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12:30 pm: Personalized Medicine

I spent some time yesterday playing with Google Health. While it’s certainly an interesting idea, it’s very far from ready for prime time. That said, it falls in an interesting category of “technology that I’m playing with while it doesn’t work very well, but that in 10 years everyone will be using.”

The key change is that here in the future, everyone is responsible for their own medical records. The time of a priesthood of doctors who maintain all this information behind a veil of anonymity and secrecy is ending. Be it good or ill – we live in a time of free information flow and consumer driven medicine. Nobody has a job for life anymore, so you have to take care of your own retirement fund. SImilarly, we don’t have a single trusted doctor whose advice we heed anymore, so we’ve got to track our own medical records.

Both my insurance company and my pharmacy allow me to log on and download usage history. Google offers the ability to “link” those accounts with my google health profile. Just like downloading my checking account statement into Quicken – I can download my prescription and billing info into my google account. Interestingly, when I did this I was greeted with a massive mess and very little useful information. This is because of the different viewpoints represented – none of which is my own. CVS knows when I filled a prescription. That’s excellent for tracking things like potential drug interactions. Blue Cross knows when a procedure or test was billed. So I can see that in April I visited the doctor a couple of times, got a few x-rays, and was prescribed some potent painkillers. In May, I went to physical therapy a bunch of times. Further, I can see that there was a diagnosis in billing terms, of CL ACROMIOCLAVICULAR JOINT. So that’s my separated shoulder. I can by date piece together the things that were related to busting my shoulder and annotate the items … but I would love to be able to “tag” events and sort by my tags.

I think of these tags as Medical Incidents. It’s not just the complaint or the office visit – but how I categorize the set of events that hang together. Because I’m young and mostly healthy, this is how I think of the world. Most of my diagnoses go away after the bone heals or the virus is defeated. I would like to be able to associate all those x-rays and other things under a heading that’s meaningful to me. I’m sure that google will keep chewing at this over time.

Once I get a condition or a diagnosis in google health – it appears to stay with me forever. I can set an “end date” on a condition – but it stays on the primary list of conditions. So, that one time I had bronchitis tags me as a “bronchitis” sufferer forever. I can imagine that being a source of confusion to an insurance company who doesn’t understand how incredibly healthy I really am … all they have is this data.

A feature that I like a lot is their nod to “provenance.” Where information came from. Part of the value of a medical record is not only “what was said,” but “who said it.” Once a doctor signs off on a diagnosis or an authorization – I should not be able to change that. I might, however, be able to note what I learned downstream. Google supports this explicitly by not letting me edit things that are imported. Once it’s signed by Blue Cross, it stays Blue Cross.

There’s another perspective that is needed too – which I’ll hopefully get when my medical provider approves my request for online access. I can see when tests were ordered and paid for (insurance), but I can’t see what the results were! This is the part that’s most likely to be interesting to me. I want to track things like cholesterol, blood pressure, and so on. I’m a total pack rat, and I’ve been keeping this stuff in Excel for years. However, I consistently have to ask “could I see the actual number you just wrote down?” Much simpler to know that as they enter info into their records – that information actually belongs to me and I’ll be able to see it later.

There are already three companies linked on the page who will take a box of medical records and scan and enter them for you. While this doesn’t mean much for me, I can imagine it being a huge help to medical providers for first time patient visits. You get the shoebox full of records – and rather than paying the doctor for two hours of digging through that crap (and suing them when they miss some detail), you outsource that effort to the equivalent of a paralegal. They would sort, scan, and organize the data – which the doc can then review.

In the category of “damn nifty” is the little tab on lab results that lets me flip back and forth between tabular and graph views of any measurement.

Right now the very most useful thing is the ability to write down in a single, internet accessible place dates of my vaccinations and immunizations. Over time, I expect the utility of the rest to come up to par – so that the next time I find myself in a doctor’s office or an emergency room I’ll be able to pull up some needed piece of historical info, right there and then.

Originally published at chris.dwan.org. You can comment here or there.

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