Tim Patton, Project HealthDesign Ph.D. in Engineering Student, University of Wisconsin-Madison
There is wide speculation regarding the reasons for Google Health’s recently reported “failure.” At Project HealthDesign, we’re excited about experiments that probe the potential of personal health applications (PHAs), but we also know some won’t last. Although Google Health was one that didn’t, their experiment still leaves us with many valuable lessons.
The industry-wide consensus seems to be that personal health records (PHRs) and PHAs can only grow as extensions of EHRs. Because it provided a place to store data that has yet to be reliably unlocked from proprietary systems like institutional EHRs, others have indicated that Google Health was in some ways before its time.
However, those remarks are only one part of a larger and more complicated picture. Beyond support for clinical health information, we know people also want support for personal health information like observations of daily living. These types of personal information have little representation within current EHRs. Thus, a central challenge will be to provide systems that can integrate both clinical and personal health information in meaningful ways. In the wake of Google Health, we can learn several lessons about how we might meet this challenge:
Must be social
Adam Bosworth, the original force behind Google Health, provided a very short answer as to why Google Health didn’t catch on with the general public. “It’s not social,” he says. I agree with him: Google failed to create a PHR experience that allows users to know they aren’t alone. Sharing raw health information isn’t enough. Technologies must also allow users to share experience and knowledge.
Unlike most Google products, Google Health didn’t allow users to leverage the prior experience of other users. Contrast this with PatientsLikeMe, which leverages user input to provide new insights into self-management and even potential scientific discoveries. To be fair, Google was working in a regulatory environment that made such sharing difficult. Thus, the challenge will be to develop methods that allow for voluntary sharing of personal health experiences and knowledge in ways that preserve privacy.
Must not add more work to busy lives
Google Health’s failure also suggests that PHR users are deterred by the burden of data entry. Their platform largely required manual data entry. Tech professionals who work with various types of data say that health care data is by far the most complex type of data. Although Google likes keep its products lean and its interfaces minimal, lots of calculation is typically done behind the scenes to leverage prior user input. Without similar ability to leverage the experience of prior users, Google Health’s minimal interface provided new users little direction and little motivation for making full use of the PHR.
Google Health has also been criticized for adapting—rather than adhering to—established standards, such as the CCR. Thus, future adoption of PHRs and PHAs might require some form of template system that allows health records to be set up and quickly populated through the use of interoperability standards. This is where the ability to learn from prior users’ experiences will be crucial.
Must provide a value proposition
A successful PHR platform must provide much more than a central repository for clinical and personal health information. It must also provide a means to easily work with that information to improve personal health and wellness (e.g., a personal health app store). Indeed, devices and apps that provide useful information in an unobtrusive way and integrate seamlessly have already shown some promise, even thriving in a marketplace where consumers have to pay for the service (e.g., Withings WiFi-enabled scale). PatientsLikeMe has had some success with this approach, focusing on smaller communities with unique and complex needs and building applications around them (starting with ALS and adding from there). We must find focused areas of need and create smaller PHAs that interface with data platforms like EHRs in order to add value. And these systems must align with recognized standards and allow users to maintain personal control.
What do people want when it comes to personal health management?
It’s likely that PHRs and PHAs that serve solely as stand-alone data repositories will never see wide consumer adoption rates. If personal health tools are to gain traction, they must leverage previous user input to benefit future users, automate and simplify management tasks (e.g., allow for automated data collection) and create value propositions by targeting demonstrated areas of high demand.