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By McBride, Michael
On Feb. 28th, at the 2008 annual HIMSS conference, Google announced its first product for healthcare - Google Health - a new personal health record (PHR) that will be free to use and available just about anywhere in the United States. To say that the news was received positively does not adequately describe the response. Hours before Google's press conference, several EMR/Practice Management software vendors had already announced agreements to interface their technology with Google Health, which created a stir that became fervor and, ultimately, the talk of the show. Since then, more companies have announced agreements with Google, even though the results of the pilot haven't even been announced. No other PHR release garnered this much attention from both sides of the industry.
Why does Google Health have the industry all a-twitter? Because, it's the Internet, and if ever there was an invention that appealed to the majority of people, this is it. Studies repeatedly show that the portion of the population using the Internet to research medical conditions and medications is growing rapidly and shows no indication of slowing down.
Anyone who believes Google created Google Health simply to make money on ads needs to be aware of what else Google has been doing globally in healthcare. Through a subsidiary company called Google.org, they have been donating funds to healthcare organizations around the world that combat diseases such as blindness and polio.
"It's one thing to run a company - it's another thing to save someone's life," said Eric Schmidt, Google's CEO, during his keynote address at HIMSS.
"We like the idea of predict and prevent," he said. "If our computer systems can be programmed to detect early outbreaks, we can prepare response systems for emerging threats, especially in the third world, where a little bit of uncorrelated data can give us enough information [to warn] of a sudden outbreak of a strange disease before it crosses over into a much larger population."
"We can also use Google to make sure people [in the third world] know that [medical] services are available to them - especially the free services," he said.
First Steps
Once users sign in with a secure login and password, Google Health displays listings of Healthcare organizations and product/ service vendors that have integrated with Google Health. The first release is slated to enable users to download or "pull" their medical records from multiple sources directly into their Google Health accounts, including medications, conditions, allergies, test results and immunizations, or, they can input the data themselves. Users can then send or "push" their data directly to caregivers and hospitals. Eventually, users will be able to push the data contained in their accounts to doctors and relatives in a "read only" manner, as well as other features Google has in mind.
"We're just at the beginning here with this product," says Missy Krasner, product marketing manager for Google Health. "When we launch we'll already have some connected partners, like Walgreens and large PBMs (pharmacy benefits managers), and possibly even some health plans; however, it's going to take some time for us to build Google Health to its full potential. Down the road, we might take it international, since we're a global company, and as we mature this product, we hope more and more partners will come onboard and integrate. Google is committed to a multi-year effort with Google Health."
By creating a broad user base, Google hopes to forge what they call a new "eco-system" where innovative healthcare organizations, such as emergency records access companies, can integrate with Google Health and develop their own business models.
Because each integration is unique, initially IT personnel at each partner company will have to write the programming that will reach out and touch Google Health using the supplied application programming interface (API) documentation. The complexity of that process is expected to decrease over time, since as more and more companies integrate, more commonalities will be discovered. Eventually, some of those companies may choose to license or sell their connections as middleware to other companies that will simply install it and have instant access. This is fine with Google, which will receive no part of those sales.
"We're not a healthcare company, nor do we aspire to be one," says Krasner. "But, there are lots of companies out there that are vertical domain experts, such as a diabetes company that specializes in disease management or makers of glucometers that can upload their readings directly into diabetics' PHRs. All of these company's will be able to integrate their platforms, applications and services with Google Health."
Usability
An important factor in Google Health's success will be its usability and whether it can fulfill its intended role in healthcare. By the time you read this, Google Health will be nearing the end of the pilot phase, and indications are it will have a high degree of functionality straight out of the gate. That's partly because the award-winning Cleveland Clinic, where Google Health is being piloted, has had a working EMR in place for years and already provides electronic clinical and informational tools for thousands of physicians and patients within and outside of their networks.
However, Google Health is not designed to integrate only with hospital organizations that have existing EMRs. It can also integrate with a clinic's practice management system, as well as to any healthcare-related companies with products and services that produce medical record data. Thus, users can pull their medication prescription records from large retail pharmacies, as well as structured medical data from EMRs, store it in their Google Health profiles and, when needed, push the data to new pharmacies or hospitals.
"There are multiple examples of how we'd be working with different providers," says Krasner. "Cleveland Clinic served as the most sophisticated integration to date."
"We're very new at this and learning about the healthcare system as we go," says Roni Zeiger, M.D., a Google Health product manager. "We've built a platform that systems can integrate with, but we'll still have to work with partners, especially the earlier ones, to make sure that not only do we have the technical connections working, but that we're speaking the same language. We're using the Continuity of Care standard and plan to support other standards, in the future."
Bringing a new system to pilot is never a trivial task. Besides designing the API that healthcare organizations and third-party vendors will use to interconnect with Google Health and exchange information, Google also had to study healthcare to ensure that the standards by which medications and procedures get described are precisely followed. Even minor deviations can produce catastrophic results. Therefore, Google Health will support industry standard medical terminology coding systems, including NDC, ICD9 and SNOMED.
Break the Glass
It's a natural first impression that Google Health could be used to save the lives of unconscious patients who cannot grant access to their health data. The "Break the Glass" scenario involves an emergency situation where a patient's life is at stake, but the patient cannot provide ED personnel with historical medical details. In this case, it would seem to make sense for there to be a method whereby an attending physician could gain temporary access to the patient's Google Health record. Google considered this, but decided that the privacy risks outweigh the benefits of a true break-the- glass interface. However, at launch, Google Health will be able to integrate with third-party medical records access companies, providing a similar safety net but without the security risks.
"Users could push their medical data to these companies," says Zeiger, "Then, a user can wear a medical emergency type bracelet that would alert ED staff and direct them to contact the medical records access company, which would verify the patient's identity before providing the data. This is the kind of manual high-touch work that Google could never do, but the platform that we're providing is one that, we hope, will be used to connect users with such services."
Google Health is a revolution in the making that stands to become reality for healthcare. It may trigger a new era where patients and doctors truly collaborate to maintain optimum health. Many companies are already onboard, with more waiting in the wings for their turn to integrate with Google Health. One would think this would be enough; however, it's the yet-to-be-invented applications that intrigue Zeiger the most.
"Having this kind of access to medical records is going be important," he says. "But, perhaps, even more important, are the innovative tools that no one has even thought of yet. To me, that's the most exciting thing about all of this."
"We're very new at this and learning about the Healthcare system as we go. We've built a platform that systems can integrate with, but we'll still have to work with partners, especially the earlier ones, to make sure that not only do we have the technical connections working, but that we're speaking the same language." Roni Zeiger, M. D.
Product Manager
"We're not a healthcare company, nor do we aspire to be one. But, there are lots of companies out there that are vertical domain experts. All of these company's will be able to integrate their platforms, applications and services with Google Health."
Source: Health Management Technology