A prescription for Google Health?

by Hans on 2007/08/21

About a year ago, Google indicated that “health care information matters”, with little to report since then. Google seemed to have formed a health board comprised of physicians and some patients to guide its efforts. Recently, I’ve read a few pieces speculating about Google’s efforts toward building a health care product/service (here and here).

In 2005, I had an idea for how Google could potentially disrupt health care. I even shared it with my supervisor, who thought it was an interesting idea and mentioned he would mention it during a meeting he had set-up with some senior execs at Google. Unfortunately, the meeting never took place, and I sort of forgot about it because of my studies.

My idea was that Google develop a personal health record using basic Web2.0 technologies already in its portfolio. Google has several services that could potentially be re-organized into a functional health information product:

  • Gmail & Google Talk – for communicating between health professionals and patients
  • Google Calendar – for scheduling
  • Blogger – to allow patients to record notes about daily activities, responses to medications, etc.
  • Google Video/YouTube & Picasa – for capturing images (e.g., wounds) and sharing video (e.g., teaching)
  • Search – the obvious one for searching for health information on the web or within the health product itself
  • Orkut – a social networking service that could be used to develop family trees, geneologies, and identify possible shared common environmental and/or hereditary factors
  • Google Office – could be modified to allow for recording and tracking of prescribed medications (using the spreadsheet application)

This idea of Google developing a consumer oriented electronic health record was based on the theory of disruptive innovations described by Clayton Christensen.

Currently, efforts are underway to develop electronic health records (EHRs) by governments, regional authorities, hospitals, health information companies, and pretty much everyone else in health care. EHRs have been somewhat of a “holy grail” in the health informatics community since the 1970s, promising an assortment of benefits. Currently, there is no standard EHR product available, and so vendors have been pitching integrated solutions for the last little while. In recent years, hospitals (at least in Canada) have been examining the possibility of assembling EHRs based on “best of breed” technologies – basically taking one component from company A and another component from company B etc. With more governments getting involved in setting an agenda for ehealth/eletronic health records, the vendors seem to be more open towards adopting standards for sharing information between systems and with other organizations (a push for a more regionalized model). Needless to say, these efforts are quite costly in terms of purchasing hardware, building-up an infrastructure, training, and licensing costs. Physicians and other smaller medical groups have been largely left alone to purchase products from vendors – which isn’t necessarily a bad thing.

So where does Google fit in? Well, Google could release a “free to use” personal electronic health record – here are some reported “screen shots” of the would-be Google product (looks like my suggestion might be pretty close). How would it work?

For patients
This product would be a central place that a patient could record and store health information. Information could be found on the web and then recorded for future reference (search). Patients could record some thoughts and questions about the information they found (blog or docs). Alternatively, patients could keep a “health diary” recording responses to medications, daily activities, food eaten, difficulties with activities, etc (blog). Some specialists have mentioned that patients don’t remember enough detail about past events to be helpful when first noticing symptoms, leading to delays in diagnosis/treatment and additional tests. Basically, all of the functions of a personal health record freely available to patients. The “home page” (or “about page”) could list pertinant information (age, existing conditions, allergies, etc). Basically, the patient version is an easy way for patients to view their own information, add additional information, and link to family members (social networking), and share with health professionals.

For providers
While patients can create large quantities of data (usually in text format), this isn’t so great for busy health professionals. Health professionals could be provided a “dashboard” that summarizes the information contained in electronic health record – things like charting medications taken with responses. Obviously some development of appropriate applications would need to take place. Ideally, lab data could be either imported or linked to provide a full picture of the patient. The best thing would be for Google to pitch this type of service to small physician offices who don’t have the expertise to set-up and maintain their own systems. All a physician would need is an internet connection and a few computer terminals. Scheduling could be handled either by the patient using the calendar service and monitored by some administrative staff. No more lost charts!

But wait…
Some will mention that this Google health product will not be “good enough” to meet everyone’s needs. You’re right. But it doesn’t need to be. Google can simply release this product and develop it by adding new features and functions along the way and go “up-market” (following the classic disruptive innovation curve). Of course, Google would need to insure security and privacy and be cognizant of any reglations and laws.

Others might point out that the existing vendors will not sit still. True, but most vendors are interested in making money, and thus they focus on selling to hospitals, HMOs, or other health care groups. Patients aren’t a lucrative market (yet). Vendors might release a product aimed at patients, but that’s more to ensure that hospitals will keep buying their products. Google has an inherent cost advantage here because its services are free to the users because it’s paid for (presumably) by advertisements. Google stays happy because it maintains its user base, and thus increasing its potential ad revenue. At first, the product might not have all the features, but new ones can be added quickly by opening up APIs so that developers can add new features, putting pressure on existing vendors to provide services at Google’s price points and pace (yikes – how do you compete against free?).

Another potential snag is that hospitals and lab companies will not want to share their data with Google. Yeah, that’s true. But, as more standards emerge and governments push for sharing of information, getting other players involved (like Google, Microsoft, or another firm) should be easier. It’s not a question of whether existing players want to, but more a question of when will they be forced to start sharing information.

As Christensen predicts, we’ll soon enter a stage of “commoditization and modularization” where standards allow for components to be swapped interchangeably (we may be closer than we think). If that’s the case, then vendors will need to switch their efforts at providing integrated products to focusing on specialized components like decision support modules, data visualization, or other applications that can “plug” into a larger framework.

I’m interested to see just what Google has up it’s sleeves. The idea that I’ve just described would also follow in Google’s current practice of releasing “beta” products, getting feedback and gaining market share, and then monetizing the product with new releases (see their history with their office products). In one scenario, Google could provide a suite of EHR products for physician offices for free, or with some basic support for an annual cost, slowly moving up the value chain. It’s unlikely that large hospital corporations will ditch the investments they’ve made in the near future. Besides, large corporations have much more demanding needs that Google probably can’t match initially. But, things may change. If enough patients start using Google’s services for Health, maybe there could be a radical shift in power from the health professionals to patients.

I don’t know about you, but I’m very curious to see what Google releases.

{ 9 comments }

Anonymous August 21, 2007 at 12:39 pm

Personally, I think there are some very large EGOTISTICAL knuckleheads like Revolution Health, Google and finally Microsoft who think they can just waltz into this dance and take over– like everyone is just going to fall into place and put their medical records on line! GIVE ME A BREAK! There have been some very large EHR players who have been playing this game alot longer than these newbies on the block like McKessen, Epic etc. If there was an opportunity to seize the market, it would have been these guys…A LONG TIME AGO! The problem here is that when considering PHRs, technology should be the last on the list to consider! Just look at what happened to the RHIO in Santa Barbara, CA..CLOSED!

Hans August 21, 2007 at 2:54 pm

Hi Anonymous – thank you for the comment.

I agree that health care is not like other industries and that special care needs to be taken to develop an understanding of the special needs and nuances of the industry.

I’m also not suggesting that a company can auto-magically create something that everyone will use, usurping the entrenched, health care vendors. As you point out, it’s not so easy.

I also agree that the issues in health care are not so much technical but a combination of technical, medical, and social factors. As my colleagues and I often point out, technology can’t solve the problems in health care – they can play a role, but that depends on judicious use, planning, and foresight.

But, the point of this post was not to suggest that Google *will* take the EHR/PHR market. Instead, I was using Christensen’s theory of disruptive innovations and applying it to health care. The theory predicts that someone organization (like Google) has an opportunity to introduce a potentially disruptive innovation. The McKessens of the world aren’t going after patients because in their value chains, they are non-consumers. These large corporations are trying to meet the demands of the large hospitals/HMOs/RHIOs, leaving an opportunity for someone (it could be McKessen) to develop a solution.

Based on the cost structure of the established vendors, they are not likely to develop such a product (according to the theory). Google could introduce a lower cost product that is just “good enough” to meet the needs of patients who aren’t as demanding for decision support, integrated systems, and electronic ordering. As Google introduces a product, they can slowly move “up market”.

Again, I appreciate a) that you read my post and b) your comment. This post was more an exercise of taking a theory/framework and applying it to a situation and to try and predict some outcomes.

Dr Eric Rice August 28, 2007 at 10:26 am

Disruptive innovations in health care are so new that vetting what is good versus what is hype is difficult. If this issue grabs you, I suggest that you investigate the Ashoka/ Robert Wood Johnson competition. They are trying to revolutionize the grant writing and winning process by inviting the global community to help pick the best disruptive innovation in health care. Anyone can vote for their top 3 of the 10 finalists at http://www.Chnagemakers.net . I am part of the group at UCLA and so of course I think our innovation is among the top three, but I encourage you and your readers to decide for yourselves which disruptive innovations are the most compelling. If you want to know more about my group’s proposal go to http://www.gccf.ucla.edu.

Heather Weller November 16, 2007 at 4:39 pm

Hello –

I found your hypothesis about Google quite interesting, we all know they have been discussing moving into the healthcare field for quite some time. I recently heard they created a new solution for the Pharm industry, I’m not really sure what it is but just heard rumors. I’m thinking it has to do with managing clinical trials data – which would really make sense and really help the industry. What’s your take on their move into the Pharm industry?

Hans November 16, 2007 at 6:43 pm

Hi Heather, thanks for the comment.

Unfortunately, I haven’t been able to follow Google’s work recently so I’m not sure what they may have in mind regarding the pharma industry. However, if I had to guess, I don’t think it would relate to clinical trials.

My reasoning is that clinical trials have very specific information needs to meet regulatory demands and also for research purposes. From my observations of actual clinical trials here in Canada, I’m not sure what value Google would provide. I’ve seen some very interesting electronic tools that seem to meet the needs of clinicians (see TrialStat! at http://www.trialstat.com). Besides, it’s not as if pharmaceutical companies are short of money to develop their own (custom) tools.

However, if Google were to develop a pharma specific strategy, I would think it would be directed at consumers. I would think Google could leverage its search technologies to develop a compendium of drugs (which exists elsewhere), but make it accessible to consumers (for free of course). Its search capabilities could also collect things relating to side effects or patient experiences. I could also potentially see some sort of Google product that could also check drug prices to help consumers determine where and from whom to fulfill their prescriptions.

These are just some thoughts that come to mind. We have to remember that Google is a search company that makes money off of paid advertising. Developing tools to help companies complete clinical trials doesn’t really fit into this business/operating model. This isn’t to say that Google *can’t* develop such a suite of products. I just don’t think Google is targeting pharmaceutical companies.

I suppose Google could leverage the recent trend of social networking and “open source”, community knowledge by recording side effects of drugs (dosages, frequency, etc). This work could potentially benefit the FDA (Food & Drug Administration) and drug companies to track long-term effects of taking drugs.

Again, thanks for the comment. I’ll definitely think about this a bit more and potentially write a post on the topic.

Hans.

Ray Brooks December 5, 2007 at 5:03 pm

Dear Hans,
I read your proposal with interest. There is a need for a personal health record and google is one market player that may be able to provide an interesting product.
I have closely examined a number of competing products available and under development in Ontario, Canada. I note that Ann Cavoukian, the Information and Privacy Commissioner (IPC) for the Province of Ontario has stated that “The Personal Health Information Protection Act, the third statute under the oversight of the IPC, does not include freedom of information…” She continues “Personal health information can only be accessed by the individual or his or her substitute decision-maker, without express consent and is NOT available to the general citizen.”
Source: http://www.ipc.on.ca/index.asp?navid=29
Dec 5, 2007

The rules in Ontario concerning who can record and store information, what can be stored, who can access that information and when it can be accessed, by whom, are complex, detailed and subject to interpretation.

Unfortunately there are more than 70 jurisdictions in Canada and the USA, with different laws, rules and regulatory mechanisms to control health information. For so long as the separate Provinces and States have their own laws and systems of regulation it will be difficult, if not impossible, for any one health information provider to provide a personal health record without bearing an onerous liability.

There is little value in offering a disruptive technology if the resulting penalties cause insolvency.

I suggest that there are as many competing software solutions as there are jurisdictions because each solution is designed for a limited legal and regulatory environment, typically comprising one jurisdiction.

From this analysis I suggest that the primary need is for the Federal Government’s of Canada and the USA to create one market for health, and one set of laws governing the market with one regulator to control it.

Then it is possible that disruptive technology may be applied in the face of fierce opposition from the entrenched professional and business interests. But that is a thought for another time.

Ray Brooks December 11, 2007 at 10:08 am

Correction, with Apologies.
In fact,health information, as opposed to actual healthcare delivery, is under Federal jurisdiction in the USA. It is primarily governed by the Health Insurance Portability and Accountability Act (HIPAA). It covers privacy, transaction code definition, security, identifiers for providers (the National Provider Identifier, not patients) and enforcement.
The relevant legislation in Ontario are: The Freedom of Information and Protection Act (FIPA) and The Personal Health Information Protection Act (PHIPA). The key areas here are again security and privacy.
All provincial jurisdictions has almost identical legislation in place, and it is all based on the 10 Privacy Principles:
See => http://www.justice.gc.ca/en/news/nr/1998/attback2.html
In Canada, there is one more piece of legislation that is relevant (and in fact all provincial legislation is loosely based on it) and that is the Personal Information Protection and Electronic Documents Act (PIPEDA).
Foreign jurisdictions has very similar laws, with a few extra provisos. For example, for the UK, the data must actually be stored on servers and disks that are actually on UK soil.
Finally, President G.W. Bush complicated the international position when he signed the ‘Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act’, a.k.a. the infamous USA PATRIOT Act. This act allows the US government to demand personal information on any person held by any USA company, anywhere in the world.
It may be argued that due to that act no large company or organization in Canada or Europe wants any American company to hold health information. Although most individuals are not aware of the impact of the act, most large organizations are and seek health a care information provider that is not based in the USA.
It may be argued that the Patriot Act was disruptive to the development and providios of PHR systems by American Companies outside the US.

William Hill December 20, 2007 at 2:51 am

RxPop.com is very excited about Google Health. After reviewing several of Google Health’s features it’s likely to be a big hit!

I’m very much in agreement with Han’s in that Google will eventually build out or acquire an existing brand that helps consumers to check drug prices and ultimately fill their prescription with a licensed online pharmacy.

That’s exactly what RxPop.com does! It puts legitimate patients in touch with licensed online pharmacies operating within the U.S. and Canada and enables them to securely place their orders.

It will be interesting to which direction Google goes in terms of “pharmacy” and “prescription drugs”.

William Hill December 20, 2007 at 2:58 am

Ray, In your post you mention a lot about politics and healthcare policy.

On RxPop.com you can find a very nice collection of recent videos which feature various 2008 U.S. political nominees and figures speaking out on the Healthcare Crisis in the United States.

RxPop.com also features an API to ProjectVoteSmart.com. This API provides for useful information on all politicians.

Healthcare Crisis in Politics Videos can be found at:

http://www.rxpop.com/politics.asp

Enjoy!

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