Saturday, May 24, 2008

Google Health

This week, Google rolled out its new electronic medical record (EMR) function, Google Health. I am not particularly impressed. Don't get me wrong, I love Google, in fact I can't imagine my personal or professional life without it (I consult with my colleague Dr. Google, MD, frequently). And, it's not that I distrust health information technology, on the contrary, I am a convert to the new frontier of the EMR. Kaiser Permanente's EPIC system makes my clinical care better and more efficient on a daily basis. The available research supports my personal experience: EMRs are estimated to improve efficiency by 6% a year and (from a recent Kaiser study)* significantly improve coordination of care between multiple providers. Fewer redundant laboratory and xray tests are ordered, medication errors are reduced and waste is lessened by reams and reams. The end result is not only better patient care, but also a significant cost savings - an estimated $5-$10 million per year at one prominent academic center (Brigham and Women’s Hospital in Boston).

The problem with Google Health, as I see it, is that at least in its infancy it relies on patient driven (rather than provider-driven) coordination of medical records. One of the four bulleted selling-points on the Google Health welcome page urges patients to "Keep your doctors up-to-date about your health." As I am sure most providers would agree, this is a fabulous idea. Working in the ED, I am tremendously appreciative of patients who bring and show me an updated list of medications they are taking. Nonetheless, I find that even the most fastidious of patients hand me lists that contain duplications, miss-spellings or omissions. This is understandable; just as I excuse myself for not recalling which index funds I hold in my retirement account, I don't expect patients without medical backgrounds to keep completely accurate records of a laundry list of medications. So, the idea that patients be the caretakers of their own medical information, while laudable, will turn out to be unreliable. With Google Health, patients enter only the medical information they want to, and although Google promises to safeguard personal health information, there are sure to be privacy concerns. A better model, I think, (and I am clearly biased here) is an integrated health system with a universal IT system. In this (provider-driven) system, patients can review all of their medical information and are encouraged to alert their doctors to changes or inaccuracies. Ideally, this sort of system would offer incentives to patients who are actively involved with their medical record and help to keep them up-to-date. This sort of EMR hold tremendous potential for providers and patients. Google Health, on the other hand, will appeal to a small segment of tech-savvy and health-conscious patients and probably make money doing so. This result offers little in the way of improving our national health, and if anything may add to the divide between the have and have-not's. It's probably too early to pass judgement, but I don't anticipate becoming part of the Google Health community.

*Graetz et al. Care coordination across clinicians and health information technology: connecting the medical home with the rest of the village.

Answers from the previous post's trivia, with accompanying links found through my good friend Google:

A) A girl born with two faces (TRUE

B) A parasite twin (a fetus growing inside of another fetus) (TRUE)

C) A girl born with a cyclops eye (TRUE)

D) A boy with a true human tail (TRUE)

E) A true hermaphrodite with both ovarian and testicular tissue (TRUE)