Now that Google Health is dead, what did we learn about PHRs? That engagement and messaging is what matters.

June 24, 2011

UPDATE: eWeek picked up this story and referenced it in their latest post on the subject.

As I mentioned by way of the Wall Street Journal back at the end of March, Google Health was supposed to get less support under the new CEO. We learned today that “less support” meant that it would be retired on January 1, 2012 and eventually shut down on January 1, 2013. Basically this means that the grand experiment didn’t work out, but it was valiant and worthy try.

The folks at Google raised the bar for PHRs and I for one was a fan; however,  if Google couldn’t make it work, does it mean that Personal Health Records (PHRs) in general aren’t worthwhile or won’t be successful? I don’t think so, but what we learned from the Google experiment is that there’s little or no demand from the general consumer to store their personal medical records — at least in numbers that would matter. Here’s what Google said in their retirement letter:

There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people.

PHRs managed and maintained by patients themselves has been sort of a holy grail for years — but no one has been able to figure out how to make enough money from them or keep the data accurate enough to make PHRs useful enough to clinicians. And, it’s not for a lack of trying; in fact, Microsoft’s got a nice offering (HealthVault) that’s still in good shape so far. But, it’s not clear how long even they can last without a sustainable business model. It’s not like Google didn’t have the money to continue the experiment — they just realized that there were not users in quantities high enough for them to be able to monetize it sometime in the future.

Why aren’t there enough users? There’s one key reason people don’t use something: because the value isn’t there — storing records are nice, but putting the records to some use is important and at least Google’s PHR didn’t show enough utility.

While PHRs haven’t caught the healthcare world by storm, their “Patient Portal” cousins are doing great. Unlike PHRs, which are usually managed and maintained by patients, “Patient Portals” are managed and maintained by a healthcare professional or provider organization — and usually allows for a major feature: messaging and private emails. What we’ve learned is that people aren’t that interested in managing their healthcare records,  they are more interested in engaging and communicating with their health professionals. Yes, shocker! People want more time with their physicians and don’t really care who manages their chart. :-)

Share with us what you’ve learned from Google Health’s demise. I welcome your comments on what you think.

  • Dr. L

    Are patient portals really doing much better than PHRs? Are more people really using them or is it just the same select group that was using PHRs? Of course they’re going to exist and be maintained: it’s part of meaningful use. Most won’t risk the pay-cut if they don’t do it.

    It’s pretty clear that people in general aren’t that interested in their health. Just stop by McDonalds, Chipotle, Taco Bell etc. at lunch time. Morbid obesity and horrible (purely from a calorie perspective) food choices abound. 

  • http://www.shahidshah.com Shahid N. Shah

    Great point, Dr. L. From what I’m seeing in the market those portals that allow patient communications and direct engagement are doing great. Those that are just passive records aren’t doing as well.

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  • Apjonas

    Thanks for a very helpful post.  As a Family Physician, no patient formally brings up the PHR, but I see the early adopters come in with superphones that show me their baby’s first steps, etc. about once monthly and people with photos of new grandchild or dog on lesser device once daily.  Diabetics once monthly have a chart with glucose levels, if nicely controlled; once yearly someone (two total patients) will show how poorly controlled their diabetes is.
    Once monthly someone emails in photos of a skin infection as agreed at regular intervals to reassure us that the medication is effective and immune system is healing the wound.
    Overall, many of my patients are willing to brag with technology.  Very few in my practice want to reveal flaws about their health to their physician with technology.
    They will be happy to be able to schedule appointments online (we don’t offer that yet) and retrieve lab results with physician comments online.
    They would also like to get health information mandated by employers, government, etc. from their EMR- immunizations, BP, BMI, etc. online without hassles.
    Until the cable company allows people to bet their favorite TV show against their commitment to lose weight or decrease other health risks via their PHR portal, most people will be slow to use PHR’s.

  • LOVE_MOS_NOT

    Good summary, I work for a EMR system, we have a portal, and all in all, having seniors visiting portals is just plain ridiculous.  What’s the real benefit? none..

    yay we have a portal, works with Chrome, looks good, etc. etc.. etc… it’s all BS>

  • http://www.shahidshah.com Shahid N. Shah

    Thanks for the note — if your portal is one-way (meaning no messaging, no alerts, no email, etc.) then I agree it will have little value. However if your portal can do the kinds of things that patients want — which is to request appointments, send messages, and otherwise engage with their health professionals then it will have value.

  • http://www.shahidshah.com Shahid N. Shah

    Thanks, Apjonas, and great points. I loved this statement that you made: “Overall, many of my patients are willing to brag with technology.  Very few in my practice want to reveal flaws about their health to their physician with technology.”  Would you be interested in writing a guest posting for my blog about that sentiment? I think others would be interested in what that means for direct patient involvement with healthcare IT.

  • http://twitter.com/leonardkish Leonard Kish

    Spot-on points on business model and community. Similar to some thoughts I shared yesterday.

    Seems PHRs run up against some major obstacles:

    1. trust and privacy – who can you really trust to manage your health info? (I think Shahid is correct that providers have the edge here)

    A sense of community is an important aspect of success that I think we’ll hear about more.

    The success of patientslikeme (not a PHR, but a place where people do manage and share their health info) because of
    the community and interaction, even though they openly sell
    the data as their business model. If data is the new
    platform and social is the new intelligence http://gigaom.com/2011/06/23/data-is-the-new-platform-and-social-is-the-intelligence/ (I believe this to be true), health care has a long way to go.

    Another key point is that data needs to be actionable. patientslikeme does an outstanding job of this (it’s no accident that they spent their seed funds on UX design figuring this out).

    2. if you’re not healthy, do you really want to track how unhealthy you are? Probably not until it’s too late. I’d guess 75% of the country likely falls into this category.

    We
    may be able to change number 2 with the right incentives. Payers are
    starting to understand the power of patient data, and I think we’ll
    start seeing more incentives for better personal health (and health
    data) management in the coming years.

  • http://twitter.com/jonmertz Jon Mertz

    In my opinion, Google Health is just too early to the market. The health IT infrastructure is not in place yet to make it easier to get our patient data and pull it into a PHR. Who wants to re-type data? Obviously, we don’t, evidenced by Google Health closing down.

    We also as citizen-patients need to understand and drive the EHR & PHR changes. We need to request electronic records from our physicians, and we need to engage more actively in our own health.

    When we wake up and engage and health IT infrastructure is in place, the role of PHRs will become easier to use, and we can maintain our health information more effectively.

    Enjoying the discussion and the post! 

    Thanks!

    Jon

  • http://www.shahidshah.com Shahid N. Shah

    Thanks, Jon — you’re on both counts: perhaps they were too early but certainly there was an issue of people not wanting to type in their own data. I think that physician- or health professional-maintained health records will be the only real solution going forward.

  • http://www.shahidshah.com Shahid N. Shah

    Excellent summary, Leonard, thanks for sharing. I especially liked your example of PatientsLikeMe which is doing quite well because it’s actually useful to patients. And, I enjoyed the GigaOM article — it’s something I’ve believed in for a long time, namely that apps come and go but data lives forever so we need to be data centric. See my article “Understanding electronic health records and third-party application databases” published by IBM at http://goo.gl/kBdkd

  • http://www.shahidshah.com Shahid N. Shah

    That’s great, thanks Apjonas. Please see http://www.healthcareguy.com/request-guest-article/ for instructions on the guest article.

  • inchoate but earnest

    People are people first, patients … if persuaded, and then intermittently. 

    From a ‘person’s’ eye-view, PHR may be useful, but far too seldom visited/consulted/tapped/responded to, by far too few individuals, to hold the interest of an ad-driven business. No amount of ‘engagement’ (which, as elliptically described by the author, sounds suspiciously like one-directional advertising entreaties into which possibly useful health info, tips, tricks is woven) is likely to matter. Ever.

    Try this, PHR enterpreneurs: on a bit of info from me (perhaps about my location, age, gender, for starters), show me the profile of a person vaguely like me, together with examples of how the PHR helps me today. Then, let me try it on via that template. 

    GOOG’s “blank-page” approach aligned with their very minimalist approach, so successful in other spheres; it just has not translated well enough, for enough people, in health.

  • Jawilliams

    If people are more than willing to invest in Quicken to manage their personal finances or to rent TurboTax to speed up their tax filings, why wouldn’t they invest something reasonable to keep their health records in order?  Because people don’t spend money till they see value.  When value is shown, they’ll do it.  But when they spend, they’ll want all of their information, not bits and pieces.  Until it can be aggregated better, and more effectively, this won’t move as it ought to.  And yes, I have a Google Health and a MS HealthVault account, and I have the ZipHealth iPhone app that ties into HealthVault.  It’s all just too much work right now. 

  • http://www.shahidshah.com Shahid N. Shah

    Great points, Jawilliams. I completely agree, value is key. Healthcare data is too complex to be treated the same as banking information, though, so it will take a while. EHRs, EMRs, PHRs, are all views of a single person’s health record that doesn’t really exist anywhere in totality — they are simply slices. Thinking that we’ll ever have a comprehensive record for anyone is like saying there’s one comprehensive financial record for a person that would include their taxes, bank statements, 401k statements, etc. There are aggregators like Mint.com and Yodlee.com that do financial data aggregation because there is no single source for a financial record and there never will be (too many players). I think healthcare is the same.

  • http://www.shahidshah.com Shahid N. Shah

    The “template” idea is a great one and worth checking out, thanks for sharing. Your point about blank pages is spot on.

  • inchoate but earnest

    Shah wrote: “Healthcare data is too complex to be treated the same as banking information, though, so it will take a while.”

    This peculiar statement needs elaboration. “WHOSE healthcare data is too complex?”  For the majority of individuals, their health care data  ‘statement’ is no more complex than any bank statement they might have. When i have an interrelated set of transactions in the course of a complex health episode, my health care record probably IS more complex – but is it necessarily more complex than the confusing blizzard of information involved in contemporary real estate transactions, or investment brokerage accounts?

  • http://www.shahidshah.com Shahid N. Shah

    Great question (“whose healthcare data is too complex?”). The answer is that people who are most likely to benefit from PHRs are those with the most medical necessity and those with the most medical necessity have complex records so we need to design systems that can contain large amounts of highly variable data. Yes, healthcare data is far more complex than real estate transactions or investment brokerage accounts. I’ve built real estate, healthcare, government, and financial systems and databases in my 25 year career; my personal anecdotal experience is that healthcare has the most complex data sets. Your mileage may vary, though.

  • http://www.shahidshah.com Shahid N. Shah

    Thanks, Jeanne. I think you’re right that it will take some smart patients to create the most appropriate record keeping mechanism for their complex cases.

  • http://healthcare.flexity.ca Whitney

    Great blog post! People have brought up some interesting points for discussion as well. Overall, I believe as others do- there was not enough patient demand for this technology. I believe there was also redundancy that discouraged others from really using and accessing the potential of this technology. Thank you for sharing! 

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     I totally agree with you Doctor Shahid.

  • Anonymous

    Superb post Shahid. Beautifully written and explained the topic. Information Technology Healthcare   is the issue which needs to be looked after.

  • http://www.facebook.com/people/Asif-Ali/100002153848433 Asif Ali

    couldn’t understand the connection “There has been adoption among certain groups of users like tech-savvy
    patients and their caregivers, and more recently fitness and wellness
    enthusiasts. But we haven’t found a way to translate that limited usage
    into widespread adoption in the daily health routines of millions of
    people.” please can you explain in short. I make looking to make reference of your post in my post on http://www.surgical-blog.com/

  • http://www.shahidshah.com Shahid N. Shah

    Asif — the connection is that Google Health may have failed because it wasn’t able to get widespread consumer adoption among rank and file patients. It seemed to have been adopted by enthusiasts in the health and fitness field (a tiny population) and technical folks (again, a tiny population) but not patients at large. Thank you for the reference in your post.

  • Jim Rose

    fundamentally, PHRs were a solution without a problem.  How many people stormed their insurance company demanding to see claims data?   How many actually took the time to revisit a health survey (assuming they took one in the first place) and consider changes?  Same with portals, and perhaps similar with EHRs.  Unless something builds upon the existing relationships between providers and patients, and leads to a desirable outcome, it will always be superfluous.   Now, what they were building (I had some insights) was really very interesting, so keep in mind this was version 0.009 that we saw.  Its a model that works in many industries and would, in my opinion, have been a very useful resource.

  • Surgical-blog

    Yes M.Shah i do agree, but it may be possible that google is trying to grab every field.. 

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  • Julie

    Is that do to adoption by the physicians themselves, or that complexity of the data?  It seems to me that a part of the piece is developing something that the physicians will use readily.

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  • Mark C.

    I enjoyed reading your post, Shahid.  To the comment below about Mint and Yodlee, these are modestly useful, with some of the value coming from their suggestive power, e.g., the software comments when a user receives a bank fee and suggest a no-fee alternate bank.  

    Same with PHR’s.  Simply housing data is not useful enough.  When the data is utilized in the context of outcomes projections and related suggestions regarding behavioral changes, it will have meaningful value.  In short, the incipient provider/payer/network-focused outcomes management software will eventually face the patient as well.   Result?  An electronic health and wellness coach driven by a rich personal dataset and outcomes analytics.  This set of capabilities will have great public health benefits and consumer appeal.  

    My guess is that it will be another three to five years before outcomes management software is mature enough for broad adoption – not because of the complexity of the problem but because of the cross-organizational data sharing that is required.  It may not be more than a few years beyond that before we can be nagged based on scientific evidence of what is best for us.

  • http://www.shahidshah.com Shahid N. Shah

    Thanks, Mark. Great comments — if you’ve got more good advice you might want to consider a guest posting for my blog :-)

  • http://www.genamlier.com/ Fredrick M

    According to me there was not enough patient demand for this
    technology. I believe there was also redundancy that discouraged others
    from really using and accessing the potential of this technology, Was a great outstanding post, Keep it up.

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  • Badri

    Shahid,

    Great post!

    Although I do not have a personal experience with either Google Health (RIP) or MS Health Vault, as the developer and provider of patient-centric solutions, I have some thoughts that I would like to share.

    The general apathy amongst most people, especially in India where I come from, towards their own health is largely due to the fatalistic attitude. Many patients whom I know personally, are merely trying to survive and not looking forward to an active life, especially when faced with chronic illness like Diabetes. They are more concerned about status-quo rather than take responsibility to be healthier. Thus levels of compliance, specifically with reference to taking the tests and meeting the doctor on time, are pretty low. When there is a problem or a pain, they tend to take action rather than have a proactive approach.

    Given this state of affairs, EHR or Technology adoption is the last thing in their minds and even if they go for it, the usage will be very sporadic.

  • Badri

    I beg to differ! Its not that people do not want to retype their data but they do not see much value in doing so. merely having information available for easy access isn’t worth the effort, especially on an area that they do not want to confront! Their illness! I think most vendors Google and MS including, did not do a good job of selling the value of EHRs and merely assumed that people care about their health, which they do not

  • Badri

    Perhaps portals can offer to deliver pizzas and other such food items relevant to the health condition and indulge their subscribers and perhaps make money on the transactions! LOL

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