Google Health's demise spells trouble for 'untethered' PHRs


Google's decision to pull the plug on its Google Health platform, effective Jan. 1, 2012, is not unexpected. As John Moore of Chilmark Research points out, there have been numerous warning signs since Google Health was launched in March 2008. But the real question raised by Google Health's impending exit is whether consumers will ever adopt personal health records en masse--and if so, whether PHRs will reside on universal platforms like Google's, or will be attached to particular provider organizations.

Let's be clear at the outset: some of Google Health's problems are of its own making. Somehow, the Internet behemoth had the idea that if it built a PHR platform, consumers would flock to it, attracted by the Google name. That, they believed, would provide the "scale" that Google needed to generate enough healthcare searches to make Google Health a viable business proposition. Obviously, that didn't happen. Only 7 percent of Americans have a PHR, and only a small portion of those people utilize Google.

One reason why more consumers haven't turned to Google Health is that not many people want to enter their own health data in an online application. To get more consumers to use PHRs, providers must be willing and able to send the patient data in their electronic health records to those PHRs. But when Google Health and Microsoft HealthVault--the former's main competitor--started up three years ago, relatively few providers had EHRs.

Even as more patient records were digitized, providers needed a way to export the information to PHRs. That wasn't an issue if the PHR was part of a patient portal attached to their EHR system, such as Kaiser Permanente's; but sending data to "untethered" platforms like Google Health and HealthVault proved rather challenging.

HealthVault facilitated data interchange by enabling providers to upload Continuity of Care Documents (CCDs) from their EHRs; but Google stuck with the Continuity of Care Record (CCR), a format not widely used with EHRs. Similarly, a few months ago, when the Direct Project--a standardized messaging protocol--was announced, HealthVault said it would accept clinical data sent via Direct to its PHRs. Google's response? Zilch. (Ironically, in the blog post announcing Google's intention to shut down Google Health, the company said it would allow PHR users to shuttle their existing data to other platforms by using the Direct protocol.)

Not surprisingly, Google Health has enrolled far fewer partners among healthcare systems and physician groups than HealthVault. On the other hand, even HealthVault has enlisted a small fraction of the provider universe to date.

In a 2009 interview I conducted with Colin Evans, CEO of Dossia--a PHR firm founded by several big employers--he suggested that one reason why providers might be reluctant to collaborate with vendors of "untethered" platforms is that they want to keep everything in the family to build patient loyalty. If that's the case, the HealthVault business model might be just as flawed as Google's.

Another potential stumbling block is consumers' deep and abiding distrust of the privacy and security of digital medical records, whether stored in EHRs or PHRs. Google Health and HealthVault have done nothing to dispel these suspicions by resisting calls to abide by new HIPAA privacy rules, which both claim do not apply to them.

Ultimately, though, as Chilmark's Moore points out in his blog, PHRs must offer real value to consumers before they'll use them. Google Health doesn't help consumers get lab results, deal with insurance companies, make appointments or request prescription refills. Kaiser's patient portal and PHR, in contrast, provide clinical data and educational materials, as well as the ability to perform online transactions such as refill and appointment requests. Sixty percent of eligible Kaiser members have PHRs, and they use them, according to Kaiser officials.

In many ways, consumers would be better off with untethered PHRs, which would store their lifelong medical data regardless of where they receive their care. But with large, integrated healthcare systems emerging as the winners in the marketplace, it's likely that the future of PHRs belongs to them. - Ken

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