So, Google Health’s slow collapse — akin to a tire with a slow but obvious leak — has finally come to an end. This week, Google officially ended the project, one of the pioneering efforts in the Personal Health Records space. While GH will stumble along through January 1, 2012, the jig is finally up.

Why did a high-visibility project backed by one of the world’s premier Internet companies fail so miserably? Well, according to former Google employee Adam Bosworth, who first launched GH, the effort failed because “it’s not social,” TechCrunch reports.  Another pundit, more convincingly, argued that unless PHRs are tied to reimbursement somehow, they’ll be “irrelevant” for most providers.

So, why should we care about the failure of a project that, I’d argue, was pretty much pie in the sky from day one? And more importantly, is the failure of GH relevant to people who care about the future of EMRs?

Well, for one thing, Google Health does offer some pretty interesting insights into what doesn’t work in the world of patient-centered clinical data. As I see it, they include the following:

*  Clinical data projects that aren’t interoperable are eventually going to wither away.

I think it’s telling that Google is, at the last possible moment, rolling out the ability for patients to transfer health data to other services supporting the Direct Project protocol.  Also notable is that Google is offering patients the option of downloading data that meets the Continuity of Care Record format. (That’s ASTM E2369 – 05e1 to any standards geeks out there.)

Does that imply that EMRs that don’t share data are going to be outmoded or a waste of time?  Certainly not, as EMRs can potentially solve many in-house problems that providers face, and serve a far more expansive purpose. That being said, the failure of siloed PHRs should be a warning.

* Without a live, fluid source of data, PHRs don’t matter.

In this cynic’s mind, the idea that patients would suddenly begin to post data to PHRs on their own was, to put it simply, pretty dumb.  Why would they?  Consumers seldom think about their health data unless they’re at a doctor’s office, if at all, and they don’t exactly know what do do with the data once they’ve compiled it.

Since day one of the PHR craze, I’ve been wondering who thought they’d change patient behavior en masse by dangling a technology carrot. What were they thinking? I’m not just slamming Google, I’m targeting pretty much any PHR that isn’t linked to an EMR or other clinical data source directly. (I’m talking about you, HealthVault, and probably Dossia too.)

* PHRs must be run by a trusted intermediary, and marketed vigorously to patients, before patients will take heed.

I think it’s no coincidence that while Google’s PHR, and possibly Microsoft’s, haven’t won over many consumers, patients are beginning to pay a bit more attention to PHRs provided by providers and health insurers.  (OK, I don’t have hard data on this, just a strong gut feeling — can any of you provide stats that support or contradict this assumption?)

A case in point: While they’ve arguably spent way, way too much to get there, Kaiser Permanente has built what may be the largest PHR user-base in the world — 3 million users as of spring 2010 — linked to KP’s big Epic installation.  True, Kaiser had to spend millions in advertising and other forms of outreach to get patients on board, but what’s telling is that patients seem to have stayed once they arrived.

So, I’m just wondering when the managers behind HealthVault will throw in the towel. Hey, MS, just turn out the light when you leave, OK?

I found this recent post by Howard J. Luks, MD very intellectually stimulating. It’s a great read. Particularly if you’re a doctor or someone who tries to understand some of the various physician perspectives.

Here’s one section that sounded all too familiar to me:

Discussions about physician dissatisfaction occur at every water cooler, in every operating room lounge, and that every dinner many of us attend. But I often wonder if any of my colleagues are actively pursuing workflow changes, office efficiencies, or changes to their daily habits which may improve their level of job satisfaction. Interestingly, when I pose that question to my colleagues… the answer always seems to focus on finding another job… hmmm.

I can’t tell you how many doctors I’ve had come up to me with some hair brained website/internet idea and they want to build it. The story is so often the same. They make good money as a doctor, but they have to do it forever to make that money. They see the internet as this font of wealth. I try to let them down easy when I describe what it really takes to do what they’ve described. Ok, maybe I’m not that gentle in my description. I don’t want to crush dreams, but I do want them to understand what it really takes to do what they want to do. I digress…

Here’s another powerful part of Dr. Luk’s post:

Last week in my office, I received 5 emails germane to this topic. Three simply mentioned how satisfied they were with their encounter in the office in terms of the time they were given, the time I took to listen to their complaints, and the time I took to explain the natural history of their disease. Two of the e-mails came from long-term patients who are many years out from surgery — yet ventured onto my website and decided that they would touch base.
…
That simply makes my day.
From a work perspective, there’s no greater level of satisfaction that I could ask for.

The whole post is great since he covers the challenges of medicine as well and has a great golf analogy about how the perfect shot makes up for all the bad shots kind of like the grateful patient makes up for the bad ones.

Of course, all this discussion of patient and doctor satisfaction makes me wonder what role things like social media, PHR and patient portals can play in a doctor’s satisfaction. Many doctors fear the idea of being connected to their patients in some sort of social media. I’m not saying there aren’t reasonable precautions that need to be taken in our litigious society. However, I wonder if many doctors are missing out on some of the satisfaction they could get by using social media.

I have first hand knowledge of the job satisfaction you get when someone sends you a kind email in response to your blog post, tweet, or other communication. I know I can recount many such experiences because they were so satisfying that I’ll never forget them. I’m sure many doctors are missing out on similar experiences, because their afraid to open a channel up for that communication.

Yesterday I started testing out a new idea where I’d film some original EMR and EHR videos where I answer questions about healthcare IT and EMR that people have sent to me. I’ll post the first video here and possibly another one this weekend. Then, I’ll probably start posting the videos on my new EMR and EHR video website. Although, I may do some updates with links to the latest videos that are posted.

It’s a low budget production as you can imagine. I also was streaming it live on the internet, so you’ll see me look down a number of times to check how many were viewing it live. Those things aside, hopefully you’ll find the content of the video interesting and useful.

This first video tries to answer the question:
Does the EMR allow data sharing with the patient’s PHR and/or Social Net account(s)?

As always, I’m interested to hear your thoughts on the subject as well. Was there anything I missed? Was I wrong about anything? What else is important about EMR data sharing? Should we be able to share our EMR data with social networks like Facebook, Twitter, etc?

Also, if you have other questions you’d like me to answer in a future video, be sure to leave a comment or let me know on the contact us page.

The always insightful John Moore (so many great John’s in Healthcare IT), posted a great blog post back in September of 2010 about Google Health hitting the reset button. The post was interesting as it tried to show Google Health going in a new direction. The irony was that almost a year ago John had posted about Google Health’s irrelevancy in the PHR market.

Despite the up downs of Google Health, today John put Google Health in Stasis. He sights a great list of yellow and dark orange flags that are a bad sign for those who love Google Health. Here’s one section from his post:

Beginning in late March 2011, we started hearing the rumors of the impending demise of Google Health once again (is this becoming some sort of annual thing with Google Health?). We waited a few weeks to see if the rumors would die down, they did not. We put a call into Google Health to set up a briefing, get an update. Response back was slow (one yellow flag). When they did get back to us, they said it will be at least a couple of weeks (two yellow flags). Next, our Google contact told us by email that they were going to hand Chilmark’s inquiry off to Google’s PR department (screaming dark orange flag). And now today, we received an email from one of Google Health’s most visible spokespersons, Missy Krasner that she is leaving Google.

He then projected that we shouldn’t “expect anything new out of Google Health for at least the next 5 years.” That’s quite the projection. However, I’d take it one step further. I don’t expect to see anything really mainstream out of PHR software for another 5 years either.

I do think that PHR software is going to have a strong showing in chronic patients. I could also see an interesting niche in secondary caretaker healthcare management using a PHR (I’ve got an interesting announcement about baby boomer healthcare coming soon). I definitely want an online means for tracking my parents healthcare. Not to mention, then all of my brothers and sisters could participate as well. A few other niches are likely to be successful as well. Not to mention, other consumer PHR-like applications for healthcare that will become popular like the Nike+.

I’m embarrassed to admit this, but over the last week I’ve become addicted to a hideously cute little iPhone app called Shopkick.  The app locates where you are geographically, spits out a list of retailers for you, and when you click on the retailer’s name, typically rewards you with “kickbucks.”

The more kickbucks you get, the higher “level” you’re at, whatever that means — and when you collect, say, thousands of points you can get a $25 gift card. (Yippee!)  In truth, the rewards Shopkick offers probably average out to about 3 cents an hour. Who cares?  I keep playing with the stupid app until I’m out of offers to click.

Now can anyone tell me why the same type of scheme wouldn’t motivate at least some consumers to add data to their PHR on a regular basis?  Small cash rewards are already proving effective at improving medication compliance, after all, and for most people, updating their PHR would be no harder than taking a pill.

In the past, I’ve scoffed mightily at online schemes which reward people for participating in communities, filling out forms or otherwise doing what they’re told.  After all, why should anyone care if a site names them an “explorer” or a “champion” or a “grand poobah”?  But there I am, getting psyched when Shopkick promotes me from level 3 to level 4.  Hey, I can’t help it — every time you level up you get such a cute little chime and a big green bubble to pop…  (Yes, I am otherwise a mature, responsible adult.)

But I’m being taught, by playing with this app, that rewarding people — even with very small incentives — can do an amazing job of getting them to repeat behavior.  Offer patients relevant reinforcement and patients are likely to take the PHR maintenance job more seriously.   What if, for example, a health plan teamed up with a pharmacy retailer to offer discounts on products if patients maintained their data? It could be huge.

But don’t make the rewards too exciting. Hey, you might have to keep releasing new, updated versions of your gaming system to satisfy fans.

The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician’s workflow. The EHR has the ability to generate a complete record of a clinical patient encounter – as well as supporting other care-related activities directly or indirectly via interface – including evidence-based decision support, quality management, and outcomes reporting.

An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital and doctor’s surgery. Electronic medical records tend to be a part of a local stand-alone health information system that allows storage, retrieval and modification of records.

So, there you have ‘em — the two major terms that compete for attention in our business.  The top definition comes from HIMSS and the second, from Wikipedia.

In the circles where I travel, “EMR” and “EHR” are used interchangeably, but not everyone agrees they should be.  In my mind, for example, the two terms shouldn’t exist — only EMR does the trick.

Why?  To my knowledge, the term “medical record” has a widely-accepted definition, but the term “health record” has no formal place in medical care. And there’s no reason to toss an imprecisely-defined term into the mix when we’re struggling to define so much about digital healthcare. (For what it’s worth, Wikipedia defines the EHR as an “evolving concept.”)

Good Lord, toss in the even more poorly defined term “PHR” and you’ve officially created a conceptual traffic loop which could create traffic crashes for years to come.

But  I know not everyone cares about terminology the way a slightly-obsessed editor does.  What do you folks think?  Do you care which acronym the industry uses?  Does it matter?

Recently, I wrote a piece for this blog arguing that the PHR model was at a turning point — and didn’t hide my doubts that this approach had much of a future.

In response, one of our readers was kind enough to tip us off to a massive PHR project which had never shown up on my radar. Apparently, the Australian government is well into building the infrastructure to support a nationally-available PCEHR (personally controlled electronic health record).

The $467 million project, which is undergoing its second wave of testing and development, will make PCEHRs available to consumers by July 1, 2012.  Nine sites are running related projects, including:

*   A system making prescribing and dispensing data available to 2 million citizens and their providers

*   A project targeting data sharing among palliative care patients and clinicians

*   A site focused on improved health for a population of about 9,000 mothers and newborns

*   A consumer-oriented portal, serving chronically-ill patients, integrating patient-entered medical data into a “Health Book”

The PCEHR project comes as Australian health officials undertake a package of national health reforms, including efforts to increase access to primary care and a $20 billion investment in improving public hospitals.

While I still doubt that the current US approach to personal health records makes sense — who decided consumers would bother with a sort of “extra” set of records designed to make key data available in a poorly-defined emergency situation? — rolling out PHRs aggressively as a key component of a primary care-oriented national health reform makes a great deal of sense.

I’m eager to see how Aussie citizens respond next year when the PCEHR goes live.  If consumers are convinced that the personal record is the key to better health, I’m sure they’ll jump on board.

So,  Google is going through some internal upheaval as co-founder Larry Page prepares to take over the reigns as CEO.  According to an piece appearing in today’s Wall Street Journal, Page is aggressively reviewing existing projects and is likely to take an axe to those that don’t seem to be working. Does it surprise any of you that one of the programs facing cutbacks may be Google Health and its faltering PHR?

As HIT expert Shahid Shah notes, Google has created some decent PHR technology — but despite having a vast reach and rich resources, hasn’t figured out how to grow its user community.  Even with its massive bank account, I’m not surprised to see that it hasn’t turned healthcare into a major income source. Google just isn’t that great at going outside of its box.

Then, consider that Microsoft doesn’t seem to be pushing Health Vault very hard these days, and you’ve got to wonder whether the whole “massive tech company builds PHR” thing can possibly work.   Yes, I realize I might get flamed by Microsoft execs saying this, but let’s get real here.  Microsoft isn’t great at connecting to markets it doesn’t monopolize either.

Oh the other hand, evidence is mounting that PHRs may be popular when driven by a provider and its own EMR.  Perhaps the highest-profile example of this may be Kaiser Permanente’s EMR/PHR ecosystem.  Its “My Health Manager” PHR system is closely integrated with its Epic EMR installation and now has millions of users.

Why is Kaiser succeeding at generating PHR interest where Google has failed? It’s largely because rather than offering a mixed bag of apps and options, as tech vendors have been doing, My Health Manager allows patients to securely exchange messages with physicians, refill prescriptions, review test results and schedule medical appointments.  Patients aren’t being asked to become updater and curator of their medical information, but rather, to use it. This just makes sense.

As I see it, the whole notion of a PHR as a freestanding app is basically circling the drain.  Realistically, patients have little incentive to interact with their health data unless it has some immediate impact on their lives.  An EMR/PHR combination, on the other hand, has tremendous potential, as it connects patients to both their providers and their health data effectively.  If I were Microsoft or Google, I’d just throw in the towel at this point.

I found an interesting article on Fast Company talking about the Facebook for Patients. Of course, I’m a sucker for anything that says Facebook and patients, so I had to check it out.

Turns out the article talks about a new Medical Social Network from IBM. Officially it’s being called the IBM Patient Empowerment System. From the description, it’s an interesting mix of PHR functions where you record your health information, patient to patient interaction like PatientsLikeMe, patient to doctor interaction, and even FDA alerts and drug checking.

Of course, I wanted to try this IBM patient empowerment system out myself, but the article didn’t have a link to it. So, I headed to Google and found no website, but the first result was this video about the IBM PHR along with some press releases:

Pretty hard to judge a system if you can’t use it. Plus, it’s hard to interact with other patients if patients can’t find the portal.

I suspect that the reason I can’t find the portal is that it seems like they’re doing a beta test of the website with Gacheon University Gil Hospital in Korea. It doesn’t seem like they’ve opened up the system to everyone yet. It will be interesting to see if they continue to do a partner based approach for rolling out the IBM PHR or if they choose to open it up to anyone and everyone that wants to join.

I’d say the most controversial part of what they’re doing is probably the FDA alerts and drug checking. This tweet by Neil Versel, blogger at Meaningful Health IT news, describes why these types of alerts and information is going to require a change:

Attitude adjustment needed, stat! RT @amednews: Only 8% of doctors say online research done by patients is helpful http://bit.ly/g5Yrzq

March 12, 2011 7:15 am via ÜberSocialReplyRetweetFavorite

@nversel

Neil Versel

The challenge to doctors is whether IBM does it or someone else, the empowered patient is already happening. IBM’s Facebook for Patients is just one piece in the puzzle.

Tonight, I checked out the always-interesting #HITsm TweetChat, which attracted a nice group of informed HIT experts. (It takes place from 8PM to 9PM Central Time on Mondays — I highly recommend you attend sometime.)

While the conversation wandered, as professional chats always do, one theme that came up a few times was the importance of PHRs in the overall healthcare data picture. I watched with interest, since I’m a real PHR skeptic and wondered if anyone had a  breakthrough idea on the subject.

One poster — if I understood him correctly — noted that while he didn’t trust Google or Microsoft PHRs, he’d manage his own health data gladly if it was stored on a very secure, easy-to-populate tool like financial site Mint.com.  I thought this was a tremendously good idea.

For those who haven’t used it, Mint.com allows consumers to suck data from bank and credit card accounts, loans and more into a single interface, making it easy to check on and edit the data with a few clicks.  Not only that, it allows you to create analytical charts, monitor for problems and set goals.  Just imagine how useful those functions could be for personal health maintenance.

Having used Mint.com happily for my personal finances, I yearn for the day when health data is equally accessible and manageable.  It’s easy to imagine — though admittedly, a tall order technically — interesting consumers in building out PHRs if they had access to a simple interface and secure connections to all needed data.

Unfortunately, I don’t know of any PHR that’s quite this sophisticated. Is it time for Intuit (Mint’s owner) to go into the PHR business?