Comments on: Microsoft, Google in healthy competition

The rivals extend their tech battle into Web-based personal health records, an area in which they are both upstarts.

[doublebullout]

deBronkart's comment: "In other words, the data that arrived in Google Health was essentially unusable," deBronkart wrote. "And now I'm seeing why, on every visit, they make me restate all my current medications and allergies: maybe they know the data in their system might not be reliable."

This has nothing whatsoever to do with the provider's confidence in the quality of their data. Medication reconciliation -- going over your meds again at every visit -- is required by many organizations that produce care quality standards, including CMS and Joint Commission. It's also prudent medical practice to review meds and allergies at every visit in order to prevent medication errors.

[ePatientDave]

Thanks, doublebullout - believe it or not, you're the first one who's pointed out that going over meds at every visit is required by care quality organizations. (I'm the guy who wrote that.)

My next question would be, isn't it pathetic (really) that healthcare industry practices would be so unreliable that this would be widely recognized as an important thing to do?

My next observation would be that when I report a change in my meds, it doesn't always end up in the system. (Same for the missing allergy that I reported many times without it getting into the system.)

Increasingly my conclusion is that the healthcare industry needs some serious lessons in the grade-school fundamentals of information management and modern processes. To me the oddest thing of all is that while doctors almost EVERYwhere were stunned to hear that a hospital thought billing data would be reliable (one commented "God help us all"), the hospital itself apparently thought it was perfectly fine. In my experience, this only happens when people hook up a "data pipe" and open the valves without having ever tested it with THEIR OWN real-world production data.

And THAT is scary. I mean, that's just silly.

Cnet is an IT-oriented site. I hope IT-oriented readers will break through their disbelief and realize yeah, it really is as bad as it looks. There are over 2,000 hits right now if you google "debronkart google health" and about the most accurate one was on the <a href="http://www.iqtrainwrecks.com/2009/04/15/google-health-dead-on-arrival-due-to-duff-data-quality/">Information Quality Trainwrecks</a> blog.

If the IT grown-ups don't get involved, then all the money we spend to move to EMRs will produce automated chaos and people will think it's the technology's fault. That's no more valid than thinking auto fatalities are evidence that cars are a bad idea. Cars used well are beneficial; cars used badly can kill. IT too.

[kt9]

It's nice that the above poster is so omnicient that he can categorically state this has nothing to do with the provider's confidence in the quality of their data.Going over meds and allergies has the dual advantage of catching errors in previous data. Hello.

[ePatientDave]

I continue to wonder why people keep suggesting that Google is to fault for the bogus data that a hospital sent them.

Seriously, all Google did was accept the data that my hospital sent them.

Once the problem was recognized, both the hospital and Google moved rapidly to do the sensible thing. Others have told me that billing data can indeed be useful, but I'm here to tell ya, it can contain garbage.

btw, before anyone comments on what I wrote, I urge them to read what I wrote, not just what others have written about my case. The original post is here http://is.gd/q6t2, and the follow-up with the rest of my errors is here http://is.gd/tnsD.

I wish I'd been contacted about this. I could have added depth to the discussion. For instance, the aneurysm entry turned out to be not what it looked like on the surface; my second post gave the details:

"441.2 Thoracic Aortic Aneurysm (9/10/07) ... the radiology report for this CT scan does say the aorta measured 43×43mm, which is <1/8? larger than the normal limit of 40×40. Billing data cannot convey those details, so when 'aneurysm' showed up in Google Health, it looked like something very different."

and

"Three months later the radiologist?s report said 'The heart, great vessels and pericardium are unremarkable,' but there was still a (different) billing code for aneurysm."

This series seems to be approaching the business aspect of the story, not the medical aspect. That's fine, but as with any new technology, I think it's important to understand what does and doesn't work. Otherwise there's not much hope of accurately predicting whose solution is gonna have legs.

[Ina Fried]

Thanks for adding to the discussion, Dave. I've already been in touch with him so that we can add more of his thoughts and experiences to our ongoing coverage. -Ina

[John_ChilmarkResearch]

Currently, the big competitor to both Google and Microsoft's efforts is simply consumer apathy. If one looks closely at the market, today we have PHR adoption at about 3.5% nationally and among those that do use a PHR, vast majority (over two thirds) are those using PHRs offered by a hospital which is most often little more than a portal to their records that offers very little if any control to the consumer.

Then there s the whole issue of physician adoption and use, an issue this article fails to mention. A PHR may provide some benefit to the consumer by assisting them in aggregating their records, but what good is that if physicians refuse to review them as part of their care practice/interaction with the consumer?

And least we forget, there is currently very little data/records in a digital construct that is actually useful, another issue this article fails to address, other than of course the "bad administrative data" that came out of Beth Israel.

Yes, security and privacy is of concern but these two issues pale in comparison to the above issues I raise that will truly hinder adoption and use of PHR technology.

BTW, Microsoft's HeathVault is NOT a PHR, it is a platform, more of a "Cloud" construct upon which other apps, including PHRs can tap the data stored therein when invoked by a consumer. Also, last I knew, Revolution Health went belly-up, no big deal, their PHR was extremely weak.

[jl747]

Quicken is also trying their hand in this market.
It would be nice if they would or could improve Quicken before expanding to something else.
Quality of Quicken has not been up to par for the last few years. So why would I trust them.
The same goes for Microsoft.

How do you trust a company who has to update their product once a month?