From his role as Director of Health IT for the AAFP, co-creation of the CCR and with his involvement behind the "NDA firewall" with the Google Health team, David Kibbe probably has a better vision than most about what’s new and different with Google Health. And he is indeed optimistic.

Much of the discussion about Google Health beta’s recent launch as an online PHR or healthURL seems to me to miss the point about what is really new and different. 

Here’s how I see it:

1) Computability. What Google Health does that no other platform is yet capable of doing is to make personal health data both transportable AND computable. Right now, this is the news. By supporting a subset of the Continuity of Care Record (CCR) standard for both inbound and outbound clinical messages, Google Health beta makes it possible for machines to accept, read, and interpret one’s health data.  It is one thing to store health data on the Web as a pdf or Word text file, for example one’s immunizations or lab results, where they can be viewed. It is a giant leap forward to make the data both human and machine readable, so that they can be acted upon in some intelligent way by a remote server, kept up-to-date, and improved upon in terms of accuracy and relevance. That is what the CCR xml subset supported within Google Health beta achieves for the consumer that is really new and different; this is what HealthVault and Dossia are to date missing. 

Right now, those web services are only mildly useful and sort of
"toyish" — allowing the user to create a meds calendar and get email
reminders (ePillBox), or setting up preferences for health and medical news searches (MyDailyApple), or suggesting alternative medications to the ones you now take (SafeMed).

But disruptive innovations are often considered simplistic and
compared to toys when they first emerge (remember the first Apple
computer?) and there is no stopping these developers and these partner
companies from making their services more intelligent, more useful, and
more convenient to the consumer. Which brings me to ….

2) Rapid design evolution. Google Health beta has established
a robust and growing community of programmers and developers eager to
attach their widgets, services, and full-scale apps to the Google
Health beta juggernaut.  Most of the public doesn’t see this activity,
because it is hidden behind the Google NDA that the developers have to
sign, swearing themselves to secrecy about what’s going on at Google
Health. But it is an enthusiastic, really smart, and tirelessly
innovative group of people who have been attracted to the Google Health
platform. They are going to help Google’s engineers rapidly evolve the
design of Google Health over the next few months and years, in ways
that are completely impossible to predict, depending mainly on how fast
Google Health’s operators are willing to move. Design creates value,
and value causes infrastructure to change. Modularization of the entire
EHR and PHR space may now be possible.

While I recognize that most of the commentary about Google Health
beta and Microsoft HealthVault will concentrate on privacy concerns,
barriers to data entry, and questions about whether mainstream health
data sources will participate or not, I think the disruptive potential
has already been unleashed. Watch what happens as the Google Health
platform modules and component services grow and start to interact with
one another.

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14 Responses for “Google Health beta — What’s really new and different?”

  1. Ian Furst says:

    Hey David, I’ve taken the platform for a testdrive and created my own record. My impression of it was that of a PHR, nothing more or less. But even on the first draft the site is heavily laced with brand advertising. There already seems to be a large bias to pay for access. For instance, many of the health tools are attached to profit sites/institutions and the doctor search, seems to be based on paid advertising rather than public phone records. I trust Google not to release my information but how badly is the information that is presented through the platform, under the pretense of increasing my Health, going to be biased by the amount they are willing to pay or the likelihood a click will convert to a new patient?
    http://www.waittimes.blogspot.com

  2. Michael B. says:

    I have also used the site and find it somewhat interesting. The big challenge is gathering up the records to input into the online profile. Google’s partnerships with providers are going to be the key ingredient here to make it a success. Inputing/loading this information needs to be easy and quick in order for it to really take off. The question is, how will Google incent providers to make their patient’s information readily available? I posed the question to a Google exec at a health care conference earlier this year. He indicated that demand will come from the patients and that will provide the incentive for providers to participate. I don’t think that is a rational expectation considering the structure of our health care system.

  3. Michael B. says:

    I have also used the site and find it somewhat interesting. The big challenge is gathering up the records to input into the online profile. Google’s partnerships with providers are going to be the key ingredient here to make it a success. Inputing/loading this information needs to be easy and quick in order for it to really take off. The question is, how will Google incent providers to make their patient’s information readily available? I posed the question to a Google exec at a health care conference earlier this year. He indicated that demand will come from the patients and that will provide the incentive for providers to participate. I don’t think that is a rational expectation considering the structure of our health care system.

  4. David C. Kibbe, MD MBA says:

    These are both excellent comments, in my opinion. I’m not a proponent for GH over MHV, or vice versa. In either case, what’s important is how well consumer empowerment is served. If the third-parties that either is able to attract are overwhelmingly commercial, I don’t think the user is going to be happy, and he/she won’t use the PHR. And I do agree that getting one’s doctor, clinic, or hospital to upload one’s health data into GH or MHV is a key to success. What’s the chicken and the egg there? If I value GH, I’ll put pressure on my doctors to participate and help me. If they care about me and my patronage, then they’ll be motivated to do so. Only time will tell! Cheers, DCK

  5. 1st GOOG no harm says:

    re: “I do agree that getting one’s doctor, clinic, or hospital to upload one’s health data into GH or MHV is a key to success. What’s the chicken and the egg there?”
    I can tell you my chicken begins with the egg, Dr. Kibbe. I am changing my primary care doc BECAUSE he has no knowledge of – or interest in – helping me ‘portabilize’ my health record, in my case by helping me obtain a PIN to access my Quest Diagnostics lab results. The arrogance! The ignorance!
    But the GOOG Health rub is this: I contacted QD for help finding an MD that IS set up to provide QD PINs – and THEY couldn’t help me identify one though it seems quite likely that if an MD is set up to PROVIDE QD PINS, QD will know it.
    So while I’m busy distinguishing chicken from egg, at least one of GOOG Health’s partners still needs to get its’ ducks in a row….

  6. David C. Kibbe, MD MBA says:

    Dear 1st GOOG no harm : Great story, comment! If people are more active in choosing their doctors on the basis of the doctors’ willingness to help empower them with their health data, the whole development cycle will quicken.
    But how to find doctors who are equipped to enable a patient to get copies of his/her summary health data and information? Interestingly, CVS/MinuteClinic is already testing electronic transmission of its summary (in CCR xml format) to physicians’ offices that have EMRs capable of accepting them, and, of course, to MinuteClinic visitors who wish to upload the summary to Google Health beta.
    One of the problems we all have, whether patients, doctors, Quest Diagnostics, or MinuteClinic, is knowing who is “in the network” and who is not. Trust someone in Health 2.0 to come up with a solution in the not-to-distant future! Perhaps Google Health’s Doctor Finder will tackle that, too.
    Regards, DCK

  7. Privacy concerns: Let’s apply the hacker approach to Google Health data to check safety: what is the worst-case hack scenario you can imagine?
    And how would you defend the system? On the other hand: How can Google Health help to homeless people? Here is a suggestion:
    http://pimm.wordpress.com/2008/05/23/how-can-google-health-help-to-homeless-people/

  8. 1st GOOG no harm:
    I help run IT at a medical billing company. Getting Quest to integrate with a doctor’s office Practice Management system is STILL pretty cutting edge. Most doctors offices aren’t even aware of the fact that they could save time by passing demographics to the Quest gateway.
    But even if the office makes the request this takes time and QD pretty much leaves this to third parties.
    So it’s great that QD is working with Google Health but this isn’t going to happen overnight.
    Regards,
    Jordan Glogau

  9. John Grohol says:

    So I noted this in my entry over at e-patients.net, but someone again point out where the “Export my data” button is…? I see the import button all well and good, but data is only as good as its portability is.
    And while it’s fine to have a set of APIs and be assured that there are “a robust and growing community of programmers and developers eager to attach their widgets, services, and full-scale apps to the Google Health beta juggernaut” (which, sorry to say, sounds like just more marketing-speak to me and my cynical 1.0 mind), the data has go both ways.
    It’s a beta, it has a ways to go, but I don’t outside of this invisible “juggernaut” I’m told is happening, I still don’t see the huge consumer demand clamoring for this sort of online record.
    I guess Microsoft and Google know something about patients and their needs that I don’t.

  10. Dear John Grohol: You’re correct that Google Health beta hasn’t made export of one’s summary health information exportable yet, except through its partner apps, e.g. Cleveland Clinic, Solventus, MyDailyApple. However, this will come.
    A “get around” that’s really neat is http://www.ccrdashboard.com. This will allow you to download your Google CCR profile data, display it as the simple AAFP-designed web page, convert this to a CDA CCD version1.0 and display same, and export the file as a validated CCR xml file to your computer. At that point, you’re set to export it anywhere you darn well please.
    Let me know if you need any help with this. Everything about Google Health is a bit buggy at this time.
    Regards, DCK

  11. Thord Johnson says:

    Keep it simple for the sake of the patient. Thord Johnson, 70+ with parkinson’s and a half dozen minor maladies and five doctors etc.

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