Since its initial launch to much fanfare, Google Health has struggled to be relevant. Since its formal launch in May 2008, Google Health has not dedicated the resources to build out this platform into a truly engaging ecosystem of applications to assist the consumer in managing their health or the health of a loved one. Rather than build out new features, support a broadening array of standards, focus on the necessary business development that is required to establish partnerships, Google has taken a laissez-faire attitude to this product/service never dedicating more than a handful of engineers to the effort and most often flexing in outside vendors, such as IBM who built the module to bring in biometric from Continua compliant devices.
Rumors are now floating about that this lack of relevancy, this lack of a true commitment to Google Health has led to that oh so fateful executive decision – pulling the plug on Google Health and either letting the team go or reassigning them to other divisions within the organization. With maybe 25 employees max at any one time working on Google Health, this will not have major implications internally, but it may have some broad repercussions in the industry that include:
Without a viable competitor, will HealthVault languish in its efforts to provide a truly clean, easy to engage and use platform?
Google Health’s interface and ease of interaction has always been one of its key features. Unlike Microsoft’s HealthVault, which initially was a beast to try and use, Google Health from the start was simple, intuitive and dare one say it, almost fun to use. Though HealthVault has come a long way in improving the user experience, it remains a more trying experience. With Google Health put on the proverbial shelf, will HealthVault no longer be pushed as hard to continuously improve the user experience.
Perception that Personal Health Platform (PHP) market is dead.
Markets do not exist if there are no competitors. If the rumors are true, what we have left are Dossia, the private, employer-based platform and HealthVault. These two alone do not constitute a market, therefore, can we now boldly state that there is no market for consumer-based PHPs? Market would seem to say yes, though Chilmark has a hard-time admitting as much as we have been strong proponents of the PHP concept. It may simply be that this market is still extremely immature as the consumer is not well-educated in the value in managing their own personal health information (PHI), nor is such information in easy to access and use digital form factors. History is littered with great inventions by great inventors who ended up in the poor-house simply because the timing was off, This may indeed be the case for PHP.
Lack of options for small, consumer-focused independent software vendors (ISVs).
Dossia takes a very cautious approach to adding ISVs to its ecosystem, basically choosing those that their employer members wish to have available for their employees. Microsoft has been quite aggressive in adding an increasingly wide array of ISV partners to create a fairly rich ecosystem. Problem is, some ISVs are reluctant to work with Microsoft for whatever reason. Without Google as an option, they are left with few options.
Could stall innovation.
Similar to the first point wherein Google Health’s attractive and easy to engage interface was a welcome relief to our experiences with HealthVault which subsequently put the pressure on Microsoft to improve the user experience, without Google pushing the innovation envelop in directions that Microsoft or to a lesser extent Dossia may not have pushed, we are now left with the very real possibility of not seeing truly new, innovative models for how consumers can gain access to, use and leverage their PHI to improve their health as well as their interactions with the healthcare system. This may ultimately prove to be the biggest repercussion in this nascent market of consumer health IT.
It is critical to state that though, if rumors prove true – Google has disbanded its Google Health team, that does not mean Google Health is dead. What it does mean is that Google Health has been put into stasis, that we will not see any new innovations, we will not see an expansion of its support of standards beyond the bastardized version of CCR that Google Health currently uses and the number of new partners, be it those providing data (payers, providers, etc.) or using it (ISVs), joining the Google Health ecosystem will trend to zero. Sure, one can still store their PHI on Google Health and one will be able to able to use one of the existing ISVs, just don’t expect much more than what we have today going forward.
So without Google Health to keep the boys and girls in Redmond on their toes, might we continue to use the metaphor in Microsoft’s efforts to package the iPod as the metaphor for the user experience at HealthVault. We sure hope not and many of the most senior executives at Microsoft have assured us that this will not be the case. In fact, to their credit, it was one of these executives that first guided us to the Microsoft exercise in repackaging the iPod video, so we remain optimistically hopeful.
[youtube=http://www.youtube.com/watch?v=G9HfdSp2E2A&hl=en_US&fs=1&]
I think the market just isn’t quite ready for this concept yet. In reading about PHRs and the meaningful use requirement to offer patient access, I’ve often wondered how many people really want that responsibility. I know, I know, it’s about empowering patients, but as SpiderMan knew, “With great power comes great responsibility.” Most of the older people I’ve asked (admitedly a small sample to survey) have said they don’t want it. One person told me, “That’s what I pay a doctor for.”
My college health class used car upkeep as a metaphor for how we take care of our health. With my car, I know I should pay more attention to everything: it’d probably run better if I looked at it more, kept up with the latest from my manufacturer (hey, actually read my owner’s manual).
But honestly? I’m just as happy to pay a mechanic to keep track of what I need, when I need it. The money I pay is as much to escape the tedium of keeping up with all that knowledge as it is for the service itself. I’m willing to bet a lot of people feel that way about health: they probably believe they should be involved, but when push comes to shove they’d rather just pay someone else to worry about it.
1. I cannot believe you have so few comments on this. Another knife-sharp hit, John.
2. OMFG – the MS iPod video alone is worth the price of admission here. I’m in Amsterdam laughing my butt off, so maybe I don’t even need to “go out for the evening,” ahem.
3. Same as a year ago, I don’t claim to understand this space, so I can comment freely: as I think Michelle suggests, the vast majority of people don’t want to be involved with their data – until the fit hits the shan. I’ve begun referring to this as a “*NOW* I care” moment. Whether it’s yourself or a parent or kid, that’s when people develop an interest.
A great example is Diane Engelman’s post about defending her daughter against weasel docs, which required exhaustive records.
A less dramatic one is the hefty folder my sister & mom kept on my father in his final years – his hobby in life had been car maintenance (ironic in Michelle’s example) but when it came to his own case, he said “The docs are the experts.” Mom & Amy prevented many booboos with their vigilance.
Both Diane and my family did it with paper, or a general-purpose writing tools. (See what Mom has posted on her fridge now, for herself.)
My semi-informed view at present is: what’s missing is a tool that lets us help the pros manage the case, as proofreaders and supplementers and monitors. My family, and I suspect Diane, want copies of the real stuff that the docs are using, supplemented by their own notes and additions.
Lately I’ve been impressed by two things:
1. I like what I’ve seen MS is achieving at NY Presbyterian. They seem to be building valuable data & workflows around real needs, and patients can see in. (That’s if I understand correctly.)
2. I recently got a demo of Epic’s MyChart. That’s okay – I like it – but what I REALLY REALLY liked was “Lucy,” the cloud MyChart thing. (Cloud … Lucy in the sky… get it?) I like it because it’s the only “see my REAL docdata” thing I’ve seen that lets you merge data from several EMRs (multiple Epic instances) and import CCRs from anywhere else.
Again, I don’t claim to have anything like your broad & deep perspective, but if I had to bet my house on something right now regarding PHRs, it’d be that the whole shebang depends on finding some ….. meaningful use for the data and related apps.
And that happens when someone hits a “NOW I care” moment. Until then it’s a non-starter.
IMO.
I belive what we are seing here is the end of the B2C direction for PHR. John Moore was the 1st to say that PHR is for B2B model. Google designed it’s solution for B2C (login to data through Google). this was wrong. if you see real addade value apps in the market they are offred as B2B under Microsoft HealthVault.
A few thoughts from my biased perspective: http://blogs.msdn.com/b/familyhealthguy/archive/2010/05/30/listen-to-dory-just-keep-swimming.aspx
Really sad to see this one die – there was such a beautiful dream attached to it.
There are alternative sources of innovation beyond MS and Dossia though. Organizations like Kaiser Permanente have massive resources dedicated to strengthening and enhancing their EHR systems – a large portion of which is the patient-exposed, patient-editable portion.
The technology and consumer engagement just wasn’t there yet?
Truly sad to see Google putting their PHR on hold…
I am concerned that if Microsoft pushes HealthVault forward only as a B2B product this will slow down consumer acceptance and use of PHRs.
Consumer awareness and education need to continually be addressed to produce effective utilization of PHR’s. The trickle down effect of PHR implementation through employers, 3rd parties and the like will not produce the acceptance and enthusiasm needed to generate widespread adoption. Education is needed to show patients how they will benefit from using PHRs and help them get started managing their personal health information.
We need to continue to promote “grass roots” efforts to educate consumers and implement PHR use, not only in seniors but widespread use in all population bases. How would the loss of medical records during events such as hurricane Katrina be impacted if there would have been widespread adoption of PHR information? This would have greatly reduced the burden on health care providers as they would be able to use the PHR information to continue to provide appropriate care.
The use of PHRs needs to become basic in everyone’s life. Consumers/patients need to be made aware of the responsibility they have for their own health. PHRs can be utilized to protect patients in the event of an emergency as well as to benefit their ongoing health care. But patients need to become actively involved in PHRs in order to reap the benefits.
dw
Thanks for the post, and I especially like the Microsoft iPod clip – LOL. What seems to be missing is the lack of a process. Several other comments described the work involved in maintaining this data. You would think that most folks would want to maintina this data. Some folks I know have been maintaining this data – as an outcome of an illness. I believe there is a way to accomplish gathering data for PHR in an automated way, and simple enough for my 82 year old mother to use.
Thanks John……. Jim Sabogal
The target rich marketplace of Personal Health Records is a sleeping giant. There was a time when we did not have cell phones and ATM cards. And now?
The ability for patient/consumers to access their PHR “Anywhere, anytime, on demand” will permit a free exchange of relative medical information between patient and doctor with critical condition updates.
What is more important than your own health information? PHR will offer patient convenience and physician collaboration. No more waiting room clipboards, either.
For more information on everything PHR and EMR, we invite you to visit My EMR Choice.
I think you used an excellent term with “target rich marketplace of PHR being a sleeping giant!” A slow start does not mean no opportunity. Many are already keeping track of their PHR’s with other means, it is just a point of convincing them to switch their efforts over to iNET based records.
This is not really a surprise (if true). Another Google science project hits the dust. I really has no refection on the real PHR market. I was in a HITOC meeting the other day and Patient-Centric care came up several times. In my grad medical informatics class it has been a topic of discussion. How are you to achieve Meaningful Use without a PHR. The top-down approach of HITSP is very difficult to implement. Dossia and HealthVault are the reasonable choose to fulfill the requirement and gain ROI.
Sometime the technology gets ahead of the market.
Jeff Brandt
http://www.hieconnect.net
The rumors of the death of Google Health may be greatly exaggerated ~
http://e-patients.net/archives/2010/06/making-health-data-sing-even-if-its-a-familiar-song.html
For those who missed the #healthapps announcements today, I think that Google still intends to be a player in this space:
http://tables.googlelabs.com/public/tour/tour1.html
Brian,
Certainly not inferring that Google is out of the healthcare market, far from it – they love data, especially structured data such as what the new HHS initiative is offering and will leverage such data to create new novel visualizations. Really not much different than what they did with the HiNi outbreak. But efforts and models to execute on them are quite a bit different that what it takes to build a rich and viable Personal Health Platform ecosystem. Google Health is the latter and this is what this particular post focuses on.
Hopefully, the rumors are wrong and even better, that Google will come to their senses and begin investing in Google Health at a level that is required to really make this platform viable
Thanks for replying John. My reference was somewhat tongue in cheek – I agree that Google has not applied nearly the necessary resources to their Google Health product to make it successful. It has always seemed strange to me how neglected it appears…
You are correct, of course, that the Google Fusion Tables are not in the same category as a personal health record. My hope is that they will indeed come to their senses and bring the full weight of the organization to bear on this important project. We may yet be surprised at what they come up with 😉
What we have to understand is that Google’s failure at google health tells us more about the market than it does about Google.
When Eric Schmidt (no relation) launched Google Health at HIMSS in 2008, I asked the first question of the Q&A. I asked him, “How can we know that Google will be committed to this product?” (http://bit.ly/9MeCPr, 39:20) His response is telling. He said, and I paraphrase, Google has to be serious about health because Google gets a lot of queries about health. However, Google is not specifically committed to a PHR model for supporting health. If this is what people want, that’s great because it’s what they built. If people don’t want it, they will build something else.
The fact is, despite a reasonable (but not extensive) effort, Google’s PHR failed. Let’s not blame Google: they are a multi-billion dollar company based on products launched on a “If we build it, I hope they come” strategy. We largely have satisfied them. They tend to build good products and we tend to use them.
There are two major issues with cloud-based (or really any digital) PHR: difficulty in sharing the information with your physician and difficulty in getting a physician to review it. How likely is a physician’s office to have an internet-connected PC in an exam room that patients could use to show information to the provider? Not likely. Second, if a physician accepts access to a PHR, then that physician will likely be liable should his patient suffer a complication that could have been anticipated from a detailed review of the PHR.
These are practical problems that result in there being little return for the work of collecting your health information in one place.
Having been a CEO of a PHR company, I can tell you that the solution to this is to evolve the model. PHR’s should be windows into a cloud-based professional system, and not a parallel environment. You should be able to see what providers see via an interface like Epic’s (although I doubt very much that any two Epic systems, chosen at random, would be able to talk to each other). Google was successful by creating a database of websites, that anyone could query. The information was already there when you got there. We need a google for health that would index the information collected by professionals, rather than asking patients to (re)enter information told them by professionals. Google health is a failure because it failed to learn the lesson of Google: don’t be a database, be an index.
I haven’t seen any official news on the bow out??
Google has so many Science projects this may be just another. I would have love to see them do well. But…
Dossia is the one to watch.
Jeff Brandt
http://hieconnect.net
Jeff,
There’s no official news on the bow-out because it didn’t happen. 🙂
They were a featured player in last week’s HHS Community Health Data Initiative (see Chief Health Strategist Roni Zeiger at 1:30 of the video here), demo’ing the FusionTables health data mashup that they discussed in the company’s public policy blog that day.
That’s not about Google’sPHR, but as we all know, there’s a lot more to the potential of health data than PHRs.
Dave,
Google likes data and their participation with Fusion Tables and HHS data is an example of such and I don’t see them walking away from that – its core to their business, its in their DNA.
On the other hand, an application like Google Health is an entirely different animal and I still believe, though Google denies it, that they have basically put this platform into stasis. That doesn’t mean you can’t use it, that it will no longer exist. What it DOES mean is that Google will not devote the resources necessary to build it out significantly from where it is today.
The PHR market is still not much of a market. Google’s direct to consumer model was destined to fail. MSFT has struggled as well with such a model for HealthVault, thus their push into provider market with HealthVault Community Connect. Google does not do enterprise sales very well. In a few years, if consumers really start asking for and using their PHI, Google will once again devote resources to Google Health. Until then, they’ll do the necessary PR and have Roni out there to keep them in the public eye.