- Smart Healthcare, Wednesday 1 July 2009 09.00 BST
Search me: Google sees its health record as an indirect way to sell advertising. Photo: David Paul Morris, Getty
Web 2.0 seems to be popular in government at present. In the US, the president has taken to delivering his weekly briefings on YouTube. The White House has a blog, and Obama even has a Twitter account. Now, the Conservative party in the UK has latched onto the idea of using Web 2.0 services to complement public services, but opposition leader David Cameron is thinking about taking it one step further - particularly in health care.
"In this age of austerity, a web-based version of the government's bureaucratic scheme [using] services like Google Health or Microsoft Health Vault cost virtually nothing to run, so this is where some really big savings could be made," he said in April at the party's spring forum. "Not just shaving a bit off this budget here; that cost there, but instead replacing whole chunks of the expensive, bureaucratic government machine with more modern methods - for a tiny fraction of the cost."
He was referring to NHS Connecting for Health's National Programme for IT, which has run into serious budget, deadline and privacy concerns. With companies such as Microsoft and Google now providing free health records management services that are controlled by the patient, we could theoretically get this aspect of the programme for free. But is it such a good idea?
Deven McGraw, director of the health privacy project at the Washington DC based Centre for Democracy and Technology, doesn't think so. "If the opposition party is suggesting turning it all over to Google and Microsoft, there will be a price to be paid for that, in the sense that people's health information will be more at risk of being used for marketing purposes," she says.
That's a good point. It comes down to advertising and ownership of data. Google's mission statement clearly spells out its goal of organising the world's information, but it has to make revenue somewhere, and over 99% of that money comes from online advertising.
John Coulthard, director of healthcare and life sciences at Microsoft, makes no bones about the need for advertising revenue, but argues that it can be done ethically. "The NHS spends hundreds of millions of pounds a year on advertising. Smoking, obesity, change for life, diabetes - tonnes of stuff," he says. "What would happen if you said to your Health Vault account 'it looks like I'm pre-diabetic'?"
Advertisements could be tailored to target people according to their potential health problems, Coulthard argues. With an increasingly privatised healthcare system, he says that the opportunities for more commercial advertising around private healthcare may also open up in future.
Private patients
However, farming outpatient healthcare records to private companies preoccupied with advertising raises privacy concerns. Can companies manage patient data and leave those patients in control of their own records, without contravening privacy boundaries? Dr Deborah Peel, a practising physician and founder of US-based non-profit Patient Privacy Rights, is currently in the process of putting together an international set of privacy benchmarks against which to measure private sector patient record management systems.
Peel asked both Google and Microsoft to work with her on defining the parameters to join the consortium and help evaluate adequate patient record privacy, but only Microsoft responded. "The one technology company that said that wanted to stand with consumers on controlling their health information was Microsoft," she says. "They built out Health Vault according to our privacy principles. Google is not in favour of consumer control over data".
However, Google isn't interested in selling ads directly targeting users of its health record system, either. "At this time, we have no plans to host ads in Google Health. Our business goal is to offer a valuable service to our users and drive brand loyalty and more searches on Google.com where we make our money on advertising," the company said.
The principle underlying both Google and Microsoft's healthcare records systems is that the patients should have control of their own data. Today, healthcare providers have that control, and patients have little or no input into the content of their own records. However, putting that control in the patients' hands raises its own issues. If the patients control that data and can update it, how can doctors trust it to be accurate? "A lot of the physician community here basically says we don't trust the information that is in a patient health record, unless they know what the source of that data is," says McGraw.
Coulthard argues that Health Vault can tell who make changes to a patient's record, so that doctors can tell if a patient altered their weight information to avoid embarrassment, for example.
There are doubtless many possible benefits to be gained by farming out patient record management to private sector companies that excel in pushing the technological envelope. For example, Coulthard describes a potential scenario in which a Facebook plug-in could be used to connect people with the same ailment. Could hay fever sufferers automatically find each other using a social network, and talk about ways to mitigate their medical problem?
You can bet that Hippocrates never had to grapple with such thorny issues. On the one hand, the power of social networking could create new opportunities in healthcare - and also, incidentally, costs a lot less than an arcane, centralised system. On the other hand, it raises distinct privacy issues. Is the UK government ready to address those issues, having lost 25m HM Revenue and Customs records on two CDs? Given the billions that we have already spent on the National Programme for IT, perhaps now is an unsettling time to be mulling these questions.
