Monday, June 27, 2011
According to Google's official blog, here, "Google Health" will be "retired" in January. Google Health was the first major company's entry into the personal health records (PHR) space (Microsoft's Health Vault is a different animal). It was announced in 2008 around the time the Bush Administration must have realized that market failures were going to derail its EHR project. A PHR model must have seemed a perfect substitute. It lacked the first mover, “misaligned incentives,” and network effects market failure problems associated with the Administration's national EHR model. Because PHRs operated in an essentially unregulated zone little touched by the HIPAA Code, jumping on the PHR bandwagon was nicely consistent with the Administrations' position that over protective privacy regimes were responsible for slowing EHR implementation. And, the PHR narrative could be conveniently interwoven with the then popular push for Consumer Directed Health Care (CDHC). As I suggested, here, a few months later, "PHRs are dangerously flawed adjuncts to or substitutes for provider-centric records, and, while lacking many of the touted quality or cost-reduction benefits of the of- ten-criticized EHRs, they pose substantially higher levels of risk regarding security, privacy, and confidentiality."
I stand by those comments and do not mourn the passing of the most visible PHR system. But, I do regret failing to appreciate the importance of Google Health being built on the universal language of the web. A few months ago the President’s Council of Advisors on Science and Technology (PCAST), available here, recommended that the, now government-stimulated, national EMR project should refocus its efforts on records interoperability and achieve that by concentrating less on records databases and more on segmented data expressed in a universal exchange language (likely an XML variant). This markup language would provide the metadata that could provide patient identifying information, privacy protocols, and provenance relating to those data elements. That data could then be accessed by providers through specialized and secure search engines that would crawl the meta-data. PCAST was pretty flawed as far as any short term implementation and rightly set off a lot of privacy and security alarms. But, longterm its concept of how to achieve efficient data interoperability may prove to be correct. After all, the closest to any PHR that most of us will see near term is a patient portal tacked on to the end of a provider's EMR. It may be accessed through a browser but it will be built on APIs that limit us to interactions with some of the proprietary data locked up in the EMR.
Chilmark Research has an insightful post, here, listing a number of explanations for Google Health's death. Google itself explained the demise of its PHR project as follows, "[W]ith a few years of experience, we’ve observed that Google Health is not having the broad impact that we hoped it would. There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people."
But, I wonder whether putting that quote through Google Translate would produce something closer to "we do search across web data but the government decided to spend $27 billion of your money creating electronic records silos built on proprietary formats that neither we nor any of your other doctors can search." If that's anywhere close to the real reason why they are burying Google Health, surely it raises the question of whether we will be praising the current Administration's EMR project design after the stimulus money runs out. [NPT]