My view (BTW, just finished a market report on the PHR market, find it over at ChilmarkResearch.com) is the following:

1) Google & MS are businesses, they are public companies, they have shareholders, so of course they have a business case for defining and supporting their efforts in healthcare, including these consumer plays. I don’t have a problem with that at all and actually see their entry into the market as raising the overall quality, security and privacy of PHR solutions going forward.

2) In speaking with numerous 3rd party PHR vendors as part of compiling the report these vendors universally reported that EMR vendors refuse to play ball. The EMR vendors drag their feet in opening up their systems, even when their customers ask them to. No EMR vendor has a vested interest (ie business case) to support opening their systems. Unfortunately, standards are not mature enough nor adopted widely enough to make it happen either. These vendors will be kicking and screaming till the end.

3) Epic MyChart and any other EMR consumer portals certainly have advantages, but all patient portals are tethered, and always will be to the host EMR. These systems do not provide a longitudinal record of health for the consumer and should they move, change physicians, whatever, its not like the consumer can easily take that tethered PHR and all the data in it with them. Google and Cleveland Clinic as well as BIDMC are providing portability and from what I hear, at least at Cleveland, much to the chagrin of Epic..

3b) In addition to the tethered issue, patient portals also do not capture the full health record for those who may have multiple physicians.

3c) And let us not forget the disintermediation of healthcare with medical tourism and retail clinics. An EMR-centric patient portal can not and will not address this issue.

Many changes are afoot and as I outline in that report I mentioned earlier, the entrance of Google and MS into this market has some extremely broad ramifications across the entire healthcare sector that I don’t believe we can even imagine in our wildest dreams.

Stay tuned, “The Revolution Will Not Be Televised”

I think you’re missing an important point in your argument. Patients have relationships with numerous providers many of whom are not using the same EMR. Google and Microsoft are working to offer a single point where patients can access all of that data. The industry hax a long way to go before that happens but Epic, Cerner and the others don’t have an interest in supporting that without their own pockets getting lined somehow.

Vendors like Epic have everything that Google offers via a MyChart type solution without the patient having to be responsible for it. Plus, it comes with a built in self service capability to reduce the cost of operations on the healthcare provider.

There’s no magic, this isn’t philanthropy or anything of the like. It’s just simple business. Unseen as to how it will play out. For G or M to succeed, they need to steal a slice of the patient attention away from healthsystems. Yet healthsystems need to have a tighter electronic connection to the patient to keep costs down and outcomes higher. G & M want that slice to profit from it and are willing to do some work to get it (the free stuff). The healthsystems need to figure out if they will fight to keep the patient relationship in order to benefit from the patient self service and improved outcomes.

Unfortunatly for a healthsystem to sell advertising space to their patients would be seen as unethical. Google and Microsoft know that and are likely willing to cut some back room deals to “do it for them”. I’d watch who associates with them and how. And, G &M don’t like to openly talk about what is really happening. They like to put the thin veil of doing something good for society over it.

When this one is over I think we’ll see something similar to the drug company detailing type interactions with physicians again. It’s about advertising and influencing patient purchasing decisions. That’s where the real money in healthcare is and has always been.