During a typical trip to the doctor, you will see shelves full of folders and

papers devoted to the storage of medical records. Every time you visit, your
records are created or modified, and often duplicate copies are generated
throughout the course of a visit to the doctor or a hospital. The majority of
medical records are currently paper-based, making effective communication and
access to the records difficult. Americans made well over a billion visits to
doctors and hospitals over the past year, with each American making
approximately four visits on average. As a result, there are millions of paper
medical records lining the corridors of thousands of local medical practices, and
for the most part, they cannot be systematically examined, and they are difficult
to share. Though the challenge of updating this antiquated system is enormous,
companies such as Google appear to be taking up the task.
In March 2008, Google announced an application that it hopes will
alleviate the inefficiency of the current medical record storage system:
Google Health. Google Health will allow consumers to enter their basic
medical data into an online respository and invite doctors to send relevant
information to Google electronically. The service is free to users. Features
will include a 'health profile' for medications, conditions, and allergies,
reminder messages for prescription refills or doctor visits, directories for
nearby doctors, and personalized health advice. The application will also be
able to accept information from many different recordkeeping technologies
currently in use by hospitals and other institutions. The intent of the system
is to make patients' records easily accessible and more complete and to
streamline recordkeeping.
Google's mission is "to organize the world's information and make it
universally accessible and useful." It's hard to disagree with the worthiness of
this goal, and as the undisputed leader in Web search, Google has proven that it
is very good at what it does. But what if Google were seeking personal
information about you? You might not feel as good about Google's quest to
organize the world's information when you consider that some of that
information is information that you'd prefer remain private.Google's
development of its Google Health application illustrates the conflict between
its
Self-avowed mission and the individual's right to privacy. As with similar
cases such as government surveillance and data aggregation, the question is
whether
or
not
the
privacy
risks
posed
by
information systems are significant enough to abandon or curtail the collection of
useful information. If information gathering should be curtailed-but not
eliminated-how will this be decided and who should decide? Google is no
stranger to this conflict of values; this is merely one example of many where

Google has clashed with privacy advocates regarding its information

collection practices and handling of that information.
With the launch of Google Health, Google aims to be the catalyst for the
process of digitizing and standardizing the nation's medical records in an
easy-to-use format. Currently only a small fraction, under 15%, of American
medical practices keep their medical records online, making it difficult for
patients and other doctors to quickly and easily access them. When a patient
changes doctors, begins seeing a new doctor, or moves, the absence of online
medical records can be a source of needless hassle and effort on the part of
both patient and practice. Sometimes, access to medical records can even be
a life or death matter in the rare cases when power failure prevents access to
local data storage systems.
But the added convenience of easily accessible medical records is just
one potential benefit of going electronic. As the healthcare industry continues
to face budget pressures from Medicare cutbacks and reductions in managedcare fees, digitizing patient records has become increasingly attractive as a
cost-cutting measure. Although many practices consider the costs of
implementing new software to be prohibitive, the potential benefits for the
industry as a whole are significant. One survey found that 26 percent of
healthcare technology professionals cited lack of financial support as the
most important factor preventing them from digitizing their recordkeeping.
But once practices make the initial investment in new technology, the
increase in efficiency is likely to reduce future costs by an estimated $80 to
$240 billion dollars, more than enough to make the switch
worthwhile.
Google Health and other efforts to convert to electronic health records
stand to provide much-needed organization and efficiency to the healthcare
industry, the single largest segment of America's gross domestic product
(GDP). But concerned individuals and privacy advocates argue that
electronic health records will be stored in such a way that increases the
likelihood of privacy invasions. Some potential users of the system are
concerned that Google will make their medical information
accessible to advertisers in a manner similar to the targeted advertisements
Gmail users currently see based on the content of their e-mail.
These privacy concerns are far from unfounded. HIPAA-the Health
insurance Portability and Accountability Act of 1996-provides very limited
protections for personal medical records. (It primarily covers information
flowing between healthcare providers, health insurers, and clearinghouses
for payment processing.) There are currently no federal privacy protections
for patients who set up personal health records online. Even hospitals and

practices that currently use electronic storage formats report a high incidence
of security breaches, with a quarter of healthcare technology professionals
reporting at least one security breach in the past year. According to a 2006
Federal Trade Commission study, about 249,000 Americans had their personal
information misused for the purpose of obtaining medical treatment,
supplies, or services. But breaches and other forms of medical identity theft
are not the biggest concern surrounding electronic health records.
Most people are more worried that sensitive information legitimately
accessible via electronic health records might lead to their losing health
insurance or job opportunities. For instance, if employers knew that you had
a chronic heart condition, would they want to hire you?
Though the healthcare industry argues that these privacy concerns
are for the most part misplaced, there is evidence that these fears are
justified. Horror stories like those of Patricia Galvin reinforce the worries
many people have about the privacy of their medical records. Galvin's
attempts to acquire disability benefits for her chronic back pain were
turned down on the basis of her psychologist's notes, which were
supposed to be confidential. The number of monthly medical privacy
complaints received by the Department of Health and Human Services
has been steadily approaching 750 per month over the past several years,
up from 150 in 2003. People fear that a switch to electronic medical
records could be even more vulnerable to security breaches and privacy
violations.
Proponents of electronic health records argue that computer
technology, once fully implemented, would enhance security rather than
threaten it. They also believe that it is more important to first get the system
up and running than to worry about privacy matters. Congressional
Representative Joe Barton of Texas, an advocate of legislation that would
speed the development of such records, said that "(p)rivacy is an important
issue, but more important is that we get a health information system in
place." Lawmakers like Barton feel that the benefits of systems like Google
Health outweigh the privacy risks, and that further legislation to impose
privacy controls can be added after the fact.
Some experts disagree with that stance, saying that unless an electronic
system has sufficient privacy controls from the outset, it is less likely to
become universally used. Even if the system's security controls are
sufficient, it is important that consumers are aware of those controls and
confident that they can use the system without fear of their records being
accessed by unauthorized parties. Creating an electronic health system

without the proper security controls would not only be an unacceptable

privacy risk, but would be doomed to failure because potential users would
be unwilling to cooperate with the information requirements of the system.
Google has tried to reassure the public that its security is iron-tight and
that businesses and individ-uals should have confidence in its ability to store
and protect their data. According to Google senior security manager Eran
Feigenbaum, "We've taken an in-depth approach to security, with lots of
different layers that build on each other." However, Google has
not provided much detail about its security practices-where its computer
centers are located, how many people it employs in its security department, and how it protects its army of servers against attack-for fear of
opening itself up to attacks.
"Businesses are hoping Google will pick the right tools to secure the
infrastructure, but they have no assurances and no say in what it will pick,"
notes Randall Gamby, security analyst for Burton Group, a Midvale, Utah,
research and advisory firm. Feigenbaum adds that Google relies on its own
security system and applications for its day-to-day business operations, and
that should be proof that its security works.
Google is not the only company to set its sights on online medical records.
Microsoft and Revolution Health Group LLC, founded by AOL co-founder Steve
Case, among others, are also launching similar sites where users can maintain
online health profiles. As of yet it is too early to tell whether any of these
ventures will be successful in the long term, but Revolution Health Group was
forced to fire a quarter of its employees in the face of lower-than-expected
earnings in 2007. Microsoft's venture, HealthVault, is still in its infancy along
with Google Health. The federal office in charge of creating a national network
of electronic health records, the office of the Coordinator of Health Information
Technology, announced in March of 2008 that it plans to integrate its system
with both Google and Microsoft's healthcare databases, among others. The
office did not provide details or a timetable on how the integration would
occur. Privacy concerns are not likely to halt the shift towards digitizing our
records entirely, but will continue to be arguably the most significant obstacle
for these ventures as they work towards creating a standardized, digital system
for medical recordkeeping.