Chilmark Research has not had a very good feeling about Google Health for well over a year now. Back in early May of this year we felt that Google had all but given up and had put Google Health in stasis. Today, Google made it official, Google Health has a little more than six months to live, then it will get the Kevorkian treatment with Larry Page administering the final lethal dose.
First yellow flag
Going back to the hey days of mid 2007, Google seemed to be chugging along quite nicely with its plans to enter the consumer health market. They had Adam Bosworth leading the team, excitement filled the air and then, seemingly out of nowhere, Bosworth up and quits. Google stumbled along under Marissa Mayer, but it just didn’t seem to have the same level of excitement. Microsoft, who was busy with their own consumer health play, HealthVault, seemingly wanted to jump the gun and have the limelight shine on them releasing HealthVault in October 2007. A premature launch as HealthVault was far from being ready for prime time – it was painful.
Yellow flag number two
Google went along at a methodic pace and finally unveiled Google Health at HIMSS’08 during Google CEO Eric Schmidt’s keynote presentation. (Google threw a great party that year at HIMSS, one of the better ones.) It was a limited beta release with Cleveland Clinic wherein they had hoped for 10,000 users, but far fewer actually signed on.
Three yellow flags and counting
Google Health was formally released to the public in May 2008. It was an elegant solution, very Google-like, obviously, with easy navigation, uncluttered screen, simple to understand, simple to use. Like their competitors to the north, Google had signed on a number of partners to create a health ecosystem of services/apps that a consumer could leverage to assist in managing their health and wellness. But there were also a few problems, the biggest one being that Google only supported a bastardized version (they modified it) of the Continuity of Care Record (CCR) standard thereby limiting what a consumer could actually import into their Google Health account. So despite having a blue ribbon advisory board, Google Health seemed to not want to fully connect to the healthcare community, the doctors, the hospitals, etc. – the ones holding the data! Google also struggled to sign-on additional partners to create a richer ecosystem and were way behind Microsoft in importing biometric data..
A bouquet of yellow flags
And as one observed Google Health in the ensuing years, one got the sense, that is if you were observant, that the Google Health team of engineers was very small and the leadership at the top of Google Health was a revolving door. Without consistent leadership, without a sufficiently large team and without the business development folks to strike partnerships, Google began struggling for legitimacy in less then a year. And now, by January 1, 2012, Google Health will go into the dustbin of the consumer health movement joining the likes of Revolution Health (at least Google didn’t waste as much money as Steve Case did) and a host of others.
Lessons Learned and Implications:
Healthcare is a tough market in and of itself and the consumer health market is even tougher. There is a paucity of consumer health information in structured, machine computable format. Maybe in a few years once we get doctors comfortable using EHRs and readily sharing records with their patients that may change, but that is still a few years out.
Few consumers are interested in a digital filing cabinet for their records. What they are interested in is what that data can do for them. Can it help them better manage their health and/or the health of a loved one? Will it help them make appointments? Will it saved them money on their health insurance bill, their next doctor visit? Can it help them automatically get a prescription refill? These are the basics that the vast majority of consumers want addressed first and Google Health was unable to deliver on any of these.
Without a worthy competitor, will Microsoft no longer feel the need to further invest in enhancements and features for HealthVault? Will Microsoft reassign those engineers elsewhere and basically put HealthVault in its own form of stasis? It’s not like HealthVault has been a screaming success in the market and Microsoft has some major work to do on Amalga to improve its own track-record there. Also, since Microsoft is no longer under the protective wing of R&D and now in Microsoft Business Solutions (MBS), thus it now has clear sales targets to reach and a more restrictive P&L. Don’t be too surprised if HealthVault goes into its own quiet period for the next 18-24 months. The only thing that may change our opinion is Microsoft’s success overseas with HealthVault.
Engaging the consumer/patient most often begins at the doctor’s office. If you do not get the physician(s) involved, actively promoting the patient to use such tools as Google Health and likewise do the hard work of creating value for the physician it may be nearly impossible to gain real traction. WebMD takes a slightly different approach, getting employers to actively promote (most often through incentives) to employees to use WebMD. But again, it takes someone advocating on your behalf. Google thought that if they built it, consumers would come on their own to Google Health. Sorry Google that was a gross mis-calculation, one may even call it arrogant.
Who ya’ gonna trust. There is still a significant portion of the populace that is reluctant to trust Google, Microsoft or just about anyone else up there in the Internet Cloud with such personal information as their health records. The reality of privacy and security of health records is far more nuanced and a consumer’s records may actually be safer in Google Health or HealthVault but that is another conversation. Bottom-line, consumers remain quite wary of putting their records into these types of services which hinders adoption.
Though we saw it coming, it is still a sad day to see the passing of Google Health. May she Rest in Peace.
Addendum:
Sean Nolan, Chief Architect at MSFT has some words of his own on the demise of Google Health as well as clear instructions on how to export your Google Health data to HealthVault. Worth the read.
Great post John!
Agree w/ your view.
In addition to the rest of Healthcare dat being on line and EZ data exchange I believe that the PHR market needs a consumer/patient version of Meaningful Use w/ goals & incentives to drive use & continued engagement. After all the business model that drives cost effective, sustained behavior change that improves health outcomes will ‘win’ the Healthcare Apps arms race!
The ‘killer’ App has not been born yet…
I still don’t understand the value proposition of PHR. To be frank, if a patient comes to the ED with some kind of home-maintained record, it is usualy riddled with misleading information and ulterior motives. I would not trust it. Why do people keep thinking this is good for patients or doctors? Like hyperbarics, it is another cure looking for a disease.
Brian, totally agree. PHRs untethered to EHRs will fail because docs won’t trust the data and won’t take the time to log into a patient’s PHR or risk infecting their computers by plugging in a patient’s USB drive. Think of Quicken before the advent of online banking. It didn’t become useful until you could download bank statements directly and pay bills/transfer money.
Brian: The home-maintained record is an accurate reflection of the history a physician will receive face-to-face. That history is time honored. Sir William Osler said famously: “Listen to your patient, he is telling you the diagnosis,” which emphasises the importance of taking a good history. What is in the history; what is not in the history; and how it is said, are all a part of digging out the diagnosis. Does the physician ever discount the oral history? Sure. But, medicine is still, in part, an art and not a pure science.
Brian, If is called patient centric care, we need to get the patient involved with their own care. This is the only way that we will reduce cost.
John, Google Health was another science project for Google, they didn’t commit and it confuse the market.
They were not CCR compliant and the XML data was mal-formed (didn’t work).
Glad it is gone.
Jeff Brandt
John, Google entered health with arrogance and left with its tail between its legs. The company even denied to me that Schmidt’s HIMSS speech to 6,000+ people was an actual product introduction. They never had a real plan, as Bosworth demonstrated at the World Health Care Congress in 2007 by asking the audience for ideas (i.e., “we don’t know what we’re doing, so help us with some free R&D). My commentary: http://t.co/FaWsugt
Hi,
I agree. Online PHR tools will likely work only when doctor consultations and health records are tightly linked. Unless people start receiving medical advice using data from the record, it just becomes a data repository. There is no incentive for users to spend their time on a tool like this. Doctors have to initiate this.
Check out http://www.pinkwhalehealthcare.com/ as an alternative. This is an attempt to bridge the two. Microsoft will be Microsoft.
Thanks,
Sai
A good review of Google Health by John. Resist making this a general review of PHRs. Google’s was a consumer-based model, a one-off registration that left the consumer the problem of linking to providers. That model will work one day, just not now.
Look instead at a closely linked organization, one in which the mission is to coordinate care using a treatment algorithm, a compliance mandate, or a commercial purpose. That PHR need not be tethered to an institution. The PHR is independent of HIPAA, in that the patient is the owner with ability to share when incented to do so. That makes the PHR, especially one that emulates the Platform advised by Chilmark in previous writings, a tool that links patient-controlled data to a purpose, and to a system of treatment.
These organizations exist today: Universities, corporations, hospital systems. They must solve problems of alignment whether or not Accountable Care Organizations or Medical Homes work effectively coming out of the gate. To solve those problems, PHRs like http://www.NoMoreClipboard, is providing the right tool, and because of that is prospering. The consumer model will come when there are enough connections to warrent a personal purchase.
A good review of Google Health by John. Resist making this a general review of PHRs. Google’s was a consumer-based model, a one-off registration that left the consumer the problem of linking to providers. That model will work one day, just not now.
Look instead at a closely linked organization, one in which the mission is to coordinate care using a treatment algorithm, a compliance mandate, or a commercial purpose. That PHR need not be tethered to an institution. The PHR is independent of HIPAA, in that the patient is the owner with ability to share when incented to do so. That makes the PHR, especially one that emulates the Platform advised by Chilmark in previous writings, a tool that links patient-controlled data to a purpose, and to a system of treatment.
These organizations exist today: Universities, corporations, hospital systems. They must solve problems of alignment whether or not Accountable Care Organizations or Medical Homes work effectively coming out of the gate. To solve those problems, PHRs like http://www.NoMoreClipboard, is providing the right tool, and because of that is prospering. The consumer model will come when there are enough connections to warrent a personal purchase.
Microsoft has the right Idea, Patient centric care. The PHR is actually at Repository for sites like Mayo Health Manager. It is a FDA Medical Devices, so to lesson the liability of the Provider and organization. A multitude of connection including directly to Providers and HC organization.
Our Company Communication Software offers a connection to Smartphone and organizations via http://mHealthBridge.com
Jeff
There’s plenty of reasons why a PHR might not work but it seems clear to me that a PHR won’t have transformative value unless the doctor/clinician values it. Today, the PHR is largely an island of information. As long as reimbursement is around face-to-face interactions and around activity rather than outcomes, there’s little reason for a doctor to be motivated to use PHR information. The picture changes in the Patient-centered Medical Home that has a global payment. Today, the best example of that are retainer-based primary care models. Pay attention to the thought leaders in that arena for a sense of whether a Connected Health Record will add meaningful value.
I posted a longer version of this comment on TechCrunch – Why Google Health Really Failed – It’s About the Money – http://techcrunch.com/2011/06/26/why-google-really-failed-money/
I am saddened by the decision, too. I had just started using it, dispite the lack of adequate linkage from my Lab Service to my Doctor to Google.
My MD cooperated with me, but he was never able to find the “button” to transfer data from his system to Google. So I had to locate printouts of key test data and enter manually. This worked for those results which were Out of Limits, but I couldn’t afford the time to do the other results data entry. The graphing system was most helpful to see trends over 6 years.– maybe some of the results still Within Limits would have shown dangerous trends if they had been available.
Hope some organization will pick up the “package” and improve on it. Alas, it may not happen without strong interest somewhere!
Hi John,
We (TrialX) were one of the first app developer on Google Health. Its is indeed sad to see it go. Here is my personal view on the whole thing:
http://trialx.com/enablers/2011/06/rip-google-health-a-heartful-retrospect-from-an-app-developer/
Very detailed and very articulated post.
http://reddysblog.wordpress.com/2011/07/03/lessons-from-google-healths-shutdown/
It’s great to see your blog with most amazing information. I really appreciate your efforts.
One thing about HealthVault is that it works and it is CCR compliant , unlike Google Health.
The other is that HealthVault is a FDA Medical Device, which bring comfort to Healthcare organizations and Docs.
Being first is not usually best.
Jeff Brandt
Microsoft, unlike Google is actually in the healthcare space for the longterm and have made the resource commitment which Google was very reluctant to do.
BTW, HealthVault was first to market, Oct ’07 (it was far from user friendly) while Google Health arrived in May ’08 with a much nicer interface, albeit with far less features and supporting only a bastardized version of CCR
yep, and HV CCR will make it through a xml parer
jeff