PubMed's Electronic Health Records Special Query

The August 7, 2009 National Library of Medicine Technical Bulletin caught my eye with the news of a new electronic health record (EHR) special query

... a PubMed search including subject terms and other keywords. Areas of coverage include implementation, attitudes, beliefs and use, data privacy, health data standards, and consumer access to the EHR and personal health records... [and] retrieves literature in many languages and from more than 27,000 PubMed citations, including research from many countries.

Cool! I took it for a 91 second test drive using Jing and I'm not too sure about the last part of the query. Take a look and feel free to use my internal audio of 'PEW-PEW-PEW-PEW!' as I minimize each of the fields in Advanced Search:



The snippet I cut was
AND (j ahima [ta]
OR j am med inform assoc [ta]
OR amia annu symp proc [ta]
OR health data manag [ta]
OR int j med inform [ta]
OR yearb med inform [ta]
OR telemed j e health [ta]
OR stud health technol inform [ta])

I'm not certain what the rationale is to construct such a comprehensive search then limit it to this handful of (admittedly great) sources. Are the 3,961 other articles about EHRs in different journals/sources less worthy? What do you think? I'll dig in to take a closer look later.

Do check out the EHR Information Resources below the query, there were links to other federal agencies and some associations & foundations I didn't know about.

Health Information Technology Bibliography

The most beautiful combination of my interest in health information technology (HIT)/health informatics and librarianship I've seen for a while:



The Health IT Bibliography from the Agency for Healthcare Research and Quality (AHRQ) has a list of broad subjects (Organizational Strategy, Technology, Evaluation, Operations, and Populations & Perspectives) with topics listed first and then the acronym, such as Health Information Exchange (HIE). Bookmark it now, the URL is very long and not memorable!

The first click in on a topic brings you to a page of peer-reviewed sources selected by subject experts (several were at Woods Hole!) that represent "the best known evidence on the benefits, challenges, and best practices" associated with it. They have also made an attempt to list freely accessible articles although some may need institutional/individual access permissions.

Scrolling down to the bottom of the subject page to the 'Click here for more' link leads to supplemental resources to the core listings on the subject page that may not be peer-reviewed but are still valuable contributions to the field. They welcome additional submissions and there are resources from 2008-2009 so it is actively maintained.

This resource has been live since February 2008 but I don't recall hearing about it either in the blogosphere or at Woods Hole. Have I been living under a HIT rock?

Electronic Medical Records: Who's On the Menu?

with caption 'EMR's are saving time, money and making people safer how???' by El Mnopo

I recently finished The Last Lecture, the book written after Randy Pausch's inspiring lecture that delved into more of his stories. One of them brought to mind both the error message from an electronic medical record (EMR) above and some frustrating databases I've encountered. Dr. Pausch used to bring in videocassette recorders (VCRs, remember those?) to his classes on one day, then a sledgehammer on the next day to destroy them in front of his startled students. Why?

When we make something hard to use, people get upset. They become so angry that they want to destroy it. We don't want to create things that people will want to destroy.

His hope for his students creating new technologies now is that

Once in a while I come into their minds, swinging that sledgehammer, reminding them of the frustrated masses, yearning for simplicity.

While I can't advocate taking a sledgehammer to EMRs (they cost a heck of a lot more than a VCR) I can certainly understand the temptation to do so from system demonstrations/screenshots I've seen in addition to watching when the nurses, my doctor & lab staff enter data into my own. Simplicity seems to be an impossible dream for current systems, even if they are considered really good ones.

Nonetheless, the push is on to mandate EMRs in the United States and Scotland's National Health System is on track to be the first paperless health service in the world.

If you aren't at the table, then you are on the menu.

This response from Dr. Val Jones to Dr. Rob's discussion about a healthcare reform article isn't new but it is relevant to the healthcare information technology (health IT or HIT) stakeholder discussion for EMRs and the amounts of future funding coming down the federal pipeline for them.

Who is at the table? According to Dr. Rob, "Politicians, hospital corporations, pharmaceutical and insurance companies, and lobbyists". There is no mention of physicians or patients, the core of health care, although in theory they are there.

A look at 'Making Health Information Technology Work' at HealthIT.hhs.gov, bold emphasis mine, includes

Health IT will help consumers gather all of their health information in one place so they can consider it in as a whole.

It's important to note this is not about having a patient's health information in one place for a clinician to 'consider it'. How does a complete collection of health information transfer into patients' knowledge and understanding in order for them to 'consider it'? There is no Google Translate button for clinical data in EMRs to convert to consumer health language, and even if there was I wouldn't want to make decisions about my health based on that output.

How do you get the public to care about and support EMRs/health IT? A good first step is the video below that is available here:




How do you get medical librarians to care about and step up to their roles in EMRs and health IT? Yes, there are roles to be had here. Check out Librarians and the EHR: Envisioning the Future, which is where I learned about Woods Hole & why I applied to go there in order to develop a health informatics class geared towards medical librarians' involvement in health IT and particularly EMRs.

It was during a presentation at Woods Hole I learned about medical librarians' front-and-center involvement in a patient information portal not from the presenter himself while he was demonstrating the system, but on Twitter from Rachel Walden with a link to this 2007 JMLA article that covers their experience.

If that doesn't emphasize the fact that nobody will invite medical librarians to the table unless we step right up and take our own seats there, I'm not sure what does.

Perhaps a stronger version of 'you're on the menu' line may help. We are in the 21st century, where medical libraries are being abruptly closed or the librarian retires and institutions decide not to fill the position. Like the video above, the Vital Pathways resources are a step in the right direction for medical library advocacy although rather vague on direct librarian EHR/EMR/HIT involvement and I'm hopeful for much more meat in the white paper.

Perhaps the majority of medical librarians don't care about involvement in health IT. I hope I'm wrong, as there was stiff competition to attend Woods Hole and I know of other bright stars kicking butt out there. One of them wants my tomatillo salsa recipe. Maybe 'Cannot quit' should be our motto!

EHRs & Woods Hole: What happens when I think on the bus

Four months ago I attended the Librarians and the EHR: Envisioning the Future continuing education event by our local Medical Library Association (MLA) chapter, PNC/MLA, with a fair amount of guilt. The only reason I was able to go was because I took the place of a colleague who was seriously ill and that is never a cause for joy. I should have shared my 5 pages of notes from the EHR CE long ago, they serve as a brief guide to the presentation audio files although I had to take a phone call in the middle of one of them so there's a gap of information somewhere.

It was there that I learned about the Woods Hole bioinformatics program, although with total bafflement at first: it was one of those things that everyone else already seemed to already know about and I didn't. On the bus home it occurred to me that maybe I should apply and create an online class teaching more about medical librarians' involvement with electronic medical records (EMRs) because I couldn't be the only one who didn't know about the Woods Hole program. If I am, it's ok to laugh at me now that I'm going there in May.

My goal is to share the value from the experience as much as possible because I don't want to be an information silo. I know I can't promise blogging from there beyond a picture a day due to the sheer volume of information we'll be going through. I have since heard from many medical librarians who have been to Woods Hole and heard of several others. I'm curious: What has what you have learned there done for you, your organization, etc.? Are we already collaborating on this as part of MLA advocacy and I've missed the boat entirely? Thank goodness Rachel shared the tip about no elevators there so I only pack what I can haul up the stairs myself!

Research talk: What is the role of informatics in cancer care?

One of the greatest delights of working in an academic environment is never knowing what fascinating research may unexpectedly cross paths with you each week. Last year I held a lunar meteorite, which will probably retain the OMG COOL award for life because how often do you get to wrap your arms around a very heavy chunk of the Moon? I will never forget how I and everyone else around me was beaming with happiness approaching rapture at being able to do so.

While not quite as exciting as a lunar meteorite, being invited to research discussions by those who are passionate about their field and how their projects can help people is equally interesting to me. On Friday I was pleased to be able to attend a research conversation with Dr. Kent Unruh, a senior fellow with the Division of Biomedical and Health Informatics at the School of Medicine here at the University of Washington.

This was a reprise of his 2008 American Medical Informatics Association (AMIA) symposium presentation earlier this month of Barriers to Organizing Information during Cancer Care: I don't know how people do it, abstract of

People organize their personal information to conceptualize what they know,
enhance information retrieval in the future, and cue or remember tasks in
everyday life. However, studies also suggest that organizing is difficult and
people fail to use their information effectively for emergent tasks. In the
health-care domain, patients face grave consequences if they cannot access and
use information effectively. Arguably, patients have access to more information
about their health than at any previous point in history. However, information
access is only the first step to managing health care needs. Patients must
organize it effectively to support the underlying tasks required to manage their
health proactively. Ironically, ever-increasing access to information
exacerbates the challenges patients face in using information effectively. In
this paper, we describe five barriers patients encounter when organizing their
information for use during cancer care. We describe each barrier using rich
examples from our triangulated data set, and conclude with four recommendations
to help patients organize information more effectively during active treatment.

I'm not too sure we followed the abstract presentation to the letter, but the implications I came away with for ways to help with information organization for cancer patients were

• Provide a rich intermediate structure (embed pre-organized links to other related information on insurance, necessary customization that is highly personalized)
• Leverage assistance from others (support co-management model, enable assistance from others & organization strategies for their particular situation)
• Provide a functional view of information (integrate descriptive & procedural info (who/what/where/when/who), distinguish information for active tasks, represent patient's view of cancer care system) Discovery of time-sensitive financial info in the stack added significantly to emotional stress, sort information/bills by date due instead of date services given.
• Incorporate emotional considerations (negative feedback loop of not being able to retrieve information when needed for patient involvement in own care)
• What is the role of informatics in cancer care? Clinicians and designers can explore stress reduction techniques, embed cognitive cues & known stress reduction techniques for stress relief in managing information

For the research study background that led to these implications & a great discussion, my notes are over here. I asked about Health Insurance Portability and Accountability Act (HIPAA) & Protected Health Information (PHI) concerns and he responded that he's currently a co-primary investigator (co-PI) on a portal for patients to manage cancer care information that involves portable workstations where clinicians enter & annotate information. I want to know much more about that although it wasn't really the focus of this particular talk, and will definitely keep an eye out for more of his findings in the future.

I also see social networking (such as Facebook pages) as a way to meet the need of being able to "coordinate in common information space between disparate groups" to help out in areas of emotional support, driving to appointments, bringing meals over, helping with childcare and other related activities in a patient's cancer treatment. I'm convinced Facebook is probably already being used this way and I just haven't seen it yet. Blogs are great for sharing cancer diagnosis, treatment and other information with everyone at once and receiving messages of support from loved ones in return but not so much for group coordination from what I've seen, which is sadly way too much.

Other Aeries: Dr. Reed Gelzer's EMR perspectives

The following is taken from a recent comment thread on my April 2008 post, "Clinical Plagiarism": Calling EMR copy/paste what it is that Reed Gelzer, MD, MPH, CDCC was kind enough to contribute to. I have only edited to explain acronyms & link directly to cited resources. Thank you very much, Dr. Gelzer, for these resources and informative insights that are not often part of the EMR decision, implementation and maintenance discussion. ~N.S. Dettmar

Here is a link to the public section of the American Health Information Management Association (AHIMA) website:

http://www.ahima.org/e-him/

I'd recommend readers start with this paper from late 2005, the 14th on the list of documents at the link above.

Update: Maintaining a Legally Sound Health Record--Paper and Electronic

The electronic medical record (EMR) industry has been remarkably resilient to taking up basic documentation integrity functions, in large part because that is not something demanded by the buyers and users of these systems.

Eventually the accumulated weight of problematic and untrustworthy documentation will spill over into legal cases. Hopefully then the buyers and users of these systems will require better designed systems.

In the meantime, my associate and I have published a screening tool for evaluating electronic health records (EHRs) that we gave to AHIMA to publish as an article.

Gelzer, Reed D., Trites, Patricia, "Using Test Vignettes to Assess EHR Capabilities", in Journal of AHIMA, 5/2/06. We have published a more extensive testing methodology in book form, also thru AHIMA.

We find that many practices with EHRs do not know the risks these systems pose to them and so created these testing tools for an objective, reproducible evaluation of systems in place, or systems under consideration for purchase.

Copy functions in EHRs are actually just a subset of the problem of authorship accuracy. Since payment for services is driven by who actually provided the service, there are substantial financial incentives to use EHR capabilities to misrepresent who did what. Patricia A. Trites, of Healthcare Compliance Resources, often notes that EMR advertising especially highlights higher reimbursement as the main attraction of an EMR. Another auditing professional, Rebecca Busch of Medical Business Associates, notes that EMRs are simply too tempting to those she terms, "the ethically challenged".

My concern is that the majority of doctors, nurses, physician assistants (PAs) and other hardworking professionals will be doing things exactly as they should, but their EMR will betray them if ever challenged in a legal setting. For example, EMRs can dutifully record that documentation has been altered but not retain the original version, making it impossible for a doctor to prove that the alteration was not done for improper reasons.

I hope you have success in conveying to others the need for thorough due diligence in evaluating how a system actually works, to make sure it meets the basic requirements for valid, accurate, and trustworthy medical and business records.


RDGelzer
Advocates for Documentation Integrity and Compliance

NAHIT vs. medical librarians for PHR: Advantage NAHIT

Back on June 16th I shared what the National Alliance for Health Information Technology's (NAHIT) workgroups proposed for uniform definitions for healthcare information infrastructure, including the personal health record (PHR).

On October 15th, the National Network of Libraries of Medicine, Southeast Atlantic Region (NN/LM SEA) shared what a joint task force of the Medical Library Association (MLA) and the National Library of Medicine (NLM) proposed for the definition of an PHR.

Let's compare the two:

NAHIT

Personal Health Record (PHR): An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

MLA-NLM Task Force

Electronic Personal Health Record (PHR): PHR is a private, secure application through which an individual may access, manage and share his/her health information. The PHR can include information that is entered by the consumer and/or data from other sources such as pharmacies, labs, and care providers. The PHR might or might not include information from the electronic health record (EHR) which is maintained by the health care provider and is not synonymous with the HER. PHR sponsors include vendors who may or may not charge a fee, health care organizations such as hospitals and health insurance companies, or employers.

Both are written as found with no editing or emphasis from me. I'm assuming HER in the latter quote is a typo, and one I may understand the origin of since I recently attended a forum (will blog about it soon!) where Word kept auto-correcting EHR to HER and it nearly drove me insane.

When it comes to explaining what a PHR is to the general public and not other people in the medical field, librarianship or information technology, I'm not sure either definition will be sufficient as a stand alone. I see a stronger possibility of "...what?" being their response to the one from the medical librarians with 4 sentences and 3 variables vs. NAHIT's single sentence with no variables.

I studied Pogue's Anti-Jargon Dictionary and think NAHIT's 'interoperability' may fall in alignment with his 'Functionality' complaint. Clarifying the 'multiple sources' as being healthcare-related would help so it's not totally arbitrary. The Social Security Administration will not suddenly suddenly plunk your disability information in your PHR... at least I hope not.

On the other hand, we in medical librarianship are fond of calling people 'consumers'... so why did the definition include both 'individuals' and 'consumers' for describing the same population? Was it really necessary to include all the 'and/or', 'might or might not', 'may or may not' variables up front for a basic definition? Why are we mentioning an electronic health record (EHR) in the definition for a PHR without also defining an EHR beyond something 'maintained by the health care provider', thus putting prior assumption on the consumer/individual to know exactly what that entails?

I am all for promotion of consumer health resources as part of PHR applications, but what exactly is the 'information assistance statement' that is being sent to these organizations to include in PHRs?

Am I a traitor to my field in respectfully disagreeing with the members of the joint task force about their definition for PHRs and wanting to use NAHIT's?

Google's Chrome Health ethics?

I encourage a look at Brier Dudley's column today with a provocative beginning of

Imagine what it would be like at the library if, instead of using the Dewey Decimal System to find things, everyone had to use a system run by digital ad companies.

Eventually, people would get used to having companies know who reads what, when and where. You'd either trust the companies or find other ways to search for information.

Dudley then delves into some of the same concerns I do regarding Chrome and other Google programs that have a very heavy emphasis on targeted advertisements for their sales revenue.

I see this as a slippery slope for ethics where electronic medical records (EMRs) are concerned, and previously blogged about the language Google Health used regarding their "Interesting companies that offer personalized online health tools" and third-party advertising not clearly indicated in the FAQ. I haven't checked back to see if they have revised this and plan on doing so soon.

Dudley concludes with the same sentiments, bold emphasis mine

Maybe I'm jumping the gun.

I'll bring the subject up again in a couple of years, after Google and Microsoft are storing our medical records and we're using Chrome 3.0 and Internet Explorer 10.

Unless we're all used to it by then.

Edit: My colleague V. Lawrence shared NPR Marketplace's September 5th coverage on Google health with me. Is there truly no co-mingling if someone uses Chrome?

Halamka: It's not on Gmail, it's not on Blogger, it's not on YouTube, it's not on Search. It's a totally separate, isolated, secure area and they have not co-mingled any Google features with Google Health.

EMRs in plain English

I had no idea that beginning last month there are now weekly MedlinePlus podcasts, let alone a MedlinePlus topic covering electronic medical records for consumers. Maybe I missed it in the data flood during our European vacation?

I particularly appreciate the instant turnaround on the transcript for today's podcast about electronic medical records. Thank you, Journal of the Medical Library Association (JMLA) blog!

As a reminder for those in the Pacific Northwest (I wouldn't recommend non-natives coming to visit in October for this, it's rather cool and soggy by then), registration is open for the Pacific Northwest Chapter of the Medical Library Association (PNC/MLA) Continuing Education Update featuring an electronic health record forum that I will definitely blog about.

EMR, PHR, HIE, Aieee!

If I go overboard in explaining acronyms here it is because I can hardly stand the things. I understand their necessity, especially in writing, but when assumptions are made regarding their usage that's when barriers to information access start going up in the name of jargon. Perhaps I'm overly aware of them due to my journalism background, my human resources experience where some days all I did was demystify the acronyms involved in the Family & Medical Leave Act (FMLA, which will never mean Fellow of the Medical Library Association to me), or because I'm new to the field and trying to find covert ways to get my colleagues to explain and pronounce acronyms and listserv names so I don't sound like a dork.

Librarianship and Information Technology (IT) are fields loaded with acronyms, and combining the two in the area of health/medical informatics is especially deadly. The fact that there are over 100 controlled vocabularies in the Unified Medical Language System® (UMLS®) where nearly every language vocabulary itself is also an acronym, and you'll see why I nearly went insane last year trying to tackle comprehension of UMLS® as part of my coursework.

This is why I was relieved to see a focused effort to not only clarify the acronyms involved in electronic medical/health records (EMRs and EHRs) and other health IT issues, but also the meaning behind the words themselves instead of tossing them around to look trendy and in the know. However, the Life as a Healthcare CIO source cited by Kevin, MD began with a sea of acronyms so I knew I needed to dig deeper to the original source. I do have a lot of respect for healthcare Chief Information Officers (CIOs), by the way, and this is exactly how they talk. I was a babysitter for one of them 2 states away as a 15-year-old and that connection is how I got my foot in the door & interested in the health information field.

The National Alliance for Health Information Technology (NAHIT) recently issues a 40 page pdf report on what two workgroups (one for records, one for network) who used a 'comprehensive literature review'*, forums and comments to propose definitions for health IT infrastructure.

Without further ado (click the image to enlarge),


Concise, jargon-free descriptions that clearly define the difference between EMRs, EHRs & PHRs. Brilliant! I don't think most people (except healthcare IT and their stakeholders) need to be as concerned about the network terms, but personally I appreciate the proposed distinctions between these different types of medical records and hope they are adopted so everyone is on the same page with terminology as EMR, EHR & PHR usage becomes more common. They even envision a health informatics future of (click image to enlarge)



Now the big question posed by The Health Blog: Do people even care? Interesting post and comment thread there, and combined with my own suspicion of Google Health's 'no advertising unless our partners include it under our terms' I think medical librarians need to have an increased role in EMRs, EHRs & PHRs because I'm not convinced other entities are looking at things from the perspective of patients as more than sources of data and revenue. We are experienced not only in information organization, but in information-seeking behavior and consumer health literacy and I'm not hearing much about how these are being incorporated in PHRs or patient-accessible EMRs and EHRs.

* I also hope medical librarians were involved in this 'comprehensive literature search', perhaps my colleagues in the Medical Informatics Section. The report states what sources were reviewed by the work groups, but not how they did their search to obtain the sources. The degrees and titles of those on the work groups don't seem to indicate the inclusion of medical librarians, but it doesn't indicate if other sources helped collaborate on the project.

Upcoming regional goodness: PNC/MLA in October

Just as we've collectively settled down from the fun & excitement of our Medical Library Association (MLA) 2008 conference in Chicago, Michelle Goodwin gave us a taste of what's in store for us in the Pacific Northwest Chapter of the Medical Library Association (PNC/MLA):

The Pacific Northwest chapter of the Medical Library Association is planning an exciting continuing education event October 3 & 4 at the beautifully appointed Watertown Hotel (not far from the University of Washington) in Seattle. With the unseasonably cool weather, many of you may be wondering if the cool, crisp days of autumn are already upon us. Fortunately, we still have a few months before September is here, so you have plenty of time to sign up for the PNC '08 Education Update.

Forty rooms have been set aside for members at a reduced rate of $145/night. The Friday evening Welcome Reception will be held at the Portage Bay Cafe. We are excited to offer several valuable, interesting courses for our education update, including:

* "Electronic Health Records & the Health Sciences Librarian: A Forum"
- Thomas Payne, Sara Pimental, Kaye Martin, Emily Hull & Judith Hayes ($35)
* "Data Collection for Health Information Outreach" - Susan Barnes ($50 members/$80 non-members)
* "Hands-On Web 2.0: Collaboration, Embeddable Web, Online Software, and
New Ways of Sharing Information" - Greg Notess ($50 members/$80 non-members)
* "Value-added Searching" - Mary Ellen Bates ($50 members/$80 non-members)

The Hands-on Web 2.0 class will be held in the UW Health Sciences Library computer classroom; all other classes will be held at the Watertown Hotel.

With captivating topics and nationally-renowned speakers, this is an event not to be missed! Additional details will be forthcoming on the PNC/MLA website.


Regards,
PNC/MLA Professional Development Committee

Personally, I'm quite excited about the electronic health record (EHR) forum as I hold Dr. Tom Payne in high regard. The integration of EHRs with current, quality medical information for both clinicians and patients is a strong interest of mine, and I'm delighted he's agreed to join us for what should be an interesting discussion of how we as medical librarians can be part of this essential part of healthcare information systems.

I must confess to being completely Web 2.0ed out (is 2.0ed a word?) although I've enjoyed articles from Greg Notess (of Search Engine Showdown fame) when I was in school and his presentation at our regional conference last year in Billings, MT so I may have to give that a go as well.

Making the C list, Google Health & advertising

As a followup to last week's post about not making the HMO C list regarding Web 2.0 mentions, I actually did beginning the next day according to my statistics. My guess is it's due to linking directly to the source article. Hello out there! :)

It is with this experience in mind regarding health information on the web that I'm mulling over the recent public debut of Google Health, an online electronic health record (EHR) that is owned by the person who creates it but has import capability from the electronic medical records (EMRs) of healthcare and other organizations that have partnered with them.

This sounded great to me, until I dug around to find out exactly who these partners are

Google Health Partners: About our partners

Google Health is an open platform. We publish our technical documentation and anyone who wants to integrate or partner with us can do so. We don’t work exclusively with any organization or company. We partner with doctors, hospitals, medical clinics and groups, retail pharmacies, health insurance plans, laboratories, pharmacy benefit managers (PBMs), and interesting companies that offer personalized online health tools to our users.

"Interesting companies that offer personalized online health tools" sounds suspiciously vague to me. Seeking more information about just how the partnerships work, I checked out the developer policies in place for them. Under the Data Use section is

Only use Google Health user data for the purposes disclosed in your privacy policy, and obtain users' opt-in consent if personally identifiable health data will be used for ad targeting.

Clearly label advertising

and in Notices is

• Promotional* notices must be clearly labeled as promotional
• Promotional notices may be sent a maximum of once per week per user
• Links in notices must open in a new window or provide a working back button

* Definition of promotional: Promotional materials are any materials that promote a product or service - such as encouraging the user to purchase or "ask their doctor" about a specific item. This includes coupons and sale announcements, as well as drug advertisements.

Contrast this to Frequently Asked Question (FAQ) #6

6. If it’s free, how does Google make money off Google Health?

Much like other Google products we offer, Google Health is free to anyone who uses it. There are no ads in Google Health. Our primary focus is providing a good user experience and meeting our users' needs.

So, as I understand it, Google Health itself will not have advertising as part of its basic platform. If users opt in to use third-party applications as part of their Google Health records, then there could be advertising generated from them.

This fact is not currently stated anywhere in the FAQ or the general user information that I can locate, but there is You can also use Google Health to access a host of online services and tools, from a variety of third-party companies, that can help you better manage your care. in FAQ #3 that states outside applications are possible to integrate in your Google Health record.

I'm concerned about this, especially regarding user populations with low web and/or health literacy who may 'keep clicking' to access applications without reading the terms of service or understanding the consequences of sharing their personal health information with them.

I have not signed up for my own account as I'm satisfied with my access to my HMO's EMR (got that down as a positive mention, guys?) that is protected under HIPAA and prefer to keep my health information that way.