Earlier this week in the Boston Globe, there was a front-page article that focused on a subset of ECM, electronic medical records. As I read the article I wondered if its author knew how much was being said "between the lines"? While the focus was on e-records, it spoke volumes beyond that to me.
OK - lets start with the focus of the article. Apparently, a Mr. Dave deBronkart, a "tech-savvy kidney cancer survivor", accessed his online medical records from Beth Israel Hospital, and transferred them to Google Health. This Google App, allows users to centrally store their e- medical records to facilitate sharing. The Google App also provides related services, and in the case of Mr. deBronkart, it went perhaps one step too far. It provided an automated diagnosis, informing Mr. deBronkart that his cancer had spread to either his brain or spine. WRONG.
The article critiques the accuracy and viability of e-medical records. WRONG. Once again technology is being blamed for poorly thought out processes, lack of a complete strategy and misappropriation of technology. Yes, I am a bigot - I am a firm believer in e-medical records (just about e- anything actually), but only with the caveat that implementation needs to be preceded with a well thought out strategy, careful roll out and governance.
If you want to better understand how Google Health did what it did, read the article. Whether you read the article for details or not, realize that what went wrong here was Google taking technology too far, without a strategy or governance, and boldly going where Google has never gone before - and perhaps is not qualified to - dispensing medical advise - which is a far cry from collecting and making available medical records. Sure, the two services are related/complementary, but the credentials and skills to do one do not directly map to the other. This isn't the first time Google has overstepped its core competencies - see my earlier post. In their enthusiasm and rush to provide SaaS-based/Web 2.0 business apps, many providers, in this case Google, often step too far. The article, in my opinion does not point to the shortcomings of e-medical records, but rather the mistake Google made in trying to mashup medical billing data with automated diagnosis. Google is NOT a medical expert, and thus should not be dispensing medical diagnosis or advice, not without the proper partnerships/expertise, governance and testing. Although the risk of what Google has done in Google Health is more profound,the cause and effect is the same as the company that allows "any user" to mashup billing data and customer support databases, automates processes without taking a deep look into how the current process really works (as opposed to is supposed to work), or enables the use of blogs and twitter without "aligning" the usage with marketing, branding, records management, security and other related business practices. As technology such as mashups make it easier for "lay people" to create applications and create or expose content, the tendency is to think that strategy, vetting, testing and alignment are no longer necessary. Build it (its easy) - they will come - and if it breaks - fix it. In some cases, as this article illustrates, this "new" approach to real-time beta testing can be far more costly in the long run.
That said, I also believe that some blame lies with the consumer. I recall debating with colleagues during the advent of the Web, the risk that was posed by enabling virtually anyone to be a "published authority". A common topic, interestingly enough related to the Globe article, was, "What if a web site dispensed medical advice (from an undisclosed 10 year old), which proved wrong and detrimental to the user. Who, if anyone is liable of "malpractice?" Web users need to be more diligent in verifying the source and credentials of web content. Some of my readers may recall a blog post I made 2 years ago entitled "Are You for Real?", that explored this issue in greater detail, and used as an example a website that appeared to be an authoritative source on the life of Dr. Martin Luther King Jr., but upon diligent investigation was uncovered as providing content originally created by a white supremacy group.
Is Google really the place to go for medical advice? A place to store records - maybe (if they can get the security right, an issue also under debate), a pointer (i.e. query tool) to potential medical advice yes, but "the source" of medical advice - no - not yet.
Lastly, I should mention, in case you missed it, that last week I blogged about a debate between Dr. Jonathan Oberlander and Dr. John Halamka , the latter an e-records practitioner and the CIO of Beth Israel Hospital ( the original source of the patient's e-medical records). Dr. Halamka is quoted in the Globe article, and he blogged on it (worth a read). Dr. Halamka states that " I'm working with Google to evaluate the impact of sending our existing free text problem lists instead of billing codes. It will reduce the number of features available to patients, since Google's educational materials are based on billing codes, but it may be more informative to patients to see the text their clinician wrote, not the diagnosis on the bill. Showing problem lists is what we've done in Patientsite for 10 years." - Exactly - Google through ignorance of medical billing versus diagnosis, and lack of planning and strategy, is responsible for this unfortunate event, not e-medical records created at Beth Israel.
As I stated in my last blog post, KM, Enterprise 2.0, collaboration - no matter the focus, there has to be a strategy in place or the risk of getting it wrong is too high. While the focus of the last post was on potentially getting the business model wrong and underestimating the required effort, in this post, I broaden the risk associated with poor planning and lack of strategy to include potentially rendering a most erroneous end state.
Most infrequently is technology to blame for failed KM, collabortion and ECM projects, yet it is all too often the focus of the blame. The blame lies not with the technology but the lack of strategy, planning and misappropriation of technology.
