Google Health: Great idea, but scary as all get out

Google has launched its personal health portal, Google Health. It's a clear and straightforward hub where users can store their medical information, and look up information on conditions and medications relevant to them. See the video for the pitch from product manager Roni Zeiger, a physician who left his practice to run this project (although he still keeps his hand in, as it were, by doing urgent care medicine on weekends).

Google Health is an important initiative, if only because it shows users how completely broken medical record-keeping is right now. But this product comes with a warning label.

The good

If you want to track all the drugs you've been prescribed (and the ones you self-prescribe), all the medical diagnoses you've received, all the lab results done on you, it's a clean place to record that information. It does smart things with the data, too: if you look up drug that has a dangerous interaction with one that's already in your profile, Google Health will alert you.

Hardly anyone, of course, actually has all their medical records at hand, nor the time or expertise to enter in everything in their file accurately. The idea with Google Health is that you get the data from your medical providers--your doctors, your pharmacy, and your lab. Google has a few relationships with diagnostic (lab) companies, some pharmacies, and a few medical centers. But at the moment, chances are that your family physician is not in the system.

But assuming they get there, once you pull in your data, you'll be able to annotate or add to it as you wish. (But not modify it.) When you head off to another doctor or hospital, you can then give them your complete online record, saving time, money (in duplicated lab tests), and potentially your life (if there's data in there about prior conditions, allergies, etc.). This is exactly what a medical record is supposed to do for you already, but the portability of medical data has never been very good; Google is trying to fix that.

You'll also be able to push your medical data to services that analyze it for you. For example, there's a heart attack risk calculator from the American Heart Association, and pill-taking reminder service.

The platform is somewhat open: there's an API that developers can write to use the medical data that users open up to them. Zeiger joked with me that the "When am I going to die?" button will be added within days.

So what's not to love?

The worry

In a word: privacy. Google VP Marissa Mayer told a crowd of reporters that the health data is stored on new super-hardened servers. That's all well and good, but access to Google Health is via your standard Gmail/Google login, and plenty of people (like me until an hour ago) have old or weak passwords on their accounts. User security on this product is the weak link.

User-input data on conditions like allergies is good, but what you really want is to read in your physician's records.

More importantly is the relationship of online medical records to the elephant in the room: the insurance industry. Your insurance carrier likely holds more medical data about you than your doctor (whether it's accurate is another story). I do not expect that the carriers will open up their databases to consumers, since that would enable a level of scrutiny on bills that the companies so far have been able to brush off. It's telling that no insurance companies or HMOs are partners with Google on this project.

My bigger concern is that insurance carriers will begin to give financial benefits to patients and client companies if they allow data to go the other way: if patients grant carriers access to their online medical records. In the guise of keeping patients safe, that makes sense. But giving insurance companies access to detailed health profiles on all their clients also lets them mine the data, carve out small insurance groups, and selectively apply elevated rates to people who, through no fault of their own, are at greater risk of requiring insurance company payouts. I would not be surprised to see rate premiums lowered for people or groups who gave the carriers access to their data. But heed my warning on this: it's a trap.

Yes, I sound paranoid. But I think it's fair to say that consumers and health insurance companies have long been locked in an adversarial relationship in the U.S., and that the carriers will find a way to use the Google Health data to increase their profitability foremost. We can hold out hope that in doing so they also increase the level of patient care, but I wouldn't count on it.

Unproven results

I'm in favor of any product that helps patients understand health care in general and their own situation in particular, and Google Health is a great step in that direction. But due to the divisive economics of health care in our country, I can see this remedy having some nasty side effects.

See also: Microsoft HealthVault.

[TommyVallier]

I'm with you on the fear side.<br /><br />I'm in Canada, so a lot of the partnerships Google's made don't (At least for now) extend up here so I won't be able to take advantage of some of those anyway.<br /><br />It seems odd to me t put all of that info into Google's hands, though. Now, I'm not one to dis-trust Google completely - I have all of my email in their hands and (with rare exception) don't back it up. Same with my calendar. But I'd be wary of entering the more personal details like my history and medications I've taken and allergies. Heck, I got to the "height/gender/weight" page and chose not to enter my blood type.<br /><br />Don't get me wrong - the idea of keeping on top of your health is a good one, and I'm all for using web apps, sites and tools to make life easier, but this is one I'm not touching. I'll stick to - ahem - Googling my symptoms when I get sick.

[robstak]

Well, Rafe, while I don't entirely disagree with you that this might be a bad idea, I think we do differ as to the reason why...<br />As a doctor, I think I have a unique perspective on the topic. The problem *I* have with GH is that the patients would have easy access to their charts. Now, this might seem absurd, as in "it's my health information, not the doctor's", or "why am I so paternalistic?" There's good reason for that: the average American wouldn't understand their own chart and it's implications. That's why your doctor calls you with your test results instead of mailing them to you, so he or she can explain them in context and then answer any questions you might have. Sure, you can read all you want from WebMD and the like, but that wouldn?t even be the tip of the iceburg in all reality. Sure, you can get some results or you can take XRays to your doc, but access to your whole chart could be detrimental to your own care. For example, I just went through this with my own family. A family member was ill and I got a copy of some test results because her doc was a friend of mine. I naively told my family the results and they freaked out. Low potassium!! High creatinine!! What does that mean!? In reality the results weren't that abnormal at all, and were most likely just secondary to dehydration, but my family doesn't know that.<br />Also, by the looks of it, it seems Google Health gives you the option of filling in your own information. While that?s all and well, that can certainly be less than trustworthy when pertaining to personal information, and I?d certainly not want to read false or distracting information when making important medical decisions for a patient.<br />Finally, to address your point about heath insurance acquiring the information: certainly, they would only attempt to do it legitimately (ie no buying hacked information). Also, if patients are given the OPTION to share such information, maybe it would get people to take better care of themselves to save more money. Don?t get me wrong, this could go the other way too, but don?t forget that it is illegal to drop a patient?s coverage because they contract a disease or condition.<br />I think if GH really takes off, it will have to be overseen by some group, either the government or some kind of medical professional oversight, or it needs to be changed as currently planned. It seems in keeping with Google?s mission statement, but these are far more dangerous waters than taking candid pictures of people in street-view. I guess we?ll see?<br />PS1: when I log into my hospital's EMR program, I can't even look at my own chart, and I am pretty well-versed in interpreting health information.<br />PS2: There's a decent, albiet kinda snarky blog about the topic here: <a class="jive-link-external" href="http://www.grahamazon.com/2007/08/patients-should-not-control-their-medical-record/" target="_newWindow">http://www.grahamazon.com/2007/08/patients-should-not-control-their-medical-record/</a>

[brecklundin]

wow....not like you don't have a vested interest in siding with the DrugCo's &#38; InsuranceCo's to keep prices high, huh? Gimme a break...and keep your nanny big brother I know what is good for you crap to yourself...cannot wait for you family to fall into the target groups who cannot get insurance because they had the sniffles once...or, heaven forbid an xray.

[adammetz]

Rafe, normally I sorta think you're a nervous Nellie, but on privacy issues, I think you generally toe the line of sanity. That said, the insurance angle on this Google Health product is scary as ****. Good call, especially the last part of the story.

[jbhsieh]

Rarely am I a skeptic of anything from the Google camp. I am sure based on my clickstream today, they can already put together a pretty darn good profile of my health record/conditions. For example, they probably know what phsycians, specialists, conditions I have searched for. However, explicitly handing Google my health information seems to cross that invisible/moving line. Plus, a gurantee from Google regarding privacy does not solve the issue. Just think of how many letters you get in a year from your Credit Card company alerting you to privacy/policy changes. Corporate policy can and will change to benefit the CORPORATION (as it should)..

[AppleSuxLeo]

Our colonoscopies , CT and MRI results would end up on YouTube...Then YouTube would have to be re-named SueTube !<br />And this just in...Mary Jo Kopechne is eating Fat-Fart Ted`s brain. <br />Payback is a BIOTCH !!

[bopster]

Apparently, even those who spend their entire lives doing exceptionally good things for other people---with no possible expectation of any remotely commensurate reward---are still considered fair game whenever some petty loudmouth requires a forum for displaying impertinence Does anyone from c|net actually monitor these posts for relevance or even decency? <br /><br />"The posting of advertisements, profanity, or personal attacks is prohibited." (sic)<br /><br />People make mistakes. Sometimes very serious ones. Occasionally, they learn from them. Sometimes, they even atone for them. Anyone who has done such incalculable good for so many people for so many years---even if he is a public figure---is surely not an appropriate target for the petty, vindictive ranting of someone who has obviously confused himself with a recalcitrant bull terrier. <br /><br />Perhaps AppleSuxLeo is unable to pass a single trouser cuff without clamping his jaws around it and growling and gnawing himself into a state of complete insensibility; perhaps he has never done anything stupid or irresponsible himself. Surely, those who are utterly without sin must feel themselves as completely at ease with stone-throwing as this fellow apparently does when it comes to venomous muckraking about a very serious tragedy that occurred so very long ago. <br /><br />Give it a rest, Leo, and try, if you can, to stay sufficiently focused to contribute something relevant. Despite your obvious enthrallment with your capacity for word play, your readers remain unimpressed with your wit.

[croquethed]

I had occasion to talk to a Canadian healthcare IT exec, and he told me experts and laymen alike up there are looking at the privacy concerns down here as red herrings. They expect a certain amount of security as a given; they also do not have the fear of an insurance industry that can deny them coverage for pre-existing conditions (one egalitarian benefit of single-payer government healthcare). So I see this technology as a wedge for universal coverage, which is long overdue in the US.<br /><br />To the doctor who left his comment that patients should not see all their records: Sorry, Doc. The good old days of "doctor's orders" are ridin' into the sunset. It is OUR data, and it will be the job of the clinician to help us interpret it, not to keep the secret decoder key from us. <br /><br />If the healthcare industry had wanted to put its money where its mouth was in terms of "the patient comes first," they would have come up with something like this long before Google Health and HealthVault. Instead, we have had years of proprietary formats, expensive systems, and pie-eyed office staff who insist that we "fill out this form" every time we go to a different office, even if that office is in the same practice as the last office we went to.<br /><br />Viva la revolucion.

[harpic04]

Is this a world wide application?

[PIRASF]

[dolansc]

This highlights the biggest issue with Google Health and Microsoft Healthvault. Neither is HIPAA compliant.

[jengilburg]

Completely agree with your concerns. See my blog posting several months ago when Google initially announced this.<br /><br /><a class="jive-link-external" href="http://blogs.verisign.com/identity/2008/02/security_of_online_medical_rec.php" target="_newWindow">http://blogs.verisign.com/identity/2008/02/security_of_online_medical_rec.php</a><br /><br />Beyond the obvious privacy issues- with all the uninsured Americans out there- easy access to medical information creates a huge opportunity for fraud. When was the last time your doctor or pharmacy asked for identification? <br /><br />There are solutions out there (again see my blog :) but Google and Microsoft tell us they are not hearing the security concern arise from their installed base. <br /><br />Hmmmmm.

[mickeyhansen1949]

what about small towns? how are doctors going to go on line? i like haveing the part about the drugs and interaction and what the drugs are,and talking to drs in general as not necessarly your dr but to ask other drs questions on your condition I have MS and i always want down to earth answers i can understand.<br />mh

[Jalice888]

Ignorance is such a '*****"<br />Obviously this is more help to drug companies while the utter ignorance that drugs are 'Lethal Dose 50' tested to guarantee death eventually to anyone while natural products rarely kill anyone at all. Glyconutrients could help in so many disease treatments alongside such help as Chemotherapy and Radiation treatment against cancer cells and yet this is hidden from public knowledge as Drug Companies are still trying to make a synthetic equivalent that, like all their others, is so much less effective than NATURES OWN REMEDIES but it is only the profit that Drug Companies truely care about.<br /> This idea will only lead to the DRUG COMPANIES taking the site over in the background then continuing to falsely use this data to sell even more un-needed drugs when they already sell over 90% of drugs that are not required at all. Add to this the increase in false drugs made by pirate companies and watch how bad health is rapidly increasing everywhere in the world.<br />This idea while in simple thoughts will destroy health even more - put pressure on drug companies to tow the line of 'Health Care' instead of just profit making and wake people to natural health or don't even start such an idea!!!

[sallyanon]

As someone who has had a chronic illness for 20 years I know way more about it than most doctors, they have often wasted my time asking the same old questions and patronised me. This tool should help,IF used carefully - I intend to import a copy of my medical records but not let any drs export or edit them without my say. So for me it's a personal health record I'll be able to show any Dr in any country.<br />I'm all signed up, but no surname or identifying email address ;)<br />And being Uk not USA I don't need to worry about Insurance co.s - Can't blame uninsured U.S folk for not signing up.