#Gchat Medicine?

Google just announced that they are piloting a specific health focused service for Helpouts which apparently is a fully HIPAA-compliant system that allows patients to receive telemedicine from clinical providers.  They are currently partnering with One Medical Group, an “experience-focused” medical practice, which allows patients to “request a Helpout, and typically speak with a physician within 20 minutes. It’s recommended for people with cold and flu symptoms, rashes, or simple infections.”

I love the idea of medicine finally moving away from the clinic and towards a digital future, and in our health system we are currently exploring ways that we can deliver telemedicine to our patients with diabetes.  But to do this effectively, we have to understand the elements needed for a health visit.

One of my students helped me map out this diagram of a diabetes visit and it makes me realize that telemedicine is much more than just communication technology.  For a larger view click here.

How do you measure height, weight, and blood pressure of the kids to make sure that they are growing and developing and are not hypertensive? How do you check their injection sites to make sure they don’t have scar tissue affecting absorption of their insulin?  How do you obtain hemoglobin A1c, which is the 3 month measure of glycemia that we usually obtain in clinic to help inform our treatment decisions?

And how do we review blood sugars from afar given that most patients walk in with numbers written on a piece of paper?  It’s not that simple, even with a number driven disease like diabetes.  I do believe the sky’s the limit in digital health, but for right now I don’t think the google solution will fly for us. Other options include using designated telemedicine centers, or even delivering co-managed care in partnership with general pediatricians; time will tell as we also try to figure out that horrible tangled web of reimbursement!

Joyce Lee, MD is a pediatrician, diabetes specialist, and Associate Professor at the University of Michigan.   She blogs about design and healthcare at joycelee.tumblr.com.

5 replies »

  1. Is this a joke? But pediatricians have bad habits of doing too much care by phone. That they so not get sued more often is a testimony to the resilience of the body of a child.

  2. Since I am are you aware of the solid scientific studies on the physiology of human touch? – before we all go rushing into the merits of telemedicine?

  3. The friend I quoted, now that I have researched it and probably should have before I posted, might not be as explicit as the comment, but in independently going to the healthcare exchange’s privacy statement, to me, it seems complex. (https://www.healthcare.gov/privacy/)

    For example, the privacy statement clearly states they collect information (such as your IP address) for statistics and measurement which is done when you just visit the website, without letting the user know. The policy indicates they protect individual information which you provide (this is good), but collecting an IP address is really individual information.

    Another example, for me, is the area of third parties. Not sure everyone realizes the difference when interacting on the web (and they probably should) with third party providers, but if the government is using these tools, should the government have responsibility? “As a response to OMB Memo M-10-06, Open Government Directive, HealthCare.gov uses a variety of technologies and social media services to communicate and interact with citizens. These third-party website and application (TPWA) tools include popular social networking and media sites, open source software communities, and more. Examples include Facebook, Twitter, and YouTube.

    TPWAs are not exclusively operated or controlled by HealthCare.gov. Users of TPWAs often share information with the general public, user community, and/or the third party operating the website.”

  4. Can you give a citation for “the source code on the gov’t website says that if you sign up for Obamacare you ‘no reasonable expectation for privacy.’

    This sounds a lot like political propaganda to me …

  5. The issue of privacy also comes into all this. Will google own the information you provide? Privacy is already a big issue. As a friend pointed out on the issue of ACA and privacy: Most physicians and other providers, as well as all hospital and clinic workers have had many hours of meetings to make sure they are HIPAA-compliant and understand the many complexities of this new law, so it irks me to no end that the source code on the gov’t website expressly says that if you sign up for Obamacare you have “no reasonable expectation for privacy.”