out that within the next few years, users of EMRs like Practice Fusion will be able to choose physicians based on whether they have EMRs and allow the patient to have access to his or her data. After five years of waiting for the market to catch up with his innovation, Ryan has found himself sitting pretty, with open data ready for the new wave.

[ Aside: I also found out that in the early days of the company, Ryan actually took an insurance settlement check for an automobile accident and used it to make payroll instead of having his torn rotator cuff fixed. Yes, he's a hard core entrepreneur]

However, if you are a patient of the VA, of Medicare, or of any other insurer that is part of the Blue Button initiative, you can get your data today, by logging into VA.gov or Medicare.gov and registering online. Once you prove your identity, you will be given an opportunity to use the Blue Button  to download your data as a text file, or view it as a .pdf . You can save the data to your hard drive or send it to a PHR, such as Health Vault.