Webware

Updated March 5 at 10 a.m. to clarify link policy, and at 12:20 p.m. to address privacy concerns.

Google Health has introduced a new feature that lets people share their online health records with designated doctors, friends, and family members.

Google said the move is in response to people's concerns that caregivers and loved ones might not be up-to-date on all the details of a patient's health situation, especially in the event of an emergency.

Google Health now lets people share medical information online with caregivers and loved ones.

(Credit: Google)

Sameer Samat, director of product management at Google, explained his personal impetus behind the new feature in a company blog post on Wednesday:

Just a few years ago, my father suffered a minor heart attack and was sent to the ER. I arrived on the scene in a panic, and was asked what medications he was taking. To my surprise, I had no clue. If my father had a Google Health account, and had shared his profile with me, I would have been up-to-date on his current medications.

Along with the sharing feature, Google added a graphing feature that lets people enter lab results and visually track trends in their medical test results, such as their cholesterol levels.

Google Health also lets people create graphs to track trends in their medical test results.

(Credit: Google)

Recognizing the sensitive nature of sharing health records, Google said it has built in several security measures to preserve privacy. Users choose who can view their histories, and the link to the patient's profile will work only in connection with those people's e-mail addresses--meaning the link won't work if it is forwarded to a third party. Users can also decide what information they want to share, and those allowed to view the profile will not have the ability to edit the data. Users will also be able to see exactly who has reviewed the profile.

However, one security measure that is a bit confusing is a feature that restricts the usability lifespan of the e-mailed link to only 30 days. Unless the user is diligent about regularly sending links to loved ones, this protection could negate the feature's value in the event of an emergency. While this was initially interpreted by some to refer to a continuous process of sending e-mail links to partners, it apparently applies only to the initial invitation.

Google also announced a feature that lets users print wallet- and letter-size hard copies of their profile, including medications, allergies, conditions, and treatments. But the value of these printouts may be questionable if they are not updated regularly.

Users concerned with privacy should also note that Google Health isn't regulated by the Health Insurance Portability and Accountability Act, a federal law designed to protect patients' privacy. Google also admits that some employees will have access to users' records.

"Within Google, only the people who are operating and improving Google Health have access to user information, and they are bound by strict policies to not disclose this information to others, either within Google or to the outside world," Google said in a help page.

Google Health, which is dedicated to the digitization of health records, launched in May 2007. Microsoft has also planned a medical records service called HealthVault. President Obama, meanwhile, has made it clear that he plans to make digital health records part of his health care reform agenda.

It's going to get easier for Google to keep tabs on your health.

The ubiquitous tech conglomerate has signed on to a new software product created by IBM with help from the Continua Health Alliance, an organization that promotes interoperability of medical devices. It'll take data from personal health monitoring devices, like blood sugar meters for diabetics, and share that directly with the patient in question's Google Health file (and the patient's physician, if he or she uses Google Health as well).

Other personal health record (PHR) services will also be able to use the IBM software, which was built partially on open-source standards.

"Our partnership with IBM will help both providers and users gain access to their device data in a highly simplified and automated fashion," Google Health director Sameer Samat said in a release. "IBM has taken an important step in providing software that enables device manufacturers and hospitals to easily upload recorded data into a PHR platform, such as Google Health."

Google Health, dedicated to the digitization of health records, launched in May. Microsoft has also planned a medical records service called HealthVault. President Barack Obama, meanwhile, has made it clear that he plans to make digital health records part of his health care reform agenda.

Google has brought seven new languages to its Google Translate service. According to the company, Albanian, Estonian, Galician, Hungarian, Maltese, Thai, and Turkish have been added. The company also announced that its English dictionary has been improved to "include synonyms, antonyms, pronunciations, detailed definitions, and examples from Collins COBUILD Advanced Learner's English Dictionary." All its new features are available now.

User Centric, a company that researches user experiences, announced Monday that it has concluded its usability study of Google Health and Microsoft HealthVault. According to its findings, which took opinions from 30 participants who were asked to complete seven basic tasks on each site, users preferred Google Health over Microsoft HealthVault, even though both services were plagued with flaws. Participants claim Google Health is more usable thanks to better navigation and simpler data entry. Microsoft HealthVault received low marks from participants due to its overabundant use of medical terms the participants didn't understand.

TVtrip, a company that provides video reviews of hotels around the world, has secured approximately $9 million in venture funding, the company said Monday. Balderton Capital and Partech International led the round. The company, which claims it has over 9,800 video reviews on its site, will use the funding to expand its presence online.

Travel company, Travelzoo, acquired the Fly.com domain for $1.8 million The company is using the domain to launch a new travel itinerary search that it claims, will offer better travel options than it has in the past. The search is free and available now.

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.

Update 4:20 p.m.: I added some more detail and comment. Update 12:50 p.m. PDT: I added more detail.

MOUNTAIN VIEW, Calif.--Google on Monday launched a beta test of its Google Health service to archive medical records and find medical services.

The site is a personal portal that can be used to upload, store, and view personal information, retrieve records from partners, investigate health matters, set alerts such as a reminder to take medication, and run applications that can, for example, keep track of how many miles a person has walked.

Roni Zeiger shows off the beta debut of Google Health at Google headquarters.

(Credit: Stephen Shankland/CNET News.com)

In some areas, Google's expansion from just search takes on incumbent powers; Google Docs, for example, competes with Microsoft Office. But Google Health competes more with a tangled mess of regulatory and privacy complexity.

"Personal health records is an area that's just beginning," said Roni Zeiger, the Google Health product manager. "The fact that only few people are using those tools means we"--the computing and health care industries--"haven't gotten it right yet."

Google has been talking about the health initiative for a year. Now, "we actually have the product," said Marissa Mayer, vice president of search products and user experience. "You can sign up today. It is open to the public."

The service will never sell a patient's information and will only share it with the patient's permission, Zeiger said. And a user can revoke rights to share at any time.

"No Google Health user will ever find their Google Health information as search results anywhere on Google. That information is yours," Zeiger said.

To join, users must agree to various terms of use, including this: "When you provide your information through Google Health, you give Google a license to use and distribute it in connection with Google Health and other Google services."

Google Health is now live, in beta testing.

(Credit: Google)

Growing beyond Google's control?
Google has done well with privacy for Google Health, but there are larger issues that pose problems, said Leslie Harris, CEO of the Center for Democracy and Technology.

"I think Google's privacy policies are good and the fact that they are going to vet applications and services is also good," Harris said. But there are potential problems, too, if Google Health grows beyond Google's grasp.

"I think the biggest concern is about the applications and services that will ride on top of the service that Google will have only limited control over," Harris said. "The company has appropriately developed a set of rules for those providers and will screen them before they are allowed to offer services. Those rules require express user consent for any use or sharing. But it will be impossible for Google to monitor all the vendors closely over time."

And, she added, "Consumers are going to need to have a legal remedy for misuse of their personal health information." The Health Insurance Portability and Accountability Act (HIPAA) doesn't govern much of what Google itself does, and after that, the only recourse is trying to get the Federal Trade Commission to enforce companies' privacy policies.

Central copy of medical data
Google essentially creates a master record of an individual's health information by importing data from health-related institutions or by letting the individual add it themselves.

"Google on your behalf is storing a copy of your records," Zeiger said. Connections with medical organizations can be set to update regularly to stay up to date.

The service integrates with medical records already stored electronically at pharmacies including Walgreens, Medco, RxAmerica, and Longs Drugs; medical facilities such as Beth Israel Deaconess Medical Center and the Cleveland Clinic; Quest Diagnostics, which stores medical test results; and AllScripts, which stores medical records for more than 40,000 doctors. For importing doctor records from AllScripts, the doctor must approve the connection to Google Health, said AllScripts spokesman Todd Stein, but the company's software is enabled to make the link.

If a patient permits sharing, right now it's an all-or-nothing affair, Zeiger said, so if you want to share your data but keep information about a sexually transmitted disease secret, you'd best wait for now. Google is working on making a finer-grained permission system, Zeiger said.

Marissa Mayer, vice president of search products and user experience

(Credit: Stephen Shankland/CNET News.com)

For more details on regulatory issues, see Google's blog entry on privacy and data protection with Google Health.

Making money?
Google was mum on how exactly it hopes to make money from Google Health other than driving a bit more traffic to its search engine, which of course shows ads alongside search results, and in increasing the user loyalty--in other words to keep them coming back for more.

But I could see a longer-term possibility similar to what the company has done with Google Apps, the collection of online applications for word processing, e-mail, calendars, and other tasks. It's free for average folks, but the company charges subscription rates for enterprise users.

Perhaps Google Health could be free for ordinary patients but a managed storage subscription for doctors, hospitals, or others that need to archive this sort of data. Few relish the task of storing huge quantities of data--think of a large hospital's daily output of high-resolution images from X-ray film and MRI scanners. But Google can't get enough of it.

Plus, it's programmable
Google wants more elaborate software to run in conjunction with Google Health, and accordingly has an application programming interface (API) so people can, for example, integrate Web site widgets.

"Today we're publishing our APIs--our instructions for how programmers connect," Zeiger said.

The service right now is only available in the United States, but Google will expand it, he added. To do so, Google Health must navigate choppy waters.

"Health care is more complex than other products Google launches. Even at the level of privacy and regulation, we have a lot of homework to do and a lot of learning," Zeiger said.

Update at 12:19 PM PT: This story was updated to reflect the World Privacy Forum's position on PHRs in general.

Google is set to announce on Thursday that it will be using the Cleveland Clinic hospital in Cleveland, Ohio as the pilot site for its new personal health records initiative.

The Cole Eye Institute (foreground) and the taller Crile Building, which is the flagship facility of the Cleveland Clinic.

(Credit: Cleveland Clinic)

Between 1,500 and 10,000 patients at the Cleveland, Ohio, facility will participate in the project's test run, volunteering to have their medical records transferred to their Google accounts. The hospital already keeps electronic records for over 100,000 patients in an internal system called MyChart, but when those personal health records, or PHRs, are shared with Google, patients will be able to use them outside of the Cleveland Clinic. Included in the data will be prescription information, medical histories, and details about conditions and allergies.

"Patients are more proactively managing their own healthcare information," Dr. C. Martin Harris, the Cleveland Clinic's chief information officer, said in a statement. "At Cleveland Clinic, we strive to participate in and help to advance the national dialogue around a more efficient and effective national healthcare system."

"We believe patients should be able to easily access and manage their own health information," Marissa Mayer, Google's vice president of search projects and user experience, said in the same statement. "We chose Cleveland Clinic as one of the first partners to pilot our new health offering because as a provider, they already empower their patients by giving them online tools that help them manage their medical records online and coordinate care with their doctors." Additionally, Cleveland Clinic president and CEO Delos M. Cosgrove is a member of Google's Health Advisory Council.

Google isn't the only tech titan looking to change the healthcare industry. AOL founder Steve Case has launched a new company, Revolution Health; InterActiveCorp has invested in several health-related start-ups; and Microsoft has been working on a medical record service.

But all these "health 2.0" initiatives will inevitably raise privacy concerns, and critics of such projects have already begun to make themselves heard. The World Privacy Forum, which has highlighted concerns about medical identity theft in the past, has already issued a report voicing concerns about third-party PHR systems that aren't covered by the Health Insurance Portability and Accountability Act (HIPPA), which has been in effect since 1996 and requires individuals to be notified when a party other than a patient's doctor wants to access confidential medical data.

Not only is security an issue, the nonprofit has said, so is the likelilhood that marketers and other corporate entities will be able to exploit otherwise confidential data. The World Privacy Forum has not taken a specific stance on Google's new project or on others like Microsoft's.

Google is of particular concern to some privacy advocates because the company already has so much data about its users.

"While PHRs may have some laudable goals," the report by privacy consultant Robert Gellman read, "they are also a tempting target for companies or others that want to evade whatever privacy protections remain in the health care system in order to make a profit."

Web search is a whole lot easier than thumbing through a household copy of The Merck Manual when you're trying to find out what you're sick with. A simple search based on symptoms might steer you the right way, but several medical Web services have gone the route of attempting to emulate the kinds of questions you'd get when visiting a doctor's office. One of them, called MEDgle has quietly been offering up a symptom-based medical search tool for the last year.

The crux of MEDgle is the search tool, which either lets users type in what's wrong with them, or pick it out piece by piece by clicking on affected body parts or general symptoms. There are also tabs to hone down your search by drugs, procedures, and health care providers. The goal is to give you a list of conditions, along with pointing you the right way to places to get them checked out. What makes it interesting is that some of the results you get are actually hand-picked by physicians working with the service. Similar to the idea behind Mahalo, the hope is that you can get some guided search recommendations alongside the standard Web hits that have been tailored to the information you've provided on sex, age, and body type.

What makes MEDgle worth checking out is the results system. It'll first break down possible afflictions or conditions, then let you mouse over to get a quick overview of what it is. Each one is also rated on a five-star scale, which is tied in to the symptoms you've listed; the higher number of symptoms that match up to that condition, the higher the star count. You can then drill down by clicking on the condition, which will pull up the Web results, along with Snap-powered previews of each site.

While MEDgle lacks some of the polish and visual flair of WebMD, it's dead simple to use, and does a fair amount of hand-holding along the way, which I think novice users will enjoy. Until Google rolls out its own health search service and records platform, sites like these are a great place to bookmark for the next time you feel like doing a little research on what ails you without having to phone or visit your medical provider.

See also: Outlook healthy for health care Web sites, but use caution

Not for the faint of heart, MEDgle's symptom checker lets you pick out what's wrong with you visually.

(Credit: CNET Networks)