Medical Device Daily Executive Editor

ORLANDO, Florida — The electronic medical record (EMR) landscape appears to be shifting.

The federal government has been serving as the leader in developing standards for creating a universal, interoperable and portable EMR that often linked to the development of universal healthcare coverage. The assumption – that the government would be the one to have, and the one to control, this information – perhaps in the manner of Medicare and Social Security.

But last week’s conference of the Healthcare Information and Management Systems Society (HIMSS; Chicago) here clearly offered a different view of such a system: an EMR that is controlled by the patient, thus more of a personal health record (PHR).

Access would be available to any clinician, any time, in any system or office, but with any access authorized only by the patient or patient proxy.

“Patient-centric” was the most common term heard in the meeting rooms and on the exhibit floor of the Orange County Convention Center for this type of system, emphasizing patient control and privacy.

John Wade, chair of HIMSS, put it this way: “Patients, not providers, should be in charge of their healthcare information,” with a system offering “a better patient-educated process, easy to use and organize, according to what is relevant to that particular individual.”

And that was the paradigm described by Eric Schmidt, CEO and chairman of Google (Mountain View, California), another of the IT stars in a star-replete lineup of speakers at HIMSS 2008.

“Why would Google be here, right?” he asked (not mentioning that, the same day, Google’s stock had fallen to a low point, less than two-thirds of its 52-week high of $747.24.)

“Not a conference we would normally attend,” he added, then making clear the good reasons for his appearance.

His subject: Google Health, currently in pilot development — a system for enabling the creation of PHR, based on “cloud computing” – offering healthcare data that would be completely portable and privacy-protected (well, mostly – but more about that further down).

“We’re in the midst of this enormous shift to cloud computing, rather than having all the information stuck on my personal computer,” Schmidt said, the “cloud” being large amounts of data on a server with huge memory and capacity.

“With this new, emergent model of server-based information, the computer connects to the Internet and a program comes down in less than a 10th of a second, with the data managed by professionals to make sure you never lose it.”

He said Google Health will be “consumer-focused – users can access their data and control who sees it. The data follows the consumer, wherever they go. Interoperability is important.” Thus the system would not be “tethered to a particular health system.”

Schmidt called Google Health “an opportunity to get [current disparate] systems tied together and get the best of breed in all of them.”

The data sets this system could provide would include “useful dashboards” concerning key health issues, such as children’s immunizations and “customized news targeted” to a particular condition.

Thus, he said, one day a user could get this message: “The disease you have has been cured — call here,” as one example.

Importantly, this wasn’t an infomercial.

Schmidt offered Google Health as a product needed because of the intensive use of the Internet by more and more people to find healthcare information and that Google was not initially attempting to “monetize” it – at least not “initially,” he said.

Following the presentation to attendees, he met with reporters in a Q&A session set up by HIMSS, with Schmidt knocking back a variety of queries of the “Is this really possible?” variety from a very skeptical herd. His answer was to focus on the positives and the benefits it would bring to patients.

MDD’s question in the Q&A was: Given the current governmental propensity to monitor the phone calls and Internet searches of Americans, what was the “absolute guarantee” that government would not tap into this highly personal information?

Schmidt replied that there is no such guarantee.

He said that if served by a court subpoena seeking information from the system, Google would determine if that request was “rational” and act accordingly. “We are subject to U.S. law,” he said.

The development of the “cloud” database is being developed through a variety of partnerships – ranging from Wal-Mart (Bentonville, Arkansas) to the prestigious Cleveland Clinic, the latter partnership announced just last month (Medical Device Daily, Feb. 22, 2008). (And the newest partner, announced last week, is Quest Diagnostics (Madison, New Jersey), that company touting the team-up with Google as facilitating patient access to diagnostic lab information “through the more than 100,000 physicians nationwide who are electronically connected to Quest Diagnostics.”

Through these relationships, Google intends to pull large amounts of the data that these partners have into the cloud computing system, with Google Health users having control of their own personal data but also having broad access to information concerning diseases and medical resources.

During his keynote presentation, Schmidt specifically selected the Cleveland Clinic for praise, calling it “a really neat group.”

“They have a lot of different sites that were willing to work with us to help define the standards. We’ll see how well this goes over the next month,” with the expectation of then broadening it “to everyone possible in the U.S.”

He emphasized that Google does not see itself as the owner of Google Health, but rather as providing a platform that many others have the ability to use.

“Our message to you,” Schmidt said, “is that if you have an opportunity to build an application on top of this platform ... . we want you to build it on top of this platform.”