Google Health: A View From the Inside

Google Health launched on Monday, which sent the world’s Google-watchers into a tizzy. I serve on Google Health’s Advisory Council – which met all day Tuesday – and so here’s a bit of inside dish, along with my impressions of the site and the company.

Google Health page

FYI, my work on the Council is covered by a Non-Disclosure Agreement, so I won’t reveal anything that isn’t publicly known regarding Google’s products or intentions. Also, in the interest of full disclosure, you should know that I am compensated for my Google service. (No stock options, darn it.) With that as background, here’s the scoop.

Google began working on its version of the personal health record a couple of years ago, after the company realized that a remarkably high percentage of searches were for health information (I know, if that’s going to be how priorities are set, you’re wondering if Google Sex is next). Google put together an impressive team to develop the concept. One of the leads is a former UCSF medicine resident, Dr. Roni Zeiger. Many of our residents come to me for career advice, and I seem to recall Roni asking me about pursuing his interests in informatics after residency about a decade ago. Sage that I am, I probably told him that this computer thing didn’t have legs. Luckily he didn’t listen, and now he’s the top doc at Google. Go figure.

Another lead player in Google Health is Missy Krasner, an effervescent woman who served as David Brailer’s senior advisor when he was the first federal IT czar. Missy, who sports an ever-present smile, serves as the glue that holds the team together, and her knowledge of all the national IT players (including those in DC) is crucial.

Google Health’s Advisory Council is chaired by Dean Ornish, the famous physician-author, and includes a bunch of luminaries, including Cleveland Clinic CEO Toby Cosgrove, Harvard’s CIO John Halamka, and Dan Crippen, former head of the Congressional Budget Office and now a top McCain advisor. Yesterday’s meeting was held in a large conference room in the Googleplex in Mountain View, CA; a huge Google poster was on the wall, with the first “o” in Google morphed into a cartoon of Einstein’s face, and the notation “=mc2” following the “e” in Google.

Google Health began with a vision of aggregating personal health information in one place. It rapidly became clear that asking a 75-year-old to type in 13 meds was a non-starter, so the team began to focus on establishing links that would allow data-sharing between Google Health and large healthcare entities that control key data. Ergo, Google Health would be an aggregator of data, a trusted and portable repository of health information. You can only imagine the challenges of establishing these affiliation agreements, particularly working through each organization’s privacy and proprietary concerns. Impressively, 14 partners were signed up by the launch, including two large provider systems (the Cleveland Clinic and Beth Israel-Deaconess), several pharmacy systems (Walgreens, Longs, CVS), a pharma benefits company (Medco), and the company that performs about half the lab tests in the U.S. (Quest Diagnostics). Reps of all these companies were there for the launch and Tuesday’s meeting.

Why did all of these companies want to play (after all, they already host websites with significant functionality). There were probably a number of business reasons, but I think that the Walgreens representative captured the true motivation when she said, “Hey, I work for Walgreens. This is Google.” One can’t put a monetary value on the “cool” value of teaming up with Google.

What about the Google Health site itself? I’d recommend you play around with it. The site looks “Googly” – the lines are clean and attractive. I found it easy to enter diseases and meds, and to check for drug interactions. There are already a bunch of neat tools linked through “Personal Health Services.”

On the other hand, the Find-a-Doctor function is a start, but needs work. It should provide more useful credentialing and quality data – right now the map of the doctor’s office is its most prominent feature, which is fine if you’re searching for a Starbucks but not if you’re searching for a cardiologist. When I look for an ENT doc in Philadelphia, at the minimum I’d want to see board certification, med school, residency, and fellowship. And ultimately, I’ll want to see quality data, volume by diagnosis, publications, and patient and perhaps even peer ratings. Ditto for hospitals.

The partner interface thing works well – I found it easy to link to one of the partnering sites (in my case, Walgreens), and, during a demo at the Council meeting, we were able to import one of our member’s medical records from the BI Deaconess site into his Google Health record. “Never forget this day,” said one of the Council members, with forgivable hyperbole. “You’ve just seen a demonstration of portability.” Is that how Thomas Edison felt?

During Council meetings over the past two years, we really hammered away on the privacy theme. Unless people feel 100% confident that their medical records won’t be leaked, shared, or sold, they won’t feel comfortable jumping in the Personal Health Record pool. Of course, the majority of the reviews of the site (in traditional media and the blogosphere – a few of the best are here, here, and here) scrutinized this issue with a fine tooth comb, and most came away reasonably impressed. It seems to me that Google has done a nice job addressing the concerns about leaked personal data.

You’ll notice that there is no advertising on the site. “How are they going to make money?” my mother asked me, cutting to the chase. I remember sitting next to Google CEO Eric Schmidt at a prior Council meeting, and he said simply, “Getting into health is the right thing for Google to do.” And I believed him. Of course, you can afford to be a little altruistic when your market cap is $100B. Marissa Mayer, the tech genius and Silicon Valley rockstar with overall responsibility for the Google Health project (she has the Googly title of “VP of Search and User Experience”) made the point again yesterday. “Not everything we do has to make money,” she said. “Google is an ecosystem” – a term used repeatedly around Google – “and we’re trying to grow a loyal, devoted user base.”

Where is Google Health going? American healthcare is a series of disconnected and dysfunctional silos. Unless you are lucky enough to be in a closed system (Kaiser Permante or the VA, for example), your best hope for coordinated care is if you or your family serve as your own orchestra conductor. Although several companies are jumping into the mix (Microsoft, Revolution Health), Google is probably best positioned to do it right. It has both the trust and the eyeballs of the public, enjoys strong partner relationships, and boasts a universe of developers itching to build applications that add functions. As one example of the latter point, when iGoogle launched (which lets you customize your main Google Search page), there were about 10 third party applications (those cute little widgets like calculators and Letterman’s Top Ten list) available. A couple of years later, the number is about 75,000.

From my two years working with Google on this and another project (more on that one in a future post), I have come to appreciate the company’s unique culture and lingo. I’ll close with a few observations, along with reflections on how they may impact Google Health over time:

  1. Google people are wickedly smart. And they’re nice. It is a bit scary.
  2. Googlers are also really happy (or so it seems), despite the fact that they work their tails off. People say things like “we think we’re changing the world” and truly believe it.
  3. Why wouldn’t they be happy? They work for a great company, with smart and interesting people, in a beautiful place with great weather. And they make a lot of money. Anybody who isn’t happy should have his or her head examined.
  4. Part of the way Google gets these young folks (you never see anybody over 50 on campus, and most look to be about 25-35, even those in leadership roles) to work their tails off is by making the Googleplex into the nicest college campus you’ve ever seen. “How do I get to building 43?” I remember asking on my first visit. “Oh, walk between the hot tub and the sushi bar, take a right after the big dinosaur, and it’s right there.” No kidding. There is no reason to ever leave, and it seems that many people hardly ever do.
  5. The food is really terrific. And yes, it is free for staff and visitors. On Tuesday, the choices included Croque Monsieur, caramelized scallops in brown butter, and freshly made California Rolls. But before you get too jealous, realize that it isn’t all Utopia – the sushi was limited to six pieces per customer.
  6. How about information technology? Yes, they do that too. Here, Google’s obsession is on the user experience. As in Marissa’s answer re: making money off Google Health, their corporate philosophy hinges on making Google the destination for all your IT needs (including some you didn’t know you had until Google filled them) – they know they can “monetize” your eyeballs (read: display ads) eventually without having to nickel and dime you at every turn.
  7. An incredible culture of restraint and discipline is built into their corporate DNA. It is manifest in all kinds of ways. There are no fancy cars in the parking lot (I’m told that a few years ago, one of Google’s top brass threatened to take a chainsaw to any showy car he saw in the lot). I assume that many people have Porsches at home, but it is not a “flout your wealth” kind of place. I saw more bikes than Beamers.
  8. In addition, the iconic uncluttered look of Google pages (beginning with the famous home page but extending to everything they do) is a miracle. When you sit around the table brainstorming with Googlers or their advisors, everybody has a great idea. The trick is in the filtering – the recognition that the cost of clutter is simply too high. That takes extraordinary discipline.
  9. This philosophy also plays out in their launch strategy for new products. When they launch a new site, they want it to be good and stable, but they don’t obsess about making it perfect. (After all, it’s not like they have to reprint a book if they find a typo.) Instead, the mantra is “iterate, iterate, iterate.” Get it out there, “mine” user behavior religiously (they follow every click for signs that Search needs to be improved, for example), and continuously strive to make it better. It is a winning strategy. Obviously. And people now have come to intuitively appreciate this philosophy sufficiently to give Google the benefit of the doubt. So, even if you visit Google Health and say, darn, I wish it did X or Y, there is a pretty good chance you’ll come back to the site over time, because your past experience tells you that your wish list might just be filled by your next visit.
  10. The “Don’t be Evil” (Google’s corporate motto) thing is real (or, if not, they’ve fooled me). Here’s one small window into it, told to me by one of the key leaders in Google Search. You’d be shocked to know how often the Google search algorithm is tweaked to make it a teeny bit better (I can’t give you the precise number, but trust me, it is more often than you think). “I used to work at another company that did Search,” this Googler told me. “Before I ever touched the search algorithm, I needed to get the approval of the business types, since I might be changing their ad revenue formulas. But at Google, the message to me has always been, ‘just make Search into the best user experience possible. We’ll deal with the business consequences.’” This is remarkable, since a tiny recalibration of the search algorithm might cost the company millions of dollars in ad revenue (since ad charges were based on the old algorithm). “In years of working here, I’ve never heard a single person complain about this.” That is one amazing culture.
  11. Google is all about scalability, another Silicon Valley buzzword. Google Health, like many Google apps, is really a platform on which partners and third party developers can work their magic. So, although the functionality of GH is fairly limited today, come back in a few months and I’m guessing you’ll see all kinds of medical calculators, reminder systems, data sharing links, tailored searches, slick ways to find a doctor, connections to the literature, advice, maybe even user groups. Google will have developed only a small part of this – most of it will be third party products building on Google’s scaffolding.
  12. One key question for Google Health going forward will be how to parse all the great ideas that are likely to spring up. Here are a few: What if there is another Vioxx recall – should Google create a way to notify 100,000 people on Google Health who are on a certain med? How about 1,000 people who have a recalled pacemaker? Yes? OK, then, how about when a New England Journal blockbuster article comes out demonstrating a much better way to manage Type 2 diabetes – do they let all diabetics know? And how much should the data be “mined” looking for patterns? One way to identify an emerging epidemic or bioterrorist attack might be to notice a surge in searches for “shortness of breath” or “skin rash” from a given locale. Should Google’s mega-computers be sniffing these things out? And should researchers have access to Google Health data (stripped of personal identifiers) – what better way to find out the average creatinine of community-dwelling octogenarians with diabetes and hypertension? All of these issues – and more – will inevitably arise. In general, it appeared to me that Google’s philosophy on these “wouldn’t it be great if…” ideas is to go slow – and to never sacrifice the user’s experience and privacy.

Ultimately, patients need to be able to control their own health records, and to have them reliably available when they move from hospital to SNF, from primary care doc to specialist, or from car crash to an ER far from home. At this moment, I see Google Health as the best hope for accomplishing this in the near future, and as a remarkable opportunity to blend the scrapbook aspects of a personal health record with all kinds of functions that might well lead to better health and healthcare. Congratulations to the Google team for a great start.

Now go iterate…

2 Responses to “Google Health: A View From the Inside”

  1. Nate Lanier May 24, 2008 at 7:16 pm #

    Bob,

    Very interesting thoughts, especially on your time inside the Googleplex. It seems like the media and other outlets are increasingly trying to paint Google as a less agile and less innovative company than they were, say, pre-IPO.

    However, t is important for Google to lobby DOCTORS and practices and not the individual patient. The individual patient is probably not capable of accurately maintaining their own record and this will lead to doctors not trusting the system.

    There’s no question that Google knows this. I hope they don’t miss this opportunity because, in my experience, universally accessible health records are absolutely essential for future generations to speed up care, minimize costs, and reduce frustration.

    Nice work everyone!!

  2. christineRN September 23, 2008 at 6:48 pm #

    Great! I look forward to reading more of these posts. I am interested in IT health.

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