The Tangled Web of Google Health – Online Medical Records Could Change Healthcare Receivables Strategies

Others have argued that the PHR systems, many promoted as cost free to consumers, must be somehow financially underwritten; Google and Microsoft are, after all, for profit corporations. The simple solution would be to sell certain data points from consumers’ PHRs for online marketing purposes. For example, under Microsoft’s HealthVault model, topical advertisements will appear next to a patient’s search results inside HealthVault. Thus, a patient seeking information on rheumatoid arthritis symptoms might see ads pop up for Humira, an Abbot Laboratories treatment for RA. Some detractors suggest that PHR vendors might eventually leak personally identifiable patient information to parties that would normally not be privy to it, but are more than willing to pay for the privilege to access it. BusinessWeek recently noted that the market for web-based health search advertising is estimated at $500 million to $1 billion annually. Finally, the most adamant skeptics caution that storing one’s medical records online without HIPAA protection opens the door for employers and insurers to deny applications for work or medical coverage based on health information that outside of the PHR system would have been kept private.

Recent Commercial PHR Models

On February 21, Google announced a partnership with Cleveland Clinic to launch Google Health. The pilot program, comprised of between 1,500 and 10,000 Cleveland Clinic patient volunteers, is slated to run for six to eight weeks. With nearly 40,000 employees, the nonprofit Clinic system is the largest employer in Cleveland, and has developed international partnerships in countries such as Austria, Egypt, and the United Arab Emirates. Cleveland Clinic already maintains electronic records for all of its patients, and more than 120,000 patients have enrolled in a program called eCleveland Clinic MyChart which gives patients access to their health data. Although Google Health has no current plans to sell advertising on the PHR system, it has not ruled out the practice in the future.

Last October, Microsoft Corp. introduced a beta version of its PHR system, Microsoft HealthVault, in partnership with the Mayo Clinic. Microsoft has organized a group of medical device companies (like those that manufacture blood pressure monitors) and service providers (mostly software firms) that are compatible with HealthVault. If a consumer utilizes one or more of these products or services, the patient’s medical data can be automatically added to an online PHR in HealthVault. All data outside the compatible list must be manually uploaded by the consumer. In many respects, HealthVault shares numerous characteristics with Google Health. A significant divergence for HealthVault, however, will be the placement of advertisements next to consumers’ search results.

Insurance giant Aetna revealed plans last week to bring its SmartSource free of charge to the company’s 16.8 million insured customers. The new program, similar to those of Google and Microsoft, has been put through a trial run by Aetna’s 35,000 employees. Two key factors set SmartSource apart from other commercial PHR vendors. First, Aetna is a health insurer, so much of the internal focus of the PHR system design is heavily industry-focused, pitched toward healthcare expenditures and billable medical events. The company claims that information contained in an insured patient’s PHR will not be used “to raise or lower premiums or reject membership applications,” according to The New York Times. Second, as an insurance company, Aetna is a covered entity under HIPAA; thus, consumer data housed in SmartSource is protected by the privacy and security arms of federal law, unlike the PHR systems to be offered by Microsoft and Google.

In addition to these recent and highly publicized efforts, hundreds of other smaller scale PHRs are available to consumers, many offered by individual hospitals or clinics as a component of online recordkeeping systems that sometimes include electronic patient billing, along with appointment or prescription refill reminders.

PHRs and Healthcare Receivables

Clearly, PHRs hold the potential to significantly impact the hospital industry, the ARM industry, and physicians — all on the receivables end of healthcare expenditures. And as is true for vendors like Google Health or enrollees in Aetna’s SmartSource, not all of the receivables effects will be positive.

The following list, although not exhaustive, attempts to outline several possible implications of PHRs on healthcare receivables that have been for the most part overlooked in the mainstream debates on the topic:

1. Partnerships with commercial PHRs could cushion the shock of technology investments, especially for physicians in small practice groups. A 2007 New York Times article reported that approximately “one-fourth of primary-care doctors use electronic health records, but only five percent of them are in offices with five doctors or fewer—where about 50 percent of all doctors practice.” Why? The story notes the experience of one small physician group in Philadelphia that spent $140,000 on hardware and installation, and projects annual technology costs upward of $50,000. The office now operates with three fewer full time employees and the doctors are able to quickly obtain information for hospitals, insurance companies, and patients. Were small physician groups able to defray the cost of some technology investments by collaborating with Microsoft or Google (who would absorb server expenditures, for example), the benefits of electronic patient records might begin to pay dividends that are measurable in dollar amounts.