As Lisa Wagsness, a writer for Boston Globe said in Electronic Health Records Raise Doubt article that making use of information systems in health care is somewhat new and " a revolutionary tool to help patients navigate a fragmented care system.". By using some information systems called EHRs or Electronic Health Records, health care providers have the option of managing medical information online. Not only this but nowadays it is possible to manage your own personal health information by using a PHR, or Personal Health Record, program.
Electronic Health Records (EHR) offer patients the opportunity to access their own medical records. The primary two PHRs are Google Health which was released in February 2008, and Microsoft's HealthVault which was released in October 2007. Google and Microsoft knowing as the dominant players of the "Internet" and "desktop" respectively, lately broadened their public services by introducing internet-based personal healthcare information platforms- Google Health and Microsoft HealthVault. Since these two services were launched the number of people being registered at the two of them has been rapidly increasing reaching one hundred thousand online health care members. Both companies have constantly been collaborating with other non- profit organizations as well as for profit- companies in order to design, develop and distribute their health-care applications. These applications stand on the free available Electronic Health Record systems of Google and Microsoft and provide subscribed patients with a variety of benefits.
"Health care systems are in continuous transformation. Currently, Germany is introducing an Electronic Health Card, following the global trend towards full digitalization of patients medical information. Patients' files which were once handwritten by medical staff of different hospitals and clinics now will be collected as Electronic Health Records (EHR). This transition provides numerous benefits for patients, health insurance companies and medical staff" (Tang et al.,2006). For instance patients not only can gain detailed access to their records but they have the option of choosing whom to share their information with such as doctors of their own choice, family members or insurance companies and also save money by avoiding useless repetition in patients care.
According to a study of Roland Berger, the secondary healthcare market in Germany alone has a value of 60 billion ( Berger, 2007). "Because of its value and growth potential, numerous solution providers are preparing to enter the healthcare market worldwide. Frameworks for EHR are an especially exciting opportunity for obtaining a strong market position. They enable third parties to develop applications in order to reach a large number of patient; e.g., a potential application could look a patient's medications and, according to the patient's postal address, construct a database of low-cost pharmacies in order to buy the cheapest medication available and ship it to the patient. Implementing such an application and selling it to the users of the EHR system is one possible business model for such a value-added application. The patient can choose his favored out of a wide array of available services and add them to his personal EHR profile. Therefore. EHRs are very powerful and valuable tools for future health service providers." (Sunyaev et al., 2010).
Google Health
"Better Health comes from better information." (Google ).
"Organize, track, monitor, and act on your health information with Google Health. Google believes you should have easy access to your own health information- anytime, anywhere. All you need to get started os a Google username and a password. With a Google Health account, you can store, manage and share all of your health information in one central place. We believe that your health information belongs to you, and you should decide how much you share and whom you share it with. We will never sell your data. We use sophisticated security techniques including encryption on connections and on our servers to help keep your information secure and private. And you are always in control of what you want to share and what you keep confidential." (Google Privacy Policy)
Google Health is an EHR built to provide an easy way for users to store their own personal health records online. Google describes its product as an EHR " of a different model" which, in addition to offering a place to store, manage and share health information. Also provides a directory of online services to aid in using this information on a daily basis (Google 2009b).
Features of Google Health
Manage your Health Information Online
If your health information is in disorganized and perplexing Google Health offers you the perfect solution by creating a single place where you can organize, store and access your personal health information online as many times as you find it reasonable. The subscribed patient can track his wellness metrics, gather and organize personal medical records, or import his health data directly into his personal account from connected doctors, hospitals and retail pharmacies. Google Health makes it possible create multiple profiles as weel for family members or other people who a user cares for..
Set Personal Health Goals
If you have looking for a better and more efficient way to track your goals for blood pressure, weigh or other possible wellness metrics or if you want to track your progress while working out, check out your sleep patterns, Google Health provides you with all the possible answers by making different sophisticated applications free of charge, easily accessible. In this way, everyone is being offered the choice of setting personalized goals online as well as monitoring them on a regular
Track your Progress
Create custom trackers for things you want to monitor like daily like sleep, how much coffee you drink a day, or how many times you exercise a week. You can also take notes or keep a diary on your how your are doing with a particular medical condition or a personal goal you set.
Share your Health Information
By using Google Health you have the opportunity to coordinate and control your health condition by sharing the personal medical records with friends, family members, specialists, doctors and other individuals in your network. What makes this feature more preferable is the fact that the only person who has the ultimate right of deciding when to stop sharing or choosing the people who can have full access to your personal information is only YOU. Furthermore you can share your health information posted in your profile with your doctor or a relative by having printed a wallet-sized version of it.
Personalize your Health Needs with Content and Apps/Devices
You are given the chance of accessing different content on health topics from confidential sources and Google search results. Moreover you can make use of applications which are integrated with Google Health. These applications help you to manage in a better way your health complications.
Google Health is based on open standards (Continuity of Care Records for data exchange, SOAP for the web-services interoperability), and provides a development API, programming libraries and test infrastructure. Even though Google is not an HIPAA (Health Insurance Portability and Accountability Act) covered entity, it assures that it will protect the privacy of the information by giving the user complete and absolute control over his personal health information held online. Taking this fact into consideration it can be said that the purpose of advertising is definitely not a purpose of Google initiative of digitizing health information. U.S market is currently the major focus of Google Health since the third- party services which are used by it are exclusively American.
Google Health enables third parties to contribute further services to the Google Health platform that can work with the user's data ( Sunyaev et al.,2010). Google Health currently has more than ten partners who provide services for importing medical records, exploring medications and treatments, converting paper records, finding personalized tools, copying files, and sharing users' records.
As the expansion of the World Wide Web has demonstrated, digital information which is easy to be accessed as well as inexpensively networked is the basis for disruptive applications and great innovative ideas. An increasing number of applications are expected to be accessible by Internet users such as:
1. Diet Monitoring: Every user who has a Google Health profile is able to keep track of his daily milk, sugar and caffeine intake.
2. Fitness Monitoring : The users can correlate their workouts to their baseline-calories burned, resting heart rate, training intensity- and find out if they are overtraining or not.
3. School Records: Every student's health information is linked to the school so that it is possible to keep track of step throat, lice, ear infections or sport injuries.
4. Eldercare: Authorized family members check from time to time their grandparents Google Health profile and receive email notifications if case of health condition worsening or if special attention is required.
"Because every story has two sides"…
An increasing number of Internet users are of the opinion that keeping their personal health information private is a way of covering issues of a high importance with other people including employers, loved ones and insurance companies. As Google launched free electronic health service for patients, fears over security started to increase among citizens is written in an article of British Medical Journal. Even though President George Bush has promoted electronic health records as an important means of reducing the costs of health care in the United States and a way of reducing medical errors in different hospitals, these facts do not seem to have a significant effect on people to induce them create a Google Health profile and enter their personal information. A number of real cases such as stolen data because a specific user is not careful with his Google Health password or because a hacker gets his record, getting bombarded in the email, on the phone and on-line with sales pitches for new cures and treatments specific to a user who has once opted-in with his Google health record to a random on-line health group or making use of old people for different scientific research in the city are an evidence of the lack of trust on Google Health effectiveness. As mentioned in the case study "Should Google Organize Your Medical Records" in Management Information Systems 11th edition textbook, Google development off its Google Health application is a pure example of the conflict between self-avowed mission and the individual's right to privacy. A big question rises : Are the privacy risks posed by information systems significant enough to abandon or curtail the collection of useful information? And if the second option will be the case how will this be decided and who should decide?
On December 26, 2006 Wall Street Journal published the story on Patricia Galvin considering as one typical case of electronic medical horror stories concerning the security of accessed information by Google Health program. Patricia Galvin was screwed by insurers after medical information about her psychotherapy which she was sure that would remain confidential and accessible only with her will, was actually divulged to an insurance company. This article indicates that objections to HHS (Health and Human Services) about violations of medical confidentiality have gone beyond 23,000.At present HHS receives approximately 700 new complaints on a monthly basis.
Even though Google representatives have claimed so many times that advertising is not a goal of launching Google Health, this does not seem to be true in a number of cases. Advertising their users' personal medical information seems not to hurt anyone but when this information is advertised to physicians it might and it can lead to a number of undesirable and sometimes disastrous consequences such as changing the way that patients are treated by their physicians. For example physicians maybe become less responsible and use a cheaper treatment than what it was planned if Google Health advertises information and serves it from pharmaceutical companies or insurance companies. Being influenced by pharmaceutical ads, they can also prescribe drugs to their patients which are much more costly and leading to an increased number of patients not being able to afford treatments and vital drugs.
Microsoft HealthVault
"Bring your health information together so that it's available when and where you need it." (Microsoft)
"HealthVault offers you a way to store health information from many sources in one location, so it's always organized and available for you online"( Microsoft, 2009). "With more than thirty partners, HealthVault also offers a broad variety of services to users. HealthVault consists of two distinct products-an electronic repository for health information on the World Wide Web, both free to users" (Cross, 2007). "HealthVault is most of the times described as "PayPal for health Information" for being able to store and share medical information at the discretion of its owner, as well as for utilizing of its owner, as well as for utilizing similar security features" (Blankenhorn, 2008, Berndtson, 2008, Kolakowski, 2009). "HealthVault stands out from other EHR providers because of its extensive partner network, particularly in the area of medical and fitness devices" (Sunyaev et al., 2010). Microsoft is planning to gain profit by placing advertisements next to the HealthVault search results. Similar to Google Health, Microsoft offers an open API and an SDK, including libraries for Java and Ruby. Similar to Google Health, Microsoft HealthVault is presently U.S- centric and it can be used only from inside the U.S. Microsoft HealthVault collaborates just with American pharmacies, hospitals and physicians.
"It's going to be a long journey," Neupert told the Times. "To make a difference in health care, it is going to take time and scale. And Microsoft has both."
According to The New York Times, a considerable number of non-profit organizations, clinics and hospitals have signed up for Microsoft HealthVault including Johnson & Johnson LifeScan, the American Heart Association, the Mayo Clinic, New York Presbyterian Hospital and MedStar Health which is a network of seven hospitals in the Baltimore Washington region. Peter Neupert said for The New York Times that one of the biggest challenges faced by Microsoft is building trust at people that the service offered by HealthVault is secure and private. For the achievement of this specific goal, Microsoft specialized programmers have made it possible for the personal medical information of every single HealthVault member to be stored in a secure and encrypted database. Similar to GoogleHealth privacy rule , in this case it will again be the user the only person with legitimate right to have access to the uploaded information as well as other options like who can see the health records.
Microsoft HealthVault Platform
Features of Microsoft HealthVault
Create an account for yourself
Internet users need only to compile some basic information regarding their health in order to set up a personal HealthVault account.
Add any family member you are caring for
HealthVault gives his existing members to add records about other people including older parents, kids, spouse or anybody else whose health is important to them.
Get health information into HealthVault
Using fitness or health devices you can upload data on the internet and connect with online labs and pharmacies or even use online services in order to digitize medical records once written in paper. Finally you will through away your notebook and this will be the point where all of entries scratched in pen and piles of documents with your health information will end up.
View and track your information with online health tools
HealthVault connected tools are designed to help the users who have a personal account to make sense of small details which might seem to be very irrelevant. After gathering you medical records you can use tools to help you check side effects and interactions. Even though medications are supposed to help patients get well, it is always good to be vigilant and keep a close eye on the medicines you are taking. HealthVault offers the option of keeping track of your prescriptions or those of the person you are taking care of.
"Head or tail?????" ( Disadvantages of HealthVault)
HealthVault is not considered to be secure and safe in the same way as GoogleHealth. As mentioned above, Microsoft representatives assures patients of their online health accounts safety. They say that there is no possibility of information being accessed by another person that is not the user who has the account since the only way of accessing it is by using a log ins and password. However, there are real life cases which show the opposite and reveal the fact that encryptions or passwords are not that adequate. There are stories of stolen identities, data hacking or blackmail abound which make the public not to trust too much on Microsoft " promises" and privacy policy. In addition, there exists some criticism over Microsoft HealthVault not being a HIPAA (Health Insurance Portability and Accountability Act" covered entity and as a result it is not subject to HIPPA privacy of individually identifiable health information.
"Use Health Vault, Lose Your Rights" says Ignacio H. Valdes from the Health-IT Failures dept. in an article posted on LinuxMedNews website. According to him, the term of use specified by Microsoft Corporation are such that they make the contract completely unfair and biased, giving Microsoft the possibility of hurting its users but not the opposite way. Microsoft privacy and security software is constructed in such a way that no 3rd party can be able to verify if all that is declared and claimed is actually true and implemented. Somewhere in between lines it is clearly stated the following sentence: "In using the Service, you may not: use the Service in a way that harms us or our affiliates, resellers, distributors, and/or vendors (collectively, the "Microsoft parties"), or any customer of a Microsoft party;" and it further goes on to say: "We may use technology or other means to protect the Service, protect our customers, or stop you from breaching this Service Agreement...In order to provide you the Service, we may collect certain information about Service performance, your machine and your Service use. We may automatically upload this information from your machine." Ignacio H. Valdes insists that all this should be enough to make a person pass on Health Vault and not upload personal medical information on the Internet.
Microsoft Health Vault and Google Health- The 'Coke and Pepsi' of online health
The two technology competitors have much in common when it comes to Microsoft HealthVault and Google Health, their online health applications. It seems to be difficult to 'taste the difference' between Google Health and HealthVault since both platforms are not trying to be a healthcare provider or to be a conduit between patients and healthcare professionals, and they both have search as they business model. Even though there are slight differences in the two services if you take a deep look into them, from a high level view they result to be somewhat similar.
Google and Microsoft both claim that their ultimate goal is the creation of integrated online environment that will enable everybody to create and store personal records, find doctors, communicate online, get information share it with providers and manage medications. And talking about Google and Microsoft, there is always another goal: Domination of the world
Both Microsoft and Google assures users that they have complete control on what is going on into their medical records and who is and can have access to it. If for any reason you would like to keep some information private and not share it with others such you employer or insurance companies both programs have the feature of leaving this information out.
Google Health as well as Microsoft HealthVault are free web-based services, which means that the access of your personal information is possible anytime and from anywhere without incurring any cost. These two services have been compared to online banking regarding to their security. Microsoft and Google pledge not to share any single detail of your information unless your give them explicit permission to do so.
Differences between Google Health and Microsoft HealthVault
Google Health and Microsoft HealthVault have many common features as well as similar future challenges. However, one cannot conclude that these two platforms are the same.
First of all , HealthVault seems to depend more on its coordinators for ultimate success. If the partners build good applications and attract a lot of patients then HealthVault can flourish. If the opposite happens and Microsoft partners decide to sit down and do nothing, Microsoft most probably would think it twice whether it wants to build and market further applications on its own. On the other side, Google Health allows 3rd party collaborators to build different applications but seems to be more inclined to build applications on its own as well.
Google Health and Microsoft HealthVault distinguish between authentications for web applications and desktop applications. While Microsoft HealthVault uses just one procedure, Google Health uses two very different procedures. "Google's web-based method allows the developer to choose between Google's AuthSub and the open protocol OAuth in order to create a connection between a developer's site and Google Health. Microsoft HealthVault uses one method for web and desktop applications. Both types need to be aligned with security certificates that can be easily created and uploaded to Microsoft HealthVault by the HealthVault Application Manager" (Sunyaev et al., 2010). On one hand this makes Microsoft HealthVault application much more complicated but it also makes it more secure than Google's approach.
Microsoft HV and Google Health differ in permission management as well. Microsoft HealthVault allows a very detailed specification of permissions for every possible application which has been installed to a user's profile. The permissions are known as Create, Read, Update and Delete (CRUD) permissions. In contrast, Google Health allows a write-only and a read & write mode for the profile. This means that it is not possible to set specific rights for item classes as in HealthVault case. This leads to a lack of user's control over his data which is accessed by an application and is considered as a serious weakness Google should immediately address on.
Conclusion
