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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

  • 1. 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
  • 2. 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
  • 3.
  • 4. 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:
  • 5.
  • 6. 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).
  • 7.
  • 8. 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.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13. 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
  • 14.
  • 15. 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)
  • 16.
  • 17. 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.
  • 18.
  • 19. 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.
  • 20. 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 --
  • 21.
  • 22. 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.
  • 23.
  • 24.
  • 25. 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
  • 26.
  • 27. 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.
  • 28.
  • 29.
  • 30. 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.
  • 31.
  • 32.
  • 33.
  • 34. 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.
  • 35.
  • 36.
  • 37.
  • 38. 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.
  • 39.
  • 40.
  • 41.
  • 42. 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.
  • 43. 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.
  • 44. 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.