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The Impact of Google Health on Healthcare
Med Info 401 – Winter 2009
Team Members
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Chad Hodge
Nadine Lewis
Michael Lim
Jennifer Linton
Agenda
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Introduction (Michael)
PHR Background (Michael)
Google Health (Michael)
Google Health’s Impact On Technology (Chad)
Google Health’s Impact On User’s (Jennifer)
Google Health’s Impact On Clinicians (Nadine)
Conclusion (All)
Introduction
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Google is widely regarded as the world’s most successful
Internet company
Entered the Healthcare market in 2006 - Google Health
May 2008, Google Health (Beta Version) is released
Google brings its strengths in ease of use, simplicity,
information organization, information availability, and no cost
philosophy
Competitor PHRs: Microsoft and WebMD.
PHR Background
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A Personal Health Record (PHR) is any device that
allows users to store medical information and
history about themselves.
4 basic types of PHRs: paper based, computer
based, Internet based and portable storage based.
New Definition: an electronic application through
which individuals are able to access, manage and
share their health information, and that of others for
whom they are authorized, in a private, secure, and
confidential environment.
PHR vs EHR
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PHRs should not be confused with an Electronic
Health Record (EHR).
An EHR is an electronic version of the patient
medical record kept by doctors and hospitals.
– The data in the EHR are controlled by and intended for
use by medical providers.
PHR vs EHR Potential Savings
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It is estimated that personal health records could
save the U.S. health care system more than $19
billion annually after expenses with an initial start
up cost of $3.7 billion to provide interoperable
PHRs to 80% of the population.
Compared to EHRs, estimated cost to implement
EHR - $28 billion per year during a ten-year
deployment, $16 billion per year thereafter with a
potential fifteen year cumulative savings of $142$371 billion. [1]
[1]
http://www.eecs.harvard.edu/cs199r/readings/RAND_benefits.pdf page 12
PHR vs EHR - 15 year Potential Savings
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PHR – 15 year savings $315 billion
PHR – 15 year costs $33.7 billion
EHR – 15 year savings $142-$371 billion
EHR – 15 year costs $360 billion
PHR Information
– Name and birth date*
– A list of emergency contacts *
– Contact information for all healthcare
providers, such as your family’s dentist and
medical specialists*
– Health insurance information
– Living wills, advance directives or medical
power of attorney
– Organ donor status
– Dated list of significant illnesses,
hospitalizations and surgical procedures *
– A list of your current medications and
dosages *
– Dated list of immunizations for patient and
patient’s family members*
– Lab test results*
– Plan for managing diseases/conditions over
time*
– A record of key health statistics like weight,
blood pressure, cholesterol, glucose, etc. *
– Allergies or sensitivities to drugs or
materials such as latex *
– Important health and family events,
dates and medical conditions in the
patient’s family history
– Summaries of medical office visits *
– Specialists’ medical opinions
– Vision, eye and dental records
– Correspondence, such as letters and emails, between the patient and their
provider(s)
– Educational materials or sources,
relating to the patient’s health *
– Spiritual affiliation and considerations
affecting the patient’s care
– Lifestyle factors such as exercise, diet,
supplements/herbal medications* the
patient takes and any counseling patient
may receive
*Currently available in Google Health
PHR Benefits
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aids in educated discussions
about health with healthcare
providers
securely share individual health
information to someone who
needs it, like a new caregiver
manage the health information of
family members
effectively manage chronic
disease(s)
better coordinate care with your
various health care providers to
improve efficiency, quality and
safety of the care received
access health information while
traveling, during events like a
natural disaster or another
emergency situation
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retrieve health information
instantly and securely 24 hours a
day
measure progress towards
specific personal health goals
maintain healthcare provider’s
instructions, summaries of your
medical visits, allergy information
and status of insurance claims
track prescription medication
dosages, instructions, and actual
usage
track appointments, vaccinations
and other wellness healthcare
services
PHR Architecture
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Provider-tethered PHRs are tied to a healthcare organization’s internal
record system. Estimated annual savings of $13 billion.
Payer-tethered systems are tied to a given payer’s system. Estimated
annual savings of $14 billion.
Third-party PHRs can be used to aggregate data from different,
unconnected sources. This type can lead to great cost savings as user's
are relied on to enter information from all their care providers. Estimated
annual savings of $16 billion.
Interoperable PHRs represents the future, with ability to connect to and
download data from all regional data sources such as EHRs and other
PHRs via standards-based automated data exchange, leading to a
record that is more complete than any non-integrated repository.
Estimated annual savings of $21 billion.
Google Health currently falls between the third-party PHR and the
interoperable PHR.
Google Health
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Currently users of Google Health can:
– Build online health profiles
– Import medical records from hospitals and pharmacies
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Allscripts ePrescribe, Beth Israel Deaconess Medical Center,
Blue Cross Blue Shield of MA, Cleveland Clinic MyChart, CVS
Caremark, CVS Pharmacy, Drug Fair, Longs Drug Stores,
Medco, Meijer Pharmacy, MinuteClinic-CVS, Quest Diagnostics,
RxAmerica, Walgreens Pharmacy
– Learn about health issues and find helpful resources
– Search for doctors and hospitals
– Connect to online health services
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Blueprint for Wellness, Cleveland Clinic MyConsult,
DestinationRx, ePillBox.info, MedNotes by Drugs.com, Patient
Assistance, SafeMed, webLab, Trialx.org
Impact on IT - Data
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My experience
Roles
– Data Provider
– Data Consumer (Service)
– Either role needs to understand how/what data is stored
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CCR (Continuity of Care Record)
– Analogous to HL7 (Health Level 7)
– Only uses a small subset of overall standard
– Created by ASTM - American Society for Testing and
Materials and many provider groups.
Impact on IT - Data
<Alerts>
<Alert>
<DateTime>
<Type><Text>Start date</Text></Type>
<ExactDateTime>2000-04-04T07:00:00Z</ExactDateTime>
</DateTime>
<Status>
<Text>Inactive</Text>
</Status>
<Source>
<Actor>
<ActorID>Cecil Baker</ActorID>
</Actor>
<ActorRole>Treating clinician</ActorRole>
</Source>
<Description>
<Text>Egg</Text>
</Description>
<Reaction>
<Severity>
<Text>Severe</Text>
</Severity>
</Reaction>
</Alert>
</Alerts>
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Medications: RxNorm, NDC, FDB
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Conditions and symptoms: SNOMEDCT, ICD9, FDB
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Procedures: CPT, SNOMEDCT
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Allergies: SNOMEDCT
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Immunizations: CPT
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Lab test: LOINC, CPT, SNOMED*
*http://code.google.com/apis/health/ccrg_reference.html#ccrgreference
Impact on IT - Security
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Health data will not be returned in web searches
– User concerns over discrimination based on exposed
personal health data. Employers and insurers.
User has to seek out people to get or use their data. These
services are not pushed to them.
Only able to use services listed on Google Health service
directory, which screens and validates services before
listed.
Break a link with a service or data provider at any time.
Data secured with SSL, access tokens, and x-509
certificates.
Impact on IT - API
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Application Programming Interface (API)
– Tool used by programmers to extend functionality to an
existing program.
– Supports .NET, and Java
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Can read users health profile, submit notices or
CCR to profile, and can delete entries in profile.
In Beta state, and fluctuates weekly.
Forums to ask and answer questions, as well as to
grab latest binaries, and watch videos for help.
Impact on IT - Services
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Ability to send your medical profile to another
physician for a second opinion, or to a physician as
part of a new patient process are core to what a
PHR is made to do.
– Google itself only allows for you to print your records out.
– Must use a third-party service to do so electronically.
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Many wellness center sites that read your own
profile, and tailor their site to fit your conditions and
history.
No way to attach images or documents, so a little
lacking. No X-Rays, no PDF’s, or other types
User Scenario
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Elderly population is growing
– The need for caretakers continues to increase.
– The need for caretakers to have a central location to
record information (such as history, medication,
conditions, medical contacts, etc.) is highly needed.
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A daughter keeps track of her parent’s information
because she is their power of attorney
– She currently keeps the hard copy of information in four
3-ring binders. (paper based PHR)
– There is no disaster recovery for the records and longer
time to find the information needed for clinical visits.
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Harvey (90 yrs. old) and Doreen (87 yrs. old)
User Study Observations
Enter
Conditions or
Symptoms
Screen
Edit
Medication
Details
Screens
User Study Observations (continued)
Medication
List Screen
Profile
Details
Screen
User Study Observations (continued)
Edit Condition
Details
Screens
Medical
Contacts Screen
User Study Observations (continued)
Example of the
User’s Walletsized Card
Example of the User’s Full Summary
Print Out
User Study Findings/Recommendations
Capabilities that the user liked:
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drop down selection menus for medications to indicate
“How to take,” the dosage, and frequency
notes fields in the medication details and condition
details
alphabetized medications list for easy reference
formatted the notes in the conditions and medications
sections to easily see them under each diagnosis
liked the ability to click on the link for a map to each
medical contact’s office location
ability to create a new profile
User Study Findings/Recommendations
Features the user would like to have available:
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compare the cost of different medicines
edit the medication name after it has been entered
provide a way to enter new weights after each doctor’s visit and then be able to
somehow graph the weight gain and loss differences
the need to use the calendar function each time she had to enter the Start Date and
End Date was not helpful
structure the notes in the conditions section into multiple sections to record the
physician’s diagnosis and another to record the recommended treatment plan for
quicker look up rather than having to read through the notes each time to decipher
the treatment plan
there was a column to indicate the name for the “Treated by” healthcare provider, but
there was nowhere to actually enter this information into the condition details window
separate section in the medical contacts to add the web site for each contact
ability to create a new profile that links to an existing profile
create links and share profiles between different individuals
Conclusion
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Meets the 7 attributes of a PHR as defined by the Personal
Health Working Group (2003)
– Each person control his or her own PHR. Individuals decide which
parts of their PHR can be accessed, by whom and for how long.
– Contain information from one’s entire lifetime.
– Contain information from healthcare providers.*
– Accessible from any place at any time
– Private and secure
– Information is “transparent.” Individuals can see who entered each
piece of data, where it was transferred from and who has viewed it.
– Permit each exchange of information with other health information
systems and health professionals.*
* currently limited
Impact on IT - Conclusions
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There are many players in the PHR space, Google
Health being the one we examined.
– Large players such as Google will help it to catch on
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CCR is not as widespread as HL7.
Patients with better knowledge about their health.
Burden to providers or hospitals to be able to
accept or send this type of data.
– Must already be digitized (EMR)
– Alter processes
– Potentially different format.
Google Health’s Impact on Users
Benefits
 The user found the ability to record all of this information in one single
location very helpful (No 3-ring binders are necessary)
 Google Health provides the majority of features any PHR system should
(note: more improvement is needed however)
 Helps users be more educated and take ownership in keeping track of
their own health and records
Concerns
 Users feel overwhelmed with this newfound responsibility of keeping
track of their personal information
 Users hold legitimate concerns about the privacy and use of their
electronic personal data
Conclusion
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Other Impacts
– Potential to be the largest source of patient health information on
earth.
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Researchers would be able to study “live” data instead of data that was
several weeks to several months old.
For Example, Google recently released its flu tracking data which
showed they were accurately able to determine flu activity across the
country two weeks before the CDC. This could allow Public Health
teams to react quickly to outbreaks.
Savings Impact
– $21 billion in potential annual cost savings from use of interoperable
PHRs
– Can be implemented to 80% of the population for $3.7 billion.
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Therefore the potential impact of Google Health is
affordable, welcomed and needed in today’s healthcare
landscape.
The Impact of Google Health on Healthcare
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Questions?