Thursday, March 5, 2009

Cool Technology of the Week

Yesterday, Google Health quietly launched a disruptive technology - social networking for personal health records.

Here's how it works.

In your Google Health profile, you click on Share this Profile. You can then invite anyone by email to share your medical record. To test the application, I invited my wife to join (see screen shot above).

Once you've invited others to see your medical record you can monitor audit trails of who has accessed your records, what they saw and when the looked. You can remove access at any time.

On the receiving end, your invitees receive an email with login instructions to view your medical records. They cannot change or add to your records. All their actions are audited.

Everything is done securely via HTTPS.

As a country, we continue to debate the appropriate privacy policy for sharing records in ways that protect confidentiality. We continue to work on technology solutions that restrict the flow of information to those we need to see it, when they need to see it, with the minimum need to know. These are all hard problems.

The Google solution, introduced without fanfare, solves many confidentiality issues by putting the patient in control of medical record sharing. Call it "Facebook for Healthcare". You invite those who you believe should see your medical information and you can disinvite them at anytime.

I've already invited my primary care doctor, my family, and a few of my clinical systems colleagues who built the BIDMC-Google interface. Thus, in one morning I've become my own regional health information organization, sharing medical records across multiple organizations with perfect privacy controls.

Social Networking for Personal Health Records - that's cool!

28 comments:

e-Patient Dave said...

As you know, I love it - I used PatientSite this way during my illness. But is this social networking?? I'm not a student of the subject but my impression is that social networking applies to conversations propagating, spreading, with visibility to an increasingly wide audience.

Scratching my head. Is merely giving access to my records "social networking"?

jamesadell said...

John, I love this idea. My parents are both in their mid-70's and my father manages several chronic diseases, thankfully my mother is a nurse practitioner. But, the day will come when the five of us kids are going to have to pick up the slack that my mother carries now. I sent your blog to my family and encouraged them to try out the new google phr the way you have. Thanks for sharing!

jamesadell said...

John, I love this idea. My parents are both in their mid-70's and my father manages several chronic diseases, thankfully my mother is a nurse practitioner. But, the day will come when the five of us kids are going to have to pick up the slack that my mother carries now. I sent your blog to my family and encouraged them to try out the new google phr the way you have. Thanks for sharing!

Ed Dodds said...

No doubt the former JotSpot and Google Doc tools will eventually be integrated allowing for "Community of Practice" based collaboration. Over time, semantic richness will be added as well (that's where the ad sales get micro-targeted). Please see: The Future of Semantic Wiki: Trends, Challenges and Outlook - http://is.gd/lV6H

Lisa said...

While this seems like a great idea, essentially a portable medical record, I have several questions...
1. Can people who VIEW the medical record INPUT information (i.e. can your primary care doctor update information or are we relying on the individual to input updates?)
2. Can the individual limit what portions of the medical history someone can view? A parent may want their adult child to know their medications, but not their sexual history for example.
3. If we transition to portable medical records, what happens in an emergency? If an individual is brought to the ER with a heart attack, will they have to pause to "invite" the ER doctor to view their medical records?

I think the take home message is that this can NOT serve as the individuals COMPLETE primary medical record. It can however serve as a useful source of some information.

Katrina said...

Hi Lisa,

While I cannot tell you what kind of restrictions Google Health places on their access... I use a site called change:healthcare (I also work for them... and use our product for my family). I can share my account with other people and decide the level of access I want them to have, such as "read only."

It has been especially helpful with managing all of the medical paperwork, like bills and EOBs.

wljcr said...

Dare I ask which ads come up when you login? It isn't had to imagine Google looking for key words in your medical record and feeding you ads based on your conditions. Your BMI is high? Hear comes the ads for Weight Watchers and Jenny Craig.

I actually do love the concept, but would read the user agreement twice.

ben said...

John,

This isn't all that impressive and new, is it? Indivo and Children's Hospital Boston have had this for a while now :)

dnigrin said...

Echo'ing Ben's post - c'mon John, you know that the open-source Indivo, which forms the basis for Dossia's PCHR, has had this baked in from its get go (and in a more robust manner than Google):

http://indivohealth.org

What's more, the degree of granularity with sharing that other comments have pointed out is necessary is also already supported by Indivo - see:

http://www.jamia.org/cgi/content/short/15/6/737

Stop feeding the Google hype machine!

Dan

e-Patient Dave said...

Personally, I don't mind that things like this have been done before. PatientSite, whose development John co-managed, has let me do this for years, although not with separate log-ins and audits.

What interests me is that the ENTIRE world of healthcare has been severely behind the curve compared to the rest of the enterprise world. If Google can bring everyday common sense features to healthcare, so much the better, IMO.

Having said that, it's sure not perfect. As John knows, I've begun moving my BIDMC data into Google Health, and all I can say is, it's messy. But I'm happy to be one of the early adopters who moves things forward toward the new world we want to build, in which providers and pts alike have more modern tools available to them.

(Having said that, I still don't see how shared access is social networking. :))

Dirk and Leah Stanley said...

This is exactly how I envision Google pushing the next chess piece... It also solves the UPIN issue - who needs a UPIN key when the patient can be the key... Now just wait for the marketing in the form of a Superbowl commercial... "I got admitted to the hospital and somehow the doctors didn't know what I was on... I almost died! But now with Google Health, that speaks _________, all of my doctors can share my information!" Googles next step is going to push consumer demand for health portals, and their protocol of choice, so the rest of us should get prepared and learn what CCR is so we can meet that demand when it comes. (my prediction, take it for what it's worth.) :)

Carl said...

John,
I'm concern about who at Google will be looking at all this information? Not so much for marketing, but maybe something a little more devious. Isn't that what HIPAA laws are for? Where do they play a part in this? I don't want to sound paranoid, however I'm sure I'm not the only one worry about medical information flying around on the web.

e-Patient Dave said...

Carl,

A year ago I was one of the world's biggest cynics/skeptics about this. But for the past year I've been studying it, and although my concerns haven't been changed, my overall view of the situation has done a 180.

I posted about this last week here, expressing both my concerns and why I've decided to go ahead with both Google Health and Microsoft HealthVault.

Bottom line, my top commitment is to build (in my copious spare time, heh) a new world of healthcare in which we all have access to vastly more (and better) tools than exist today, and I've reached the personal conclusion that getting personal control of our data, outside of any private system, is the best way we can do that.

As I say in the post, I respect anyone who doesn't feel the same. But after a lot of study that was my choice.

JamesR404 said...
This comment has been removed by the author.
JamesR404 said...

Actually I read the Google blog about this just now and then I thought of you John. Of course I should've know you would have written your own blog about it already :D

This really is very interesting, in Holland we are facing a lot of controversies with Electronic Patient Files as well..... incidents with illicit access and security are affecting customer confidence whereas the government is pushing forward for implementation with an opt-out clause for citizens.

Anyway, Google has just silently introduces something that can give people the power to take their health records into their own hands. Great!

John Sam said...

Oh boy let's see, I have a gmail mail account which unlocks my iGoogle portal; opening the door to my Picassa Web Albums, Bookmarks, Blogs, News, Documents...

So I can upload my videos to Google Video (only until June) ah, but I am already signed into YouTube with my gmail account - cool; where am I, ah... I check my Google analytics so I can see how many views I got on my video library, and from where, age group, and gender percentage.

I then check AdSence to see how much money I made on my Google AdSence Video Units, only to find out, I have a service bill to pay for Google Premium, so I use my Google Charge.

Ok I know I forgot something, same thing that Obama said all the past administrations have been forgetting, same thing that is scratching my brain every morning; My Health, right! Google Health, everyone's health!

I am hooked in completely with the Google Health social network; and hopefully in the near future, a widget to LinkedIn, Facebook, Myspace and Good Genes!

John Sam said...

oops - gadgets not widgets - for are we not Google

CMH said...

I think some of the other PHRs like Google's fellow CMS pilot competitor Health Trio have had this functionality. The challenge is building provider trust - docs will need assurance that the information in the PHR is accurate and complete, before they use it.

CIOGuy said...

Microsoft HealthVault has had this functionality since launch, I believe. I do not have a preference between HealthVault or Google as I think any technology that is free and promoted the communication of health records in a secure environment is a great thing. At our health system we are about to go-live with HealthVault to synch specific records but will be adding Google later this year. Indeed, this is an exciting time!

John Halamka said...

Folks - thanks for all these great comments! I was one of the folks on the Google Health Advisory Council and we ensured that strong policies were put in place - no advertising of any kind, no data mining, no sharing without consent, and when the patient deletes data it is truly gone. Thus, the policies behind this technology are strong.

peter said...

I agree its cool. Just hope this doesn't happen too much...

http://www.techcrunch.com/2009/03/07/huge-google-privacy-blunder-shares-your-docs-without-permission/

mvic said...

A drawback of networking
"Portable Health Records" is that they are only valid for people with minimal medical history. For people with complex problems (which is to say, multiple providers), a "do-it-yourself" PHR is dangerous and counterproductive. Almost nobody can create a valid PHR without expert medical editing. And EHRs (institutional health records) are demonstrably too inaccurate and incomplete to use as PHRs. Neither can health plan administrative data (cash register tape) make a valid PHR. The only current way to make a real PHR is by expert, human abstraction of the complete longitudinal record. [I must declare a conflict of interest because my company does this.]

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musag08 said...

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Aubidaded said...

I look forward to future inventions to improve software technology. With todays society being as corrupted as it is, theres no going to say that your child, growing up in a public school, will not be exposed to something of an illegal substance or negative nature. I mean we all just want our kids to grow up strong physically and mentally. We cannot afford to see them deteriorate, but we can afford McAfee! :)
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Rennasauce said...

Does Google Health allow the "patient/user" to restrict access for a provider to *just* certain parts of their profile, or is it "all or nothing" access for each provider? I might choose to allow CVS access to just my prescription info, for example - not to all of my profile. I can't find anything that suggests this is possible. If not today, is it planned?

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Football Matches said...

This really is very interesting, in Holland we are facing a lot of controversies with Electronic Patient Files as well..... incidents with illicit access and security are affecting customer confidence whereas the government is pushing forward for implementation with an opt-out clause for citizens.

Anyway, Google has just silently introduces something that can give people the power to take their health records into their own hands. Great!

Recep Deniz MD

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