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Challenge to Google: Understand that PHR Data is Different

Dr. Barry Chaiken

March 5, 2008

In his HIMSS Annual Conference keynote address last week, Eric Schmidt, CEO of Google, presented an easily understood and exciting review of his plans for an online Personal Health Record (PHR). For those of us committed to using health IT to improve quality, enhance patient safety and reduce costs, this was a great moment. Google’s plans to provide an OS platform for outside development of applications to expand the capabilities of its PHR offer fertile ground for rapid PHR expansion. In addition, it seems that some of the vexing problems inherent in interoperability, RHIOs (distributed vs. centralized models), and PHR funding could be soon solved.

Although Schmidt’s vision for his PHR suggests that the Google’s PHR space would be funded by advertising and other web revenue models associated with Google’s search capabilities conducted outside the PHR vertical, he did not guarantee that other revenue models would be utilized within the PHR environment. This suggests that Google has not ruled out using PHR data to drive ads and promotion of other revenue generating activities to PHR users.

In a private discussion with Schmidt and his assistant Missy Krasner, formerly the assistant to Dr. David Brailer when he headed the ONC, I outlined to them the dangers of commercializing the PHR space. If personal data stored in the Google’s PHR is used for purposes other than care of the patient (e.g., marketing of specific drugs [Viagra] based upon data within the PHR [erectile dysfunction]), PHR users would, over time, be reluctant to fully populate their PHRs.

Most PHR users will consider the mining of the data for the purpose of marketing and sales as a violation of privacy leading to their decreased openness. Only a fully complete and accurate PHR offers great value. Incomplete ones are no better than the paper or electronic records we use today.

So, it is up to Google. They can become a leader in the effort to construct electronic health records for all Americans or they can take the wrong steps that set back our industry a decade or more.

Further Reading - Patient Information: Who's Your Daddy

Barry P. Chaiken, MD, MPH, has over 18 years experience in medical research, epidemiology, continuous quality improvement, utilization management, risk management, health care consulting, and public health. He is a member of the board of directors of HIMSS and a former associate chief medical officer of BearingPoint.

Comments

John Daniels responded March 11, 2008: #1

Barry, the World Privacy Forum released a report last month that speaks to the concerns you outlined. It described a view that “… some PHRs can have significant negative consequences for the privacy of consumers who authorize the maintenance of their health records by PHR vendors.” The report maintained that “Federal rules for health providers and insurers do not protect records maintained by many PHR vendors.” Would the problem be solved by adding “PHR vendors” to the definition of a covered entity?

Kiwi Pete responded March 14, 2008: #2

Google will inded start the population thinking...and may create some movement in the approach toward consumer managed health records. However, it may take some years before there is reality in the acceptance of this approach.

We are a litigious society and no segment of our professional population is more cognizant of that fact than our beloved physicians. Is the physician of today likely to advocate a new course of drugs...or determine a procedure based on the contents of a customer managed medical record? The physician will not know the extent to which that record may have been altered or manipulated and he/she is unlikely to open up the possibility of litigation based on an undesirable clinical outcome if the only data presented prior to the encounter was consumer managed.

If the physician receives such a record he/she will most likely believe in the need to also access the providers record...creating more work for physician and staff.

No...I do not think Google's approach will fly...just yet. However, their initiative may prompt further innovation that will improve outcomes and lower cost while giving the patient ready access to their electronic medical (health) record.

Randy responded March 18, 2008: #3

Will this approach complete the circle of continuous improvement? In the abstract: where is the input from the patient on the effectiveness of individual treatments. i.e. A) treatment helped immediately B) treatment helped eventually C) treatment didn't help but issue resolved anyway D) issue resolved without treatment E) sought additional treatment (and which ones if any were effective) F) issue unresolved. I'm sure each of us has experienced one or more of these outcomes and it seems like consumer managed health records could be a repository for this information.

Barry Chaiken responded March 18, 2008: #4

I am not sure covering the vendors will do enough. It may help with protecting the vendors as a covered entity, which would be good to promote the adoption of PHRs, but I am most concerned that vendors will take advantage of the information in a PHR and use it unfairly.
It is chilling to think about the marketing of products and services to patients using information contained within their own PHRs. Aggregate data analysis may provide both useful scientific and marketing research, which is probably acceptable, but patient specific analysis for commercial purposes is, to me, unacceptable.

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