Wednesday, June 29, 2011

Obligatory Post on Google Health

Not that anybody needs another post on the seemingly shattering news of Google Health’s recent entrance into palliative care hospice, but I think we may be missing something. Opinions out there range from Mr. Histalk’s summary of how Google Health is not offering anything of value to consumers, to the passionate cry for how the Google Health model is vital to health care, from Matthew Holt, and everything in between, including Jon Mertz’s view that Google Health’s Personal Health Record (PHR) was ahead of its time and should, or will be resurrected someday, with the usual comparisons to online banking and its one aggregator Mint. So which one is right? Perhaps all…..

Online banking’s main attraction is online bill pay. Online banking, which commenced in its current form in the mid ninties, would have probably languished without electronic bill pay. Paying bills is something people had to do since the days when this activity entailed hunting down a buffalo and carrying its various parts across one’s shoulder to pay for those cool moccasins with the lovely colored stitching. It continued to the day when you had to pull out a few banknotes and coins from the secret jar and run them over to the corner store to pay your tab, culminating with writing a check, placing it in an envelope, turning your house upside down to find a stamp and running it over to the mailbox, and of course you had to order checks and buy envelops and stamps in advance. Online banking allows you to pay for life’s necessities and its pleasures without moving an inch from your couch. It’s all in the wrist, and it takes 5 seconds at the most. What required a few thousands calories in the buffalo days and at least a hundred or so in the paper checks days, only takes about 5 calories of your energy today. The contribution of online banking and online shopping in general, to the obesity epidemic must be quite substantial.

The point here is that online banking is an evolution in the process of transacting business between human beings, which is as old as humanity itself. Online banking is just one more stepping stone between bartering for goods and the eventual disappearance of the archaic Gold calibrated valuation of human effort ant output. Online banking did not need to create a new market and did not need to convince customers to buy something they didn’t know they needed. As a byproduct, online banking took the intellectual effort out of balancing a checkbook. Not everybody was balancing their checkbooks, but those that didn’t were acutely aware that they should and that dire consequences are inevitable, and you could see the victims everywhere. Would people lineup to sign on to an electronic check balancer? Perhaps, but they would not log in very often, if at all. Enter the online banking aggregator. Mint was launched in 2007, well over a decade after online banking was introduced, to solve the unique problems of those with too many accounts, at too many banks, to keep track of. It’s a nice problem to have and obviously this aggregate service did appeal to a niche market. Mint says that they have 4 million registered users, but no numbers on how many registered users actually use the system. Either way, this is a rather small fraction of online banking users.

Patient Portals are to the health care sector, what online banking is to the financial industry. These are web utilities made available by the institution providing you with services (health care or banking), that allow you to efficiently perform transactions from your couch, transactions which you are forced to perform anyway. Patient Portals are rather new, certainly not a decade old just yet, and are slowly being adopted by consumers. As health services are being consolidated into larger and more comprehensive systems, just like banks historically were, Patient Portals are becoming more capable of providing efficiency and actually solving consumer problems. And just like online banking did not require interoperability between banks to become useful, Patient Portals have no such requirement either. You don’t need interoperability to make an appointment or pay a bill to Kaiser. You just need to log into Epic’s MyChart. And the same is true for many other large health systems running on Epic or Cerner or smaller technology platforms. In a few short years, most people will have accounts on Patient Portals (some more than one), and gone will be the days when you had to call the office for an appointment, call for a copy of your immunization record for school, or look for a tattered stamp to send your doctor payment in.

Google Health is not like direct online banking. Google Health is like Mint, and just like Mint had to wait over a decade after the introduction of online banking to be born, Google Health would have to wait until online health becomes a reality, examine its shortcomings and see if aggregation can solve problems for those who have too many health accounts at too many health facilities, and are wanting to balance their healthbooks. Most people don’t have enough ongoing financial concerns to actually need a Mint, just like most people don’t have enough health concerns to see value in an aggregated PHR. Sure, there are those who want to keep track of self-generated measurements of their health, just like some folks need to use Quick Books to keep financial records independent from, and comingled with, banking records. Most folks don’t feel compelled to use Quick Books in addition to bank accounts and most folks don’t have the urge to keep records of their health status outside a medical facility. Unless these market drivers change, either by popular culture shift or by regulation, Google’s business model will not be a good fit with aggregating health records any more than it is for aggregating financial records. Since Intuit, who makes Quick Books, was interested enough to acquire Mint, perhaps Apple, who has more self-measuring gadgets on its platform than any other vendor, may find an interest in health data aggregation. Call it Coconut, which is also a fruit and goes fabulously well with Mint.


  1. Plain and simple - Google thought they could make a buck..found out they could not and have moved out of the business after probably quite significant investment. Microsoft's Peter Neupert said last November that MS were unlikely to make money from HealthVault; surprising as they apparently have hundreds of people in their health division and their stock is going backwards - isn't there something pretty major wrong with this picture? Maybe time to leave health to health folks and make sure the health folks don't mess around with tech.

  2. Like Jon, I believe Google's PHR was ahead of its time. This technology will become more popular when medical professionals transfer from paper processes to electronic processes. The transfer is going to improve the quality of care patients receive- inspiring patients to become more involved in their health care, leading to an increase in patient demand for PHRs. Overall, the want and need for this technology will only resonate with the public if used by our industry leaders. Thank you for the great content!

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