Traffic, parking, and Dodgers: three hallmarks of Los Angeles. How can we address the first two to make a Dodger's game better? Lots of folks have suggested public transit to Dodger Stadium. One of the more reasonable suggestions is an aerial tram between the Gold Line and Dodger Stadium. Let's see how the numbers stack up agains two similar, recently constructed aerial trams, the Portland Aerial Tram to Oregon Health & Science University and the Emirates Air Line in London. Obviously, the Dodger's airline sponsor, United, should buy naming rights to the United Air Line.
Dodger Stadium (estimated)
Generally, health is just so heavily regulated. It's just a painful business to be in. It's just not necessarily how I want to spend my time. Even though we do have some health projects, and we'll be doing that to a certain extent. But I think the regulatory burden in the U.S. is so high that think it would dissuade a lot of entrepreneurs. -- Sergey Brin
However, creating an exchange like the one described by Larry is possible. Let's start by evaluating the interests of the different parties involved:
I am really excited about the possibility of data also, to improve health. But that's-- I think what Sergey's saying, it's so heavily regulated. It's a difficult area. I can give you an example. Imagine you had the ability to search people's medical records in the U.S.. Any medical researcher can do it. Maybe they have the names removed. Maybe when the medical researcher searches your data, you get to see which researcher searched it and why. I imagine that would save 10,000 lives in the first year. Just that. That's almost impossible to do because of HIPAA. I do worry that we regulate ourselves out of some really great possibilities that are certainly on the data-mining end. -- Larry Page
Both patients and researchers understand they fundamentally need each other to succeed.
Next, as with any project, let's look a how research currently works. Large university medical centers treat lots (millions) of patients per year. These patients' medical records are just now being stored electronically. Researchers at the university can create studies and request medical records. These studies have to first be approved by the university's Institutional Review Board (IRB) before the researcher is allowed access to the medical records. The researcher then performs his or her study and can publish the results.
So, what are the problems with the current system? Like Sergey and Larry said, there is a lot of red tape. Any changes to a study have to be approved by the IRB again. Most universities are limited to just one hospital or a few hospitals. This means they have a limited number of patients, a limited geographic sampling of patients, a limited set of standard treatments, etc. These limits hinder research studies. Also, typically only researchers at universities have access to the university's medical records. A brilliant private practice doctor would have to partner with a university. Multi-university studies require a sponsor at each university and a review by each university's IRB. As you can see, large scale research projects don't happen easily.
So... How do we fix the problem?
We need to create an exchange (data warehouse) for patient records. But where will those records come from? They can't come from the doctors, hospitals, or universities. Those are all regulated by HIPAA. The records must come from the patients themselves. Here's how:
Patients can delete their accounts at any time. However, once a researcher has accessed their data, it cannot be revoked. The exchange could charge researchers for each study and pay patients for their records. The exchange could be created as a for-profit company,but patients would be more willing to upload their records to a non-profit. The exchange could also be used by researchers to recruit patients for their clinical studies.
This framework still needs a few tweaks, but it has huge potential. There are issues, technical and legal, to overcome, but they are not impossible.