The Impact of Google Health on Healthcare

1. The Impact of Google Health on Healthcare Med Info 401 – Winter 2009

2. Team Members • Chad Hodge • Nadine Lewis • Michael Lim • Jennifer Linton

3. Agenda • Introduction (Michael) • PHR Background (Michael) • Google Health (Michael) • Google Health’s Impact On Technology (Chad) • Google Health’s Impact On User’s (Jennifer) • Google Health’s Impact On Clinicians (Nadine) • Conclusion (All)

4. Introduction • Google is widely regarded as the world’s most successful Internet company • Entered the Healthcare market in 2006 - Google Health • May 2008, Google Health (Beta Version) is released • Google brings its strengths in ease of use, simplicity, information organization, information availability, and no cost philosophy • Competitor PHRs: Microsoft and WebMD.

5. PHR Background • A Personal Health Record (PHR) is any device that allows users to store medical information and history about themselves. • 4 basic types of PHRs: paper based, computer based, Internet based and portable storage based. • New Definition: an electronic application through which individuals are able to access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment.

6. PHR vs EHR • PHRs should not be confused with an Electronic Health Record (EHR). • An EHR is an electronic version of the patient medical record kept by doctors and hospitals. • The data in the EHR are controlled by and intended for use by medical providers.

7. PHR vs EHR Potential Savings • It is estimated that personal health records could save the U.S. health care system more than $19 billion annually after expenses with an initial start up cost of $3.7 billion to provide interoperable PHRs to 80% of the population. • Compared to EHRs, estimated cost to implement EHR - $28 billion per year during a ten-year deployment, $16 billion per year thereafter with a potential fifteen year cumulative savings of $142-$371 billion. [1] • [1] http://www.eecs.harvard.edu/cs199r/readings/RAND_benefits.pdf page 12

8. PHR vs EHR - 15 year Potential Savings PHR – 15 year savings $315 billion PHR – 15 year costs $33.7 billion EHR – 15 year savings $142-$371 billion EHR – 15 year costs $360 billion

9. PHR Information • Name and birth date* • A list of emergency contacts * • Contact information for all healthcare providers, such as your family’s dentist and medical specialists* • Health insurance information • Living wills, advance directives or medical power of attorney • Organ donor status • Dated list of significant illnesses, hospitalizations and surgical procedures * • A list of your current medications and dosages * • Dated list of immunizations for patient and patient’s family members* • Lab test results* • Plan for managing diseases/conditions over time* • A record of key health statistics like weight, blood pressure, cholesterol, glucose, etc. * • Allergies or sensitivities to drugs or materials such as latex * • Important health and family events, dates and medical conditions in the patient’s family history • Summaries of medical office visits * • Specialists’ medical opinions • Vision, eye and dental records • Correspondence, such as letters and e-mails, between the patient and their provider(s)‏ • Educational materials or sources, relating to the patient’s health * • Spiritual affiliation and considerations affecting the patient’s care • Lifestyle factors such as exercise, diet, supplements/herbal medications* the patient takes and any counseling patient may receive *Currently available in Google Health

10. PHR Benefits • aids in educated discussions about health with healthcare providers • securely share individual health information to someone who needs it, like a new caregiver • manage the health information of family members • effectively manage chronic disease(s) • better coordinate care with your various health care providers to improve efficiency, quality and safety of the care received • access health information while traveling, during events like a natural disaster or another emergency situation • retrieve health information instantly and securely 24 hours a day • measure progress towards specific personal health goals • maintain healthcare provider’s instructions, summaries of your medical visits, allergy information and status of insurance claims • track prescription medication dosages, instructions, and actual usage • track appointments, vaccinations and other wellness healthcare services

11. PHR Architecture • Provider-tethered PHRs are tied to a healthcare organization’s internal record system. Estimated annual savings of $13 billion. • Payer-tethered systems are tied to a given payer’s system. Estimated annual savings of $14 billion. • Third-party PHRs can be used to aggregate data from different, unconnected sources. This type can lead to great cost savings as user's are relied on to enter information from all their care providers. Estimated annual savings of $16 billion. • Interoperable PHRs represents the future, with ability to connect to and download data from all regional data sources such as EHRs and other PHRs via standards-based automated data exchange, leading to a record that is more complete than any non-integrated repository. Estimated annual savings of $21 billion. • Google Health currently falls between the third-party PHR and the interoperable PHR.

12. Google Health • Currently users of Google Health can: • Build online health profiles • Import medical records from hospitals and pharmacies • Allscripts ePrescribe, Beth Israel Deaconess Medical Center, Blue Cross Blue Shield of MA, Cleveland Clinic MyChart, CVS Caremark, CVS Pharmacy, Drug Fair, Longs Drug Stores, Medco, Meijer Pharmacy, MinuteClinic-CVS, Quest Diagnostics, RxAmerica, Walgreens Pharmacy • Learn about health issues and find helpful resources • Search for doctors and hospitals • Connect to online health services • Blueprint for Wellness, Cleveland Clinic MyConsult, DestinationRx, ePillBox.info, MedNotes by Drugs.com, Patient Assistance, SafeMed, webLab, Trialx.org

13. Impact on IT - Data • My experience • Roles • Data Provider • Data Consumer (Service)‏ • Either role needs to understand how/what data is stored • CCR (Continuity of Care Record)‏ • Analogous to HL7 (Health Level 7)‏ • Only uses a small subset of overall standard • Created by ASTM - American Society for Testing and Materials and many provider groups.

14. Impact on IT - Data <Alerts> <Alert> <DateTime> <Type><Text>Start date</Text></Type> <ExactDateTime>2000-04-04T07:00:00Z</ExactDateTime> </DateTime> <Status> <Text>Inactive</Text> </Status> <Source> <Actor> <ActorID>Cecil Baker</ActorID> </Actor> <ActorRole>Treating clinician</ActorRole> </Source> <Description> <Text>Egg</Text> </Description> <Reaction> <Severity> <Text>Severe</Text> </Severity> </Reaction> </Alert> </Alerts> • Medications: RxNorm, NDC, FDB • Conditions and symptoms: SNOMEDCT, ICD9, FDB • Procedures: CPT, SNOMEDCT • Allergies: SNOMEDCT • Immunizations: CPT • Lab test: LOINC, CPT, SNOMED* *http://code.google.com/apis/health/ccrg_reference.html#ccrgreference

15. Impact on IT - Security • Health data will not be returned in web searches • User concerns over discrimination based on exposed personal health data. Employers and insurers. • User has to seek out people to get or use their data. These services are not pushed to them. • Only able to use services listed on Google Health service directory, which screens and validates services before listed. • Break a link with a service or data provider at any time. • Data secured with SSL, access tokens, and x-509 certificates.

16. Impact on IT - API • Application Programming Interface (API)‏ • Tool used by programmers to extend functionality to an existing program. • Supports .NET, and Java • Can read users health profile, submit notices or CCR to profile, and can delete entries in profile. • In Beta state, and fluctuates weekly. • Forums to ask and answer questions, as well as to grab latest binaries, and watch videos for help.

17. Impact on IT - Services • Ability to send your medical profile to another physician for a second opinion, or to a physician as part of a new patient process are core to what a PHR is made to do. • Google itself only allows for you to print your records out. • Must use a third-party service to do so electronically. • Many wellness center sites that read your own profile, and tailor their site to fit your conditions and history. • No way to attach images or documents, so a little lacking. No X-Rays, no PDF’s, or other types

18. User Scenario • Elderly population is growing • The need for caretakers continues to increase. • The need for caretakers to have a central location to record information (such as history, medication, conditions, medical contacts, etc.) is highly needed. • A daughter keeps track of her parent’s information because she is their power of attorney • She currently keeps the hard copy of information in four3-ring binders. (paper based PHR)‏ • There is no disaster recovery for the records and longer time to find the information needed for clinical visits. • Harvey (90 yrs. old) and Doreen (87 yrs. old)‏

19. User Study Observations Enter Conditions or Symptoms Screen Edit Medication Details Screens

20. User Study Observations (continued)‏ Medication List Screen Profile Details Screen

21. User Study Observations (continued)‏ Edit Condition Details Screens Medical Contacts Screen

22. User Study Observations (continued)‏ Example of the User’s Wallet-sized Card Example of the User’s Full Summary Print Out

23. User Study Findings/Recommendations Capabilities that the user liked: • drop down selection menus for medications to indicate “How to take,” the dosage, and frequency • notes fields in the medication details and condition details • alphabetized medications list for easy reference • formatted the notes in the conditions and medications sections to easily see them under each diagnosis • liked the ability to click on the link for a map to each medical contact’s office location • ability to create a new profile

24. User Study Findings/Recommendations Features the user would like to have available: • compare the cost of different medicines • edit the medication name after it has been entered • provide a way to enter new weights after each doctor’s visit and then be able to somehow graph the weight gain and loss differences • the need to use the calendar function each time she had to enter the Start Date and End Date was not helpful • structure the notes in the conditions section into multiple sections to record the physician’s diagnosis and another to record the recommended treatment plan for quicker look up rather than having to read through the notes each time to decipher the treatment plan • there was a column to indicate the name for the “Treated by” healthcare provider, but there was nowhere to actually enter this information into the condition details window • separate section in the medical contacts to add the web site for each contact • ability to create a new profile that links to an existing profile • create links and share profiles between different individuals

25. Conclusion • Meets the 7 attributes of a PHR as defined by the Personal Health Working Group (2003)‏ • Each person control his or her own PHR. Individuals decide which parts of their PHR can be accessed, by whom and for how long. • Contain information from one’s entire lifetime. • Contain information from healthcare providers.* • Accessible from any place at any time • Private and secure • Information is “transparent.” Individuals can see who entered each piece of data, where it was transferred from and who has viewed it. • Permit each exchange of information with other health information systems and health professionals.* * currently limited

26. Impact on IT - Conclusions • There are many players in the PHR space, Google Health being the one we examined. • Large players such as Google will help it to catch on • CCR is not as widespread as HL7. • Patients with better knowledge about their health. • Burden to providers or hospitals to be able to accept or send this type of data. • Must already be digitized (EMR)‏ • Alter processes • Potentially different format.

27. Google Health’s Impact on Users Benefits • The user found the ability to record all of this information in one single location very helpful (No 3-ring binders are necessary)‏ • Google Health provides the majority of features any PHR system should (note: more improvement is needed however)‏ • Helps users be more educated and take ownership in keeping track of their own health and records Concerns • Users feel overwhelmed with this newfound responsibility of keeping track of their personal information • Users hold legitimate concerns about the privacy and use of their electronic personal data

28. Conclusion Other Impacts Potential to be the largest source of patient health information on earth. Researchers would be able to study “live” data instead of data that was several weeks to several months old. For Example, Google recently released its flu tracking data which showed they were accurately able to determine flu activity across the country two weeks before the CDC. This could allow Public Health teams to react quickly to outbreaks. Savings Impact $21 billion in potential annual cost savings from use of interoperable PHRs Can be implemented to 80% of the population for $3.7 billion. Therefore the potential impact of Google Health is affordable, welcomed and needed in today’s healthcare landscape.

29. The Impact of Google Health on Healthcare Questions?