In Part 1 of this series of articles, I described the landscape of online Personal Health Records (PHR) and how they might benefit both the patient and the health care provider. In this article, I’ll dive into the feature set of one of the most prominent PHR implementations: Google Health. In Part 3 of the series, I’ll walk you through one approach to integrating Google Health into the SOA of a healthcare provider, using the BPEL engine provided in IBM WebSphere Process Server.

Google Health Feature Set

Anyone who has a Google account can use Google Health. Just point your browser at Google Health and login, or create a Google account if you don’t have one already.  Once on the home page, you’ll see there are four main feature categories:

Add to Profile

This is how you can manage your own PHR, called a “profile” in Google Health terminology. You can manage multiple profiles. For each one, you will put in basics like name, age, sex, height, weight, and then you can add any or all of:  diagnosed conditions, medicines prescribed and taken, allergies you have, procedures you have had, test results, and immunizations.

To make it easier to enter medical terminology, Google Health provides an extensive database of terms you can select from, organized alphabetically.

All of this information becomes part of your permanent online PHR and you can decide which of your medical providers to share it with and which parts are shared.

Import Medical Records

Rather than key in all your own information, if you have a current online account with a health care provider, and the provider is participating with Google Health, you can simply import your medical records from that provider in one shot.

This is how it works:

1. Find your provider in the list and click the logo.
2. You’ll see a short marketing blurb and a button labeled “Link to Profile”.
3. Clicking the button takes you to a provider-authored page where you will be presented with a login dialog.
4. After logging in, you will be taken to one last page where you will be asked for your permission to “Yes, link my accounts”.
5. When you give your permission, the provider will prepare a Continuity of Care Record (CCR) on your behalf and transmit it to Google Health. This process is non-trivial, perhaps involving multiple back-end systems, and can be time-consuming so you will not be asked to wait. You’ll have to check back later or be notified.
6. After the initial import, you will be able to see in your profile all your medical information which the provider has available in electronic form.
7. Optionally, on a continuing basis, the provider will send daily or weekly updates to Google Health on your behalf. This is the “holy grail” of PHR from your point of view, because whenever you visit Google Health you will be seeing the latest information about any contacts you have made with your provider.

You can do this multiple times, perhaps including the pharmacy where you fill your prescriptions. If you still have a relationship with a past provider,  you can work towards a lifetime PHR.  You can choose which parts of your profile to share with which provider.

Participating with Google Health for a provider means they have registered their domain with Google, provided a logo and all the required HTML pages, and most importantly, have implemented delivery of a CCR through their own electronic records.  This last part is one of the reasons provider adoption has been slower than hoped. [4]

Explore Online Health Services

This is similar to importing medical records only in reverse – instead of giving your permission to receive data from the provider, you are giving your permission to give data to the provider so they can perform some health-related service for you.  Most providers in this list charge a fee for their service, so they participate because they want your business.  The services provided are quite varied; here is a partial list:

• risk assessment for a particular disease
• online consultation with a doctor
• drug interaction tools, find out about new drug research
• research particular diseases or conditions
• online search for your medical records and automatic import on your behalf

All of these services benefit from personalized information about you – which you have already stored in your profile – either by entering it yourself or by importing it. If you choose to, you can link some portion of your PHR with a service provider. You control who sees what from your profile.

Find a Doctor

This feature is not limited to participating providers. It uses Google search, integrated with Google maps, to find and locate any medical professional by name or by specialty.  Just type in “Johnson 15228″ for example, and it will find all providers named Johnson near that zip code. I also tried “orthopedic surgeon 15228″ and it came back with over 1600. (Can there really be that many near me? The radius of the search is not specified)

Each doctor, once found, can be reviewed, you can read other reviews, and you can find them on the map.

The search is surprisingly limited (this is Google after all), and since doctor search across the web badly needs improvement this could be a differentiator.  Hopefully this will get some attention from Google soon.

So when is this going to take off?

Google Health launched two years ago, yet if you tried it just now, you noticed how few medical providers are in the lists for “Import Medical Records” and “Explore Online Health Services”. Where is the big database with hundreds of names organized alphabetically? Clearly this is not a big success for Google – what is the hold up? I did some digging and found several different opinions:

• John Moore, of the Health Care Blog, wrote an article last month which attributes the lack of traction at Google Health to inadequate funding by Google and to lack of competition generally in the PHR space.
• Matthew Holt, also from the Health Care Blog, sees a chicken-and-egg scenario wherein there are not enough cool features to draw in the users, yet Google, which makes money from page views after all, needs a critical mass of users before they will invest the resources to make the service top-notch.
• An article in Health Data Management magazine suggests it is the complexity of the CCR aggregation – pulling in medical data from many different providers and sources – that is keeping the big medical systems away.
• PC World decries the low adoption rate (3%) of online users and asserts that doctors don’t trust the online PHR history anyway.

I choose (e) all of the above. While I agree that cool features will bring in users, the cool features in this space don’t work without medical information in the profile. Medical record import is the killer feature; without that the service is all but useless. Users are not going to sit for hours typing in their medical history, allergies, and immunizations.  And they can’t import their data unless their providers are in the list. So to save Google Health, Google must somehow incentivize providers to integrate. How Google does that remains to be seen.

Don’t bet against them.

References

1. http://health.google.com
2. http://code.google.com/apis/health/ccrg_reference.html
3. http://www.thehealthcareblog.com/the_health_care_blog/2010/05/googles-irrelevancy-leading-to-demise.html
4. http://www.slideshare.net/MatthewHolt/google-health-446725
5. http://www.healthdatamanagement.com/issues/18_6/googlehealth-same-story-different-platform-40375-1.html
6. http://news.yahoo.com/s/pcworld/20100520/tc_pcworld/webtoolsforhealthcaredataarrive

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