Electronic medical records after Google Health’s failure

July 26, 2011

By Vineeta Vijayaraghavan and Clayton Christensen
The opinions expressed are their own.

It may seem that the viability of electronic health records looks dismal after the failure of Google Health, yet in integrated health systems around the country they have been implemented and utilized by patients. In Google’s failure we must see an opportunity to address the fragmentation of our healthcare system and take notice of those health systems that are offering innovative services that help provide better care at a lower cost.

Earlier this month, Google announced that it was closing down Google Health, its foray into personal health records, because it failed to find “a way to translate limited usage into widespread adoption in the daily health routines of millions of people.” Based on 30 years of research, we are firm believers that technology will enable disruptive innovations in healthcare – the types of innovations that will dramatically lower costs, increase quality and improve access to millions. But Google Health was doomed from the start. The obstacle standing in the way of its success was the massive fragmentation of our healthcare system, and its closure signifies the urgent need to integrate healthcare.

Google thinks big. With Google Health, it would have loved to solve the fundamental problems facing consumers – making it easier to schedule appointments and communicate with doctors, allowing patients to manage medications remotely, or even helping them avoid the doctor’s office entirely. Accomplishing these goals would have almost certainly inspired consumers to embrace electronic health records. But to do so, Google needed a fragmented maze of insurers, hospitals and medical groups to also share their data, requiring them to clear complex regulatory and privacy issues to complete the onerous process of bringing their own information online. These organizations do not have the right incentives in place to invest in such an effort, and so Google Health failed.

There is only one way to speed up the process of getting robust health records online, and that is integration. Over the last year, we closely studied seven integrated health delivery systems – which typically contain a medical group, an insurer and a hospital – and found that electronic health records are immensely popular with consumers enrolled in the systems because they solved their most urgent problems.

At one well-known system, HealthPartners in Minnesota, patients can access their online records to schedule an appointment and have all their files automatically available to a new specialist the patient might never have seen before. At Group Health Cooperative in Washington, when patients go in for a blood test, test results have often been emailed to them and added to their electronic health record before they even arrive home.

Even the Medicare population served by some Group Health physicians has embraced electronic health records, contrary to expectations. In fact, some physicians have seen a 50 percent drop in in-patient visits by Medicare patients while retaining the same satisfaction ratings and outcomes. If replicated widely, that result has astounding implications for lowering the cost of care across our healthcare system.

Integration is critical in creating high-value health records and encouraging usage. Physicians who are employed in integrated systems comply with inputting patient data, and are often compensated for time spent on email and phone visits. The insurer in an integrated system can aggregate information so that patients can view and pay bills from different specialists and hospitals in one online site. Most importantly, the entire organization invests money and staff time into making integration and technology work better for patients over time.

At HealthPartners, a dedicated team worked for a year to revise its online appointment scheduling system, reducing 800 appointment types to a few dozen. The team also reengineered physician workflow, ultimately bringing average wait times down from 17.8 days to 4.2 days, and enabling many patients to actually get an appointment on the same day they called.

If you want a better experience, find your way to an integrated system in your part of the country and see what the future could hold.

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There are, of course, a bazillion different reasons why a given idea might or might not work in practice, with much of that most immediately having to do with the skill (or not) of the entrepreneur bringing it to market.

In that regard, rather than become fixated on the idea that “the reason’ for failure is due to the fragmented condition of our health care system, one must take the perspective that Google Health failed because it did not take the fragmented condition of the health care system into account – and while there’s only a subtle difference in those words, the difference in meaning is anything but.

Said another way then, the responsibility to develop a business proposition which drives critical stakeholders towards adoption lies with the entrepreneur and not the other way around. Clearly that did not take place for this initiative and as such, the project (in its current form and under this particular sponsorship) died a predictable and poductive death. That isn’t to say that a universal medical ID won’t ever come into existence, it only means that that it’s not going to come about in this particular form at this particular moment.

On what remains in the discussion, I’d challenge the assertion that integrated health systems are necessarily ‘better’ than modular systems. Whereas integrated systems can be configured for optimal overall cost at a given point in time, such efficiencies can be developed in a manner which detract from other stakeholder priorities – and since existing integrated health care systems have not come to dominate the health care industry despite having had a longstanding opportunity to do so, I’d suspect that such may be the case here.

So while it could be that we’re all being held hostage by one or another monopolistic element within the existing system, you and I both know that once an appropriate disruptive innovation becomes deployed AND adopted, elements such as these will fail and fall by the wayside of their own weight – and the next era of healthcare management methodology will take its place.

On that basis – what has transpired is just another of the failures needed to guide providers towards convergence on a method or means that will actually work well enough for a enough people such that it has the opportunity to become improved and eventually assume the dominant role in the way health care is managed and maintained. Until that time, we can (and should) surmise and experiment, but only the market can dictate which approaches will be sufficient to initiate the eventual (and inevitable) departure from the incumbent system.

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