Editor’s Note: The following article is a Guest Column from Edgar Wilson, an independent consultant who writes and follows health, education, and environmental policy. You can contact Edgar on Twitter @edgartwilson. To learn more about submitting a Guest Column, Click Here.
With a captive market, abundant infrastructure, and an appetite for moon-shot ventures above and beyond its core slew of services, making a foray into delivering an Electronic Health Record (EHR) platform seems like a match made in heaven for Google.
Unfortunately, Google’s initial EHR venture failed early on, and in no small part because it was treated as just another attempt to sway consumers—rather than the clinical users—with its nascent EHR product.
Now that FHIR is gaining ground on the premise that HTML can be the master key that unlocks all the disparate EHR platforms in use, the field may be primed for Google to swoop back in and recharge the shift to digital all over again.
In fact, since Google became a subsidiary of the newly formed parent company Alphabet, medical research, wearable health tech, and related devices were immediately touted as a lead research and development endeavor across several of the new Alphabet branches. This aligns with Google’s maneuvering between other consumer-oriented tech-and-service giants like Apple, Microsoft, and Amazon. But the market of healthcare service providers, from small practices to major clinics, represents a potentially lucrative new market—and one hungering for a more robust, integrated, and above all, user-friendly response to the HITECH Act and resulting drive to digital, modern medicine.
As thrilling as moon-shot ventures into the consumer marketplace are, this EHR landscape seems—at least on the surface—tailored to Google’s bread and butter: search.
HTML is the landscape across which the Google Search Algorithm blazes, constantly mapping and remapping the terrain until every feature has been identified and, at the click of a mouse, re-accessible. This is the exact sort of functionality that is needed in healthcare. All this nonsense about how many clicks it takes to navigate between screens, the variable interfaces pointing at users (physicians, nurses, surgeons, insurers, etc.) who all need access to overlapping data for their respective functions belies a simpler, more elegant, and more personal solution: search engines embedded in customizable home pages.
And as for the concerns that cloud-based storage and online sharing of patient data creates greater vulnerability than the more stagnant, localized storage and proprietary structuring that currently dominates: that is a bit of a non-argument. Patient portals and the glaring need for broad interoperability means that sensitive data is, and must, become ever-more mobile and accessible, which carries an unavoidable risk. FHIR’s HTML-based solution to the data-sharing roadblock effectively proves this.
What is more, troubleshooting can be aided substantially when the problem (online data security) is being managed and researched by a larger pool of stakeholders, rather than a handful of providers with distinct products and proprietary shortcomings therein. Privacy and ownership is another matter, but not an intransigent one, even if keeping user data discrete goes against the basic structure of Google Search.
Just because it would employ a host of Google properties does not require that the storage (and retrieval) of digital health data also follow the pattern of Google’s other mainstays. Namely, those silent tracking tools which gather and record data on individual users, making the free search tool profitable by selling said data to marketers and retailers. Such a mistake has already been made by Practice Fusion, a cloud-based, free EHR solution that, after climbing the ranks to become one of the leading platforms, managed to enflame clinicians and patients with equal ire, publishing a trove of “reviews” replete with sensitive, personal information.
Anonymized consumer data is one thing; retailing anonymized health data opens a whole different slate of privacy, legal, ethical, and practical questions that unnecessarily distract from other organic money-making opportunities. Indeed, Google might stand to make a great deal more money not by enabling its capitalist partners, but by integrating its own consumer-facing Alphabet arms: wearable tech, new health apps, and integrated devices, all seamlessly designed to wirelessly communicate through proprietary channels and deliver real-time, personalized data into through portal of the consumer’s choice.
Clinicians shouldn’t have to waste time mucking about between different screens to access patient data, nor should they need to choose their words or navigational methods carefully to get an effective, accurate search of the records. Learning to accommodate a new, proprietary EHR is, by many accounts, a cumbersome burden on a professional class already coping with legal overhead, evolving best practices, emerging scientific knowledge, and a disproportionately growing demand from an unprecedented population shift.
But we can certainly rest assured that everyone from the most novice physician to the most seasoned RN is familiar with the now-ubiquitous internet, the organization of its many web pages, the basic operation of its search engines, and perhaps even the customizability of its various—often proprietary—access platforms. Google crawls between and operates seamlessly amid all the various web pages that comprise the internet and its access points–mobile and traditional–mirroring what (with admittedly some much-needed security and privacy accommodations) is needed in healthcare.
It isn’t so much a question of liking Google or tolerating the company’s monolithic dominance over a growing slice of the market, as it is aligning existing technology with a clear, felt need. Google Health may have been before its time, but now that time has arrived. As we wait for FHIR, it is hard not to wonder what might have been…or, could still be.