It's been nearly a week since the big announcement and I've read a herd of thoughtful reviews of why google decided to shutter their health experiment.
But I've not yet seen anyone say what was obvious from the outset: It was a dumb idea.
Google Health is a classic case of a solution looking for a problem.
When we apply technology thoughtfully – we need to be solving a problem! No problem = no adoption. No adoption = no revenue.
Case in point: Tim's got a survey up on histalk at the moment. Who reads HISTalk? Health IT disciples. How many of us have PHRs? 13%.
If WE don't use them .. nobody will.
Some think that "portals" will be the answer – and will succeed where PHRs have failed.
I wouldn't bet on it. A portal may work in a setting like Group Health / Kaiser or Geisinger – but it's not likely to work in the real world. Patients see too many physicians – go to too many care facilities and have changing relationships with all of the above. EHR-tethered portals simply can't scale in a way that they would need to in order for patients to embrace one or another. As a way to communicate with a practice or a hospital – fine – I'll use a portal instead of a phone. But as a trusted place for my medical information to "live?" No way.
So – if Google Health was a solution looking for a problem – what problems might we solve so that the next iteration of health 2.0 entrants aren't so confused.
- The ubiquitous clipboard. Many companies are focused on this end of the problem. Digitally capture "new patient information" in the office or at home. Portals, ipads, text messaging, telephony/IVR ..
- Data availability. Raise your hand if you have been to a physician who didn't have your records. It feels rotten on both ends. When I visited Ecuador – I was impressed that the physicians didn't really have many records. Who had the records? THE PATIENTS! Got labs done? They're sent to YOU. The patient brings a folder into the office. Likewise – I visited Germany a few years ago. The patient carries a smartcard that unlocks a data repository in the cloud. Hand the smartcard to your doctor's office .. and they get your data. No Smartcard? No data.
- Communication. No secret that I'm working on this with my team @ Twistle. No – we're not open for business yet. But we're funded and working. Stealth mode. Stay tuned. The problem we're solving is a self-evident one: e-communication is more efficient than in-person and telephone interactions between care providers and between patients and care providers. 7% of physicians e-mail their patients. Will this number increase – especially as reimbursement models change? Of course it will. But the current tools (Intuit, RelayHealth, etc) are klunky and use proprietary APIs. The world needs a standards-based secure e-communication tool that is easy and fun.
- Information. Perhaps we call this "clinical decision support" .. or perhaps we don't. Patients and providers need to be participants in revolutions of process. It's not rocket science. Indeed – that's the whole point. Many of the steps we can take to improve care (and as a byproduct – save money) are NOT intellectually challenging. Rather – they challenge us to be deliberate, disciplined and evidence-based in how we manage care. Take this fantastic paper (sorry – not free) in June's Health Affairs. Intermountain Health focused FIRST on process changes that would enhance quality. A byproduct was (significant) savings. Example: inductions of labor are common. Decades of research has demonstrated that the evidence-based criteria for labor induction are not universally applied – and that induction is associated with many bad things: longer hospital stays, more c-sections, more infection, more sick moms, more sick babies. So if a process is instituted that requires providers to follow a specific protocol (or make a call to get special permission) the rate of inappropriate induction can be reduced from roughly one in four deliveries to one in fifty! The authors say:
"We estimate that the Intermountain elective induction protocol reduces health care costs in Utah by about $50 million per year. If applied nationally, it would lower health care delivery costs by about $3.5 billion annually."
Wow. Read the paper. It's a great summary of how Health IT enables this sort of endeavor. They couldn't have done this without clinical systems, analytics, and CPOE.
So let's focus on some real problems … and stop worrying about why Google killed a little beta project before it came to market.