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Putting health into the patient's hands
May 23, 2007
Posted by Adam Bosworth, Vice President
I gave a speech today at the 2007 American Medical Association of Informatics (AMIA) Spring Congress. I used this opportunity to suggest a vision of what I think consumers should expect from our health care system over the next decade, including three core principles of a future health care system:
Discovery
- Consumers should be able to discover the most relevant health information possible
Action
- Consumers should have direct access to personalized services to help them get the best and most convenient possible health support
Community
- Consumers should be able to learn from and educate those in similar health circumstances and from their health practitioners
Here are my
notes from the speech
, which include both an example of how these principles could come together to improve health care and suggestions about what core technology I believe is needed to support them.
How do you know you're getting the best care possible?
March 28, 2007
Posted by Adam Bosworth, Vice President
When I talk to people using Google to search for information about their health questions and how well search answers these questions, I hear several common concerns. I want to list them and discuss our thoughts about them.
How do I know if the information is trustworthy and reliable?
There is a lot of material out there about drugs, diseases, procedures and treatments. How do you know what is trustworthy and what isn’t? Search is great at finding us places with relevant information, but it is hard to know which links are reliable and which are less so.
Honestly, this is a hard problem. At Google, we have tried, as I said in an earlier post, to enlist the help of the health community to help us know which links contain medically reliable information, sift these reliable links so that they tend to show up relatively earlier in the search results, and then let you decide which groups in the health community you trust. If you go to Google and type in [Lipitor], for example, and then you click on the “For patients” link and look carefully, you’ll see that the search results often include at the bottom the word “Labeled By,” followed by words like NLM and HON. NLM stands for the National Library of Medicine, the world’s largest medical library, and HON stands for Health on the Net Foundation, an organization which is in the business of certifying web sites with health content that is reliable. These are organizations that have marked the part of the web that this link in the search results points to as medically reliable. It seems that we at Google may not have done a great job of making this clear enough. Unfortunately, many of you either don’t notice these words when you’re searching about health questions at Google or have no idea what they mean. Clearly, we can do better at making this kind of labeling noticeable and your ideas on how we could make it clear to you that a site is medically reliable or trustworthy would be greatly appreciated as we think this through.
Am I getting the best standard of care?
There is, actually, a lot of information out there about generally accepted medical guidelines for care. For most diseases, the medical literature lists the medically agreed-upon standard of treatment, rules to follow, and guidelines for which tests to administer and the best course of treatment - although it is hard to pull together from the various medical organizations and texts as it is constantly evolving. Experts determine which drugs make sense based upon a patient’s condition, other conditions and drugs, age, gender, weight, and so on. There are of course always cases where doctors need to make exceptions to these rules about which drug to administer due to side effects and/or prescribe an alternative drug due to the patient’s specific medical history. The point is that there are guidelines to help doctors with these decisions. However, this information isn’t really accessible to those of you who aren’t health professionals.
Speaking, I think, both for those of us at Google and most of you, given our specific condition or conditions and medicines, just knowing what the guidelines and generally accepted standard of care is for us specifically would be hugely helpful in knowing what to discuss with our doctors and what to research further. Today, even if we can figure out which sites upon which to rely, it is hard to find this out. We don’t know where to start. Our treatment scares us, or our drugs have worrying side effects, or we’re just frightened that we’re not getting the treatment we should be getting.
Honestly, this information can even help our doctors sometimes. They are over-worked and often pressed for time and it cannot ever hurt to double check. Sometimes they didn’t get accurate or complete information from us. While most drug-to-drug and drug-to-condition interactions are known to our doctors, they do change and the doctor might miss a new one or not know about all your drugs because we forgot to tell your doctor about one. The statistics show that mistakes happen. In fact at some point in a patient’s life, the odds of them being treated in a way which doesn’t follow the guidelines and rules is about 45%. There are estimates that somewhere between 44,000 and 98,000 Americans die every year from a preventable medical error at a hospital — or about 150 to 300 preventable inpatient death a day. And approximately 770,000 people are injured or die each year in hospitals from an adverse drug event. There are roughly 5,000 preventable medical errors a day taking place at doctor’s offices.
So it seems that it would really help to let people know. It is tricky, however. Everybody’s condition is unique. It isn’t possible to just play doctor and tell you exactly what your treatment should be and why. Even doctors have a hard time with this because of the incredible and ever changing complexity of modern medicine. What is the best way to help people searching for answers to their health questions to know the right standard of care they should be receiving, what treatments or classes of medicines they should be researching, and what procedures might be indicated?
Who is the best doctor or institution for you?
Isn’t it strange that you can find out a lot about a restaurant on the web or about a movie, but not about a doctor? In fact you usually don’t even know who to go to and just accept whoever your general practitioner recommends? You clearly don’t just eat at restaurants other restaurants recommend, even though you might take it into account. Now admittedly there is a difference here. When it comes to food, you know what you like and the worst that can happen is you don’t like it. But when it comes to your health you may not know what is best, and you can’t necessarily tell if we’re getting the best possible care. Still, here is a common situation: You’ve been diagnosed. Your primary care physician and you have discussed it and it is clear that you need a specialist and your doctor has referred you to one, but you’re wondering how you know who is the best out there for you. How do you know whether they cover your insurance? How do you find them? Today, often you just take your doctor’s referral.
Normally there are lots of doctors who could treat or diagnose you. And in point of fact there is a lot of information about doctors floating around in the ether. Where they went to school is known. Whether they are board certified is known. What is their specialty is known. CMS (Medicare) and insurance companies actually know how many procedures of various types most doctors regularly perform. And this turns out to matter. There is an excellent book out called
Complications
by Atul Gawande
discussing a lot of these matters, but in particular the book notes that practice really does make perfect.
But how do you know who is well seasoned? Do you always judge who to take care of you by how long they’ve been in practice? What does “best” really mean? This is a hard question. Mortality rates, for example, may not be a good indicator. Some specialists only treat the patients that others can’t handle, and so, naturally, even though they are the best in the world, their rates might not be the best. Sometimes your choice may be dictated by other considerations. If there are two possible specialists, one is a man and the other is a woman, then sometimes people care about that.
It isn’t clear how we can best help. We don’t want to inadvertently steer you away from a brilliant doctor just because his or her mortality rate appears too high. What do you think, and what would you like to see made available on the web when you are searching for doctors?
Summary
At the end of the day, all these questions are about how you find the information you need. They are deceptively simple. If they were about restaurants, they would be trivial. But they are actually matters of life and death in the extreme and quality of life in the common case. In short, they matter profoundly.
I’d like to say that we have all the answers. But we don’t. Mostly, at the moment, what we have is questions and
we’d love to hear from you
.
Update:
New contact link.
Thoughts on health care, continued
December 7, 2006
Posted by Adam Bosworth, VP
As
I indicated in my post last week
, I've been interested in the issue of health care and health information for a while. I just spoke at a conference about some of the challenges in the health care system that we at Google want to tackle. The conference, called
Connecting Americans to Their Health Care
, is a gathering focused on how consumers are transforming health care through the use of personal health technologies.
This speech
will give you some insight into the problems that we believe need our attention. There are, of course, other challenges in health care that we plan to work on, and we'll share more information with you about the solutions we're trying to develop as this work advances.
Seeing RED
December 1, 2006
Posted by Sheryl Sandberg, VP
You might have noticed from our homepage that today is
World AIDS Day
. We want to remember all those who have suffered from HIV/AIDS in the 25 years since it was first identified, and we want to support everyone working to eradicate this scourge: Today, there are about 40 million people living with HIV worldwide, and it is increasing in every region in the world. In Africa, it is the leading cause of death -- 5,500 Africans die each day from this insidious disease.
One effort that is making a difference is
(RED)
, a company founded this year by Bono and Bobby Shriver. A percentage of the profits from each (RED) product sold is given to
The Global Fund
. We are supporting the (RED) effort by offering promotional support to (RED) and
(RED) products
on Google properties throughout the holiday season.
We hope you choose to support them with your purchases. Companies offering (RED) products have committed to contribute a portion of profits from the sales of that product into Global Fund-financed AIDS programmes in Africa.
Together, let's make a big difference. Read more at
JoinRED.com
or visit the
(RED) blog
.
Health care information matters
November 30, 2006
Posted by Adam Bosworth, Vice President
At Google, we often get questions about what we're doing in the area of health. I have been interested in the issues of health care and health information for a while. It is now one of my main focuses here, and I've decided to start posting about it. I've been motivated in this field in part by my personal experiences helping to care for my mother, who recently died from cancer after a four-year battle. While the quality of the medical care my mother received was extraordinary, I saw firsthand how challenged the health care system was in supporting caregivers and communicating between different medical organizations. The system didn't fail completely, but struggled with these phases:
What was wrong -- it took her doctors nine months to correctly identify an illness which had classic symptoms
Who should treat her -- there was no easy way to figure out who were the best local physicians and caregivers, which ones were covered by her insurance, and how we could get them to agree to treat her
Once she was treated, she had a chronic illness, and needed ongoing care and coordinated nursing and monitoring, particularly once her illness recurred
Once she had a correct diagnosis and we'd found the right doctor, her treatment was excellent. But before and after treatment, most people with serious illnesses have to live through these other phases and suffer similar problems. She was trying to get help from her caregivers in the family and it was incredibly challenging to get the right information and help her make the right decisions. Often the health care system isn't well set up to address these issues. I believe our industry can help resolve some of these problems and ameliorate others.
In the end, one key part of the solution to these problems is a better educated patient. If patients understand their diseases better -- the symptoms, the treatments, the drugs, and the side effects, they are likely to get better and quicker care -- before, during, and after treatment. We have already launched some improvements to web search that help patients more easily find the health information they are looking for. Using the
Google Co-op
platform, Google and the health community have labeled sites and pages across the web making it easier for users to refine their health queries and locate the medical information they need. Do a search on Google about a medical issue or treatment like diabetes or Lipitor and you'll see some choices for refining your query, such as "symptoms," "treatments," and so on. If you click on "treatment," your search results are refined and reordered so that sites that have been labeled as being about treatment by trusted health community contributors are boosted in the rankings. Note that how trusted a contributor is -– and thus how much they affect your search results -– is dependent both on Google's algorithms and on who the user decides they trust. For example, if my doctor is a Google Co-op contributor and I indicate to Google that I trust her, then when I search, the sites she has labeled as relevant will show up higher in my search results.
This is just the beginning of what our industry can do. People need the medical information that is out there and available to be organized and made accessible to all. Which happens to be our mission. Health information should be easier to access and organize, especially in ways that make it as simple as possible to find the information that is most relevant to a specific patient's needs.
Patients also need to be able to better coordinate and manage their own health information. We believe that patients should control and own their own health information, and should be able to do so easily. Today it is much too difficult to get access to one's health records, for example, because of the substantial administrative obstacles people have to go through and the many places they have to go to collect it all. Compare this to financial information, which is much more available from the various institutions that help manage your financial "health." We believe our industry should help solve this problem.
As the Internet increasingly helps link communities of people, we also think there is an opportunity to connect people with similar health interests, concerns and problems. Today, people too often don't know that others like them even exist, let alone how to find them. The industry should help there, too.
These are some of the health-related problems we're thinking through at Google. We don't have any products or services to announce yet and may not for quite some time, but we thought we'd share a bit about the problems we're interested in helping out on even before we introduce solutions. As we explore these problems and continue to work on them, we hope to share more about our efforts along the way. Your help is welcome and, of course, if you're an extraordinary engineer with a passion in this field, we'd love to hear from you.
Read through our Help Center information and let us hear from you.
Update:
New contact link.
Bird flu basics
October 10, 2005
Posted by Taraneh Razavi, M.D., Staff Doctor
As flu season approaches, there's been a lot of talk about bird flu. I thought I'd try to clarify some of the issues and misconceptions around this illness. I keep up with news on this and other emerging diseases in a number of ways, including
Pro-MED
, which is produced by the Federation of American Scientists, and the
World Health Organization
site. You can also read lots more at the CDC site, especially
here
.
Bird (avian) flu is an influenza virus type A that normally infects birds, but can also infect pigs and other animals. Wild birds, the natural hosts, normally don't get sick from this virus, but domestic animals such as chickens and turkeys can be severely affected severely. Humans, meanwhile, can be infected with influenza types A, B, and C.
Genetic changes and sharing (the closest thing viruses have to sex) can occur under certain circumstances such as in crowded conditions where poultry, pigs, and people live in close quarters. This change can allow a virus to become much more infectious to humans and more easily transmitted from person to person. And this is where a "pandemic" comes in: it's a worldwide outbreak of a new influenza A virus between humans, while epidemics tend to be seasonal, involving viruses that already exist.
For you history buffs, previous pandemics include:
1918-19: Spanish flu.
Caused more than 500,000 deaths in the U.S., and 50 million worldwide.
1957-58: Asian flu.
70,000 deaths in the U.S.
1968-69. Hong Kong flu.
34,000 deaths in the U.S.
Both the 1957-58 and 1968-69 pandemics were caused by viruses containing a combination of genes from a human and an avian influenza virus. It may be reassuring to note that the number of deaths has decreased with each pandemic, possibly due to better supportive medical care.
The avian flu's jump to humans was first detected in 1997, although all the human deaths reported so far (about 60 since 2003) have been due to transmission from animals to humans. There has been more concern recently because the virus has been detected in migratory birds which can't be caught and killed - and which may carry the virus to Europe and Africa within the next two migratory seasons.
The consensus is that although it's possible an avian flu epidemic may occur, no one can predict if it will take place in weeks or years. It all depends on when that genetic shift (from birds to humans) takes place.
There has been no detection of this virus in the U.S. It is possible for travelers to be infected, but most of the cases in humans have been in those with closer contact to birds than a casual traveler has. Since the infection occurs via fecal-oral route, to reduce your risk while traveling, avoid bird markets, zoos, and areas in parks, etc. with high concentrations of bird feces.
Countries that are the most vulnerable to this flu are Indonesia, Vietnam, and Cambodia, due to their high concentration of bird markets. Other areas involved are Thailand, China (south and north), Tibet, Russia, Kazakhstan, and Mongolia. For an update on outbreaks before you travel, check the
CDC info for southeast Asia
and
east Asia
.
Symptoms of bird flu in humans have ranged from typical flu-like symptoms (fever, cough, sore throat, muscle aches) to eye infections and pneumonia. If you feel you've been exposed, there are a couple of treatment recommendations available today that you may want to discuss with your doctor. Until these are tested in a pandemic, however, their true efficacy is unknown. There are currently no vaccines available, but many companies are working on them.
Bottom line: For now, avian flu is just a "virus of interest" to medical researchers. Of course, you should always consult with your own doctor about any medical conditions or risks that concern you.
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