About a year ago, Google indicated that â€œhealth care information mattersâ€, 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, Iâ€™ve read a few pieces speculating about Googleâ€™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 â€“ for scheduling
- Blogger – to allow patients to record notes about daily activities, responses to medications, etc.
- Google Video/YouTube & Picasa â€“ for capturing images (e.g., wounds) and sharing video (e.g., teaching)
- Search â€“ the obvious one for searching for health information on the web or within the health product itself
- Orkut â€“ 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 â€“ could be modified to allow for recording and tracking of prescribed medications (using the spreadsheet application)
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 â€œholy grailâ€ 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 â€œbest of breedâ€ 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 isnâ€™t necessarily a bad thing.
So where does Google fit in? Well, Google could release a â€œfree to useâ€ personal electronic health record â€“ here are some reported â€œscreen shotsâ€ of the would-be Google product (looks like my suggestion might be pretty close). How would it work?
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 â€œhealth diaryâ€ recording responses to medications, daily activities, food eaten, difficulties with activities, etc (blog). Some specialists have mentioned that patients donâ€™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 â€œhome pageâ€ (or â€œabout pageâ€) 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.
While patients can create large quantities of data (usually in text format), this isnâ€™t so great for busy health professionals. Health professionals could be provided a â€œdashboardâ€ that summarizes the information contained in electronic health record â€“ 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 donâ€™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!
Some will mention that this Google health product will not be â€œgood enoughâ€ to meet everyoneâ€™s needs. Youâ€™re right. But it doesnâ€™t need to be. Google can simply release this product and develop it by adding new features and functions along the way and go â€œup-marketâ€ (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 arenâ€™t a lucrative market (yet). Vendors might release a product aimed at patients, but thatâ€™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 itâ€™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 Googleâ€™s price points and pace (yikes â€“ 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, thatâ€™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. Itâ€™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, weâ€™ll soon enter a stage of â€œcommoditization and modularizationâ€ where standards allow for components to be swapped interchangeably (we may be closer than we think). If thatâ€™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 â€œplugâ€ into a larger framework.
Iâ€™m interested to see just what Google has up itâ€™s sleeves. The idea that Iâ€™ve just described would also follow in Googleâ€™s current practice of releasing â€œbetaâ€ 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. Itâ€™s unlikely that large hospital corporations will ditch the investments theyâ€™ve made in the near future. Besides, large corporations have much more demanding needs that Google probably canâ€™t match initially. But, things may change. If enough patients start using Googleâ€™s services for Health, maybe there could be a radical shift in power from the health professionals to patients.
I donâ€™t know about you, but Iâ€™m very curious to see what Google releases.