Tree of Knowledge

The long flagged Google Health launched in the US a few days ago and I’ve been keen to blog about it ever since because it’s going to be an influential development. Here’s the product description from The Age:

The service is free and enables people to have electronic copies of information such as prescriptions, lab test results, hospital stays, and medical conditions stored on Google computers.

Google Health has links to pharmacies, clinics and diagnostic labs.

And here’s a bit more detail from Google:

Google Health acts on behalf of users to store their medical records.

Google Health puts users in complete control over who views their health information and who can add information to their profile.

We also have strict data security policies and measures in place to limit access to sensitive information and to protect against data breaches.

The Potential

A Big Step Towards Electronic Patient Records

Google Health is significant as it could be a big step towards facilitating the widespread adoption of Electronic Patient Records. Standard setting between medical practitioners has been one of the key obstacles to its roll out to date and Google is the kind of player that has the influence to potentially create a de facto standard (Microsoft’s HealthVault might also be a contender here and has a big head start).

As the Progressive Policy Institute has long argued, EPR has potentially enormous benefits for both patients and government. It could facilitate more efficient (ie less bureaucracy) and better quality (ie fewer treatment mistakes) patient care. The UK has been especially active on this front, if not especially successful.

However, while Google Health might offer the prospect of circumventing the current squabbles and creating a de facto standard for health records, it doesn’t deal with the infrastructure (ie required ICT infrastructure in medical practices) and privacy issues that are holding up the roll out of EPR. So there’s still a long, long way to go. As the National E-Health Transition Authority has found, this is a fraught area.

A Great Platform for Information Therapy

There’s also potential for integrating this with information therapy (ie providing credible information about patients’ medical conditions and treatment) as discussed before here or online support communities as discussed here. The role for government as a trusted intermediary for information therapy is also clear.

It looks like Google is already moving in this direction as Jeff Jarvis has noted it also provides:

news about each of my conditions

A Resource for Medical Research through Data Mining

Centralised electronic management of patient records could also make medical research through anonymous patient data mining far more effective. As Josh Gans has noted:

there is real potential for systematic data gathering that could actually help medical research. That makes it an activity with a positive externality that may be worthwhile getting government assistance.

It sounds like Google Health already has the capability for this kind of application:

Google said it will mine anonymous trend data along the lines of what percentage of people with diabetes using Google Health report getting flu shots.

That’s the good news…

Policy Issues

However, there are a number of potential hitches too, the biggest of which being privacy.

Privacy/Security

The biggest policy issue that Google Health raises in the short term is clearly its privacy/Security implications. While Google has done the right thing by giving users complete control over who can upload and access the data in their profile, there simply isn’t a regulatory framework in place to account for the enormous privacy implications of the intentional or inadvertent abuse of a central repository of patient health data of this kind. While Google notes that many of the parties it deals with are subject to specific privacy obligations for Health Data, in the US at least, Google Health isn’t:

some third party services integrated with Google Health are covered by HIPAA (ie specific health privacy regulations), and those that aren’t must comply with Google Health’s Developer Policies, which establish strict privacy standards for how they collect, use, or share user information.

I’m not saying that I think Google wouldn’t be sensitive to the privacy implications of this data – it’s in its interests to protect the privacy of its users – I’m just saying that at the moment there aren’t sufficient consequences for the misuse of this information.

This is really an area where government needs to be taking active steps (as it looks like John Faulkner is well on the way to doing).

So in short, a fantastic development that presents government with a number of opportunities to realise substantial public benefits, but also an (almost) equally large policy threat the needs to be addressed sooner rather than later.

Further Reading:

Here’s a report on it at The Age.

Here’s a Google Factory Tour of Google Health.

And here’s the Google Public Policy Blog’s take on the privacy implications of the product.

UPDATE: Robert Merkel writes on Google Health at LP and focuses on the security/privacy issues but (seems to think it’s a new idea).

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