Google Health shutdown spurs debate over PHR viability

By John Andrews
01:55 PM
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Google Health’s recent announcement that it will discontinue its personal health record vault service has analysts from around the industry questioning whether PHRs are a workable information source in their current form.

“The feeling is that if Google couldn’t make it work with their user base, who could?” said David Hartzband, chief technology officer for San Francisco-based Resilient Network Systems. “This is Google’s model – they give things a shot and if they don’t develop over a period of time, they’re done with it. Did they give it enough time? Maybe not – it’s arguable. You could also argue that there were a number of different people in charge of the program and that indicates a lack of strategy or commitment.”

Hartzband, who also teaches system design at the Massachusetts Institute of Technology, believes Google Health’s failure was most likely a question of sustainability and credibility.

“There are three criteria for PHRs – a viable business model, a viable technical model and adoption by those other than patients and consumers, which boils down to credibility,” he said. “What is meaningful to us as consumers might not be meaningful to a clinician. A lot of what we’re doing in IT rests on credibility – authentication and authorization – all of this has an aspect of credibility to it.”

While Hartzband points to clinician indifference to PHRs, Oleg Bess, MD, CEO of Culver City, Calif.-based 4medica says patients are not showing much enthusiasm, either.

“The biggest reason for PHRs’ failure is that the patients really are not very interested in seeing static data … they only want to see data when they want to, not when someone else wants them to see it,” said Bess.

“That is a limited time period which is so short that you have to be able to capitalize on it. The problem has always been that when the patient leaves that doctor’s office, within the next week they are interested in the results and what the docs think. The next time they’re interested is when they’re having a problem. But by that time, the way our IT and computers work and they way things are, they have forgotten their password. This happens over and over again.”

If PHRs are to succeed, said Bess, “that mundane logistical problem will have to be solved – if it is, the PHR is going to be much more accepted than it is today.”

To be sure, consumers “are more interested in managing their Facebook status than their healthcare information,” said Eric Mueller, president of Seattle-based WPC Services. “You can debate the ‘whys’ about it, but it comes down to consumers not being accountable, the cost is completely transparent and they are not incentivized to do it.”

Mueller sees the Google situation as one where “fuzzy compliance and liability” were hurdles the vault service could not clear because it “stifled innovation” by the company. That said, he believes PHRs can succeed under the right format and business model.

“PHRs are not the end-all answer, but they are certainly a step in the right direction,” Mueller said. “They will go through some kind of iteration, something that has a better business case associated with it … but there isn’t one yet.”

Todd McNitt, senior vice president of sales and marketing for Phoenix-based DICOM Grid, adds that “too much front-end labor” contributed to Google Health’s problems.

“It could be the project is ending because the consumer had to load all the data to then track it, versus the hospital and EMRs/EHRs porting to referring physicians and patients,” he said. “What we’re hearing is related to that [disjointed] workflow. For the large healthcare provider with meaningful use, EHRs, physician access and a patient access port, a synchronized interface would be a better business model, because everything is there and everyone is in the loop. That is the model that people want.”

RSNA boost?

While Google Health has faltered, the Radiological Society of North America is conducting a PHR project of its own. Funded by a $4.7 million grant from the National Institute of Biomedical Imaging and Bioengineering, RNSA will be designing and launching an Internet-based network for patient-controlled sharing of medical images. The network will facilitate access to imaging exams for patients and physicians, “potentially reducing redundant examinations, minimizing patient radiation exposure and enabling better informed medical decisions,” an organization statement said.

The two-year pilot project will include several research centers, including the Mayo Clinic, Mount Sinai Medical Center in New York, University of Chicago, University of Maryland and University of California-San Francisco. The initial goal is to establish image sharing in the clinical domain, according to principal investigator David S. Mendelson, MD, associate professor of radiology at the Mount Sinai School of Medicine and co-chair of Integrating the Healthcare Enterprise. Eight more research centers will be added in the second year, along with a number of smaller community satellite sites. At that time, the sites with patient consent will be able to share medical images and reports for clinical and research purposes.

Participating sites will also educate patients on PHRs, including establishing PHR accounts with selected providers that will enable patients to retrieve, view, archive and share medical images, reports and other medical documents, creating a detailed medical history accessible through any secure Internet connection. The goal of the project is to provide patients with the interoperability necessary for easy, secure access to medical data and control of medical information. The network is also expected to help improve longitudinal health records, reduce the number of redundant examinations by providing an exam history and reduce radiation exposure to the individual and the population at large.

“Patients are given the choice of having a CD, DVD or a user name password and through a PHR portal can download images, which they can share with e-mail access,” McNitt said. “These are patient-controlled images. As to how many patients take part, it will be interesting to see.”