Analyzing Google's exit from the PHR market

Google is not talking further about its decision to drop its personal health-record platform, Google Health, preferring to let last Friday's blog post announcing the move stand for itself, according to company spokesman Jason Freidenfelds in an e-mail today.

So, to get the big picture of what Google's withdrawal from the PHR space might mean, Missy Krasner may be one of the best people to ask.

Health IT cognoscenti will remember Krasner as the peripatetic special adviser to Dr. David Brailer, the first head of the Office of the National Coordinator for Health Information Technology at HHS. From there, Krasner shipped out to Google to serve first as a founding member and project manager of Google Health and then as a product marketing lead for consumer search.

Krasner's departure from Google earlier this year was a signal for some that the search giant's interest in health IT might be waning. Krasner, still in Mountain View, Calif., now works as an independent IT consultant.

Krasner has no dispute with Google's stated reason for announcing it will drop its Google Health platform at year's end—it just didn't attract enough users.

So why didn't it attract more users? Several factors were at work, Krasner said.

"The first is just something that's pretty basic," Krasner said. "It's the way our healthcare system is made up: It's not made up with the patient at the center of every transaction. They're blind to every transaction—to cost and to where their data is stored. Patients don't know about these things, so the demand for these services is lower."

The second issue, she said, was the Health Insurance Portability and Accountability Act of 1996, which was modified by the health IT and privacy provisions of the American Recovery and Reinvestment Act of 2009 in an attempt to rope in personal health-record systems under HIPAA regulations. But Google and rival Microsoft—the latter offering the Health Vault PHR platform—protested that their form of "untethered" PHR system was not subject to the new rule.

On the other hand, potential data sources for Google Health, providers and their business associates, are covered under the HIPAA privacy and security rules.

"That made the model very challenging," Krasner said.

Linking various provider EHR systems into Google Health also proved "problematic," she said. At issue were user identification and security concerns rather than interface technology difficulties.

"You can't link in once," Krasner said. "You have to do it for every connection when you want to push information in and suck information out. You would want to find a link and then jump over to their site and satisfy their credentials. And all of the different providers have different authentication methods."

That makes the linking experience unwieldy for a provider who has "about 30 seconds" of attention to make the system work, she said. "They say, 'Oh, I don't have a user password with Walgreens. I have to go through all this?' That was a barrier."

Krasner also asserted that the audience of people who want to use a PHR is small—typically, people who are chronically ill or individuals who have a specific medical condition, such as pregnancy. Healthy individuals without a chronic illness are more interested in having a health calendar to alert them to appointments and an application for handling their medical contacts, and they're using their cellphones for these purposes, she said.

Still, the Google foray wasn't a total bust, Krasner said. As far as using personal health records as a health-management tool, Google Health "really contributed to the national dialogue," she said.