The U.S. health-care system is the most costly in the world. Yet it's also remarkably antiquated. The medical records of as many as 90% of patients are hidden away in old-fashioned filing cabinets in doctors' offices. Prescriptions are scribbled on paper. Most Americans need to fill out separate medical histories for each specialist they visit.
"We are trained, like Pavlov's dogs, to repeat the same information 17 times," says Scott Wallace, chief executive officer of the National Alliance for Health Information Technology, a not-for-profit alliance of health care providers, information technology vendors, and health and technology associations. The result: mistakes, duplicated tests, botched diagnoses, and billions of dollars in unnecessary costs and lost productivity.
Many providers, including Kaiser Permanente and Cleveland Clinic, have invested millions of dollars in information technology systems and creating electronic medical records for patients. Here's the rub: Much of that information can't be shared from one doctor or hospital to the next. As a result, blood-test results in the database of an Arizona doctor, for instance, are of little use when the patient is visiting a doctor halfway across the country.
Linking systems "is the real challenge in this industry," says Dr. C. Martin Harris, chief information officer at the Cleveland Clinic.
Pilot Project Kicks Off
In an effort to meet that challenge, the Cleveland Clinic and Google on Feb. 21 announced a project to give patients and doctors better access to electronic medical records. "It is clear that one of the big needs is assembling health records from a variety of places and giving people control of those records," explains Marissa Mayer, vice-president for search products and user experience at Google. And while the Cleveland/Google project may revolutionize medical record-keeping and improve how hospitals and physicians provide care, it also raises concerns over patient privacy and the security of sensitive information.
Here's how the pilot project, officially begun on Feb. 18, works. 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.
The system is still fairly primitive compared with sophisticated electronic information-sharing systems such as an ATM network. The information being shared is limited to data on allergies, medications, and lab results. That's because this data is more easily put in a standard form that can be read by different computer systems.
Paring Health-Care Costs
For the health-care system as a whole, though, it's an important move forward.
"What Martin [Harris] has done is revolutionary," says Wallace of the National Alliance for Health Information Technology. "It may not be the perfect solution, but it is a better solution than we have now." Over time, more information can be added, and more patients and doctors will be able to access the records. And if the pilot program works, Google intends to roll out a comparable service for the general public.
One payoff: cutting health-care costs. "There's a real potential to affect the slope of the health-care cost curve," Harris says. "I believe this kind of exchange is the way we will get the total value out of an electronic medical record."
Projects like the one started by Cleveland and Google could also have big implications for business. Companies want employees to take greater charge of their health care. Experts say employees can do a better job of that by gaining control over-and access to-records, and that they'll get a leg up, technology-wise, from the participation of such players as Google and Microsoft . "I think Google is spectacular on this," Wallace says. "Health care is a mainstream issue, and getting the purveyors of information involved in this is a brilliant step."
What's In It for Google?
How the e-health program plays out for Google is less clear. Mountain View (Calif.)-based Google is not the first high-tech giant to dip a toe into health care. Microsoft, for example, launched a health records and information service, HealthVault, in October (BusinessWeek.com, 10/4/07). The company has more than 100 partners including the Mayo Clinic, a nonprofit medical practice and large online health-information network, and hopes to use its large health software business to help bring new players on board.
On Feb. 20, the company released source code to help outside organizations and developers integrate their information and build programs around the HealthVault platform. "We think that we are the best health search out there, and we think more and more we are going to convince people of that," Sean Nolan, HealthVault's chief architect.
Being late to the game has hurt Google in the past. The company's finance site, launched May, 2006, has failed to gain much traction. It ranks 16th in the business information category of Hitwise, a company that measures Web traffic. Yahoo's much older finance site has remained No. 1 for much of the past three years. Similarly, Google's payment service Google Checkout, launched in June, 2006, has failed to grab market share from eBay's leading payments service, PayPal .
Thorny Privacy Issues
When it comes to online health information, the obvious prize is the estimated $500 million to $1 billion health search advertising. Google won't admit to aiming for that market, though, and those familiar with the project suggest revenue could come from other sources. "They aren't wedded to advertising," Wallace says. "Their attitude is that this is such a nascent area, they can play around for a while and find a way to make huge amounts of money." It's not yet clear how that might happen. "The unanswered question is what is the business model that justifies the investment of these big players," says David Lansky, senior director of the health program at the John and Mary R. Markle Foundation, a nonprofit dedicated to improving information technology in health care.
One worry is that the companies might be tempted to sell personal information. While strict laws govern patient privacy at hospitals and health-care providers, "there is no federal regulation of what these middle-layer players can do with your data," Lansky explains. And while consumers might trust Google or Microsoft now, what might happen in years or decades? "This is deeply personal information that is being collected about you and your family," says Jeff Chester, executive director of the Center for Digital Democracy. "There is unease about marketers being able to access that vast range of information."
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