By Jack Powers
ANALYSIS Google Health organizes a patient's diverse medical data into a coherent on-line personal health record (PHR). At base, it's a simple convenience, good record-keeping for important information that puts the patient in control of his own data. But as the growth of the World Wide Web has shown, standardized digital information -- cheaply networked, easily accessible, interoperable and extensible -- is the foundation for great new ideas, disruptive applications and boundless innovation. Looking ahead a decade of Internet time, here are a few possible applications.
Cafe Kara links her Starbuck's card to her Google profile to keep track of her daily caffeine, milk and sugar intake. Her on-line grocery store updates nutrition data from her weekly grocery order, and American Express logs the calories, fat and protein counts for her restaurant purchases -- plus the alcohol totals from her bar tabs.
FITNESS MONITORING
Bicycle Bob's wristmounted fitness computer reports his heart rate and cycling cadence to his gym's wellness network which maintains his customized fitness profile and updates it daily to his Google Health file. Bob can correlate his workouts to his baseline -- resting heart rate, calories burned, training intensity -- and his doctor can watch if he's overtraining. He logs in from his mobile phone to see if he can afford the extra calories from the chocolate cake at dinner, and he links his fitness stats to his Facebook page to show off to members of his runners group.
PERSONAL GENOMICS
Curious Jean links her commercial DNA analysis to her Google account. The DNA service identifies risk factors in her Google profile. Her doctor uses the genetic data to derive the appropriate personal dose of her arthritis medication. When researchers identify a new genetic marker for a disease, she gets an email update if it's applicable.
SCHOOL RECORDS
The Turner Twins' immunization records are forwarded to their school each September. Throughout the year, their schoolmates' anonymized records are linked to the school to keep track of ear infections, strep throat, lice and sports injuries. Schools publish aggregate wellness data to attract new students, and education watchdogs lobby for funding based on overall student health indices.
TRAVEL
The Columbo Family's vacation plans change when their on-line travel service notices that their original destination would be at peak season for their youngest son's allergies. Their airline checks the family's immunizations and suggests supplements for the new destination. And after the Columbos return, an email notes that a passenger three rows back was just diagnosed with Avian Flu, so the family should seek medical care.
SEX
Ready to take their relationship to the next level, lovers Romeo and Juliet share STD status reports through their Google Health accounts. If things get serious, they'll open up their entire files to each other and compare genetic data when contemplating children.
ELDERCARE
Grandma Grace's home eldercare network streams status reports to the family's Google file, and her doctor visits, tests and home health aide's reports and are filed as well. Authorized family members look in from time to time and receive email notifications when Grandma's worsens or special attention is needed.
INSURANCE
Trader Ted shops for insurance by selectively releasing his Google Health record on-line. He pays for regular care through a Health Savings Account, but health insurance companies bid for his catastrophic coverage based on his authenticated medical history, diet and exercise records.
PUBLIC HEALTH
Anonymized Google Health data is mined by Pleasantville public health officials to chart wellness patterns and develop health policy. Everyone in town can log onto the Pleasantville Public Health Dashboard and measure their health status against the town averages.
RESEARCH DATA
Boomer Brian gets an email from a teaching hospital: his health profile matches a new study target. Can the hospital get a copy of his June MRI and use his anonymized health profile? The researchers save time and the cost of new scans, and Brian gets a free T-shirt.
Privacy concerns, government regulations, entrenched power relationships and comfortable custom are usually no match for Internet empowerment. As healthcare consumerism pushes patients to take charge of their health profiles, the inevitable mixture of good ideas and bad, of innovation and quakery, will challenge us all to find the right path to good health.
ANALYSIS Google Health organizes a patient's diverse medical data into a coherent on-line personal health record (PHR). The visceral reaction of many to the privacy concerns is revealing: most people think they need to keep medical data secret because they're covering something up -- with employers, insurers, loved ones, maybe even themselves.
Congressman Smith gets careless with his Google Health password -- or maybe a hacker gets at his record. His enemies post his data to the web where his colleagues, his girlfriend, his mom, his children and his constituents learn of his history of gonorrhea, depression, ED and shingles. Smith resigns.
WELLNESS POLICE
As part of her company's corporate wellness initiative, Smoker Sue is pressured to link her fitness data to the company's medical network. She places at the bottom of the wellness rankings which are used -- unofficially -- in performance reviews and project assignments. To the detriment of her career, she ignores friendly robotic reminders to stop smoking, eat better and work out more.
PERSONAL GENOMICS
The O'Halloran Family's genomic profile becomes the source of conflict when it turns out that several of the teenaged kids seem to come from different genetic backgrounds. Mom and dad have to explain which one is adopted, which is an IVF child from a donor egg, and which were from earlier marriages. In addition, the blood relations get told that they may be at higher than average risk for colon cancer. The family trip to Ireland is canceled.
DRUG COMPLIANCE
Pharma Phil doesn't always take his hypertension medicine, and his insurance company warns him that his e-prescriptions have not been filled by his on-line drug store. Phil's wife Phyllis -- and her primary care physician -- get notices of impending polypharmacy: she's getting too many different prescriptions from different doctors as well as vitamin and supplements reported through the pharmacy link. Their insurance won't pay for non-standard care.
DATING
Lonesome Larry's on-line dating service links his Google Health record in addition to surveying 23 degrees of compatibility. The service doesn't even suggest prospective mates who take anti-depressants, who seem to be less than fit, or who have had major operations in the last two years. A herpes infection is OK, though.
SEX
Facebook Fred adds an application that displays his STD test status as a badge on his social media profile pages. At some colleges, the fad is banned because some badges are counterfeit. Third-party testing firms spring up to deliver authenticated results, often to mobile phones.
ELDERCARE
Grandma Grace's home care computer tests her from time to time for signs of depression, anxiety and problems with cognitive functions. The results accumulate in her Google Health record and become the "scientific" basis for county commitment proceedings.
PHYSICIAN'S PRACTICE
Doctor Dan defensively reviews the Google Health record for every new patient: missing a detail in the record could become the basis for a malpractice action. He hires a web PR agency to monitor and correct the reviews of his work that have been posted on-line, and he worries that his patients' diet and fitness stats, aggregated by insurance companies or employer groups, are not competitive with other doctors in town.
MEDICAL MARKETING
Because she once opted in with her Google Health record to an on-line health group, Media Marie gets bombarded in the mail, on-line and on the phone with sales pitches for new cures and treatments specific to her conditions -- and to her diet and exercise history. The ads become a little insulting because they know a lot about Marie.
PUBLIC HEALTH
Anonymized Google Health data is mined by Pleasantville public health officials to chart wellness patterns and develop health policy. Government commissions use the stats as the basis for regulating smoking, trans-fats, sugar and alcohol. Households with strong wellness metrics are eligible for tax rebates.
HEALTH RECORD REPAIR
Since GenX Jerry's career, marriage prospects, insurance coverage, love life and tax bill depend on the contents of his Google Health record, he hires a health record repair company to review, correct and authenticate his health details and to estimate the damage bad data has done.
As consumers come to control their own health information, they are at risk of giving away data too freely. Most of our imagined applications are consensual commercial relationships, not regulated medical practices. Like the Google Health system itself, they don't fall under existing health information privacy regimes.
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