Google, Microsoft not there yet for health

Local health IT professionals are open to the benefits a Google or Microsoft electronic health record (EHR), but see many challenges in implementing such an offering within the New Zealand health system.

Ron Hooton, CEO of ProCare, says an IT solution will not solve the EHR problem. A Google or Microsoft EHR might facilitate some solutions and influence the shape of personal health records, Hooton says, but they won't address issues such as workflows or business processes. These should not be underestimated, he says.

"We've actually made quite a bit of inroad around giving access to information and most of the regional initiatives around the country are about giving access to information," Hooton told a Simpl-sponsored health IT roundtable in Auckland this month.

"What we haven't been very good at is facilitating new business processes."

He says companies like Google and Microsoft may provide a good repository and a quick snapshot summary, but what they haven't got are the workflows from, say, a GP to secondary care, to tertiary care, to community health and so forth.

Google began offering an online personal health record, Google Health, last May after Microsoft launched its offering, HealthVault, in October 2007. Microsoft also offers its Connected Health and Human Services (HHS) Framework and Connected HHS Platform, which aim to improve health system interoperability and data exchange. These are also integrated with its HealthVault platform.

Two years ago Microsoft bought the sole rights to Simpl's health connection engine for its Connected Health Framework.

Hooton says it's a mistake to think of an EHR as a "book you look into".

"It's the whole process around it, like how do I actually migrate through the health system and how do I get help to keep myself healthy. It's a lot more than just this set of information."

Phil Brimacombe, chief information officer for Counties Manukau DHB, Waitemata DHB and Health Alliance, says an EHR is not "one big system that solves everybody's problem that everyone can use, because that will never happen.

"It's more important to think about perhaps a health record in the key areas where perhaps the patient has the most interactions. The most interactions are with the GP and I think in the future that needs to be with the patient themselves."

Brimabombe says there is a good argument for having a shared record. But even then the system would need lots of connections to specialist systems on one side, and to non-government organisations and other providers on the other.

"You couldn't have one health record across that entire landscape. It just wouldn't work," he says. "But perhaps we might want to try and have one health record shared between those three key areas, the patient, primary and secondary.

Brimacombe says interoperability is the key rather than reliance on a single system.

The EHR issue wasn't the only area where offerings from Microsoft or Google were discussed -- and even Microsoft's games console, the Xbox, got a mention.

Johan Vendrig, chief information officer for Auckland District Health Board, says he thinks technology can create new patient-centric conversations in health.

"It's not the old fashioned pick up the phone conversation. Where the current technology can really make a difference is to go back from correspondence to conversations, with respect to an online conversation around the patient."

He says rather than having to pick up the phone, a multidisciplinary team, all working on the same care plan, might feel much more like a conversation around that patient, rather than a provider making decisions in isolation.

Steven Mayo-Smith, CIO for Radius Health Group, says he doesn't think enough use is being made of some modern technologies, such as Google Talk or one of the other instant messaging systems.

He says he uses these as a rowing coach, having conversations with people he hasn't even met. That is something that isn't being used in health, but could be, he says.

Hooton says ProCare has developed a derivative of YouTube, to deliver continuing medical education (CME).

"What that involves is usually specialist doctors preparing something between say a five minute update to a 45 minute or one hour CME session that's fully credited for multi-points for the GPs."

This provides them with an education online, when and where they want it, he says. Procare is also delivering CME across a tool called WebEx, which is similar to Google Talk and IM, he says. This allows GPs with a web connection to be in touch with other GPs and listen to and interact in a CME session.

"It's a pretty short hop from there to be able to have a WebEx session between a secondary specialist and a ProCare GP, over a patient with a patient in the room, perhaps even holding a great big dermatological thing up to a webcam and getting an opinion," he says.

Hooton points out his kids play Halo with a quarter of a million other kids worldwide on Xbox Live. Surely, he asks, it should be possible to bring together a few GPs and a handful of specialists?

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