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Perhaps mindful of this, as well as the scope of the problem the company is trying to address, Google has set modest goals. It doesn’t see Google Health as a platform for the entire U.S. healthcare network, but rather as one of the potential systems that could encourage integration. “We don’t intend to become the standard system,” says Zeiger. “A key part of what we are doing is supporting ongoing efforts around standards so that the different systems out there can be interoperable.”
It can be argued that for Google Health—or any such service—to really be effective, most healthcare providers will have to be connected. Will a service really be widely used if patients have to type a lot of their health information in themselves because they can’t import charts and other data into their profiles as their providers haven’t yet gone digital? “Creating a tool to basically be your electronic clipboard of all your information about your health simply won’t work if you the patient have to keep it updated at all times,” says Wachter. And getting the 200 or so mostly closed health record systems across the nation, as Schmidt estimated, to talk to each other will take some doing. Like the Cleveland Clinic, there are other prominent providers including the Mayo Clinic and Kaiser Permanente that have already embraced electronic medical records, but there’s a slim chance even their systems are truly interoperable.
Cost is another issue that could hold up adoption of a nationwide network and by extension, the broad uptake of Google Health. Small physicians offices treat about half of the patients in the United States, yet only 17 percent of these report having some form of electronic records, according to a recent study in the New England Journal of Medicine. Some 66 percent of these physicians surveyed said capital costs are a barrier to adoption, with initial costs of installing an electronic records system on average about $44,000 per physician, according to a September 2005 study in Health Affairs. Ongoing costs averaged an additional $8,400 per year, according to the study. Despite the initial outlay, the study authors estimated doctors would recoup their investment through efficiencies in less than three years. After that, they would “profit considerably.” But it’s a challenge. “We do know that initially, doctors who start to use electronic medical records do have an initial decrease in productivity, just because it’s hard to learn anything new,” Zeiger says.
Google maintains that time is on its side, with CEO Schmidt having said that with previous technology advances such as online shopping, adoption in the first year remains modest, around 5 percent. But by year 10, adoption rates approach 70 percent to 80 percent, he said. According to Schmidt, Google sees expanding the service to essentially everyone possible in the United States. “As people become more comfortable with these models, tens and tens of millions of people switch over,” Schmidt said in his February talk. “And as they do, we develop the systems that make sense.”
As for Cleveland Clinic patient Adams, she says she realizes that the Google Health service is still in an early stage. These days, she maintains her prescription medication information herself because she says the service has not yet partnered with the pharmacy she uses in her Cleveland suburb. One wish? More integration between Google Health and her Cleveland Clinic medical chart, she says. Test results are available, for instance, she says, but chart entries from her actual appointments at Cleveland Clinic aren’t yet available online. Google says it does not yet support an easy way to show the user doctor’s notes, but that it expects to support more types of data in the future.
Nevertheless, Adams says she’s encouraging her son, also a Cleveland Clinic user, to sign up for Google Health, and has already talked up the service to her sister in California. “I’m hoping it’s something I can show her the next time I visit,” she says. “I do think you’ll see people beginning to take advantage of online medical records more in the next few years.” That sounds like just the kind of viral marketing that an online company like Google would approve of. What remains to be seen is whether the mainly offline medical establishment will also get onboard.
November 17, 2008