Google Health

A little road test and commentary on what’s there, what’s good, what’s not so good, and what the potential might be Matthew Holt The Health Care Blog & Health 2.0

Why this little tour? I’ve been eagerly anticipating Google Health, saying that when serious players with lots of consumer eyeballs got into the data consolidation and transfer business, it might break the calcified hairball of health information. But meanwhile a couple of people I respect in health care have called it DOA. And there’s been both lots of cheerleading, and criticism so far. I come less inclined to damn Google than to praise them, although there’s lots of criticism in this presentation. But I’m very mindful of the positive potential. For now, I wanted to see what a standard, relatively typical, not too bright, user’s perspective might be, so I picked a relatively typical, not too bright, user (me) and took Google Health for a road test. Note: Because this tour is so graphics heavy I’m using Powerpoint and Slideshare to take you through it rather than posting the world’s longest blog piece. You can download this article as a PDF from SlideShare. - Matthew Holt

Getting started So the first thing I did after logging on was to attach Google Health to another of my Google accounts, which I like for simplicity. In contrast, I thought HealthVault’s demand for a “strong” password was probably a barrier for many of its potential users. Google does have some log-on issues, and if you share a username with others, you will have to make sure that you use a completely private username and password combination for Google Health – but you can’t log in automatically to Google Health from another Google app (unlike say going to Calendar from Gmail). After the legal mumbo-jumbo, you see this:

Let’s get some data You can add to the record manually, which puts conditions, medications, etc in the top right of the screen. Or (and this is much more interesting) you can go grab records from elsewhere. The list of partners sharing data is regrettably short, and also the number of health care players (like hospitals and physicians) that could offer this type of data even if they wanted to is not that great. (Perhaps the solution is to move to Denmark!). But there is lots of Rx data out there I went to Walgreens to grab mine. The next screen shows my Walgreens Rx screen. Yes I have gout (hence the Allopurinol) and I recently got some Cipro as I went to Africa in March and April. (more about that anon).

Actually linking the accounts? Now you have to go, via the list of partners, to Walgreens. It’s not too painful, once you’re through another couple of authorization screens (this one from Walgreens, not Google) and then back at Google Health it tells you the accounts are linked. It did take about 3-4 minutes for my Walgreens Rx data to show up—which panicked me for a while. (Hence the difference between the 2nd and 3rd slide in the next 3 screenshots). You can see that eventually the drug names show up automatically in the top right box.

Using a tool Now there’s some data in the record, we’re starting to see the potential behind a central data store like this. On the left, and built into the system, is a drug interaction checker from SafeMed. Click on that and it tells me that if there had been any drug interactions, it would show up there. But there are none. Incidentally, Google has a problem in dealing with discontinued meds. Walgreens’ system doesn’t care whether I’ve taken Cipro or not. It just knows I have no more refills. In fact I took a few in Africa, but haven’t taken them for more than 4 weeks. Should it be in my current drug list? I don’t know, but there’s no “recently stopped taking” category. Which might be useful for adverse reaction checking

Checking the tool So because my drugs don’t interact, to see if the interaction checker works I’ve got to cheat, and I enter a couple of drugs which I’m not actually on into the system. I enter chlorothiazide & naprosyn manually (One of which I know does have an interaction with Allopurinol). I know that because another drug interaction checker DoublecheckMD shows that there’s a moderate risk between chlorothiazide & allopurionol. (FD, I’m an advisor to Enhanced Medical Decisions, the company that makes DoubleCheckMD). Here’s the DoubleCheckMD screen (not currently a Google partner)

Checking the tool (2) Now we have what appears to be a problem. Safemed is using a similar underlying data set to DoubleCheckMD (FDB vs Multum), so hitting the “Drug Interaction” button should generate some similar information. Instead it generates a nonsensical or at least not intuitive message. Check out the next screen and figure out what you think it means.

Checking the tool (3) The message tells me to not stop what I’m doing. It then has a (far too small) red exclamation point telling me something needs attention. But it does tell me what! After that it tells me to check with my doctor soon, but doesn't tell me what to tell my doctor. Then it says “the following entries are not taken into consideration”. There’s a blank space after that. I assume this means that all entries were taken into consideration, but it’s just confusing. I’m sure that this is based on good information. But the presentation and the UI is dreadful. Plus it’s in tiny font. Most people with gout are old men (like me) who tend to also have bad eyesight. I don’t know where the problem between Google and SafeMed lies here, but it needs some (and I assume not that much) work to be more useful.

Let’s move some data Aside from the relatively few (and hopefully soon to be many more) places from which you can get data into Google Health, there are also a whole lot of other partners which will accept data from Google Health. One of these is iHealthRecord (Medem’s PHR). I have a record there too (all self-input) because it claimed my doctors office, way back when, used it. (They didn’t, or at least wouldn’t use it to email me!) Sadly apparently you can’t move data from iHealthRecord into Google. So the condition (Gout) that I have in iHealthRecord didn’t make it into Google. Worse, despite a similar partnering process to Walgreens,after I hit the update button I got this --

Trying to make the data useful So after several attempts I was unable to get anything from Google into iHealthRecord. Again this was probably user-error, but there wasn’t a great deal of explanation about what I should have expected. And more importantly, I couldn’t move data from into iHealthRecord into Google Health, so that the data I had in iHealthRecord had to be re-entered. But there are also services on Google Health which are designed to take advantage of your profile to offer you useful services. This is the most exciting part of Google Health. One I imported my data into was The Daily Apple, from Praxeon. This is a personalized search engine based on Natural Language Recognition technology.

Personalizing the experience So the drug information is moved over to The Daily Apple. The idea behind the personalization is to make the news experience more relevant to the user. However, The Daily Apple provides personal news, but it doesn’t seem to be based on the drugs in my profile. My assumption was that the news would be related to the drugs, but probably there wasn’t much gout related news! But to me this is an area where there’s great potential to provide personalized news

Personalizing the experience (2) I also imported my medications into ePillbox from Solventus. The idea is that you can create a scheduler on the site to remind you about when to take the pills. Unfortunately, this function barely seems to work. After trying to enter when I want to take the drugs on the form, all you get is a plain html form, without any obvious use. You can also apparently create an text reminder to send your self on you cell phone Again they’re may be something useful here, but it’s not apparent, and there’s no real explanation to the user of how to make it so.

Personalizing the experience (3) So the only really obvious way to personalize the outcome is to go the search “reference” page created by Google linked to the condition. This provides almost a “home page” for gout, (which somewhat reminded me of Kosmix’s RightHealth), which has results from Scholar, Groups, and series of Searches, as well as information & images from ADAM. It’s certainly different to a typical Google search. And it’s not until you get to a typical search that you see an advert. So it doesn’t seem that the fears voiced all over the Internet about Google targeting ads based purely on your medical records are justified.

Searching & Rating Providers Finally, the other thing that Google Health obviously has great potential is improving the nightmare that is physician and provider search. So far this feature has been roundly criticized. And I’m going to pile in a little here too—but there’s lots of potential. You can search by specialty & zip code. But the really interesting bit is what you find you select a provider. Google links to reviews & ratings sites. Currently they’ve linked to one set of reviews (including reviews from Vimo & JudysBook) and ratings/reviews from HealthGrades. But there are two noticeable problems. First, there are lots of review sites that Google doesn’t link to. I’m not sure why. The second is the one common to all physician search which is that the medical group and the physician are poorly matched. That’ll make sense when you look at the next three slides.

Searching & Rating Providers (2) So for Pacific Family Practice, Google takes results from Vimo & Healthgrades, but it needs to do more. There is only one rating in Vimo for the practice, but for example there are 6 in Yelp. There are also 22 reviews in Yelp for one individual physician (Stephanie Scott) in the practice. And more in Vitals. (see next 3 slides) This reveals a big problem Google (and others) need to crack, which is correctly linking physicians with their practices. Google appears to be currently searching businesses, but it needs to (eventually) search physicians and link them to practices/businesses, and then get all the reviews from different sites together—because at the moment the review business is a mess. Google can certainly help here, but there’s a long way to go.

To sum up (1) There’ll be much more written about Google Health in the months to come. Importantly we’ll find out about uptake of the service. If Google can’t get consumers to use a PHR platform given the incredible number of people they touch everyday, then the notion of an independent non-tethered consumer health records platform is probably dead. And then instead we’ll have a long wait until EMRs become ubiquitous, and consumer portals get built on top of them. So there’s a lot riding on this being at least partially successful Google clearly has to develop a better and bigger ecosystem of data sharing with providers and plans. That will be tough, but if consumers start demanding data portability, it’s a real possibility—especially as Google is using the CCR standard.

To sum up (2) To get there I think Google needs to enhance the directory of doctors, and then start offering them transactions – calendar appointments is the obvious one, so that patients can start interacting online with their physicians within two clicks of a physician search. Google of course already has a calendar and an email application, so this can’t be too hard technically (although the enhanced provider directory will be a bear) If they can get the patients to “push” onto the providers, then next the providers will be more willing to let patients “pull” their data. The other thing Google needs to work on is getting the services that their partners offer to be more relevant, personalized and user-friendly. They obviously can’t do that alone, but they can set expectations and standards, and also open up their partnerships much more widely—so that there’s real competition in offering services.

A Final word Google Health has made a decent start, although there are lots of holes, and it would have been nice for this to have come sooner. I do though have faith in their ability to improve and fix their products in relatively rapid order. (Hey, they even fixed Blogger eventually!) The key is to add functionality and increase ease of use so that consumers find it a really valuable tool. And the keys to that (as apparent from the tethered PHR world) are the provision of relevant content, lab results, great tools, and connections to physicians. The components are there, in a way that no one outside of the world of Kaiser, Group Health, etc has done. For the 85% of us who don’t live in that world, let’s hope that Google, Microsoft and the rest can get this done. Google’s effort, thought limited, is for me the most ambitious and hopeful to date.

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Google Health

by Matthew Holt on Jun 04, 2008

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Google Health — Presentation Transcript