Google Health's Cleveland pilot program — and the nagging questions it doesn't come close to answering

So Google Health has finally made its first formal announcement — not a splashy rollout along the lines of Microsoft’s HealthVault (see our coverage), but a limited — and closed to the public — testbed launched in partnership with the Cleveland Clinic.

Here’s what we know about the project: The Cleveland Clinic, which already has a sophisticated electronic medical-records system serving some 100,000 patients, will allow 1,500 to 10,000 of them to sync up their records with Google’s nascent Internet-based personal-health-records system. The main goal is to allow patients to take their medical records with them wherever they go. Many of the clinic’s patients spend as many as five months of the year elsewhere, particularly in Florida and Arizona, and the clinic’s chief information officer, C. Martin Harris, is casting the initiative as a way to eliminate the need for those patients to carry paper copies of their records with them.

Here’s what we don’t know: In the release, Google’s Marissa Mayer says that “we believe patients should be able to easily access and manage their own health information,” but it isn’t really clear what “manage” means in this context. One of the primary questions hanging over the use of personal health records — a term that usually implies some degree of patient control over their record — is how useful they’ll actually be for doctors and other health professionals if patients are free to selectively share their medical information, or even edit or delete it.

In fact, it’s something of a paradox. If patients don’t have this sort of control over their records, they won’t exactly be “personal.” By contrast, if patients are able to exercise substantial discretion over how their information is shared, other doctors may not find much reason to trust them, particularly if people are taking the opportunity to hide or minimize embarrassing information. (The average episode of House can provide several examples — albeit exaggerated ones — of how even seriously ill people might choose to conceal vital information from their doctors, even to the point of actively misleading them.)

There are plenty of logistical issues to work out, too. The Cleveland Clinic may have a state-of-the-art medical-record system, but odds are good that many of the physicians these patients will see elsewhere don’t — so how will these doctors actually use this information? Sure, the patient can “empower” their doctors to view the information on the Web, and maybe that’s enough. But I wouldn’t be at all surprised to find a lot of Arizona or Florida clinicians printing out the information and stuffing it back into paper folders, which would seem to undermine the whole point of the exercise.

Finally, of course, there are privacy concerns as well, as I’ve written about previously with respect to HealthVault. Google’s system apparently won’t be regulated by the medical-privacy provisions of the federal law known as HIPAA, at least according to this AP story.

In fact, the World Privacy Forum just released a report (PDF link) on the risks to patient privacy posed by “third party” health-record systems such as those Google, Microsoft and others are working on. The Cleveland pilot project looks pretty unlikely to actually answer those sorts of nagging questions, which suggests that Google is more interested in giving its technology a workout than in grappling with how personal health records might be used — and possibly abused — in practice.

The NYT’s Steve Lohr, who’s written some in-depth pieces on the subject, has more in this blog entry.

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