Body Browser: Think Google Earth for the Human Body!

Yesterday Google released Body Browser. Think Google Earth for human anatomy.

Body Browser is described as a 3-dimensional multi-layered anatomical model of the human body that you can rotate, zoom in on, and search. More information about Body Browser is available in Google Labs.

Great to see Google developing this new tool that should be useful for educators, physicians, and others in the health care field. I can't wait to show this new tool to my kids.

Thanks to Brian Klepper over at Care and Cost for blogging about this new Google health tool.

Very cool!

Thanks Blogger Team! Blogs of Note - June 14, 2010

Wow! Thanks to the Blogger Team for highlighting my Health Care Law Blog as a Blogs of Note on Blogger Buzz, the official buzz from Blogger at Google, for Monday, June 14, 2010. More on the Historie of Blogs of Note.

Welcome to all stopping by the Health Care Law Blog for the first time. If you are interested in health care law, privacy, security, and technology I hope you will check out my recent posts and add my blog to your regular reading list. You can follow my future posts via RSS or on Twitter at @HealthLawBlog.

Testing Google's New Search Story

Yesterday I saw a post on the Official Google Blog about making your own search story videos in minutes. The post announced Google's simple to use search story video creation tool. Google introduced these search stories during the Superbowl with this ad, Parisian Love. All you have to do is type in your searches, pick your music and transfer it over to Youtube. Try it out here.

I thought I would test out the tool by creating a quick sample video marketing my health care legal practice featuring my Health Care Law Blog.

Also thinking about how marketing staffs for physicians, hospitals and health care organizations might creatively use this tool to create great marketing and public informational pieces. For example, a search story that reminds people to do a self examination, promotes a public service announcement, recommend certain preventative health measures or make healthier micro decisions.

Google Experimental Flu Trends for Mexico

Google Flu Trends have launched an Experimental Flu Trends for Mexico as a result of the ongoing concern over the current swine flue outbreak. The experimental model for Mexico shows estimates on possible flu activity in the various states in Mexico. Google Flu Trends uses aggregated Google search data to estimate possible flu activity in near real-time.

Additional details on how the Experimental Flu Trends for Mexico works and FAQs. More information about Google Flu Trends in my prior post.

Thanks to @rzeiger for the Twitter tip on the launch of the experimental tracker.

Predicting Flu Season With Google Flu Trends

Google Flu Trends uses search terms as an indicator of flu activity by state.

According to Google.org Flu Trends the aggregated search data can estimate flu activity in a state up to two weeks faster than traditional systems. The chart comparison with CDC data is impressive at showing the consistency between tracking search terms vs. using influenza surveillance data. Read about how it works and the FAQs. More background from the NYT in Google Uses Web Searches to Track Flu's Spread. 

What about privacy concerns? Has Google stepped beyond the boundary of the "trust question" by providing aggregated search information to the CDC? It might depend upon the level of data that is being release to the CDC. Already anyone using Google Trends can get a certain level of aggregated information on a particular topic - for example "Flu".

Privacy is one thing but expectation is another. My experience in dealing with clients on privacy breach matters has lead me to believe that it is often not about whether something should or should not be private -- but rather it is a question of expectation by the person who trusted information with another party. Did that party do something with the information that was unexpected or not agreed to by the parties.

The discussion on privacy has started . . .

• Google To Track Flu Searches and Report Them to Feds? at Volokh Conspiracy
• Sick Surveillance: Google Reports Flu Searches, Locations to Feds at Drudge
• Google Flu Trends: A Glimpse into the future of Google Health at ReadWriteWeb
• Sick? Google Shares Health Searches with Government at CNET Technically Incorrect
• Google Introduces Flu Trends; Gets Red-Font Treatment on Drudge at U.S. Web

Follow the current discussion using the search term: ("google flu trends" privacy) and related search results from Google Blogs.

UPDATE: Interesting follow up thoughts by Mark Hawker and the potential use of Facebook Lexicon as a similar approach to tracking flu and other health conditions.Wasn't aware of Facebook Lexicon feature - interesting tool.

The Rise of the Personal Health Record

The October edition of the Health Lawyers News, a publication of the American Health Lawyers Association (AHLA), contains an article I co-authored with Jud DeLoss, a principal in the law firm of Gray Plant Mooty, who blogs at Minnesota Health IT. On the eve of the Health 2.0 Conference next week the article provides a look at some of the legal issues around PHRs.

The article, The Rise of the Personal Health Record: Panacea or Pitfall for Health Information (pdf version), provides an introductory background on the changing world of PHRs, highlights Health 2.0 and covers some of the legal implications and compliance issues for PHRs. We are working on a longer and more detailed analysis that will be turned into a Member Briefing for the Health Information and Technology Practice Group. I would appreciate your posting a comment on topics or legal implications that we might consider covering in the full Member Briefing.

If you are a health lawyer, law student interested in health law or otherwise interested in the the legal aspects of the health care industry and not already a member of AHLA -- think about joining. The AHLA is at the top of my professional associations for written resource material, member briefings, in person programs, listserves and collaboration with health lawyer colleagues.

The Rise of the Personal Health Record: Panacea or Pitfall for Health Information

I. Introduction
Giant bytes have been taken out of the personal health record (PHR) market by technology companies like Google, Microsoft, Dossia, and others on a mission to connect consumers with their health information. If successful, the efforts by these and other Health 2.0 technology companies could transform the health care industry. It is too early to say whether the PHR will be the catalyst for health care reform; however, we can explore what may lie in the wake if a consumer-focused PHR revolution occurs.

Technological changes in health information management are altering the way in which patients and health care providers maintain, use, control, and disclose health information. We are experiencing a paradigm shift from the current decentralized system of records maintained by multiple entities at multiple locations – often with conflicting and duplicative information – to a centralized system relying on personal health information networks (PHINs), regional health information networks (RHIOs) or national health information exchanges (HIEs).

In the 21st Century, our health care system has become more fragmented and specialized. Patients seek the services from a variety of providers – from family care providers to specialists. Moreover, as individuals move from city to city and state to state, they leave a trail of partial medical records with various providers, insurers, and others.

The rise of electronic medical records (EMRs), electronic health records (EHRs), RHIOs, and HIEs reflects a need to address the increasing complexity of maintaining and sharing health information. PHRs may be the disruptive technology providing an alternative to a complex system of interconnected interoperable health information systems, often among health care stakeholders who have conflicting and competitive interests.

A. PHRs Defined
The Office of the National Coordinator for Health Information Technology (ONC) defines a PHR as “an electronic record of health related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual.”[2]

The ONC report highlights the growing importance of PHRs to facilitate the participation of individuals in their own care and wellness activities. Encouraging individuals to become engaged in their health care, and providing the means to document, track, and evaluate their health conditions, a PHR can lead to more informed health care decisions, improved health status, and ultimately, reduced costs and improved quality of health care. The PHR is broader than a medical record and contains any information relevant to an individual’s health, including diet and exercise logs, a list of over-the-counter medications, and personal information.

PHRs are distinguishable from EMRs and EHRs. A key distinction is that a PHR is under the patient’s control. The individual patient is the ultimate guardian of information within a PHR. Portability is another distinguishing characteristic of the PHR. The goal of a PHR is to be a lifelong source of health information for an individual.

B. History of PHRs
According to Wikipedia, the earliest article mentioning PHRs is dated June 1978. Wikipedia also mentions that most articles written about PHRs have been published since 2000. In its November 2001 report, the National Committee on Vital & Health Statistics (NCVHS) mentions PHRs and the growing consumer use of Internet-based health information services.[3]

Early on, PHRs were used in a rudimentary fashion as a way for individuals to track their own specific health care information. First generation PHRs can be categorized as either stand-alone PHRs, requiring patients to gather and enter their own information, or tethered PHRs, provided by a health plan, provider, or employer sponsor who populated the PHR with information.

The past twelve months mark a new era of increased activity. Call it a second generation of PHRs or PHR 2.0. The advancement is led by the entrance of large technology companies, such as Google with Google Health and Microsoft with HealthVault, into the PHR marketplace. PHR
2.0 is not merely a data collection application, but rather a platform for the electronic aggregation and storage of health information as well as the foundation for various applications.

At the federal level, ONC also is focusing on patient-centered health care. Released in June 2008, the ONC - Coordinated Federal Health Information Technology Strategic Plan: 2008-2012 serves as the guide to coordinate the federal government’s health information technology (HIT) efforts to achieve a nationwide implementation of an interoperability health information system.[4] A critical goal is to create “patient-focused health care” through the promotion of the deployment of EHRs and PHRs and other consumer HIT tools.

C. Social Networking and Health 2.0
The transformation to a PHR-based health information system is fueled by the intensifying interest in web-based social networking and the Health 2.0 movement. The increasing adoption of social networking and lightweight web-based tools among the general public may create a willingness to have and utilize PHRs. There are various technology players positioning themselves to create the “killer PHR application” to become the default standard for industry and the personal portal for each patient’s personal health information.

The definition of the Health 2.0 movement is still being refined.[5] Jane Sarasohn-Kahn, of THINK- health, defines Health 2.0 as “the use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals and other stakeholders in health.”[6] Early use of the Internet for health care was limited to the distribution and search for health information. The read-only World Wide Web has been transformed into the World “Live” Web. Today, user-generated content is being created by businesses, professionals, and ordinary people at lightening speed through social media tools such as blogs, wikis, collaborative websites, and a variety of web based products.

Online health social networking and software as service models harness the positives of networking and collective intelligence to generate a new level of collective knowledge. Whether it is patients sharing observations on chronic conditions,[7] physicians globally exchanging clinical information and insights,[8] human powered health service searching,[9] online consulting,[10] or promoting transparency through tools for organizing, managing, and comparing health care paperwork[11] -- the Health 2.0 movement is creating business models and becoming a catalyst for improving efficiency, quality, and safety of health care.

D. The Common Framework for Networked Personal Health Information
Recently the Markle Foundation announced the Common Framework for Networked Personal Health Information,[12] which has been endorsed by a collaborative group of providers, health insurers, consumer groups, and privacy groups. The framework outlines a set of practices to encourage appropriate handling of personal health information as it flows to and from PHRs.

The framework uses the term “consumer access services,” which it defines as an emerging set of services designed to help individuals make secure connections with health data sources in an electronic environment. Consumer access services are likely to provide functions such as authentication as well as data hosting and management. The framework also provides analysis of the application of HIPAA to consumer access services.

II. Ownership of Health Information
The shift to a patient-centric PHR from a provider based record raises traditional property law issues. As health information becomes networked and technology allows for health information to be transferred more easily, the lines of ownership of health information become further blurred.

Health information is often viewed under the traditional notion of property as a “bundle of rights,” including the right to use, dispose, and exclude others from using it.[13] This legal application of historic property law may not be well suited to today’s health information where patient information is shared via a variety of formats, copied, duplicated, merged, and combined with other patient records into large scale databases of valuable information.

Who owns health information? The physician? The insurer? The patient? Under the traditional rule, providers own the medical records they maintain, subject to the patient’s rights in the information contained in the record.[14] This tradition stems from the era of paper records, where physical control meant ownership. Provider ownership of the record is not absolute, however. HIPAA and most state laws provide patients with some right to access and receive a copy of the record, along with amendment and accounting of disclosures.[15]

The PHR model, where all records are located and maintained by the patient, flips and realigns the current provider-based model of managing health information. Instead of provider-based control, where the provider furnishes access to and/or copies of the record and is required to seek patient authorization to release medical information, the PHR model puts the patient in control of his medical information.

III. Legal Liability and Compliance Issues Associated with PHRs
PHRs open the door to a wide-range of new and modified legal claims. PHR stakeholders should recognize and address the negative implications to avoid long-term problems. These, of course must be balanced against the liability risks of not adopting an available technology designed to improve the quality of health care.

A. Medical Malpractice
Medical malpractice cases address whether: a patient-physician relationship was created; the treatment provided was within the standard of care; a breach of the standard of care was causally related to the injury; and the patient was injured.[16]

Seeking to prove or disprove these elements raises the issue of whether the PHR would be relevant as evidence against a provider. Generally speaking, if the data within the PHR was provided to or accessible by the provider then the evidence is admissible.[17]

Many providers have expressed concerns over the accuracy and completeness of PHRs if controlled by patients. Whether the information is credible is a legitimate question. On one hand, a patient would not want to jeopardize his or her health by including inaccurate information. On the other hand, it is well known that patients often withhold sensitive and possibly embarrassing information.

Moreover, with the advent of electronic discovery under Federal and States Rules, the production of PHRs in their electronic form could impact evidentiary issues. Health 2.0 and other social networking sites suddenly become fair game for defense lawyers seeking to discredit patients’ claims. Patients may attempt to refer to those same records and other portions of their PHR as examples of treatment modalities approved by other medical providers. Plaintiffs’ lawyers may also investigate the potential for utilizing the collective knowledge of the types of treatments suggested online within the patient networking sites as evidence of the standard of care. In essence, the possibility exists to use PHRs as the “expert” to support or reject claims of malpractice.

B. Defamation and Invasion of Privacy
Generally, a claim of defamation requires the publication of a false statement that harms the plaintiff’s reputation or esteem in the community.[18] Accordingly, PHRs which are solely accessible by the individual or upon the invitation of the individual may not create a cause of action for defamation. However, those PHRs that include communication with other individuals or providers may provide the publication necessary to satisfy that element.

Defamation based upon online communication is fairly new. Typically, such claims have involved false celebrity information posted on the Internet.[19] Arguably, where an individual uses a PHR to publish false information, an analogous claim could be pled.[20]

Generally, the tort of “invasion of privacy” encompasses four claims: (1) intrusion upon the plaintiff’s seclusion; (2) appropriation of the plaintiff’s name or likeness; (3) publicity of the plaintiff’s private life; and (4) publicity placing the plaintiff in a false light.[21] The improper disclosure of health information contained within the PHR may form the basis for one or more of these claims. Each of these claims involves the use or disclosure of private information – such as health information – concerning a person. If wrongfully used or disclosed, those responsible for the use or disclosure, as well as those responsible for protecting the PHR, may face potential liability.

C. Discrimination and Improper Disclosure
HIPAA prohibits impermissible uses and disclosures of protected health information. Although individuals are free to use and disclose their own information as they see fit, appropriate firewalls need to be constructed where, for example, employer-sponsored health plans are providing PHRs. Information in the PHR should not flow from the plan to the plan sponsor nor should it be used for employment purposes.

In addition to HIPAA, employers – and possibly insurers – must consider the implications of the Americans with Disabilities Act, the Family and Medical Leave Act, and similar State laws. The laws offer protection to employees from access to employee health information and discrimination based upon that information.

D. Breach of Contract
Despite the disclaimers and protections set forth in user agreements, it may be possible for an individual to argue that some protections arise through the agreement itself. While user agreements tend to be drafted almost entirely in favor of the PHR vendor or provider/plan, these documents may contain limited rights in favor of the individual. The individual could bring an action for breach of those rights in the event of a violation.

E. HIPAA Compliance
Most PHR vendors have taken the position that HIPAA does not apply to them. PHR vendors generally do not qualify as covered entities. Such vendors take the position that they are not business associates because they are not providing services on behalf of covered entities but rather have a relationship with the patients. Moreover, the patient releases information to or creates information in the PHR, and HIPAA does not regulate individuals’ use and disclosure of their own information.

The contrary position is that many of the PHRs are now linked directly with covered entities to allow the health information to be transferred. Several high profile relationships have been announced relating to collaborations between PHRs and medical facilities to provide PHRs for patients.[22] The collaborations should be reviewed to determine whether a business associate relationship has been created.There has been recent activity to expand the reach of HIPAA to encompass PHRs. Federal and State proposals also may address privacy and security concerns separately. In the interim, private initiatives, by the Markle Foundation and others, propose a voluntary framework to protect health information.

F. State Laws
Many States have enacted breach notification requirements and other consumer protections, which raise new issues with respect to PHRs. Some states, e.g., California, have expanded the breach notification rules to specifically cover health information. These regulations must be addressed with respect to PHRs.Finally, many states have promulgated regulations addressing the movement towards health information exchange. Many recognize “record locator services” or other similar entities that may contain health information or act as an intermediary for locating such information.[23] These State laws may be implicated by PHRs.

G. Stark and Fraud and Abuse
The Federal Stark Law prohibits certain referrals for Designated Health Services (“DHS”) by a physician to an entity with which he/she has a financial relationship.[24] In addition, the Anti-Kickback Statute prohibits remuneration in exchange for the referral of a patient for services covered by a Federal health program.[25] The violation of these laws may provide the basis for a claim under the Federal False Claims Act.[26] State laws may provide additional restrictions and prohibitions.

Recently, a number of health plans and systems have begun to offer PHRs to patients and providers. Currently, the Stark exception and Anti-Kickback Statute safe harbor expressly allow only for EHR and electronic prescribing to be donated. PHR donation may not be protected.

In addition to the practical issues associated with the donation and use of PHRs, new avenues of identifying fraud and abuse are being opened with discovery involving PHRs. Federal investigators and qui tam litigators may turn to PHRs to prove treatment that was billed for may not have been provided. In addition, the compilation of information via Health 2.0 raises the specter of data aggregation to establish fraud over a large population of patients.

Conclusion
PHRs bring a new dimension to the debate over how to create an interoperable health information network. The shift of power into the hands of patients could bring about a sustainable model. Before proceeding with the expansion of PHRs, the legal implications that go along with such an adoption should be addressed.

Bob Coffield is a member of Flaherty, Sensabaugh & Bonasso, PLLC in Charleston, West Virginia. Bob is also a Co-Chair of the Privacy and Security Compliance and Enforcement Affinity Group, a part of AHLA’s Health Information and Technology Practice Group.

Jud DeLoss is a principal with the law firm of Gray Plant Mooty in Minneapolis, Minnesota. Jud is also a Vice Chair of the AHLA’s Health Information and Technology Practice Group.

[1] Mr. DeLoss thanks Bryan M. Seiler, a Summer Associate at the firm, for his assistance in this article. Mr. Seiler is a third year student at the University of Minnesota Law School.
[2] National Alliance for Health Information Technology, Defining Key Health Information Technology Terms, April 2008. http://www.hhs.gov/healthit/documents/m20080603/10.1_bell_viles/testonly/index.html.
[3] Report and Recommendations From the National Committee on Vital and Health Statistics, Information for Health, A Strategy for Building the National Health Information Infrastructure, November 15, 2001. http://aspe.hhs.gov/sp/NHII/Documents/NHIIReport2001/default.htm.
[4] ONC-Coordinated Federal Health IT Strategic Plan: 2008-2012 (June 3, 2008), http://www.hhs.gov/healthit/resources/reports.html.
[5] Health 2.0 Wiki, http://health20.org/wiki/Main_Page.
[6] California Healthcare Foundation, The Wisdom of Patients: Health Care Meets Online Social Media, Jane Sarasohn-Kahn, M.A., H.H.S.A., THINK-Health, April 2008, http://www.chcf.org/documents/chronicdisease/HealthCareSocialMedia.pdf.
[7] E.g., Patients Like Me, http://www.patientslikeme.com/; TuDiabetes.com, http://tudiabetes.com/; Daily Strength, http://dailystrength.org/; SugarStats, http://www.sugarstats.com/; Revolution Health, http://www.revolutionhealth.com/.
[8] Sermo, http://www.sermo.com/.
[9] Organized Wisdom, http://organizedwisdom.com.
[10] American Well, http://www.americanwell.com.
[11] change:healthcare, http://company.changehealthcare.com/; Quicken Health, http://quickenhealth.intuit.com/.
[12] Markle Foundation, Connecting for Health, Connecting Consumers Common Framework for Networked Personal Health Information, June 2008; http://www.connectingforhealth.org/phti/.
[13] Christiansen, John R., Why Health Care Information Isn’t Property – And Why That Is to Everyone’s Benefit, American Health Lawyers Association, Health Law Digest, 1999.
[14] Alcantara, Oscar L. and Waller, Adelle, Ownership of Health Information in the Information Age, originally published in Jounal of the AHIMA, March 30, 1998; http://www.goldbergkohn.com/news-publications-57.html.
[15] E.g., 45 C.F.R § 164.524.
[16] See, e.g., Nogowski v. Alemo-Hammad, 691 A.2d 950, 956 (Pa. Super 1997).
[17] See, e.g., Breeden v. Anesthesia West, P.C., 656 N.W.2d 913 (Neb. 2003) (nurse’s electronic note on patient condition which would have prevented administration of anesthesia should have been reviewed by anesthesiologist despite no verbal or handwritten report by nurse).
[18] See, e.g., Mahoney & Hagberg v. Newgard, 729 N.W.2d 302 (Minn. 2007).
[19] See, e.g., Carl S. Kaplan, Celebrities Have Trouble Protecting Their Names Online, Cyber Law Journal (July 30, 1999).
[20] See, e.g., Churchey v. Adolph Coors Co., 759 P.2d 1336 (Colo. 1988). See also Restatement (Second) of Torts § 577, cmt. k (1977).
[21] See, e.g., Werner v. Kliewer, 238 Kan. 289, 710 P.2d 1250 (1985); Humphers v. First Interstate Bank, 298 Or. 706, 696 P.2d 527 (1985). See also Restatement (Second) of Torts § 652 (1977).
[22] E.g., Google Health with Cleveland Clinic and Microsoft HealthVault with Mayo Clinic.
[23] See, e.g., Minn. Stat. § 144.291, Subd. (i).
[24] 42 U.S.C. § 1395nn(a).[25] 42 U.S.C. § 1320a-7b(b).[26] 31 U.S.C. § 3729.

The Health of Google and Google Health

Very interesting post over at ZDNet by Tom Foremski on an upcoming meeting of Google hacks at the Googleplex set for May 19.

Fascinating description of Google's use of machines and software to produce results rather than humans and how this might exist in the health care environment. I have not heard of this description of what Google does and why it does it better and cheaper.

Also, he offers compelling thoughts on the pharma advertising market target that Google may be looking for as it goes about developing Google Health.

Tip to the NewsGang Twitter feed.

Google Health: Google Partners with Cleveland Clinic

The New York Times Technology Section reports on a pilot project between Gooogle and the Cleveland Clinic in an article, Google to Store Patients' Health Records.

The article indicates the pilot project will involve a volunteer patient group transferring their personal health records so that they are available via Google Health, a new health record product being developed by Google. The article quotes Pam Dixon of the World Privacy Forum concerning privacy issues under HIPAA (incorrectly referenced by the Times as HIPPA).

I don't necessarily agree with the scope of the comments regarding the applicability of HIPAA in this situation. Although I don't know the full details of the relationship for the proposed project but it would appear that Google in this situation might be serving as a business associate of the Cleveland Clinic for the project. As a business associate it is likely that Google would be held contractually to many of the HIPAA privacy standards.

Tip to Matthew Holt at Health 2.0 Blog for noticing the NYT article.

UPDATE (2/22/08): ZDNet's Larry Dignan at Between the Lines has more on the pilot project including the Cleveland Clinic's press release.

The comments to Dignan's post are interesting reading especially a couple with a legal perspective. The comment, two misconceptions, highlights the overall light enforcement efforts by OCR and lack of penalties, whether Google might fit the "healthcare clearinghouse" definition under the "covered entity" definition, entering into a contract with the health care provider (business associate requirement) and discusses the subpeona and marketing misconceptions.

Also, more from NYT's Steve Lohr, Google Health Begins Its Preseason at Cleveland Clinic which indicates that Google Health will be made available to the public following completion of the pilot project (appoximately 2 months). The article also has a quote from fellow health care blogger and CIO of Beth Israel Deaconess Medical Center in Boston, John Halamka, who indicates that the hospital is also interested in linking its EMR with Google Health. As a board member of the West Virginia Health Information Network I would like to explore the idea of utilizing and integrating Google Health into our statewide effort to bring about an integrated/interoperable health information system.

Jane Sarasohn-Kahn at HealthPopuli shares her thoughts and additional link commentary on the Google/Cleveland Clinic project. Jane highlights a recent report, Personal Health Records: Why Many PHRs Threaten Privacy, by the World Privacy Forum looking into privacy issues for PHRs.

Matthew Holt's follow up post taking a closer glimpse at the privacy questions, motives and opportunities both pro/con surrounding the Google Health project.

UPDATE (2/24/08): For the latest article covering the Google Health project check out Newsweek's article, Web Surfer, Health Thyself, out in the March 3 edition.

Also, MSNBC provides some additional insight on how Google Health will interact with the existing Cleveland Clinic EHR (or PHR) in Google Goes to the Doc's Office. The article describes the pilot project as follows:

. . . The Cleveland Clinic already keeps electronic records for all its patients. The system has built-in smarts, so that it will alert doctors about possible drug interactions or when it's time for, say, the next mammogram. In addition, 120,000 patients have signed up for a service called eCleveland Clinic MyChart, which lets patients access their own information on a secure Web site and electronically renew prescriptions and make appointments.

The system has dramatically cut the number of routine calls to the doctor and boosted productivity, though it has yet to effectively deal with information from an outside physician, Harris says. Those records are typically still on paper, and have to be laboriously added to the Cleveland Clinic system. It is a big problem, especially for the clinic's many patients who spend winters in Florida or Arizona, where they see other doctors.

Adding Google's technology lets patients jump from their MyChart page to a Google account. Once on Google, they'll see the relevant health plans and doctors that also keep electronic medical records. That means the patient can choose to share information between, say, the Arizona doctor and the Cleveland Clinic . . .

UPDATED 2/26/08: Scott Shreeve goes Giga over Google Health. Read his first impressions of the Google PHR after his test drive at HIMSS.

However, Dmitriy at TrustedMD makes some great points, including this quote:

Yet, even with free PHRs out there, consumers simply do not care for spending their time to learn and use them. Who would bother entering and checking their medical records if you are healthy and would rather go see a movie? And once you get sick, you do not want to enter them either. You just want your doctors and hospitals to hand your medical records to you. But you see, the providers have different priorities that a mere piece of software just cannot solve . . . PHRs' real problems are not technical, usability or even privacy. The real problem is consumer and provider motivation . . .

He ends his posts with some questions we should all be discussing. Until we see a reimbursement model that creates incentives for providers to look at more health information and consumers to care about and take an active part in their health -- I'm not sure the PHR/EHR initiatives will fully develop and mature.

Follow the latest news (blog posts) and the Techmeme reaction to the project.

Get Your Google Health . . . Soon

Various reports out about the coming of Google Health. As Matthew Holt indicates, the Google purists found a log in page (screen shot).

The log in page has since been pulled down but Matthew and Tech Crunch provide a list of what the log in page said Google Health will do for you, including:

With Google Health, you can:

• Build online health profiles that belong to you
• Download medical records from doctors and pharmacies
• Get personalized health guidance and relevant news
• Find qualified doctors and connect to time-saving services
• Share selected information with family or caregivers

I'm particularly interested to check out the "Google Health Privacy Policy" which is referenced on the log in screen shot.

Stay tuned . . .

Hospital Mashup: Google and HHS Hospital Data

NetDoc now as a mashup of Google Maps and HHS hospital data. As Shahid Shah says, these types of tools takes mountains of data and makes it more accessible and easier to digest by the average public health consumer. Here is the view/data of hospitals that are 100 miles from Charleston, West Virginia.

Here is the summary of what the tool provides:

When it comes to treating heart attacks, pneumonia, surgery and other emergencies, you want to find the best medical care available.

To help you make these decisions, visit the NetDoc.com Hospital Rankings tool and enter your ZIP code to see how hospitals in your neighborhood rank on benchmarks set out by the U.S. Department of Health and Human Services in four categories: Heart Attack, Heart Failure, Pneumonia and Surgical Care Improvement/Surgical Infection Prevention.

Thanks to Shahid for the tip on this new tool.

NYT Looks At Dr. Google and Dr. Microsoft

Today's NYT article, Dr. Google and Dr. Microsoft, takes a look at how Google and Microsoft are focusing efforts on the health care industry and how to improve the traditional health care system by utilizing technology to allow patients greater access and control over their personal health information. Both companies are still in the planning phase and trying to determine what will work and what patients might want, use and need.

The entry of these two tech giants along with a slew of other health-technology companies are likely to cause disruption in the health marketplace traditionally controlled by historic models (physicians, hospitals, insurers, etc.) Whether there will be enough momentum to bring change and whether patients are willing to trust these new models is the question that has yet to be answered.

Interestingly, the article mentions a little more about what Google Health might look like. The Google Health prototype focuses on the health consumer:

The welcome page reads, “At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”

A presentation of screen images from the prototype — which two people who received it showed to a reporter — then has 17 other Web pages including a “health profile” for medications, conditions and allergies; a personalized “health guide” for suggested treatments, drug interactions and diet and exercise regimens; pages for receiving reminder messages to get prescription refills or visit a doctor; and directories of nearby doctors.

The article also mentions West Virginia native, David Brailer, former Bush administration National Coordinator for Healthcare Information Technology, who now heads up Health Evolution Partners. Note: Yesterday Matthew Holt posted at The Health Care Blog that Dr. Brailer will be joining the list of speakers at the Health 2.0 Conference to be held next month. Mr. Bosworth of Google will also be on the consumer aggregator panel being moderated by another top health care thinker, Jane Sarasohn-Kahn.

UPDATE: Interested in learning more about Google Health? Check out this post by Jeff O'Conner at the Health Care Information System Blog with links to the Clinical Cases and Images Blog with links to screen shots of the prototype.

Also check out what Doc Searls perspective at ProjectVRM Blog.

UPDATE2: Good insightful follow up post, Here comes Google and Microsoft, from Tony over at Hospital Impact. I especially agree with the last two paragraphs:

Of course, all the same old data issues have to be worked out - privacy, malpractice, storage, interoperability, and security . . . Plus, there's a little problem with funding and business model (hopefully we will never see a Google banner ad within our medical record!) . . . Make no mistake about it- this is not a continuation of the Google vs. Microsoft War that's been going on for years. This is Google or [insert brave company name here] against the most powerful force of them all: the healthcare industry status quo.

Google Health: A Virtual-Doctor In Your Family

Roni Zeiger, MD, Product Manager at Google and part of Adam Bosworth's health team at Google has this recent post on the difficulty of patients getting the information they need.

I can related to his post, Is there a Doctor in the Family? and his discussion of having "better access" to health information. There is incredible value in having a family member who understands the clinical side of health care. My dad, a retired country doctor in West Virginia, at 83 is still my "primary" resource to discuss health issues and get a valuable second opinion on anything related to my health and the health of our family. When the kids get sick we call him to confirm that the advice given by our pediatrician is accurate. When I had to make decisions on whether or not to have knee surgery - he was my sounding board for the pros/cons. I could give 100 more examples where I or others in my family have relied on him to help interpret health care options, treatments and management of our health.

Dr. Zeiger poses the following question in his post, "When I help my loved ones navigate an illness or get up to date with screening tests, I wonder how those who don't have a doctor in the family manage their health."

The answer: They don't manage their health. Most patients find themselves in a sea of information and at the mercy of a complex system. This is one of the fundamental questions that we as health care professionals need to seek solutions for today. Americans have always been great at mass production and we have taken this same approach to our health system. We produce a lot of health care but it is not individualized or coordinated as well as it could be.

If Google can find a way to become this trusted virtual-family doctor and fill this need the patients and providers will be better off in the future. I'll be interested to hear more from Dr. Zeiger at the Health 2.0 Conference who will be participating on the panel discussion on Search in Healthcare.

Tip to Shahid Shah the Healthcare IT Guy for alerting me to this new Google Blog post dealing with health care in his post Google Planning a PHR?

For more information on the Google Health initiative check out this post over at The Health Wisdom Blog which includes links to Adam Bosworth's recent presentation at the American Medical Information Association's annual convention.

UPDATE (6/21/07): Rita Schwab at MSSPNexus Blog adds an insightful post on the topic of Google as Healthcare Advocate? and what to expect when you navigate the health care system.

Scoble On Google Privacy Discussion

Scoble has a good round up of the ongoing discussion about Google's ranking in the recent Privacy International Report titled, A Race to the Bottom: Privacy Ranking of Internet Service Companies and Privacy International's Open Letter to Google.

EWeek.com Article: Google and Health Care

Today I noticed a little more traffic to my blog with much of it coming from www.eweek.com. As a result of a little searching I found an article (Google Aims to Extend Data Mantra into Health Care) quoting from one of my previous post (What Google Health Might Look Like).

My previous post on Google Health was a a reaction and response to a post at the Google Blog by Adam Bosworth, Google's VP, asking to hear from others about how you and I as patients know whether we are getting the best care. The post was not just about "concerns over what could be lost in the digitizing of medical information" (as quoted in the article) but rather an overall examination of what Google Health and some of the other Health 2.0 type companies may bring to bear on our traditional health information system and how this may ultimately impact the quality of health care we receive.