Examining the electronic health record “Death Trap”

…the relevance and implications for Medical Tourism

In his Second Opinion column, Dr Constantine Constantinides from healthCare cybernetics looks at why “Google Health” failed…the Electronic Health Record “Death Trap” and its implications for Medical Tourism

If you were wondering what ever happened to the Google Health initiative … Let me provide some background to the death of Google Health.

What Google announced was this:

“Google Health has been permanently discontinued. All data remaining in Google Health user accounts as of January 2, 2013 has been systematically destroyed, and Google is no longer able to recover any Google Health data for any user. To learn more about this announcement, see our blog post, or answers to frequently-asked questions below”

….. See Google announcement.

Even Google couldn’t master the concept of the Universal eHealth Record!

There can only be one Electronic Health Record (EHR)

Meaning… the “single-instance storage” concept and practice.

Late in life, I came to the conclusion that in many instances, success hinges on the “single-instance storage” concept and practice. With healthCare cybernetics (hCc), I am still struggling with the challenge of adopting and implementing the principle and practice.

For the EHR to succeed it must, likewise, be based on the “single-instance storage” concept and practice.

Practically all who claim to be in the business of “Medical Tourism” seem to know about the Electronic Health Record – eHealth Record – EHR – (and some feel confident enough to express informed opinions on the subject). Some who are in the medical tourism business feel even more confident enough to want to establish a proprietary eHealth Record System – to be adopted and used “by one and all”.

Everyone wants to be the keeper of your eHealth record!

What it means for medical tourism

How many ambitious plans to introduce and establish an eHealth Record System for medical tourists (or travellers) have we seen?

For example, early in 2012, , Prime India (a facilitator / intermediary) introduced the “International Wellness Card” – but how successful has this been? My impression is that many of those making forays into this tricky and “land-mine-filled” field know about the eHealth Record but do not understand it in its full context. Some are motivated by opportunism or an opportunity to exploit a market of presumably uninformed and easily impressed consumers.

My advice to medical tourism industry participants seeing opportunities in coming up with a medical tourism health record is “look elsewhere for lucrative opportunities” (and I will explain why).

The concept of “single-instance storage”

I emphasise …single and universal

The Universal eHealth Record continues to confound even the best brains in the field of health informatics. And here, we are talking about the Universal eHealth Record – and not an eHealth Record system designed to satisfy the limited (and short-sighted) needs of a hospital or medical practice.

Such “proprietary”, and limited scope systems are of little practical value to the health consumer – and in many cases, aim to create “vendor lock-ins”.

Vendor lock-in (or proprietary lock-in or customer lock-in) makes a customer dependent on a vendor for products and services.

What about Microsoft HealthVault?

Microsoft HealthVault is another example of “Vendor Lock-In”.

Microsoft touts Microsoft HealthVault as “the trusted place for people to gather, store, use, and share health information online… keep all of your health records in one place”.

But how do you gather all your health information when you receive healthcare services at a multitude of locations (and possibly countries) – and by a multitude of providers?

How many of these providers give you a record of the services provided and treatment outcomes and results of investigations in a universally compatible and interoperable format? An incomplete eHealth Record is as valuable as a jigsaw puzzle with missing pieces.

“Getting and keeping all of your health records in one place” is still impossible.

Why Google health failed

For an eHealth Record System to be “universally” and practically useful, it needs to be:

• Language-neutral.
• Comprehensive (complete).
• Stored in only one place, and updated at that place (the “single-instance storage” concept and practice).
• Universally compatible and interoperable.

This ideal eHealth Record System continues to elude us.

To a 2011 International Medical Travel Journal article “Google abandons plans for personal health records”, I contributed the following comments:

“Keith has brought to our attention an issue whose complexity had not been “factored in” by those who, based on superficial and simplistic thinking, thought they had discovered the Rosetta Stone – which they could use as the platform for a universal or provider-specific eHealth Record.

Even the HL7 organization dedicated to providing a framework and standards for electronic health information has not yet “cracked the nut”.

But the eHealth Record is also “narrative rich” – and the narrative is in a national language. Healthcare may be global but it is not language-neutral.

And of course, the ideal eHealth Record should be “readable by and understandable to” both the patient and the Health Professional.

The eHealth Record (with thousands of proprietary versions) has not managed to introduce the universally accepted – and adopted – health sector equivalent of a universal language such as Esperanto or Interlingua (neither of which achieved their aims).

Malcolm Gladwell (in “the Tipping Point”) reminds us that platforms are only adopted as “universal systemic platforms” when a lot of people adopt them – which in turn, encourages and motivates more people to adopt them (until the tipping point is reached – i.e., universal adoption and implementation).”

No single eHealth Record system yet introduced has been adopted by the number of users required for the “tipping point” to be reached.

And of course, the introduction of more and more eHealth Record systems, specifically for medical tourists, is not helping matters or the health consumer.