Ever since I started actively managing my parents’ health care I’ve been a heavy user of electronic health records and communication systems, and I am immensely frustrated. Frustrated at the paper-based world we’re facing in the 21st century, but also at my peers, reviewers in the media, blogs, when they discuss new developments in the area, as if they were just IT projects. They are not. They are about PATIENTS. Grand schemes are drawn, alliances are made, but the needs of real-life people with health problems are often forgotten.
What does a patient need? It’s simple: the ability to record medical history as well as current data, including health events, test results, vital stats, medications, ideally also supplemented by doctors, medical facilities, and the ability to communicate this data to health care providers.
The two major initiatives, Google Health and Microsoft Healthvault received a lot of attention, most of it focusing on technology, security and privacy issues. So well covered, I’m going to leave these alone, and take a quick look at usability only.
Google Health
The basics are there to enter your stats, conditions, procedures, test results, medications..etc, but I am finding lack of proper thought in just about any of the features, and in the end simply find no use for it. Google Health is a concept for the future, not a currently acceptable system – here are just a few reasons why:
- There’s no facility to upload documents as part of the Conditions and Procedures section. Sure, there is a text box where you can paste some information, but that is not the right way to handle a multi-page surgery report.
- The section for Test Results forces a uniform value / units / date structure, which may be appropriate for a quick lab test, but completely useless for more complex procedures e.g. EKG, Ultrasound, MRI…etc.
- There is no facility whatsoever for ongoing monitoring of vital stats like blood pressure, blood glucose… etc. The test results section is way too rudimentary, this area needs better data entry, charts, averages ..etc. Today’s announcement may bring major improvements: IBM and Google together will enable several home devices, including blood pressure and glucose monitors, scales to (wirelessly) send data to Google Health. This is definitely positive news, I just hope they enable manual data entry, too.
- There’s an area where I can enter medical contacts – fine, what do I do with it? I can’t communicate with the doctors (Gmail integration?) , share any of the information in Google Health, in fact the primary physician does not even get printed on the Health Profile summary.
- Talk about printing: yes, these systems are ultimately designed to make information electronically available – a dream for the future. Most medical offices don’t even accept / send email, are stuck in the age of paper and fax, so for now the only way to actually use all the information in Google Health is to print it. The only options are printing individual sections, or the entire profile – neither is sufficient.
A full profile print is a 15 or so page dump of all information, including all the supporting comments you entered in those text boxes. Information has to be weighted: an MRI scan is likely more important than a two-year old lab test, and your Cardiologist, Dermatologist or Urologist will likely want to see different sets of data. The user should have the ability to pick and choose from all sections and prepare a concise summary printout per particular needs.
These are just a few observations, but enough to conclude that Google Health is still at the conceptual stage: it can not (yet) serve as one’s electronic Health Central. Now, let’s look at Microsoft.
Microsoft HealthVault
HealthVault follows an entirely different philosophy: it does not try to be your functional Health Central, in fact there’s nothing you can do with HealthVault by itself. Like the name suggests, it’s a vault to store your data, and facilitate working with other service providers. If you chose HealthVault, you end up with an entire ecosystem, and data you enter or update in one becomes available in all others you give permission to.
Not surprisingly, permissioning, authentication are the key features in HealthVault: in fact the most frequently used function is logging in. No kidding. Every single partner service you chose requires an initial signup and then subsequent login. Some have your basic login data passed by HealthVault, others will force you to start from scratch. Of course you will use your Windows Live ID (formerly Passport) to log in, and if you are a mere mortal like I am, in the maddening sequence of screens you often won’t know whether you’re logging in to HealthVault or a partner service. When I first logged in to HealthVault using my Live ID, I was forced to upgrade my password to a stronger one – little did I know I was changing not only my HealthVault access, but Live ID itself – an oversight that temporarily locked me out of my personal fincancial data at Microsoft Money, which happens to require the same Live ID.
Since HealthVault is all about using Partner Services, let’s look at the key issues here:
- There’s an abundance of choices, including health record management sites, informational, lifestyle services, vital stats monitoring, pharmacy management .. you name it, it’s there.
- Abundance can lead to confusion: you will likely need a couple of services to have a complete Health Central, but there is no base set to start with, or even a recommendation – it’s a jungle out there, and you may very well end up with overlapping functions. (But at least you don’t enter data twice, since it flows between sites).
- Somewhat conflicting my previous remark, there are sites that simply fail to pickup Vault data, even after a “successful” sync session with Vault.
- Partner functionality is typically buried deep inside, which you can only discover after signing up for the service and experimenting with it.
- Some services are free, others charge, and not all that charge claim it upfront, what you thought was free signup may turn out to be a 45-day trial only.
- Once again, I have to wonder if some services were created by IT-types, who happen to be part of the healthy generation and don’t have a clue about the needs of real patients. A blood sugar monitoring service that does not ask whether your values are fasting or after a meal is a joke. A blood pressure monitoring site that does not record whether it’s early morning, daytime or evening is a joke. Need I go on?
- Output: what do I do with all this data? Most services don’t have decent output options – see my last point discussing Google Health.
In summary, with the wealth of its ecosystem, Microsoft HealthVault offers more than Google Health, but it does not make it any more useful. The complexity of choices, the maddening security make it unlikely that people with real health problems will be able to use it. This is a jungle system created by IT types for IT types, not mere earthlings patients.
Finally, a word to my fellow reviewers, media types, bloggers: It’s nice that you covered today’s Google / IBM announcement, it is important after all. But now that you’ve reprinted the PR message and added your doubts about privacy, security – please come back to test once the services are operational. Better yet, find somebody that actually has a relative with a lot of health problems, and have them try to use these services over a period of time. We’ve had way to much fanfare and too little reality check on just how well these systems serve real patients with real health needs.
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