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Medical Professionals Aren't Leaping For E-Medicine

timothy posted more than 4 years ago | from the our-menu-options-have-recently-changed dept.

Medicine 98

theodp writes "Despite all the stimulus money being directed toward developing electronic medical records, surprisingly few doctors, hospitals and insurers are using Google Health and other sites like it. One reason, Newsweek suggests, may be that Web-based personal-health records like the ones being compiled on Google Health don't appear to be covered under HIPAA, which requires that health care providers and health plans protect patient confidentiality. 'We don't connect that information to other aspects of Google,' explains Dr. Roni Zeiger, product manager for Google Health. Still, the federal government is in the process of drafting privacy recommendations that would apply to Google Health, as well as the makers of consumer apps that perform tasks like monitoring blood pressure."

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98 comments

Sketchy. (4, Interesting)

Anonymous Coward | more than 4 years ago | (#31561054)

I wasn't even aware Google produced a product called Google Health.

I can understand their other technology developments, but this is one area where it's blatantly apparent that they just want to know a scary amount about each of their users...

Re:Sketchy. (4, Insightful)

sonicmerlin (1505111) | more than 4 years ago | (#31561098)

Or maybe it's just Google's way of serving the public good while increasing their mindshare among medical professionals?

Re:Sketchy. (2, Insightful)

ColdWetDog (752185) | more than 4 years ago | (#31561266)

It doesn't serve as much of a help to medical professionals. It's only used by a few institutions, it isn't in a universally recognized format and it's not automatically populated. The people using this are likely the same group of patients that keep track of various medical issues on a spreadsheet with the utility that you don't have to remember to take the spreadsheet with you.

Fine and dandy, but not earth shattering nor will it ever amount to much. To be really useful, it needs to input data automatically from all providers, pharmacists, hospitals, etc. That has a number of significant privacy and organizational issues that I don't think even the Great Google can overcome.

Re:Sketchy. (1, Informative)

Anonymous Coward | more than 4 years ago | (#31561560)

Google health uses a subset of CCR. As much as I hate CCR, you can't fault them for their standards use. The only other standard remotely compatible with what they're doing is HL7, but it is more transactional whereas CCR is an actual record.

Not that google health really does anything. At this point its sort of like an appstore for your health records with no apps on it.

Re:Sketchy. (1)

imamac (1083405) | more than 4 years ago | (#31562120)

Yeah, GH is lacking some things. I hate to admit it, but I think MS HealthVault is a better product,

Re:Sketchy. (3, Funny)

dougisfunny (1200171) | more than 4 years ago | (#31563758)

Forget MS, an Apple a day keeps the doctor away.

Re:Sketchy. (3, Insightful)

carlzum (832868) | more than 4 years ago | (#31562370)

If they solve the privacy concerns, CCR is the next obstacle they need to clear. They can use CCR and offer it as an option, but HL7, X12, and NCPDP are a must for hospitals, insurers, and pharmacies. They're transactional, but that's how health care organizations communicate.

In fact, Google should focus on coordinating and aggregating transactions, it could revolutionize the industry. Coordination of benefits between insurers would reduce paperwork and speed up payment. Services that don't generate claims (paid out of pocket, provided by a non-profit, etc.) wouldn't be missing like they often are in insurers' systems today. Fraud and abuse would be much easier to spot.

The challenge has been organizing and correlating the data. Google may be the perfect company to solve that problem.

Re:Sketchy. (1)

Jah-Wren Ryel (80510) | more than 4 years ago | (#31562682)

If they solve the privacy concerns,

They don't appear to be off to a good start, at least not according to this rating of various services where they got nearly the worst rating of the bunch.

http://patientprivacyrights.org/personal-health-records/ [patientprivacyrights.org]

Re:Sketchy. (1)

hesaigo999ca (786966) | more than 4 years ago | (#31567238)

Well, it can only become adopted by the masses if more people use it and force their doctor to start using it as well. If i go see my doctor and tell him after wards to update my google health profile because I ASK HIM TO, then he has my permission , for a broken arm, to update my status, and that can become more and more useful.
Only by letting people say, it wont work and believing them, will it truly not work.

Re:Sketchy. (1)

GargamelSpaceman (992546) | more than 4 years ago | (#31571666)

Health records should be such that anyone can input data, but to read data should require a special hardware key code. This would be presented whenever health care was purchased. Optionally an implantable ( and erasable/rewriteable key code storage device could be used so that health information could be accessed in case of an accident ).

The ability to start anew with a blank medical record should be everyone's right. Also, it should be your right to roll back one's own medical record to any date and start from there.

Chinese stealing American medical data? (0)

Anonymous Coward | more than 4 years ago | (#31561192)

How will they go about ensuring that the Chinese don't steal American medical data? I mean, we've already seen that they have some pretty significant problems with the Chinese government getting access to what should be private information hosted by Google.

I'd like to know some very techincally-specific details about how they're ensuring this sort of a breach can never happen. For instance, I'd need to know that they're using OpenBSD rather than Linux on their various servers before I'd ever consent to my information going to them. I'd need to know that they're not messing around with NoSQL databases or anything insecure like that. I'd need to know that they're using OpenBSD's secure Apache HTTP daemon. I'd want to know about the encryption they're using to protect the data. I'd like to know where the data centers are located. We need these sort of details if they're getting into this line of work.

Re:Chinese stealing American medical data? (2, Informative)

Anonymous Coward | more than 4 years ago | (#31561316)

You must be incredibly naive if you think existing EMR companies are going through this much trouble to keep data secure. I worked as a contractor for a leading EMR site, and it was an ASP.NET/MSSQL hack-job littered with SQL injection holes and easy-to-guess backdoors (think admin/admin). I don't hold out much hope that we were the exception to the rule.

Re:Sketchy. (0)

Anonymous Coward | more than 4 years ago | (#31563348)

Duh, think "Doubleclick health". Even if "Google" promises absolute security, don't think for a moment that other division of Google won't want to take even just a peek at the medical records.

Googlectomy (2, Interesting)

WrongSizeGlass (838941) | more than 4 years ago | (#31561104)

Mixing Google and my medical records would give a whole new meaning to the word 'Buzz'.

Re:Googlectomy (3, Insightful)

jjoelc (1589361) | more than 4 years ago | (#31561184)

SO you would rather the insurance companies be the only ones with unfettered access to your information?

I think the REAL reason Dr.s aren't too keen on the E-records is lawyers and liability. Every person who sees that data is another risk of a malpractice suit in their eyes.

And let's get over this E-Records" thing already... Face it.. you doctor is already using computers, and storing your information on them... The real issue is data portability. Info from Dr. A should be accessible to Dr. B when needed, and we should ALWAYS have access to our own data...

Re:Googlectomy (1)

jav1231 (539129) | more than 4 years ago | (#31561280)

"SO you would rather the insurance companies be the only ones with unfettered access to your information?"

Yeah, that's exactly what he said. Are you high? We know he is, he admitted it.

Re:Googlectomy (1)

WrongSizeGlass (838941) | more than 4 years ago | (#31562562)

"SO you would rather the insurance companies be the only ones with unfettered access to your information?"

Yeah, that's exactly what he said. Are you high? We know he is, he admitted it.

Um, it was a play on Google's 'Buzz' social networking disaster that made everything public and is the antitheses of what we want Electronic Medical Records to be.

And the insurance companies don't have my medical information because I don't have medical insurance anymore. The costs went up 38% - 46% each year for the last three years (I gave up on it before paying that first huge increase).

Re:Googlectomy (2, Insightful)

onionman (975962) | more than 4 years ago | (#31561292)

SO you would rather the insurance companies be the only ones with unfettered access to your information?

I think the REAL reason Dr.s aren't too keen on the E-records is lawyers and liability. Every person who sees that data is another risk of a malpractice suit in their eyes.

And let's get over this E-Records" thing already... Face it.. you doctor is already using computers, and storing your information on them... The real issue is data portability. Info from Dr. A should be accessible to Dr. B when needed, and we should ALWAYS have access to our own data...

My doctors, and my kids' doctors, certainly are NOT using sophisticated computer storage. In fact, the last time I was in the pediatrician's office, the Dr. was complaining that she couldn't read the other Dr.'s handwriting, so she called him at home and asked him what he had written. They take all their notes by hand and refer to the hand written notes rather than anything computerized. I'm sure that the office secretaries have to compile some sort of computer-based reports for the insurance companies, but the Dr.'s are using handwritten notes.

Oddly enough, I'm glad that the Dr.'s I see are using hand written notes and direct conversations. I've done enough software development in my time that I'm not comfortable with applications written in the "standard method" for the "market-leading OS" to keep track of vital health information for my family.

If we could have some sort of quality assurance for the applications, OS, and hardware that are keeping track of these records, then I'd be more comfortable.

Re:Googlectomy (1)

bkr1_2k (237627) | more than 4 years ago | (#31565798)

Whether they use computers or not, the doctors still print out hard copies of stuff. At least all the doctors I've been to that use computers do, anyway. I always request a second copy for my own records at home.

Re:Googlectomy (1)

zuperduperman (1206922) | more than 4 years ago | (#31577154)

> If we could have some sort of quality assurance for the applications, OS, and hardware that are keeping track of these records

Your QA is called HIPAA and it enforces a whole slew of requirements on to software vendors who supply software that manages medical information.

The interesting issue, however, is that Google sidestepped HIPAA and forces users to voluntarily move their records out side of it. The requirements of HIPAA are very sane and simple - stuff like data should be transferred over SSL, data at rest should be encrypted, passwords should not be shared, etc. The fact that Google chose not to be HIPAA compliant is quite strange to me. I can understand they do not want to be sued or taken to court (criminal liability). However it really doesn't look convincing that they won't do the simple things outlined in HIPAA.

Re:Googlectomy (1)

modmans2ndcoming (929661) | more than 4 years ago | (#31561340)

You're funny. You think most doctors have been using computers to record medical information.

Health care is the LAST economic sector to move to an electronic data management system. I am in the middle to deploying electronic forms right now for physicians and they are bitching and moaning about it. Doctors are technophobic for the most part. New residents seem to be a lot more progressive in the technological realm, but for most physicians in the industry, they prefer paper records of electronic.

Re:Googlectomy (4, Informative)

demonlapin (527802) | more than 4 years ago | (#31562146)

Physicians are not (necessarily) technophobes. Allow me to explain.

One of the many oddities of medicine in the US is the payment model. There are two ways in which physicians can earn money: by doing procedures, or by applying their learning. Now, procedures are fairly straightforward; if you do it, you can bill for it. But how do you get paid to think? You prove how much thinking went into the process by your documentation. On a paper chart, this is straightforward: you see a patient, talk to them, formulate a plan, and scribble out a note. The paper is easy to pull out and read, or copy, or whatever. You can take it with you on a clipboard into the room. Unless you get laptops with carts, you can't do that with EMR.

When you're in a hospital with EMR, you have to remember your username and password (and every password system has a different expiry cycle). In the one hospital in which I work, I have SIX systems with different usernames and passwords - the general EMR system (which has labs and dictations), the radiology system, the pharmacy dispensing system, the OR EMR system, the OR scheduling system, and email. Those who admit patients to two or three hospitals have this problem at each and every one.

In other words, physicians have two jobs - one as a physician, and one as a data-entry clerk. Not surprisingly, we are incredibly averse to spending time and effort on the second of these jobs, and anything that causes that data entry to take more time is costing us money. Not only that - the electronic records are often inferior to the paper ones they replace. In particular, many branches of medicine use drawings or diagrams. It's nice not to have to deal with handwriting, but a heart diagram with coronary blockages marked by location and percentage blocked is superior to a verbal description of those blockages.

Re:Googlectomy (1)

modmans2ndcoming (929661) | more than 4 years ago | (#31562552)

That is why hospitals deploy SSO systems like Sentilian. These systems are especially effective when the application you are setting up in the system support all CCOW features because then you can create a unique application key for the vault group and anyone in that group will just log in with out ever having to register their user name and password.

Re:Googlectomy (1)

demonlapin (527802) | more than 4 years ago | (#31562728)

SSO improves the sign-on process, but doesn't do anything about having to sign on (paper never makes me sign on) or the time that it takes to do so (getting and opening a chart takes about 10 seconds).

Re:Googlectomy (0)

Anonymous Coward | more than 4 years ago | (#31584578)

SSO options like Sentilian actually do. They're made for the medical industry and using various authentication techniques are possible, such as ID badges. Depending on how it's configured you can open a record for a patient in one program and then by selecting the other program it will immediately move to their records within the next system. It was actually created specifically for the medical field and their staff consists largely of doctors, nurses, clinical study coordinators etc to determine functionality and features.

Re:Googlectomy (1)

modmans2ndcoming (929661) | more than 4 years ago | (#31590390)

And it normally works very well. Just make sure to choose a program that properly implements CCOW or you are screwed.

Re:Googlectomy (1)

modmans2ndcoming (929661) | more than 4 years ago | (#31590428)

Sentilian sign on is invisible to the user as long as the application they are accessing is set up properly and implements CCOW correctly.

As far as paper... it takes up a lot of room, costs a lot of money to store and is very difficult to search

diagram annotation (0)

Anonymous Coward | more than 4 years ago | (#31564540)

If your EHR doesn't allow diagram annotation (as you described for coronary blockage(s)), they're doing it wrong. Not a difficult problem to solve. At least one package handles this stuff well. It shall remain nameless because it does other things poorly. Sad, sad world.

Re:diagram annotation (1)

modmans2ndcoming (929661) | more than 4 years ago | (#31590478)

I didn't think anything could be done worse than Centricity. (Hierarchical DB with COBOL and SNO-BOL? really???)

Re:Googlectomy (1)

willutah (556976) | more than 4 years ago | (#31575614)

...unless you get laptops with carts...

Isn't that pretty standard now?

Re:Googlectomy (1)

demonlapin (527802) | more than 4 years ago | (#31576214)

Not in a hospital, it's not. Maybe at your clinic. But in either place, it's a pain.

Re:Googlectomy (1)

modmans2ndcoming (929661) | more than 4 years ago | (#31590440)

what are you talking about? Most hospitals use WOWs/COWs.

Re:Googlectomy (1)

demonlapin (527802) | more than 4 years ago | (#31591698)

We use them for nurses dispensing meds; do you use them for physician charting? Maybe you're just in a much more technologically advanced area of the country.

Re:Googlectomy (1)

modmans2ndcoming (929661) | more than 4 years ago | (#31607096)

We use them for RN charting and med dispensing. physicians can use them if they like but most of them like to sit down and chart on a laptop rather than on a WOW/COW. we also have super thin tablets for them to use to chart on if they wish. most like the ultra portable laptops though because of the keyboards.

Re:Googlectomy (1)

imamac (1083405) | more than 4 years ago | (#31562156)

Face it.. you doctor is already using computers, and storing your information on them... The real issue is data portability. Info from Dr. A should be accessible to Dr. B when needed, and we should ALWAYS have access to our own data...

No they are not. I was at HIMSS [himssconference.org] a few weeks ago and I think the latest stat was only 15% or less of providers use full EHRs. That is simply horrible.

nothing in common (2, Informative)

Anonymous Coward | more than 4 years ago | (#31561106)

Google health and the stimulus money are 2 very different things. They have no relationship.

They can't get it into their heads... (4, Insightful)

jjoelc (1589361) | more than 4 years ago | (#31561126)

That it is OUR health data... and not theirs. If *I* want to post my health info to google, I should be able to. I should be able to obtain my own data relatively easily and painlessly (aside from whatever the doctor did to me, I mean!) and I shouldn't have to go through the whole battery of duplicate tests everytime I go to a different doctor.

I don't exactly want just anybody to be able to get to MY data either... But I trust google with it a lot more than I trust my insurance company!

No matter how this all pans out... I just want to have access to all of it myself, not locked up in some doctor's storage shed, or some insurance company's tape archive..

It's MY data... give it to ME, and let ME decide what to do with it. If I leave it out in the open, and the insurance company decides to charge me more because of something *I* allowed them to read, or if *I* lose info, and have to duplicate a bunch of tests.. at least it will be *MY* fault...

Re:They can't get it into their heads... (1)

Aladrin (926209) | more than 4 years ago | (#31561234)

Even if they recognize that, they -still- have to consider HIPAA because there will be lawsuits otherwise. Even if you say 'Okay, upload to Google for me' there's some litigious asshole out there that will say 'Oh, I didn't mean THAT information' and sue them.

So they have to be extra careful with your data, whether you like it or not.

And that's for your benefit, btw.

Re:They can't get it into their heads... (1)

dagamer34 (1012833) | more than 4 years ago | (#31563546)

You can certainly put it up there, but physicians and their staff won't be able to edit it since it's not "secure". And since patients almost never put info into a medical record by themselves, the issue is a non-starter.

Re:They can't get it into their heads... (2, Insightful)

jav1231 (539129) | more than 4 years ago | (#31561270)

"I don't exactly want just anybody to be able to get to MY data either... But I trust google with it a lot more than I trust my insurance company!"

You are frightening!

Re:They can't get it into their heads... (1)

Hurricane78 (562437) | more than 4 years ago | (#31561414)

I”m sorry, but physics disagree.
There is no such thing as data ownership. Because data is not a physical object, like e.g. a chair. The container may be. But the data is not.
If you want control over it, don’t pass it on. Simple as that.
If you pass data on, you split control over it. Now it’s too late, so quit bitchin’.
You can not ever guarantee control over data that is passed on. Even when you threaten with punishment.

The media reproduction industries tried that. And they failed again, and again, and again.

Don’t get me wrong. I’m absolutely for privacy!
But why do you pass your private data on to untrustworthy people, and then expect them to handle it “properly”?
ONLY pass on what you trust someone with. You know, like a good friend, that you tell something very private, because you know he won’t tell anybody.
And still that won’t guarantee he won’t do it anyway, if you ever happen to start hating each other.

Things like this are, why I want to see social skills as a main subject in school. It has the same importance as English and math together!
Oh, and of course one should learn the basic physics of bitspace. ^^

Medical data has owners by law (4, Informative)

sjbe (173966) | more than 4 years ago | (#31561646)

There is no such thing as data ownership.

Pity the law doesn't agree with you. Not on medical records [wikipedia.org] at the very least.

Re:They can't get it into their heads... (2, Insightful)

scamper_22 (1073470) | more than 4 years ago | (#31561614)

And what planet have you been living in?
If you want a prescription, can you just get one yourself?

Do you know why you aren't allowed to? Because you're not responsible. You need to expertise of a doctor to diagnose and prescribe things for you. You can't be responsible with prescriptions. And you certainly can't be trusted with your own health data.

Of course that's what the medical associations tell us... to maintain their strangle hold monopoly over health care.
That's the real reason they are against any of this. So much of the medical diagnosis could be automated. Everything from image analysis to the various charts they read off.

Re:They can't get it into their heads... (1)

don.g (6394) | more than 4 years ago | (#31562100)

So what happens when people have the freedom to buy and take whatever medicine they want? There are externalities -- such as breeding antibiotic-resistant bacteria -- to you taking whatever you want.

Re:They can't get it into their heads... (4, Interesting)

demonlapin (527802) | more than 4 years ago | (#31562506)

So much of the medical diagnosis could be automated. Everything from image analysis to the various charts they read off.

I am aware that I may be pissing up a rope here. However.

I'm a physician, and I'd be happy to let every drug (except antibiotics) be over-the-counter. Kill yourself, make yourself better, get high - it's really no skin off my back. But good diagnosis is hard, and it's definitely not automatable except in the most trivial of situations. After all, if it were automated, you'd have a great product to sell to physicians who could then hire a vast cadre of nurses to do the patient interviews and generate the diagnoses, which they could then swoop in and bill for.

Re:They can't get it into their heads... (1)

Jah-Wren Ryel (80510) | more than 4 years ago | (#31562912)

After all, if it were automated, you'd have a great product to sell to physicians who could then hire a vast cadre of nurses to do the patient interviews and generate the diagnoses, which they could then swoop in and bill for.

I think a lot of doctors would have an instinctual reaction to a product like that along the lines of, "you can't replace *me* with a machine" and their resistance would make developing a market for it pretty hard. After all, its been widely reported that doctors in the US have been pretty resistant to science-guided treatment and drug regimens, preferring their own personal (anecdotal) experience over guidelines derived from broad-based studies.

Re:They can't get it into their heads... (1)

demonlapin (527802) | more than 4 years ago | (#31563142)

If a machine could do a better job than me, I'd be no better than Mengele for preventing it from doing so.

Now, when it comes to evidence-based medicine (EBM), there's a whole separate controversy. The ultimate problem in medicine is that very few studies are actually of good quality. This is partly limited by ethics, and partly limited by the sheer difficulty of enrolling patients. Classic example? There is a simple device called a pulse oximeter that measures the degree to which your hemoglobin is saturated with oxygen. However, it has never - EVER - been shown in a study to improve outcomes during general anesthesia versus not using one at all. It is, by a purely scientific standard, voodoo. Of course, the reason that it has never been tested is that it does work, and it would be unethical not to use it. A lot of medicine works like this. Studies that are released always have flaws, and sometimes they outweigh any possible benefit. In short, while physicians are not scientists, we are not anti-science - but we also will not lightly jump into something just because a study supports it. Sometimes, like with H. pylori, this approach is wrong. Other times, like with thalidomide and the FDA, a wait-and-see approach is correct. Since physicians are the ones on the hook, their judgment - for good or ill - makes the difference.

Re:They can't get it into their heads... (0)

Anonymous Coward | more than 4 years ago | (#31564556)

Hi,

(have to post anonymously because I've moderated in this story)

I followed you up to these points:

Sometimes, like with H. pylori, this approach is wrong. Other times, like with thalidomide and the FDA, a wait-and-see approach is correct.

Are referring to the guy who spent "years" (?) trying to convince everyone that stomach ulcers are caused by H. pylori bacteria? As I recall, the researcher eventually took a dose of the bacteria himself to induce an ulcer.

But why is it that some people's ulcers are helped by a dose of antibiotics, and others are not? And doesn't everyone already have H. pylori in their stomachs? Just looked at the paedia: "More than 50% of the world's population harbour H. pylori in their upper gastrointestinal tract." So why don't 50% of everyone have ulcers? Correlation != causation

Here's a word from the wikipedia article: "pathogenesis". What if ulcers are not "caused" by a pathogen, but by something else?

But taking the acid/alkaline balance of the abdominal system is 'alternative', and therefore quackery, according to many here. The pharmacy doesn't stock alkalinizing fruits and vegetables, so you can't included those in your treatment program, and the patient probably wouldn't take them anyways...

And the comment about "Thalidomide and the FDA, a/wait-and-see approach" refers to how Thalidomide (ye olde sleeping/anti-nausea pill that caused birth defects) is now finding use for multiple myeloma, correct?

Do you know how much they charge for that shit? I'll allow that it probably helps some cases with remission, but my grandmother's Mayo Clinic doctors wanted to put her on it to give her an extra month or two, and she just wanted to finish up her treatments and die already.

She should have spent the six months from diagnosis (Multiple Myeloma) to termination in hospice care, NOT the medical system. But that's just me.

Re:They can't get it into their heads... (1)

demonlapin (527802) | more than 4 years ago | (#31565104)

tl;dr: Evidence-Based Medicine depends on good evidence, which is often lacking. And while sometimes the guy who's standing out in the cold being ignored is really a genius who needs to be taken seriously, he's usually a crank.

Re:They can't get it into their heads... (0)

Anonymous Coward | more than 4 years ago | (#31564804)

If a machine could do a better job than me, I'd be no better than Mengele for preventing it from doing so.

Yeah, its all fine and dandy to say that. But doctors are human and thus, by definition, you can't expect them to be rational, especially in the face of a perceived threat. See the Checklist Manifesto for an example of some doctors doing precisely that - refusing to use a checklist because they think its beneath them, a reflection on their competency. Funny thing, of the minority of doctors surveyed who said they would never use a checklist themselves, almost all said they would want a doctor operating on them to use a checklist.

As for machines which can do a better job - there's UpToDate [uptodate.com] - for some doctors its like crack, but in a good way.

A study published in the International Journal of Medical Informatics found that there was a "dose response" relationship between use of the decision support tool and quality indicators, meaning that the more pages of the database that were accessed by physicians at participating hospitals, the better the patient outcomes (lower complication rates and better safety compliance), and shorter the lengths of stay.

Google my plagiarism for more info.

Re:They can't get it into their heads... (1)

demonlapin (527802) | more than 4 years ago | (#31565128)

UpToDate is a brilliant piece of work, but it won't make a dignosis for you. Neither will checklists - they are, as you describe, decision support tools. They will make sure that you don't miss important things, but they won't do your job for you.

Re:They can't get it into their heads... (0)

Anonymous Coward | more than 4 years ago | (#31565404)

UpToDate is a brilliant piece of work, but it won't make a dignosis for you. Neither will checklists - they are, as you describe, decision support tools. They will make sure that you don't miss important things, but they won't do your job for you.

It is unfortunate that you took that interpretation. I debated whether I should spell out that the resistance to checklists was an example of doctors not accepting tools that save lives out of pride, not that the tool will do the entire job. Same thing with UpToDate - it is a significant step in the direction of applying automation to the job. Just because current options aren't full-blown automation doesn't mean parts of the job of diagnosis haven't been significantly automated. In plenty of cases (by volume, not type) the difference between a diagnosis and what UpToDate will give you is not much more than a matter of semantics.

Re:They can't get it into their heads... (1)

kms_md (991224) | more than 4 years ago | (#31568888)

at what point does a decision tree automated algorithm actually lay hands on a patient? in my specialty, the differential diagnosis for "lower abdominal pain" cannot be narrowed without a physical examination.

evidence based medicine does have its place, and i think that we, as physicians should do our best to make sure our practice (using both local and national standards) is evidence based. however, as noted above in the pulse ox comment, sometimes current practice cannot be overcome by EBM. another example is continuous fetal heart rate monitoring in labor. no study has ever shown that continuous monitoring is better than intermittent monitoring in preventing adverse outcomes (such as cerebral palsy). every study has shown the continuous fetal monitoring increases the cesarean section rate. so , we use an intervention that confers no benefit and may increase the risk for harm. why? ask the plaintiff's bar ...

Re:They can't get it into their heads... (1)

DevConcepts (1194347) | more than 4 years ago | (#31561636)

MY MY ME ME ME.. It's all about you isn't it...

Re:They can't get it into their heads... (0, Troll)

mcrbids (148650) | more than 4 years ago | (#31563760)

And the "ME MY OUR" mentality all works wonders when you are technology centric enough to make it work, and conscious enough to apply it. But what happens when you are unconscious? And even if you aren't unconscious, what happens to the 50% percent of humanity that is statistically dumber than the average Joe?

The sad truth is that we need a system that works, even for the dumb people who can barely scratch their names onto a piece of paper and believe in aliens, creationism, and/or the illuminatti. "You don't have your records, and now you'll probably die" is not a good answer to give to the sorry young lady who lost her USB drive with the medical records on it when her boyfriend threw them into the fireplace in a jealous rage.

The problem is a problem because of the adversarial relationship we all have to have with private insurance companies. Policies such as "no pre-existing health conditions" and others required in a for-profit scenario make it a bad thing to document health conditions because they become loopholes exploited by private entities who seek to take our money while denying us the (costly) health care.

If only we could come up with a system that would allow everybody equal access to quality healthcare, without the motive for profit... too bad humanity isn't ingenious enough to figure this out! And so, because of this horrid lack of a solution, we have the messy quagmire of privacy and accessibility conflicts that all but nullify the benefits of information technology in health care.

It's time for a single-payer system - too bad we aren't going to get it.

Re:They can't get it into their heads... (1)

zuperduperman (1206922) | more than 4 years ago | (#31577224)

> It's MY data... give it to ME, and let ME decide what to do with it.

Do you realize that you have everything you want? health providers are legally mandated to give you your health data under HIPAA. Just walk in and tell them you are making a request for a copy of your records as obliged under HIPAA.

Then you can sit back contemplate the stack of random paper and obscure electronic binary formats that they give you and wonder how to read it, and you will realize that the actual problem here is about formats and standardization, not access.

Things like this tend to make people nervious. (1)

DAldredge (2353) | more than 4 years ago | (#31561186)

12. Limitation of Liability NEITHER YOU NOR GOOGLE OR ANY OF ITS LICENSORS MAY BE HELD LIABLE UNDER THIS AGREEMENT FOR ANY DAMAGES OTHER THAN DIRECT DAMAGES, EVEN IF THE PARTY KNOWS OR SHOULD KNOW THAT OTHER DAMAGES ARE POSSIBLE OR THAT DIRECT DAMAGES ARE NOT A SATISFACTORY REMEDY. THE LIMITATIONS IN THIS SECTION APPLY TO YOU ONLY TO THE EXTENT THEY ARE LAWFUL IN YOUR JURISDICTION. NEITHER YOU NOR GOOGLE OR ANY OF ITS LICENSORS MAY BE HELD LIABLE UNDER THIS AGREEMENT FOR MORE THAN $1,000. The limitations of liability in this Section do not apply to breaches of intellectual property provisions or indemnification obligations. it appears the slashdot spam filter doesn't like all the above caps.it appears the slashdot spam filter doesn't like all the above caps.it appears the slashdot spam filter doesn't like all the above caps.it appears the slashdot spam filter doesn't like all the above caps.it appears the slashdot spam filter doesn't like all the above caps.it appears the slashdot spam filter doesn't like all the above caps.

What makes me nervous (0)

Anonymous Coward | more than 4 years ago | (#31561762)

No idea if these terms of service apply to the doctors themselves or if this was intended for some other kind of user, but from the developer ToS http://www.google.com/intl/en/health/about/devpp.html [google.com] :

Allow users to permanently delete and purge the data derived from their Google Health profiles; backup copies may exist for a short time.

So, some guy does up his health record to show that he's allergic to just about every painkiller but Oxycontin. Then he goes to Dr. Techie, who has all this fancy electronic record stuff, and complains about some pain. Dr. Techie's computer pulls the Google Health record in, and tells him to prescribe Oxycontin. Mr. D. Seeker then puts an order through Google Health to delete his record. When he gets caught selling the drugs, he fingers Dr. Techie as his supplier, who says "that's funny, I remember the computer telling me that this was the only drug he could take, but now I've got nothing on him."

Can you waive liability? (2, Informative)

beakerMeep (716990) | more than 4 years ago | (#31561804)

Seems to me there are some rights you shouldn't be able to waive in any agreements. A bit of (ironic) Googling turned up an article saying that waiving rights to gross negligence is unenforceable in California. [ecnext.com]

FTA:

California defines gross negligence as either a "want of even scant care" or "an extreme departure from the ordinary standard of conduct." In contrast, ordinary negligence consists of a "failure to exercise the degree of care in a given situation that a reasonable person under similar circumstances would employ to protect others from harm."

The "traditional skepticism" concerning agreements to release liability for future torts is expressed, the court said, in a California statute providing that all contracts with the purpose of exempting anyone from their "own fraud, or willful injury to the person or property of another, or violation of law, whether willful or negligent, are against the policy of the law."

I'd be interested if a lawyer (or other slashdotter) knew of a case where someone was denied remedy in a negligence case because they waived liability.

Re:Can you waive liability? (1)

nomadic (141991) | more than 4 years ago | (#31561876)

I'd be interested if a lawyer (or other slashdotter) knew of a case where someone was denied remedy in a negligence case because they waived liability.

Liability waivers are tested all the time in court, sometimes they win, sometimes they lose. Here, it would vary by state, but it sounds like Google agrees to be on the hook for direct damages anywhere, so if they did something (like publicly release HIPAA-protected info), I would think that a doctor who was sued by a plaintiff could turn around and sue Google in return.

I trust no one with my health records (3, Interesting)

thetoadwarrior (1268702) | more than 4 years ago | (#31561228)

Don't get me wrong, i do think Google is one of the best, if not the best, company to trust my data with (not that is something to brag about) but my health records are a complete no-no. I don't want anyone except the doctor I'm using at the time to see them. Not that I'm some sort of gimp with all sorts of shit oozing from my body but my health records are *the* most private thing to me imo.

I'll happily expose my genitals online but not my health records.

Re:I trust no one with my health records (2, Funny)

Anonymous Coward | more than 4 years ago | (#31561312)

Pics or your full of it...

Re:I trust no one with my health records (0)

Anonymous Coward | more than 4 years ago | (#31561346)

So would you trust an insurance company or wherever your files are stored, maintained and secured by one or two persons, or google who have millions of servers? If I would know that my doctor can keep my files safe and easily accessible to me from another location, then sure, let them stay there, but Google is everywhere, it's where I live, and where I go for vacation in summer or winter, my doctor or insurance firm isn't.

Re:I trust no one with my health records (0)

Anonymous Coward | more than 4 years ago | (#31561914)

Don't get me wrong, i do think Google is one of the best, if not the best, company to trust my data with (not that is something to brag about) but my health records are a complete no-no. I don't want anyone except the doctor I'm using at the time to see them. Not that I'm some sort of gimp with all sorts of shit oozing from my body but my health records are *the* most private thing to me imo.

I'll happily expose my genitals online but not my health records.

A Sterling citizen of the New Republic! Someone who's ready to march through the airport scanners, and believes that insurance companies will spare no expense to keeping their computer systems secure.

Google has had its mis-steps. And one of the recent ones WAS security related. But I'm willing to trust their computer security far more than I am that of any of the finance and insurance companies I've worked with over the last several decades.

Re:I trust no one with my health records (0)

Anonymous Coward | more than 4 years ago | (#31564878)

Dream on kiddo. Every jotter blotting, ink swatting flunky in the insurance industry will be sharing and pouring over every little detail in your health records just to make sure you are not cheating of course. Not to try and deny the charge or cross charge it to another insurer, heaven forbid you should think that.

The real problem with centralized records (5, Insightful)

slackergod (37906) | more than 4 years ago | (#31561246)

I work for a company that produces various types of medical records management software (credentials management, PHI document exchange, EMR); and I've spent a lot of time talking to a number of doctors, both tech-saavy and not so much. That disclaimed...

Let me tell you what the key problem is with electronic medical records: they are legally the property of the patient, but no doctor can (or will) trust the important details of such records unless they come from another doctor, and have a verifiable history leading back to that doctor. Not that they don't believe the part that lists a patient's allergies, but when the medical record says the patient has a debilitating disease which *requires* they be given morphine and lots of it, the doctor has to be able to verify the patient didn't just fake a record for a quick drug fix.

This leads to an interesting state electronically: if data records are to be centralized, a public key system must be set up, tied to each doctor, allowing them to both contribute & authenticate records, and allowing the patient to do the same (but the patient contributions will have to remain "untrusted" medically). You can have centralization without a public key system, but then you're just trusting the gatekeeper to never mess up, get hacked, or paid off. And even if you'd set up such a system which you know (as a programmer/cryptographer) can be made to work... you have to get the doctors to trust it as well; as given how seriously most of them take the responsibility to safeguard their patient's records, that's a hard sell even to a tech-saavy doctor.

Which is why the only major movement we've had in adoption of electronic records has been a decentralized one... doctors are converting their offices to use electronic systems internally, exchange information electronically; but always records are transmitted in a p2p fashion (whether by email, fax, courier, etc); allowing the receiving doctor to trust the veracity of the information (at least as far as they trust the originating doctor); without requiring them to trust the patient.

Google Health is merely one of the most prominent "my PHR online" projects out there, but the problem they are faced with solving is not merely legal or luddite based, but a issue of cryptographic trust in it's truest sense.

And that's not to mention that centralization of medical records creates a much more attractive point of failure for all kinds of things (such identity theft, if merely for the purposes of using some else's insurance),
and even if a public key system is implemented, the doctor (and staff) are handing off part of their trust to a central database... and given the mess of outdated information the NPI registry contains, they are loath to believe in such a system.

disclaimer: my company has a number of ongoing projects in this field, but my assessment here is pretty well unbiased architecture and adoption-wise as far as I know, we have a number of pokers in the fire fitting most of the above scenarios.

Re:The real problem with centralized records (4, Informative)

slackergod (37906) | more than 4 years ago | (#31561288)

It occurs to me I used a bunch of industry specific acronyms in the above post; let me define 'em...

PHR - patient health records

PHI - protected heath information - mostly equivalent to PHR, but sometimes with private doctor-to-doctor discussions (such as a patient's drug seeking habits)

EMR - electronic medical records - "EMR" software as a class basically is the eletronic equivalent of the wall of paper charts in your doctor's office. most PHR exchange will happen between these types of systems, or be printed out, edited, and faxed (sometimes to another EMR).

credentialling / credentials management - tracking of doctor licenses, certifications, etc... this stuff is personal information about the doctors (ssn, etc) that's flying around between their office, the govt, and insurance companies.

NPI / NPIDB - National Practitioner Data Bank - government database of the public parts of a doctor's credentials; that's trying to unify and replace all the others that are out there (UPIN, Medicaid, Medicare, DEA). It's in use, but the information frequently is years out of date, even with the best intent of all involved.

Re:The real problem with centralized records (5, Informative)

CrashandDie (1114135) | more than 4 years ago | (#31561694)

Hey sg,

The thing is that a decentralised system isn't a bad thing at all. PKI was designed, from the start, to be usable as a non-centralised system (non-pyramid). Realistically speaking, using the same example as the one you offered, where a doctor needs to validate medical records provided by the patient to be truthful, you only need to verify the other doctor's credentials and a signed file.

Now we get back to the old "How do I trust another doctor's certificates?", well, we use a centralised service. Each doctor needs to enroll [nist.gov] (Google cache [google.com] of the same document) to get his certificates, and they are delivered by a central authority, possibly governmental (or whatever authority governs doctors in your country). It's not a very hard thing to do, and can be implemented for roughly a couple million dollars -- the whole system.

How many doctors are there in the US? A laughable amount if you compare how many certificates are issued for the DoD. Heck, you could even implement it to be fully PIV-C compatible, and get cross-certification from the US government, and would allow doctors' credentials to be easily validated during a crisis.

Heck, nobody even needs to own the PKI solution in the US. The government can do it for you, if you are a valid organisation, an excellent project provides certificate management [idmanagement.gov] for you. Outside the US it gets a bit more difficult, as interoperability is not quite as great as in the US, however PIV is starting to have quite a lot of traction in Europe as well (I can't remember off the top of my head if it's PIV-I or PIV-C that is being implemented with the UK police forces). A pretty good read [nist.gov] (Google cache [google.com] as it doesn't seem to be loading from here) about how data is provided on a PIV smartcard.

That being said, maybe the health care professionals ought to have raised their voice at the same time the engineers and scientists did [nist.gov] (Google cache [google.com] )?

Re:The real problem with centralized records (2, Informative)

slackergod (37906) | more than 4 years ago | (#31562106)

I agree with you: decentralized is fine; and decentralized + PKI would be even nicer security wise. And as a patient, I'd trust it over a central system for all the reasons mentioned elsewhere in this discussion.

My main point was that while PKI is optional for decentralized PHR, in order to develop a centralized PHR system like Google Health, you pretty much *have* to have PKI before the doctors will use your system. The lack of trust is a design flaw which, somehow, I don't think any of the centralized phr developers have even realized that they have, much less that PKI would fix it... otherwise they'd be hawking it at the forefront of their advertisements to doctors. I'm not really sure how they missed the trust issue, because it's the first thing the doctors I work with mentioned after they heard about Google Health.

BTW, those are some nice links regarding PKI, thanks for them! Going to have to look into how I can put that stuff to use.

risk (1)

vxice (1690200) | more than 4 years ago | (#31561258)

while the idea of online health records I think is good, I am opposed to one company/gov't agency having it all stored in their care. The more data you have in one place the more valuable that database is and greater incentive to steal it. Admittedly this does go somewhat against the idea of e-health records that is an expense I am willing to pay.

socialize healthcare (0, Flamebait)

cekander (848307) | more than 4 years ago | (#31561326)

Where buying into a public option requires your health records to be filed electronically in a government secured database. The privately insured can also use the file-system, with consent of the patient and willingness of the Dr, but not mandated. That should keep everyone happy... No?

do you want a google for preexisting conditions? (1)

Joe The Dragon (967727) | more than 4 years ago | (#31561760)

do you want a google for preexisting conditions?

Where you can a google search a way from being TOLD NO HEALTH CARE FOR YOU!

Re:do you want a google for preexisting conditions (1)

clarkkent09 (1104833) | more than 4 years ago | (#31562760)

It's hard to hide preexisting conditions anyway, as long as there is a record somewhere they'll dig it up. And if you lie they can and will cancel your entire policy when you need it the most

Re:socialize healthcare (0, Flamebait)

cekander (848307) | more than 4 years ago | (#31563812)

According to this entry [wikipedia.org] on wikipedia:

"During a June 2009 speech, President Barack Obama outlined his strategy for reform. He mentioned electronic record-keeping."

He also supported a public option during the 08 campaign. I suppose Barack Obama would be a flame baiter here as well.

EMR is much more than record keeping. (3, Insightful)

MMC Monster (602931) | more than 4 years ago | (#31561398)

I am a physician.

The only way doctors are going to go to EMR systems is when they improve the bottom line.

The people that create many EMR systems understand that, and build the systems in a way so that physicians can increase the billing rate above what they can do with paper systems.

I currently do my patients records on paper. I bill much lower than I could, because I'm scared about penalties associated with being caught over-billing.

My office is going EMR within the next year. I am positive that the amount I will bill for just about everything will increase, and I will (hopefully) offset the cost of going electronic at that point.

Is EMR going to reduce the cost of health care? Almost certainly not. It will likely allow physicians to drill down into their database of patients to see:
1. which ones haven't been seen in a while and bring them in.
2. which ones are eligible for a procedure but haven't had it yet.

Will this decrease patient morbidity (illness) and mortality (death)? Probably, but that can only be determined by (likely retrospective) studies.

Re:EMR is much more than record keeping. (2, Informative)

MMC Monster (602931) | more than 4 years ago | (#31561626)

Before you complain about number 2:

There are certain guidelines that, if followed, are supposed to improve mortality. The problem is some patients are just lost to followup, therefore miss out on the procedures that may potentially save their lives (such as colonoscopies).

If the database is not drilled for these procedures, I can see a lawsuit happen from the family members of someone who got lost to followup and then died of metastatic cancer (due to a missed colonoscopy) or sudden death (due to not getting a defibrillator when they were eligible).

Re:EMR is much more than record keeping. (3, Interesting)

Anonymous Coward | more than 4 years ago | (#31561858)

BTW, as a developer of an EMR (or as it's currently called, EHR - Electronic Health Record. Gotta keep up with the buzzword bingo) and friends with a number of doctors using our EMR, competitors' EMRs, and plain paper, the number one problem with using electronic records to get more money is that the insurance companies are on to us.

One doctor started getting regularly audited by Medicare because their E&M code "bell curve" shifted upwards - they were doing more level 4 and 5's than before, all because their medical record software told them "you're so close to the next level, add x and you'll have sufficient documentation for it!" Of course, this isn't limited to electronic records (I've got an HPI textbook that tells me that smoking status, whether smoking or not, is always pertinent medical history), but when all of the "x"s are just checkboxes, it's pretty easy to go down the list and hit them all.

Re:EMR is much more than record keeping. (2, Interesting)

Anonymous Coward | more than 4 years ago | (#31562900)

I recently did consulting for a practice going from paper encounter forms/computer billing to EMR/computer billing. With the old system, when audited, they just pull the encounter forms with a bunch of checkboxes and circles. With the EMR, if they get audited.... they're fucked because their EMR notes do not support what they're trying to bill for. I'm sure it's only a matter of time before doctors are told to optimize their billing (or they figure out how to game it to get in their required RVUs).

Re:EMR is much more than record keeping. (0)

Anonymous Coward | more than 4 years ago | (#31567056)

Does that imply that the encounter forms are then falsified, or just that it's too much trouble to compare them with other records to verify one way or the other?

Re:EMR is much more than record keeping. (1)

phorest (877315) | more than 4 years ago | (#31568292)

The only way doctors are going to go to EMR systems is when they improve the bottom line.

I believe 2014 is the target date to decrease physician reimbursement by 5% for not using EMR software

I currently do my patients records on paper. I bill much lower than I could, because I'm scared about penalties associated with being caught over-billing.

You should NOT be billing defensively! You need to have competent chart-audits regularly and bill for what you actually perform. You need to keep meticulous notes to verify your charges. Just because your office is "going EMR within the next year" and "amount you bill will increase" means absolutely NOTHING. They will still pay you the UCR rate in your area for whatever you bill for. Couple that with the fact that major insurers and Medicare/Medicaid are probably going to start paying a set fee on the diagnosis because of things like PQRI (see below), chances are you'll never make that up.

Case in point:

We have a doctor that bill $4000.00 for arthroscopic knee surgery. He only gets $600.00 and is very unhappy about it. We told him to stop doing surgery altogether and just do joint injections instead because they (payers) actually pay for that what it's worth, plus he'll save on malpractice insurance. If he takes our proposal seriously, he'll make more money for less work. Software won't give you that.

We have another doctor that tried out PQRI [hhs.gov] but for that extra 2% reimbursement it takes an extra 20 minutes of reporting per claim by the doctor herself. A chart-audit showed that all she had to do was bill her initial visit (9920X's) and she'd increase her monthly revenues by 7-15% (dermatologist - lots of new patients a month).
A different doctor (Psych) of ours asked about PORI and with what we came to the conclusion that it is nothing but research and for quantifying the data into a database to be able to start paying on the DX and not on the actual work performed. If you're a GP/Internist and you have a diabetic patient you're getting office visit reimbursement now. In the future you won't. You'll get a set-fee for the year and if it takes 2 visits, well maybe you're ahead on that patient but if it takes 20 visits you're out quite a bit of revenue... It's hard to stay on top of the reimbursement game.

Is EMR going to reduce the cost of health care? Almost certainly not. It will likely allow physicians to drill down into their database of patients to see:

Any decent billing software allows you to do the same exact thing. Even if it can't do it out of the box, chances are you can find someone who can get that data out of it with simple SQL queries. Our software does for the most part but since it is SQL based, I can extend any reporting easily either with CrystalReports or SSRS (SqlServerReportingServices) and in no time at all. Need to know reimbusement percentage? easy... Need to know detailed reimbursement analysis by CPT code and Insurance Company? easy... Need a recall list with specific parameters, again easy...You don't need EMR software to do that.

I don't presume to know your actual payer mix but if it's the normal 55% Insurance/ 45% the two M's/ 10% other you need a competent certified coder/biller/auditor who plays by the rules and investigates trends. You'll still end up with EMR down the road though some old-timers who still use ledger cards won't, but until more providers use it or it's a requirement to actually get paid... I'd wait.

Re:EMR is much more than record keeping. (1)

juliusbeezer (1558233) | more than 4 years ago | (#31580338)

I too am a physician. >The only way doctors are going to go to EMR systems is when they improve the bottom line. may be true, but reflects the lamentable ethics of the American profession. The bottom line you should care about is the outcome for the patient, who is a member of a population. Good recordkeeping is a keystone of good medical practice, and EMRs offer many potential benefits for both the individual and society: but you insist on privileging the capitalist discourse in all this. Error. Financial incentives may have their place, but to place them at the apex of the value system of a culture is dismal and wrong.

More costs than you would think! (3, Interesting)

Old Flatulent 1 (1692076) | more than 4 years ago | (#31561406)

The reality of going to an all digital system is not as clear cut as many on /. would believe. Vancouver Island Canada has to a large extent undergone a huge change over to E-film and E-records, and has perhaps the most advanced systems around. The costs of making all this work has not been reflected in reduced numbers of staff needed to handle data instead of paper.

There still are large amounts of paper necessary for day to day operations and getting Doctors and clinics to effectively use secure online services has been nothing short of a nightmare. It costs more to do day to day operations and many say they would find going back to simple reliable terminal based systems more efficient and cost effective! The costs of supporting, securing and system training for PC based software is over the top and is a tremendous burden on any essential service.

Why should I care about Google? (2, Insightful)

Bill_the_Engineer (772575) | more than 4 years ago | (#31561552)

If Google isn't getting their money's worth from all that campaigning with Obama, why should I care?

There are other corporations that understand HIPAA, the value of privacy, and willing to enter an agreement that makes them risk liability and criminal penalties for accidental disclosure.

I can't understand the irrational willingness to give all data to Google. Of course, this is Slashdot so a lot of comments are from people predisposed to like and trust Google. This is despite comments from Google executives that say otherwise. I guess Google's position would be that if you have something embarrassingly wrong with you then don't go to the doctor...

Re:Why should I care about Google? (1, Troll)

beakerMeep (716990) | more than 4 years ago | (#31562218)

Mind saying who the other corporations doing what Google is that are so respectful? Or are you just content frothing about Obama and injustice?

Really, all rudeness aside, I would love to see this list of companies willing to risk liability for accidental disclosure. And on what planet do you think Google can indemnify themselves from criminal liability?

Re:Why should I care about Google? (1)

Bill_the_Engineer (772575) | more than 4 years ago | (#31563588)

Mind saying who the other corporations doing what Google is that are so respectful?

What you actually think Google is the only data warehouse on this planet? There are plenty of HIPAA compliant medical transcription services that already handle patient records. You didn't realize hospital outsource transcription services? Not to mention, the insurance companies have a electronic clearing house too.

So how does the lack of me providing a list of competitors indemnify Google?

Or are you just content frothing about Obama and injustice?

What? I voted for him too, but probably won't make the same mistake twice.

Anyway, it's not mere frothing when Google's Eric Schmidt campaigned for Obama and was rewarded with a seat on Obama's "President’s Council of Advisors on Science and Technology". But don't let the facts get in your way...

And on what planet do you think Google can indemnify themselves from criminal liability?

From Google Health's terms of service:

4. Use of Your Information

If you create, transmit, or display health or other information while using Google Health, you may provide only information that you own or have the right to use. When you provide your information through Google Health, you give Google a license to use and distribute it in connection with Google Health and other Google services. However, Google may only use health information you provide as permitted by the Google Health Privacy Policy, your Sharing Authorization, and applicable law. Google is not a "covered entity" under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder ("HIPAA"). As a result, HIPAA does not apply to the transmission of health information by Google to any third party.

Also:

6. Content and Services Accessed through Google Health

Google Health may include content that you find offensive, including health-related content that is sexually explicit.

Google may make third-party services available through Google Health. In order to use a specific service, you may choose to allow the third-party service provider to retrieve, provide, and/or modify health and other information in your account or otherwise share your information with the service provider. Once you enable a specific third-party service provider to access your account, the service provider may continue to access your account until you affirmatively disable access. Third-party service providers include both health care providers and other entities. It is your sole responsibility to review and approve each such third-party service before sharing your information through or otherwise accessing it.

Google may screen, modify, refuse, or remove certain content or third-party services, but is not responsible for and does not endorse any third-party content or services. Google further does not endorse any third-party service providers, other health care providers, products, services, opinions, or web sites accessed through Google Health.

USE OF THESE SERVICES AND RELIANCE ON THIS CONTENT IS SOLELY AT YOUR OWN RISK. GOOGLE MAY NOT BE HELD LIABLE FOR ANY DAMAGES ARISING OUT OF OR RELATED TO YOUR USE OF ANY THIRD-PARTY SERVICE OR CONTENT. Providers of these third-party services and/or content are Google's "Licensors"

And the final piece of evidence:

12. Limitation of Liability

NEITHER YOU NOR GOOGLE OR ANY OF ITS LICENSORS MAY BE HELD LIABLE UNDER THIS AGREEMENT FOR ANY DAMAGES OTHER THAN DIRECT DAMAGES, EVEN IF THE PARTY KNOWS OR SHOULD KNOW THAT OTHER DAMAGES ARE POSSIBLE OR THAT DIRECT DAMAGES ARE NOT A SATISFACTORY REMEDY. THE LIMITATIONS IN THIS SECTION APPLY TO YOU ONLY TO THE EXTENT THEY ARE LAWFUL IN YOUR JURISDICTION.

NEITHER YOU NOR GOOGLE OR ANY OF ITS LICENSORS MAY BE HELD LIABLE UNDER THIS AGREEMENT FOR MORE THAN $1,000.

The limitations of liability in this Section do not apply to breaches of intellectual property provisions or indemnification obligations.

Re:Why should I care about Google? (1)

bkr1_2k (237627) | more than 4 years ago | (#31565744)

All those points are well and good, but none of those "license agreements" really hold up if people sue, especially en masse.

Re:Why should I care about Google? (1)

beakerMeep (716990) | more than 4 years ago | (#31568568)

So you got that list coming right up then?

Re:Why should I care about Google? (1)

Bill_the_Engineer (772575) | more than 4 years ago | (#31580190)

So you got that list coming right up then?

Sure. I'll help the lazy troll...

Kaiser Permanente is working with Veteran Affairs and DoD for their EHR exchange and below is a small portion of a list of EHR software producers and service providers:

Allscripts
Waiting Room Solutions
EaseMD Solutions
McKesson
Pure Safety
Smooth Practice Solutions
IOS Health Systems
Eclipsys
Antek Healthware
SpectraSoft
HealthPac Computer Systems
EMR Experts
Intivia
Marshfield Clinic
Bay View Soft
ProtoMED Medical Management
Clinix Medical Management Systems
Scribe Healthcare Technologies
LCD Solutions
6N Systems
AbelMed
Abraxas Medical Systems
AcerMed
Acrendo Software
Addison Health Systems
Allscripts
American Medical Software
Amstor
Clinix Medical Information Systems

Whew... I'll leave it up to you to find the rest of the alphabetized list.

Our taxes are secure (0)

Anonymous Coward | more than 4 years ago | (#31561572)

Why can our health records be secure?

they missed hippa? (1)

josepha48 (13953) | more than 4 years ago | (#31561610)

I actually worked at a medical online company that sent me through hippa and I dnd't see a single medical record while I was there. How could google miss that?

Violation of HIPAA? (1)

brianleb321 (1331523) | more than 4 years ago | (#31561844)

If Google Health isn't covered under HIPAA, it's illegal for any of these healthcare providers to enter any protected information into the system without the written consent of the individual patient. There are serious fines attached to this breach, per patient.

Like laptops in schools (1, Insightful)

amightywind (691887) | more than 4 years ago | (#31562160)

E medicine is like laptops in schools. It seems like a good idea but adds nothing to the interaction of doctor and patient. But it is great innovation for the government bureaucracy busy bodies and other do-gooders who feel the need to insert themselves between my doctor and my colonoscopy.

Big Savings Are Just Around The Corner (0)

Anonymous Coward | more than 4 years ago | (#31562434)

There are big saving is electronic records and nobody is talking about saving the postage. A primary motivation is rationing although it will be called "best practices". The best practices will prescribe the number of visits authorized per complaint per time period, the amount and type of medication per diagnosis, the switch - beyond the substitution of generics - to "therapeutically equivalent" medications and other cost saving initiatives. On the other hand the data can be massaged to reveal total cost per diagnosis by doctor. The less done/prescribed the better. Same thing with hospitals. There are big savings to be had and the push will increase.

Anonymous Coward (0)

Anonymous Coward | more than 4 years ago | (#31563066)

From my experience (employed @ a hospital for some years now) this whole EMR issue has nothing to do with HIPAA or Google. Their greatest fear is disclosure & the threats that it represents:

Doctors are hanging on with a death grip to the fragmented remains of their monopoly on medical information & the patriarchy that went along with it. They long for the pre-Internet days of patient ignorance & lower liability insurance premiums. We're working on some pre-EMR stuff now & @ least 10% of the doctors onsite have vowed to retire rather than deal with the sea change in how they do their work & the potential for increased visibility into their practices. They want to be treated like mystics who can pontificate on all things health-related without any practical accountability.

Hospitals & Insurers fear transparency of any kind. The hospital I work @ has an average markup of 190% on its services. For things like imaging diagnostics & lab work the markup is close to 300%. They fear a time when patients can "shop around" for their healthcare services. In fact my hospital is having meetings now about reducing services to only those which provide the best revenues, & scrapping plans for things like cancer treatment (too much overhead) & drug rehab services (not enough PR value).

I can't wait to see what happens if/when the Feds make any decisions regarding fee disclosure & standardizing costs regardless of insurer.

HITECH law changes make Google a Covered Entity (1)

cryptwhomp (16138) | more than 4 years ago | (#31563428)

And therefore covered by HIPAA.

EMRs can greatly harm a physician's work.. (0)

Anonymous Coward | more than 4 years ago | (#31563474)

When a physician has to use a computer interface to replace the good old paper charts, the result is INSANELY slower usage than with the paper charts. Productivity hits may reduce the physician's ability to see numbers of patients by 10 to 50 per cent. And even a few percent can be a disaster for a primary care practice. Why is it so much slower? If IT types (disclaimer: I am one) actually WATCHED a physician "interact" with the paper chart one would see that a great deal of info, of many differing types, can be reviewed in MOMENTS. Maybe input (notes) added too, also quickly. A typical EMR may require LOTS of clicks and selections and oodles of page views and scrolls etc etc etc etc. to gain acess to a variety of needed info. Physicians are also are often reduced to being clumsy data entry clerks to get data into an EMR. (And since so many physicians are employees these days, the whole EMR thing was probably done without doctor input (typical Dilbert situation), and on the cheap . . .meaning the servers are getting overloaded and each screen of the many needed is taking 10 to 30 seconds to display. While everyone is aware of the wonderful benefits of having data computerized, someone who needs to get a wide variety of data in & out of an EMR may be for big trouble. Most interface technologies are WAY inadequate to this task; biggest shortterm help may be FAST response time, and giving the EMR app the ability to have MANY windows into the data ("windows"? wow!) at once, shown on a BIG monitor (although few exam rooms would have room for one anyway). Some real creativity, new ideas, are desperately needed. (Microsoft's touch-screen table?? i-Pod technologies improved / adapted ??) Better info at two EXCELLENT links: "Why docs hate EMRs": http://www.healthcareguy.com/?p=663#comments and a really good downloadable (free) paper from the Journal of Usabilty Studies at: http://www.usabilityprofessionals.org/upa_publications/jus/2009february/smelcer1.html
(Pls forgive inexperienced post, don't think have posted here before although been reading for years.)
               

Google Health = PHR NOT EMR (1)

El Gigante de Justic (994299) | more than 4 years ago | (#31564500)

It should be pointed out that Google Health is not an Electronic Medical Record, it is an online Personal Health Record, with patient entered data. It may be handy in some cases, such as if you travel a lot and want a common place to keep your allergies and medications, and some basic information may be able to interface with existing EMR systems on a read only basis, but it is in no way equivalent to an Electronic Medical Record.

Not surprising... (1)

bkr1_2k (237627) | more than 4 years ago | (#31565318)

I have no idea why the summary says "surprisingly few" are using this. People don't want it, even the people who don't normally realize how much data they're giving away don't want this. It's not easy for the medical profession to use and it doesn't really provide anything of great value to the patients either. First, try getting your medical records from a doctor or dentist some time-- every doctor I've ever talked to about it (I move a lot) always gives me a hard time when I request copies of everything. It's ridiculous.. We all know those are "our" records, but doctors are required to keep them for insane periods of time (at least they were in the 80s and 90s here in the USA) even after no longer seeing patients and that responsibility seems to make doctors believe the records are theirs. Now, the e-records or whatever would actually make that easier, but I've yet to see a system that doesn't require manual data entry, which is often slower than the pen and paper alternative, especially in a busy office.

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