On one level, this program is definitely a step forward. Most children and adults in the US move several times in their lives. Medical records get transferred from doctor to doctor – or not. The transition sometimes leaves potentially dangerous gaps in the record. Every time a doctor sees a new patient, the patient must fill out a form that usually runs to about four pages, covering the medical history of that patient and his or her immediate family (parents and siblings). Less-than-perfect memories could put patients at risk – and even if one’s memory is perfect, filling out that form every time gets to be a real hassle.
Now imagine how an online health profile could help simplify this process. It would contain all of a patient’s information in one place: prescriptions, allergies, operations, illnesses, relevant family data (such as a father’s heart condition or a mother’s breast cancer), and so forth. With modern technology, an online health record could even store X-ray and MRI images. Mammograms could be compared over time. And best of all, the record would be uninterrupted. Are you moving or otherwise transferring to a different doctor? No problem; all you have to do is give the new doctor’s office access to your online health profile.
Having one central point for a patient’s health records could also reduce costs and save time. In covering this story, the Wall Street Journal reported the experience of Larry Stofko, the chief information officer for St. Joseph Health System in California. “His wife has seen a dozen different doctors at several hospitals. He’s been with her when doctors at one hospital wanted to run tests that doctors at another hospital have already performed – tests that wouldn’t be necessary if they had easy access to her medical records,” Journal reporter Ben Worthen noted.
Patients with access to their own health records might even get inspired to become more proactive about their own health. Granted, certain test results present difficulties when laymen try to read them. But practically everyone knows what normal blood pressure is supposed to be; seeing an upward trend can be a little sobering. Speaking of upward trends, living with an expanding waistline is a little different from seeing the rise in black and white pixels. “I’ve gained that much weight since college?!”
Any plan with that much upside potential comes with some significant issues. This one is no exception. There are several elephants in the room that Google would rather not talk much about – and one of them is a hippo.
Well, more precisely, it’s HIPAA. That abbreviation stands for the Health Insurance Portability and Accountability Act. This twelve-year-old legislation establishes strict rules that pertain to communication between a doctor and a patient; pharmacists and pharmacy technicians must follow these rules as well when filling prescriptions. The act gives the doctor-patient relationship a certain privileged status. For example, when a doctor is subpoenaed for a patient’s medical record, the doctor must inform the patient.
What happens to those records when a patient agrees to store them with an external health service, such as the one started by Google? It would appear that Google is not covered by HIPAA. That might make it easier for anyone – a government agency, a lawyer with a suit against the patient, perhaps even an employer – to get their hands on the records. What would Google do if it receives a subpoena – or even a simple request from a legal authority – for a client’s medical records?
There are other potential issues with Google storing medical records online. The most obvious, of course, revolve around security, privacy, and hacking. What could a malicious person with access to other people’s medical records do? Dealing in prescription drugs comes to mind; so does identity theft and blackmail. It’s not a pretty picture.
Then there’s the issue of what Google itself might do with the records. Google is a search engine, but it’s also an advertising agency; indeed, ads provide its bread-and-butter revenue. While the company has promised that it will not sell ads to support its new health records service, it’s difficult to believe this; after all, Google has a long history of starting a service without ads, and then putting ads on it later (Gmail is the first example to come to mind, but there are others). Google insists that it will profit by building traffic to its site, which is the same model it uses for Google News.
The only real surprise is that the negatives to storing health records online haven’t come up sooner. Microsoft has its own competing service, called HeathVault, and AOL boasts Revolution Health. Microsoft’s service has been around since late last year, and AOL’s service has been around even longer. Why wait until now for the storm of controversy?
Right now Google’s program, dubbed Google Health, is in the closest thing to a private beta stage. That hasn’t stopped anyone outside the beta from being curious. What does it look like to have everything at your fingertips? As Marissa Mayer, VP of Search & User Products at Google explains in the Google blog, “We aren’t doctors or healthcare experts, but one thing Google can create is a clean, easy-to-use user experience that makes managing your health information straightforward and easy.” You can see a full-size image of the welcome screen, or if you’d rather not click away, here’s a screen shot:
This screen lists some of the things you can do with the service. They include:
- Building online health profiles
- Downloading medical records from doctors and pharmacies
- Learning about health issues and finding helpful resources
- Searching for doctors and hospitals
- Connecting to online tools and services
The blog also featured another screen shot from deeper within the application. Again, you can view the full-sized version of the Google Health interface, or you can check out a screen shot here:
I’m sorry I had to crop and reduce the image to fit, because it doesn’t do justice to the clarity of the interface. In the left column users will find links to take them to drug interactions (with the red circle around a white exclamation point), conditions, medications, allergies, procedures, test results, immunizations, and more. There are also links to screens that let you add to the profile, import medical records, and use online health tools. You can even find a doctor.
In the large middle area users will find several prominent links that let them take several important actions related to their profile; these duplicate some of the smaller links on the left. Redundancy is a good thing in interfaces. You can also request an appointment through one of the links in the center. Finally, the column on the right shows a short profile summary, listing all of a specific patient’s conditions, medications, allergies, and procedures. At its full size, it is extremely clean, easy to read and easy to understand.
Aside from the concerns I already listed in the second section of this article, Google will need to overcome substantial technical hurdles – and significant inertia on the part of some medical professionals. According to the Wall Street Journal, only 14 percent of medical practices store information electronically. That’s abysmal, considering that the ability to create and share medical records electronically has been around for decades. In Germany, all medical records are digital; Denmark is nearly as good, with 90 percent, and our neighbor to the north has digitized half of its citizens’ medical records. What’s the holdup here?
In part, knowledge is power. “Hospitals and health-insurance companies worry that these computerized records will eat into their businesses. If a patient has easy access to his medical records, it makes it easier to see a different doctor,” Worthen notes.
And in part, it really is inertia. The Baltimore Sun quoted David Merritt, director of the Center for Health Transformation as saying that “Health care is at least a generation behind the rest of society in terms of technology…Doctors and hospitals don’t use the technology we take for granted everywhere else.” Causes cited by the Sun include an inertia-filled system, a dearth of good software, a lack of incentives to adopt the new technology and no government leadership on the issue. That may be starting to change, however.
Interestingly, a number of congressmen have put their weight behind proposals to create technical standards for storing and transmitting information. The Republican candidate for president, and both currently-leading Democratic contenders, all back legislation to support broader use of health information technology. Senator Edward Kennedy (D-Mass.) and Representative Edward Markey (D-Mass.) also support such technology.
In particular, a bill sponsored by Kennedy and Markey bill would force Google, Microsoft, and other companies storing personal health profiles for patients to comply with HIPAA. This is actually a good thing. Patients usually have to agree to share their information in order to use the applications – but once they do that, they have no recourse. If the companies must comply with HIPAA, they face sanctions if they misuse the information.
If Google Health convinces our healthcare system to finally get its act together and digitize its records, it will be a welcome change. A number of studies, including this very long one from the Maryland Health Care Commission, have shown that electronic health records reduce medical errors, save lives and could save hundreds of billions of dollars if all doctors and hospitals used them. Say what you like about Google, but if we can find a safe way to negotiate the various issues of concern (security, privacy, HIPAA compliance, etc), five years from now we could be living in a safer and healthier future thanks to Google Health.