Microsoft beats Google … but only with PHRs 7/1/11

As everybody has been writing and reading about this past week, Google announced the end of its Google Health PHR effective 1/1/2012, leaving the PHR space to Microsoft (MS). Other PHR platforms exist and some are very well supported, like Dossia or even MyChart (Epic), but MS seems to be the big winner with this most recent announcement from the search engine giant, especially because Google is coordinating with MS to transfer Google Health records over to MS HealthVault.

Ironically but not surprisingly, I would have thought since both MS and Google supported CCR/CCD this would have been an easier transfer process, but apparently the two companies are going to use the Direct Protocol to transfer the records.

I’ve had a bit of a crazy two weeks as I’ve been moving. I was hoping to get this post out sooner and realized as I was researching for it that everybody and their brother has written their opinions, and many of them very good, about the death of Google Health, what it means for MS, what it means for PHRs, what it says about healthcare consumers, and on and on. I’ll try to capture what others have written and hopefully add some additional thoughts and contributions to the discussions.
For starters, I tried Google Health, inputted my data, and really wanted to like it. For me, it wasn’t really the data entry that was the problem. I just didn’t have any use for it all. I’m married with kids, but fortunately we have no chronic med needs. The one big thing I wanted to keep track of was vaccination records for my kids, but I finally gave up on Google Health altogether when I started using a mobile app for immunization records that made data entry easier.

That’s the extent of my personal experience with Google Health. I don’t feel compelled to even export my records to MS HealthVault before Google shuts its Health service down permanently.

One of the obvious complaints about Google Health is that it did not integrate with the broader health care and health IT community, meaning most consumers had to enter health related data themselves. Google Health did integrate with certain partners (providers, pharmacies, labs) but a lot of the content had to be imported manually, so users were less likely to actually do it. This is a pain.
Adam Bosworth, who once ran Google Health and now has a startup called Keas that does employer-based wellness programs based around social games, attributes the failing of Google Health to not informing, entertaining, or creating social connections around health. All very valid points and fits with what I’ve been told about building consumer tools to cater to personal vices.

I also think consumers are driven by money (making it or saving it), so the inevitable comparisons to Mint for healthcare were made. Mint’s great success is because people actually save money by using the service. Something like one in 10 users make changes to their accounts based on Mint’s input and these changes result in large total dollar savings. Google Health or any PHR vendor today can’t make that claim.

Bryce Williams wrote a very good piece on health care consumers for Fast Company that highlights why Google Health, and I think all current PHRs, don’t provide users with much value. He talks about using PHR data to offer customized insurance quotes or procedure quotes, all things that Bryce thinks could motivate users to establish and maintain a PHR.

Another guest post from Dave Chase, formerly of MS Health, concludes the reimbursement systems caused the failings of Google because providers are not paid to use or communicate with patients via PHR. This again is valid if Google was something it was not — a real tool to help people improve health instead of a storage repository for health-related data. I guess some would argue that in order to provide that value, Google would need to gain enough user data with which to make meaningful associations and conclusions.

I agree resoundingly with the general sentiment that Google Health and PHRs more broadly only have value as pass-throughs and require integrated, tailored health tools built on top of their data. Most people do not want and will not use a personal health record because a health record, on its own, is without value to a consumer / patient.

I’d also argue that it is without value to the vast majority of people even when the data is interpreted or displayed in a meaningful way. I believe this is because most people are incredibly unmotivated to change behavior, even those that reduce quality of life and shorten lifespan. The minority of people that are motivated are not the big cost drivers on the health system, so tools only for them will not create great change. It reminds me of Bill Gates’ point during his keynote at the mHealth Summit, when he said something to the effect of maybe you can use mobile tools to to motivate people to exercise 92% of the time instead of 85% (I’m paraphrasing because I can’t remember the exact quote).

What, if anything, do PHRs offer consumers? I think a PHR as a personal digital version of the legal medical record is useless. We should step back and look at EHRs and access to data for providers. Most emergency docs, and many hospitalists, still treat patients with little or no access to medical records. Integrated record systems have not been a part of our health care systems for very long or don’t have universal adoption.

My point is only that access to and organization of clinical data, something central to Google’s broader organizational mission and something I hear touted as the promise of HIT, is still not a standard component of our health delivery or training system for providers, let alone patients.

OK, now I’m going to try to be more optimistic. I think we need to stop calling and thinking of repositories like Google’s and Microsoft’s as PHRs because of the association with provider EHR data. We need to see them as what they should be and as what most commentators have described them as — personal health and wellness tools. These tools should be based on user-generated (manual or automated) data and deliver specific actionable guidance and feedback from an individual’s social network. Maybe as reimbursement rules change providers will be more willing to participate with these personalized management tools, though I think providers, as a trusted source for patients, can still help inform patients about these tools without reimbursement changes.

Some have claimed that we are at the beginning of a cultural revolution that is going to see huge changes to the way people behave. I’m not sure if it is a revolution and I’m clearly more skeptical about changing behavior, but I do think there is an opportunity with the right mix of technology and strategy. To accomplish this, we need organized data and timely feedback loops to inform individual decision making. The data will come easier as low-cost sensors and data exchange standards proliferate, but I think the individualized, actionable feedback will be the bigger challenge, especially as we link it to an individual’s social networks.
In this area, as it was announcing the end of its Google Health PHR, Google may have made a great step forward for health this week as it announced its new Facebook competitor, Google+ Circles. The new social network, in invitation-only beta release, overcomes some of the major barriers to the use of social networks in healthcare by enabling users to more selectively share content. Imagine diabetes circles or weight loss circles or even provider circles populated with only approved members.

To me, this is the exciting part of personalized, engaged health care and the aspect that holds the most potential instead of making sure I have a graph of my sodium levels for the last 10 years.

Travis Good is an MD/MBA and is involved with health IT startups.

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