Google Health launched last Monday, which sent the world’s Google-watchers into a tizzy. I serve on Google Health’s Advisory Council – which met all day Tuesday – and so here’s a bit of inside dish, along with my impressions of the site and the company.
FYI,
my work on the Council is covered by a Non-Disclosure Agreement, so I
won’t reveal anything that isn’t publicly known regarding Google’s
products or intentions. Also, in the interest of full disclosure, you
should know that I am compensated for my Google service. (No stock options, darn it.) With that as background, here’s the scoop. Google
began working on its version of the personal health record a couple of
years ago, after the company realized that a remarkably high percentage
of searches were for health information (I know, if that’s going to be
how priorities are set, you’re wondering if Google Sex is next). Google
put together an impressive team to develop the concept. One of the
leads is a former UCSF medicine resident, Dr. Roni Zeiger. Many of our
residents come to me for career advice, and I seem to recall Roni
asking me about pursuing his interests in informatics after residency
about a decade ago. Sage that I am, I probably told him that this
computer thing didn’t have legs. Luckily he didn’t listen, and now he’s
the top doc at Google. Go figure.
A Google Health Clinical Exam
By
Not
one more pixel need be spilt about the issues of privacy, security,
HIPAA, metastatic data, third-party crashers, or corporate imperial
overreach raised by the debut of Google Health. Let’s just snap on the
latex gloves and do a quick exam. This won’t hurt a bit.
Three brief clinical observations follow:
Your conditions, your choice
You can enter your “conditions” either by entering text or choosing
from a disheartening alphabetic menu of bodily afflictions, from
Aarskog Syndrome to Zollinger-Ellison Syndrome. The list is 20 screens
by 3 columns deep when spread out on one endless page.
Immediately preceding the last entry is
“Zits”–a nice bit of diction that helps reach users where they live, so
to speak, to humanize the Google Machine. As with many conditions that
populate the picklist (no pun), there’s a pre-loaded search for zits.
But only certain conditions are pre-loaded with searches. Although
“whiteheads” was on the list, when I typed it in there was no stored
search. When I did the search myself up popped the zits search results.
To give the product a test run as you can see below I chose a number
of conditions from the list — WHICH, IF YOU ARE AN INSURER, EMPLOYER OR
ACQUAINTANCE, I ASSURE YOU ARE ENTIRELY MADE UP AND DON’T APPLY TO ME
AT ALL, IN FACT I AM PERFECTLY HEALTHY. I also tried to throw Brother
Google a curve ball by describing the same conditions using several
different terms, i.e., arthritis, osteoarthritis and bad knees. I was
permitted to add these as I wished.
Google Health finally up and open for business
After a long time in discussion, Google publicly launched Monday its free online personal health records. The operation first made headlines a couple of months ago when Google announced it at the Healthcare Information and Management Systems Society (HIMSS). I was invited to the Googleplex, but due to a prior engagement, had to miss the chance to get it from the horses mouth.
Much like the "non-PHR" HealthVault, Google now allows consumers to download records from its eight initial partners and store them for free.
As the WSJ Health Blog points out, only a minority of medical practices keep records electronically. But the good news is that Google has been thinking not just about EMRs, but also about the rest of data that’s most useful (Rx and lab results) and has some big players, such as Medco, Walgreens and Quest on its list of initial partners.
Google will also have to spend more time now dealing with the privacy zealots and not just leaving it all to, well, me!
Although I wasn’t there, a much more famous health IT person was. John Halamka is the Chief Information Officer at one of Google’s initial partners, Boston’s Beth Israel Deaconess Medical Center (and of course colleague of THCB regular Paul Levy, and more recently himself a blogger). BIDMC has offered its patients a PHR for more than 7 years, and now that data can be brought into Google Health (and I assume vice versa). John’s post about the launch is below — Matthew Holt
By
Beth Israel Deaconess Medical Center is now live with Google Health. In the interest of full disclosure, I am a member of the Google Health Advisory Council and have not accepted any payments from Google for my advisory role. BIDMC is also working with Microsoft Health Vault and Dossia.
I’m now at Google Headquarters in Mountain View with the Google Health team – Roni, Missy, Maneesh, Jerry etc. and several dozen reporters.
Here’s the functionality we’ve launched.
When a user logs into Google Health and clicks on Import Health Records – the following choices appear:
- BIDMC
- Cleveland Clinic
- Longs
- MEDCO
- Minute Clinic/CVS
- Quest Laboratories
- RxAmerica
- Walgreens
They are all early integrators with Google Health.
At BIDMC, we have enhanced our hospital and ambulatory systems such that a patient, with their consent and control, can upload their BIDMC records to Google Health in a few keystrokes. There is no need to manually enter this health data into Google’s personal health record, unlike earlier PHRs from Dr. Koop, HealthCentral and Revolution Health. Once these records are uploaded, patients receive drug/drug interaction advice, drug monographs, and disease reference materials. They can subscribe to additional third party applications, share their records if desired, and receive additional health knowledge services.
More on Google and the Cleveland Clinic
For a start, as I said in my last post and many times, and at least one of these commenters has written at length, the benefits of sharing health data in clinical situations massively outweigh the risk. So that should be the focus of the discussion.
I am NOT saying that there shouldn’t be privacy protections and there is no reason in my mind why, for all HIPAA’s flaws, it cannot be extended to PHR providers as covered entities.
However, as far as I can tell nothing that is happening here violates HIPAA. Showing you keyword based advertising may not to everyone’s taste, but it does not mean your private health data is being transferred to anyone. And presumably your data will only end up in these services if you give them permission to accept it, which will include consent to provide whatever services and advertising you’ll see.
And that’s assuming that either company does advertising based on records rather than search terms (which is Google make that 98% of their money).
But exactly where are Microsoft and Google suggesting that they’re going to be selling private identified data? Nowhere. Microsoft has bent over backwards to demonstrate that they have no intention of allowing themselves or anyone else to access your health records without permission. And Google will likely do the same when it announces its plans officially.
Google, the Cleveland Clinic and the Privacy Zealots
So Modern Healthcare‘s Joseph Conn has a whole page to write about the Cleveland Clinic and he writes just about HIPAA and the fact that this pilot is not going to be covered by it. Writing in the San Francisco Chronicle Victoria Colliver talks about not a lot more, but at least she has someone stating the bleedingly bloody obvious—
"If it’s made convenient
enough and easy enough, people will be no more concerned about privacy
with these systems than they are with their financial information," he
said. "Far more people die because health information is not released
or difficult to get … than anybody’s ever been harmed because the
information has been inadvertently released."
OK so it was me she quoted, but someone needs to give Deborah Peel
and whoever the hell the World Privacy Forum is a big shake. I say this
as a card-carrying member of the ACLU and Amnesty International who is
deeply concerned about anyone’s private information and what use is
made of it.
And the shake is, if a government overhears your private information
illegally (or quasi-legally) it can use that information to take away
your freedom and worse. So the standard for their ability to access
that information should be an awful lot higher than it is in virtually
every country—including this one.
If a private corporation unwittingly lets slip your private health
data, or even uses some aspect of it knowingly to target you for
marketing, the chances of you suffering much from it are very, very low.
These are vastly different things, and conflating the two does not help in the least.
