When Google announced Friday that it was pulling the plug on Google Health, we received dozens of calls asking, "If Google can't make it in health, who can?" But we actually think we should be looking at Google's failure as a strong sign of where the electronic medical record (EMR) and personal health record (PHR) space is headed. To use the Gartner Hype Cycle reference we are in the "Trough of Disillusionment," where technology fails to meet expectations and is abandoned. But, some businesses will persist and continue through the "Slope of Enlightenment" and experiment to understand the true benefits and practical application of the technology for the consumer. We also think Google's failure is a confirmation that consumers are finally expecting healthcare products and services to rise to the same level as other industries. frog finds this in our healthcare research all the time; patients and physicians now expect their PHR/EMR to provide all the intuitive functionality and connectivity as their smart phones and tablets. If they don't, they won't adopt these technologies. Google Health failed on two primary dimensions: failure to create a connected and meaningful solution.
Lack of Connectivity
In healthcare, it's all about the eco-system. To create a monolithic product, as Google did, instead of building a platform for connectivity, can severely limit the value of the system. In order to have a holistic perspective on a patient's health, connection between the physician, hospital, payor and pharmacist is essential. With Google Health, even the most basic connection between the patient and physician was not enabled since the patient PHR was not integrated with the physician EMR. It's a fundamental tenet that productive dialogue occurs in situations of information symmetry, meaning that the dialogue must be based on shared knowledge. With Google Health this was an extremely narrow platform - the patient and the physician continued to have access to almost mutually exclusive bodies of knowledge. Broadening the platform is key to a more meaningful patient-physician dialogue.
Sharing between the patient and physician creates symmetry of data-access that builds reciprocal trust and enables efficient and evidence-based interactions. Sharing also expands to friends and family, causing the circle of care around the patient to be empowering and engaging to support them. Patient-to-patient relationships are also crucial as they support learning, and drive motivation and engagement. Any data presentation platform today that ignores the necessity for sharing and dialog is missing out on the biggest value item.
From a business model perspective, adoption by industry players is also essential to achieve scale. In the case of Google's venture, there needed to be equal focus on the B2B and B2C elements of the play. Institutional buy-in from large employers, pharmacy chains, insurers and providers is fundamental. This is basic network theory: the value of a connected system is a power function of the number of connected nodes. Depending on singular sign ups to ensure critical mass would have taken forever, especially without a strong social component to propagate virally.
Just as the social portion of the experience was not considered, mobility wasn't integrated either. frog's VP of Healthcare Innovation Aimee Jungman was a cancer patient herself recently, and wasn't accessing her PHR when she was at home at night behind her computer. She needed to access it when she went from physician to chemo to lab. She also needed to include her most recent lab results so that when she and her physician determined her readiness for chemo, the most recent lab results where available. Google Health suffered from the lack of basic mobility, as well as the fact that devices and systems that generate data were not directly connected to an individual's PHR.
Lack of Meaning
But we need to go beyond the lack of connectivity as a reason for Google Health's failure. It also did not deliver more meaning to the consumer, whether that is the patient or the physician.
The Google Health design was elegant and the solution intuitive, but Google seemed to have forgotten that for the patient healthcare is a narrative, not a bunch of lab results, CAT-scans and tests. When Aimee was diagnosed with cancer, she knew having a high CA-125 (cancer blood marker) was bad, but she had no idea what that meant in terms of her life. Was she going to be able to have children? Was she going to be able to continue working? Was she going to survive? Interestingly enough, she never knew the answers to these questions, but she knew her CA-125 immediately and was tracked religiously against it. She used the PHR to record her scans and tests, but she told the story of her cancer through email and community sites and shared her progress based on the impact to her life goals.
Healthcare is a system that produces more data than almost any other sector, but uses it with less effect than any of them. Connectivity alone with its promise of making data available to anyone in the system is not enough if it's more of the same, unusable and unactionable information. So what does it mean to create meaning in the system and develop experiences that shape and build empowered, engaged and informed consumers?
frog has developed a list of core tenets that we believe should be integral to any healthcare platform:
- Be There – Ubiquitous, Shared, Contextual
- Be Compelling – Action-Oriented, Emotionally Driven
- Be Real – Familiar, Personal, Resonant and Culturally Relevant
- Be Transparent – Guiding, Directional and Clarifying, Demystifying
mHealth²= Mobility with Meaning
Let's re-imagine what an ideal PHR/EMR experience could be that combines connectivity and meaning for the consumer, be it patient or physician.
Be There : Establishing point of care solutions was how hospitals tried to foster physician adoption of the EMR. This set-up an unempathetic situation, as the patient fearfully described their health issues to a doctor sitting behind a screen. Ironically, what seems to have gotten lost with all the focus only on connection is that healthcare is about people guiding people, and should be a human-centered industry. We need to leverage connectivity to better support this idea, rather than distract from it.
For physicians, imagine an EMR solution that connects to the mobile smart phone and tablet devices they use already and integrates seamlessly into their workflow. The information is available anytime/anywhere so the physician can access the information when they are at home or in the car, instead of when they are with the patient on site. They can monitor the patient continuously and not just during the visit, so the patient always feels taken care of. Smart and evolving algorithms can be used to flag and prioritize patients that need attention, so that this volume of data supports physicians to allocate their time more effectively, rather than being an additional burden. For the patient, the information can be visualized in a way that they can understand and is easily sharable to support collaborative decision-making between patient-physician.
Be Compelling : One of the most important aspects of meaning is that it supports decision-making and drives action. In healthcare we refer to this as the 'empowered patient,' but more often than not it's just a buzzword that gets thrown around with no teeth behind it. One way to engage the patient is to tell their personal healthcare story in the context of their day-to-day lives. Imagine a PHR that allows them to set-up personal life goals in the system, such as attending a daughter's graduation or fitting into their prom dress. This sets up a strong association for the patient between their life goals and the actions they need to take to achieve them – actions that can be difficult to remember, time-consuming, expensive, or even painful. Such goal-setting can then be associated with self-tracking devices that monitor behaviors (e.g. drug adherence) and biometrics (e.g. heart rate), which can measure progress towards goals and provide ongoing motivational stimuli for the patient. Connectivity can also be used to invite friends and family to participate in the routine or lend support along the way.
Be Real : Improving personalization in the system is probably one of the biggest areas connectivity can help foster. The one-size-fits all approach seems to dominate the industry from how we insure patients to how we deliver medical treatment. When Aimee was diagnosed with cancer she received the same course of treatment that all women had been receiving for the last 40 years. Because there was no connectivity between her family physician, general oncologist and ovarian cancer specialist around her case, they missed the fact that she was a likely candidate for BRCA1 genetic predisposition and would, therefore, respond to chemotherapies differently. Because they didn't have a complete picture of her medical background and weren't talking to each other, she got the wrong treatment. At the end of the day, she had to go through an entirely new course of chemo because she was actually BRCA1 positive. Really? A trial-and-error approach to cancer treatment based on a 40 year old treatment protocol? Imagine connectivity providing the patient access to all possible treatment options (not just those your doctor has experience with), which make sense based on the complete patient health background stored in the PHR. This would ensure that the treatment options identified were not based on one physician's limited perspective and the patient could tap into centers of excellence having the volumes and experience to treat the disease most efficaciously.
Be Transparent : Why is healthcare connectivity limited to linking the healthcare players together around medical information? What about connecting outcomes to cost? When Aimee went through her cancer treatment, there were procedures insurance wouldn't cover and she had to pay out-of-pocket. The challenge was that she had no idea whether the procedure or treatment was worth what it cost, and whether it would improve her chances of survival over time. The insurance would cover a CAT-scan, but wouldn't cover the PET-scan. Was it worth it to pay the out-of-pocket costs to detect a reoccurrence earlier? Would identifying it earlier make a difference in the treatment outcome? Her physician and insurer didn't agree, and there was no way for her to make an informed decision.
One of the biggest challenges in healthcare is the inability to determine value. There is limited definition of quality, let alone how quality ties to cost to determine value. As consumers, we don't know how to choose the right physician, hospital or course of treatment. We are also completely unaware of the cost of care, since generally we don't pay for our own healthcare. As employers continue to drop coverage and Medicare struggles to survive, we will need to become informed consumers. Imagine a PHR solution connected to benefit plans that allow patients to balance the cost and quality of care in healthcare decision-making. By making consumers aware of the trade-offs, we can go a long way to delivering care in the most appropriate setting and reinforcing wellness decisions today by tying them to long-term quality of life and cost implications.
Clearly, it's a sad event for the industry to see Google deciding to pull out of health rather than upping their game to meet the challenge. But we believe the lessons learned from this first generation of PHR solutions will help the next generation to succeed. By moving beyond mere storage and access of health data, we can build connected solutions that are meaningful to patients and physicians alike.
This article originally appeared in design mind, the publication of global innovation firm frog, a company of the Aricent Group. It was a collaboration between Creative Director Eric Bailey, VP of Healthcare Innovation Aimee Jungman, and Creative Director Thomas Sutton.