Slowly but surely, using the Internet for your health needs is becoming as mainstream as shopping on the web: no longer futuristic, but is it for everyone? And perhaps more importantly, are mainstream commercial health platforms from companies like Google and Microsoft really useful for people with specific chronic illnesses? I thought it would be interesting to hear their side of the story.
Missy, shortly after Google Health launched last Spring, David Kibbe, former Director of Health IT for the AAFP, noted that most of its services were "only mildly useful and sort of 'toyish.'" How have these services evolved to be more useful to people with health conditions?
"Our strategy has always been to create a repository or a platform for users to store their medical records online. We couldn't pretend to try and guide people around management of their chronic illness. That's not our business. We're not medical or health professionals. We've created a platform and made the APIs publicly available for developers to come forward and develop services on. So third parties like MyCareTeam, which offers a diabetes management program, are able to integrate their stuff into our repository for health records. We're still in the very early stages, so these services are still growing and developing."
Kibbe also notes that your big competitive advantage is support of the Continuity of Care Record (CCR) standard, which makes people's health data readable by both humans and machines. Can you explain the impact of this on users?
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"There are lots of standards in the healthcare industry; it's alphabet soup.
We took a simple approach: who could help us launch with the best platform for electronic data? We talked to all kinds of doctors asking what is the minimal dataset that you need to pass on if you're sending a patient over to a specialist, for example? And what kind of messaging format is best for interoperability? They all said CCR, so it was sort of the lowest hanging fruit. Is it the champion gold standard? I would say not. Things will evolve. But for now, it's a great secure way to get data from one place to another."
So between Google Health and your competitor Microsoft HealthVault then, is it just a question of who can grab the best developers first, to offer the most compelling integrated applications?
"I wouldn't say it's a race just to see who's first. A lot of it has to do with quality. Working with high-quality third-party developers is something Google's really good at. We build platforms so that it's not just big names like the American Diabetes Association that can drive traffic through our site, but we also welcome smaller companies that can innovate and offer really tailored health services.
For example, we have a new service called MyDailyApple, that looks at the medications, conditions, etc. you have listed and then offers you links to valuable sites that mention the stuff that's relevant to you."
So you're working with the ADA?
"Not yet, but the ADA could be a good distribution arm for us. It has a good footprint with consumers. It might be a good fit, as we grow and get more users."
What about the MyCareTeam diabetes management application that Google already offers? Is it mainly a program to connect and download data off our glucose monitors?
"MyCareTeam is a full disease management program with logs for tracking glucose, meals and nutrition information and insulin and other meds. You can upload your data automatically using LifeScan OneTouch® meters, and I'm sure they'll be adding other models in the near future.
MyCareTeam also offers secure messaging to what they call your 'provider team,' so you can list your doctors and other health professionals and start corresponding with them if they provide their email addresses. They have to give consent, of course, and the messaging must be on a secure platform."
Wait, don't you offer the secure platform? Isn't the big concern about privacy and HIPAA Compliance?
"This goes back to the health records platform model. We're not in the business of offering secure messaging back and forth with doctors. What we're doing is giving people options to use great services that do offer that functionality.
For example, we integrate with web sites from the big retail pharmacy chains and provider sites like CVS, Walgreens and Quest Diagnostics labs. You can't order refills directly through Google Health, but you can import your prescription history, and you can send data back to the pharmacies via their sites.
The way it works is: you set up a Google Health account, and you choose from a list of partners. When you click on those linked accounts, a window pops up and takes you over to the Walgreens website, for example, where you have to be registered and login with a password or PIN before you can order medications.
So you leave the Google Health site when you actually make a medical transaction. This is because the pharmacy or lab is a HIPAA-covered entity and has to authenticate the ID of the user before they can administer medications to anyone. Then, when you link back and want to record your list of meds on Google Health, a window will pop up asking, 'are you sure you want to share this data?' So it's guarding security. But we're not covered by HIPAA because we don't pay for or provide health care services, nor do we store patient data for providers."
OK, so what privacy restrictions do you absolutely guarantee?
"We don't ever sell or share user data with any third party. Once your data comes into Google Health, it stays with us. Also, there are no ads in Google Health. And it's free for any partner to integrate and add on services. In fact, there is no direct monetization model for Google Health.
Our model is simply that when people sign up, it tends to encourage users to do more searches on Google.com. That's where we make our money. Every page of Google Health has search box on the side. If you click on it, it takes you out to Google.com. None of your health data goes with."
What about the provider side? How can you guarantee that doctors will be willing or able to access patients' information online — considering they're not reimbursed by insurance for this, and also that so many clinics have strict IT policies?
"Good question. Today, physicians are still very paper-driven. Or they're stuck with a proprietary or internal network system. One thing we're seeing, however, is an adoption curve. As more patients get online and start inviting physicians to review their information, more doctors are showing interest. It's just like the wave of patients doing their own research and bringing internet print-outs to doctor's visits. We believe market pressure will push more and more medical providers to go online.
We are working on enabling user-to-user sharing, so that you could send an invite to your doctor, or your mother, or other family member, and invite them to view your online health data, in read-only format if you like.
If the doctors wanted to work proactively with this information, they would have to import it to their hospital or clinic's system, which is HIPAA compliant.
Regarding reimbursement, there's a big wave of eConsultations at the moment. People are pushing for reimbursement of these 'virtual doctor's visits,' and I think this is something to consider given how busy they are. Some doctors say it saves them time because it saves an in-person visit. These are systemic issues to the US healthcare landscape that we're tracking."
Finally, it seems that people with chronic conditions like diabetes could benefit most from these online health tools, yet we tend to be the most skeptical. So can you remind us: why would we choose to store and share our information on an open commercial platform like Google Health?
"Let me give you a personal example. My mom's got MS (multiple sclerosis). She's had it since I was 9 and I'm 38 now. For years, I've been trying to manage it remotely, because she lives in another state. She's on 28 different drugs and dietary supplements — all pills except one injectable. I also manage all of her medical finances. I have to manage it by paper. So I have this huge manila folder with all kinds of statements piling up. My brother lives in yet another state and has no idea what's going on, because he hasn't seen any of the records. Now on Google Health, I can record all of my mom's medications and herbs, test results and so forth. I can even log in new doctor's appointments, and she just prints it out and goes in to the clinic. Soon we'll have user-to-user sharing, so I can send my brother an email to invite him into the system to see what's happening with our mom.
Essentially, Google is really new in this space. We don't have all the answers. We're learning. We're trying to be agnostic and neutral, to create an open health platform for people. The larger healthcare system issues go beyond our scope, but we're definitely part of dialogue."
Editor's Note: Missy tells me that the Google Health team is very open to input from the diabetes community. Have you tried the application? Got some constructive feedback? Feel free to post it below, direct to Google's ears.