• May 2008 FEATURE ARTICLES •
Special Industry Watch
Google Health:
Birth of a Giant
By Michael McBride, Editor-in-Chief
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."