For the increasing number of healthcare consumers who appreciate the value of finding relevant health content, a recent article in the New York Times, Google and Microsoft look to change healthcare, offers hopeful insights into how the tech giants plan to enable people to make smarter choices about their health habits and medical care.

The article also provides helpful insights for those who must construct online strategies for their organizations, especially when bringing an established value proposition to a new market.

Controlling health content

Steve Lohr, the Time reporter, writes that:

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.

It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. “The doctor is becoming a knowledge navigator,” he said. “In the future, health care will be a much more collaborative process between patients and doctors.”

Microsoft and Google are hoping this will lead people to seek more control over their own health records, using tools the companies will provide. Neither company will discuss their plans in detail. But Microsoft’s consumer-oriented effort is scheduled to be announced this fall, while Google’s has been delayed and will probably not be introduced until next year, according to people who have been briefed on the companies’ plans.

A user defined value proposition

While we can only speculate at this stage on Google’s health plans, it’s a safe bet that the company will continue to extend its well established value proposition.

Google’s breakthrough was PageRank, a method of using the link structure of the web, rather than just the characteristics of documents, to provide better search results. Google’s databases maintain billions of pages and employ a proprietary alogorithm to "score" the relevancy of websites for each search query. The highest ranking, or "most relevant" websites for a specific query are listed first in the search results.

But Google does not define its value proposition in terms of technical functionality, it expresses it in terms of user experience, according to Tim Armstrong, its VP of Advertising: “Our search index is the value proposition that we offer to our users. The reason people come back to Google every day … is that we offer them non-paid, relevant information, both quickly and totally objectively.” That simple message, based on a clear understanding of customer experience, has provided the company with its growth opportunities in advertising, he adds.

The Time article also demonstrates that its value proposition is leading the company into health, because Google is the default starting point for most health searches. “And people are increasingly turning to their computers and the Web for health information and advice. A Harris poll, published last month, found that 52 percent of adults sometimes or frequently go to the Web for health information, up from 29 percent in 2001.”

Related items

A new report form the Annals of Family Medicine finds that the computer, if used well by a skilled physician, can enhance the patient-doctor relationship.

Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis finds that when used,  the electronic health record (EHR -  the medical record, patient education materials, and Internet search capabilities) can add a valued dynamic to the patient relationship and enhance therapeutic relationships.

However, the computer can weaken the patient-doctor relationship if the physician uses it as a substitute for dialogue with the client. Therefore, it depends on ‘how’ the doctor uses the computer.

Whether the computer enhances or weakens the relationship depends both on how easy it is to use and how skilled physicians are in making use of it.

These conclusions were derived from a study of participant observation (80 hours) in 4 primary care offices and individual interviews with 23 physicians, 52 patient and other support works. This was accompanied by 5 focus-groups of participants.

"Physicians were often conflicted between recording data in the EHR and giving patients one-on-one attention," wrote the study's authors, led by William Ventres of Multnomah County Health Department in Portland, Ore.

Ventres (et all) found four key factors in influencing this relationship:

• Spatial Factors - for example, how the physical location of the computer monitor influenced dialogue between the patient and doctor (“Large, fixed monitors located in the corner of the examination room caused consternation among both physicians and patients, whereas flat-screen monitors on mobile arms were universally praised.)

• Relational Factors - how doctors and patients used and perceived the computer. "There are times where it’s obvious you’re going through a structured way of dealing with a presenting problem. It’s click, click, point, and your note is done. Then there are these much more complex, human interactions. It just isn’t appropriate to be sitting there typing at the time,” was a quote offered by one of the study’s participant doctors.

• Educational Factors – how skilled and experienced the doctor in using the computer and EHR.

• Structural Factors - factors such as the cost and funding for EHR, and how the host organization (e.g. clinic or hospital) perceived and influenced (culture) the use of EHR.

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