April 30, 2007

Googling Relevance and Privacy at HIT Summit
By Neil Versel
For The Record
Vol. 19 No. 9 P. 10

With less fanfare about interoperability and more serious discussion about how health information exchange might make use of—and protect the confidentiality of—patient data, particularly in the context of personal health records (PHRs), a few hundred industry professionals gathered in Washington, D.C., last month for the Fourth Health Information Technology (HIT) Summit.

Indeed, two entire breakout sessions were dedicated to product presentations from six PHR vendors. Anne Chapman, Intel’s senior program manager for PHRs, attempted to answer skeptics’ questions about Dossia, the nascent health information network being funded by Intel, Wal-Mart, Cardinal Health, and other large employers.
“Dossia really is an infrastructure,” Chapman explained. “It’s not a PHR.” But PHRs will flow across the infrastructure.

Chapman said Dossia is a nonprofit run by an independent party, namely the Portland, Ore.-based Omnimedix Institute—also a nonprofit entity—”to overcome mistrust” people may have with employers supporting anything that involves personal health data.

“Consumers must trust the networks data’s being shared across,” added David Lansky, PhD, executive director of the Personal Health Technology Initiative for the Markle Foundation.

In the grand scheme of things, the Fourth HIT Summit was a minor event, smaller than the previous one held last September, since that summit was also the annual conference of the eHealth Initiative. But, according to eHI CEO Janet Marchibroda, the timing could not have been better because of all the progress being made toward building health information exchange, engaging consumers, measuring healthcare performance, and aligning payment incentives.

“We’ve got all this momentum along four parallel tracks, and I don’t think we’ll ever get there again,” Marchibroda said.

The conference brought out a few big names, including an address from Google Vice President Adam Bosworth, but produced more snippets of news and hints about future developments than any groundbreaking pronouncements.

Internet search leader Google has been coy about its strategy in healthcare despite dabbling in the sector, notably with its participation in the National ePrescribing Patient Safety Initiative. Google is building a custom search engine for physicians for that project, which is providing free electronic prescribing software to any medical professional licensed to write prescriptions in the United States.

Bosworth didn’t talk about any plans for a simplified PHR—rumored to be called Google Scrapbook—that is said to be under development. He also did not address the topic of a “health URL,” a phrase Bosworth used in a speech several months ago to describe a place on the Internet where people with chronic conditions and their caregivers could go to share information and discuss treatment options.

Bosworth and his entourage—which he referred to as part of the “Google health team”—left without taking questions from the media, but he did encourage conference attendees to contact him.

He said Google has been seeking answers about how to help consumers and health professionals alike connect to healthcare information and evaluate what they find for relevance. “We want to help out as much as we can so that people can get better healthcare before, during, and after treatment,” Bosworth said.

“We’d love to get help from this audience and from other people in figuring that out,” he added. “To be blunt, the only way that we actually know how to provide relevant information is to start asking some questions.”

According to Bosworth, “Search is a really good tool for finding relevant information.” But Google generally ranks search results based on popularity rather than relevancy or even accuracy. He said that the accuracy of Internet queries has improved since last year when his company launched a beta version of a product called Google Co-op, which lets experts tag search results for others to consult.

Bosworth also indicated that Google users he’s heard from are asking four kinds of questions concerning their healthcare: What may be wrong with them? What information is relevant to their conditions? Who can help treat an illness? How can patients with chronic diseases live with and manage their conditions?

“It is astonishingly hard to find that information,” Bosworth said. “And honestly, we don’t know how to answer these four questions just yet.”

He suggested that Google may be able to help consumers research the number of times a specific physician or hospital has performed a given procedure to help make informed treatment decisions. “We’d like to deliver that,” Bosworth said. To date, however, no one has succeeded on a wide scale, in part because that information is largely unavailable.

Other notable conference speakers included interim national HIT coordinator Robert Kolodner, MD, and P. Jon White, MD, HIT portfolio manager for the Agency for Healthcare Research and Quality’s Center for Primary Care, Prevention, and Clinical Partnerships.

Kolodner said a third phase of federal contracts for the proposed National Health Information Network (NHIN) will focus on “tangible progress” that the interoperability of health information is making toward improving both health and care. (Kolodner likes to separate healthcare into two complementary parts.) He previously indicated that the second round of contracts, to be awarded later this year, would likely go to end users rather than systems integrators.

In phase 3, the Office of the National Coordinator for Health Information Technology will try to advance the NHIN to “trial entities” in hopes of creating healthy competition in the marketplace. “Market forces aren’t working in healthcare right now,” said Kolodner, who, like Bosworth, cited the current lack of clear information to help patients make informed healthcare choices.

White said his agency was on the verge of issuing a request for information on the stewardship of healthcare data, a key issue that must be resolved before an NHIN becomes realistic. He and other conference participants were adamant about the importance of guarding privacy, security, and confidentiality of health information. “If we violate that, we set ourselves back for years,” Kolodner said. “We will lose the trust of the public.”

— Neil Versel is a journalist in Chicago specializing in HIT.