Recent speculation about healthcare disruption seems to have moved away from HIT to mHealth (discussed here). Apple has fueled this trend with its launch of sensor-laden iPhones and the new Apple Watch, iOS 8’s Health app and the HealthKit API framework. The future, we are told, is in mHealth provided by our phones and wearables notwithstanding that we have yet to solve data protection and other issues associated with the new devices.
Over the last few days leaks have suggested that web behemoths Facebook and Google may have their own takes on the future of healthcare. Reuters reports that Facebook is doing, lets face it, what you would expect—creating online “support communities” for patients with similar conditions and diseases.and creating “preventative care” applications. Now, Engadget reports that Google is testing a new service that offers chats with doctors when a user searches for symptoms. The service seems related to Google Healthcare Helpouts, a video telemedicine platform that launched a year ago to some on-line speculation about healthcare disruption but which today seems limited to a small number of mostly non-physician therapists, family counsellors, coaches or other advisors.
The twitter (@nicolasterry) chatter this morning speculated on how Google would comply with HIPAA if such a service exists. But, of course, Google is not a HIPAA covered entity. On the other hand, the doctor offering to chat with the patient presumably is. As with Healthcare Helpouts, therefore, Google likely will be the doctor’s business associate (“Helpouts providers can enter into a BAA with Google when they create a listing on Helpouts”). Obviously we will need more information to assess such a relationship. While some Google services seem to offer HIPAA compliance not all do. At the moment it is unclear the extent that Helpouts, its chat function and the storage of any data generated would comply with both the privacy and security rules.
Some of the more interesting questions about this new service concern state not federal law. If Google follows its Helpouts model it will require credentialing of the doctors providing the services raising the specter of actions for negligent credentialing against Google.
However, it is the doctors involved that seem to face the greatest legal jeopardy. There is one outlier on the moribund-looking Google Healthcare Helpouts roll, the One Medical Group that offers state specific medical consultations to its current members. Note those closely worded limitations. Therein lies the problem. State law is going to throw several barriers in the way of the new Google service. First, opening that chat window is also going to open a physician-patient relationship with all the legal (and ethical) implications that follow. Second, some states will require all the information collected during the encounter to be documented in the patient’s medical record. Most importantly, however, it would seem hard for Helpout doctors to argue that chat encounters are anything but the “practice of medicine.” State medical boards and their regulations are astoundingly sensitive to doctors practicing across state lines or treating patients out of their physical presence.
So this really is a case of caveat doctor. There are enough legal issues here for a law school exam (bonus points for any discussion of Google and the corporate practice of medicine) suggesting an abundance of caution. In part, that is a shame. We are still dismally far from providing low cost, 24×7 convenient access to medical advice and services and just-in-time medical services triggered by a symptoms search seems an attractive innovation. On the other hand, like clinics in retail stores or urgent care centers Google’s medical chat seems more likely to increase fragmentation than solve it and, in the process, risk some medical licenses.
