Google Health Was a Dumb Idea Anyway ...

It's been nearly a week since the big announcement and I've read a herd of thoughtful reviews of why google decided to shutter their health experiment.

But I've not yet seen anyone say what was obvious from the outset:  It was a dumb idea.

Google Health is a classic case of a solution looking for a problem.

When we apply technology thoughtfully - we need to be solving a problem!  No problem = no adoption.  No adoption = no revenue.

Case in point:  Tim's got a survey up on histalk at the moment.  Who reads HISTalk?  Health IT disciples.  How many of us have PHRs?  13%.

If WE don't use them .. nobody will.  

Some think that "portals" will be the answer - and will succeed where PHRs have failed.

I wouldn't bet on it.   A portal may work in a setting like Group Health / Kaiser or Geisinger - but it's not likely to work in the real world.  Patients see too many physicians - go to too many care facilities and have changing relationships with all of the above.  EHR-tethered portals simply can't scale in a way that they would need to in order for patients to embrace one or another.   As a way to communicate with a practice or a hospital - fine - I'll use a portal instead of a phone.  But as a trusted place for my medical information to "live?"  No way.

So - if Google Health was a solution looking for a problem - what problems might we solve so that the next iteration of health 2.0 entrants aren't so confused.

1. The ubiquitous clipboard.  Many companies are focused on this end of the problem.  Digitally capture "new patient information" in the office or at home.  Portals, ipads, text messaging, telephony/IVR .. 
2. Data availability.  Raise your hand if you have been to a physician who didn't have your records.  It feels rotten on both ends.     When I visited Ecuador - I was impressed that the physicians didn't really have many records.  Who had the records?  THE PATIENTS!  Got labs done?  They're sent to YOU.  The patient brings a folder into the office.   Likewise - I visited Germany a few years ago.  The patient carries a smartcard that unlocks a data repository in the cloud.  Hand the smartcard to your doctor's office .. and they get your data.  No Smartcard?  No data.
3. Communication.  No secret that I'm working on this with my team @ Twistle.  No - we're not open for business yet.  But we're funded and working.  Stealth mode.  Stay tuned.  The problem we're solving is a self-evident one:  e-communication is more efficient than in-person and telephone interactions between care providers and between patients and care providers.  7% of physicians e-mail their patients.  Will this number increase - especially as reimbursement models change?  Of course it will.  But the current tools (Intuit, RelayHealth, etc) are klunky and use proprietary APIs.  The world needs a standards-based secure e-communication tool that is easy and fun.  
4. Information.  Perhaps we call this "clinical decision support" .. or perhaps we don't.  Patients and providers need to be participants in revolutions of process.  It's not rocket science.  Indeed - that's the whole point.  Many of the steps we can take to improve care (and as a byproduct - save money) are NOT intellectually challenging.  Rather - they challenge us to be deliberate, disciplined and evidence-based in how we manage care.   Take this fantastic paper (sorry - not free) in June's Health Affairs.  Intermountain Health focused FIRST on process changes that would enhance quality.  A byproduct was (significant) savings.  Example:  inductions of labor are common.  Decades of research has demonstrated that the evidence-based criteria for labor induction are not universally applied - and that induction is associated with many bad things:  longer hospital stays, more c-sections, more infection, more sick moms, more sick babies.  So if a process is instituted that requires providers to follow a specific protocol (or make a call to get special permission) the rate of inappropriate induction can be reduced from roughly one in four deliveries to one in fifty!  The authors say:  
   
   "We estimate that the Intermountain elective induction protocol reduces health care costs in Utah by about $50 million per year. If applied nationally, it would lower health care delivery costs by about $3.5 billion annually."  
   
   Wow.  Read the paper. It's a great summary of how Health IT enables this sort of endeavor.  They couldn't have done this without clinical systems, analytics, and CPOE.

So let's focus on some real problems ...  and stop worrying about why Google killed a little beta project before it came to market.