An interesting article about Google Health, ICD and SNOMED CT

wholx

Listening to Google Health users4/27/2009 09:03:00 AM
At Google, we believe that consumers should have convenient and secureaccess to all their health data so that they can be better informed andbe more involved in their care. Recently, a data-savvy patient known ase-Patient Dave blogged about data that was imported into his Google Health Account from his hospital in Boston, Beth Israel Deaconess Medical Center.  Once he saw his data in Google Health, he saw diagnoses that were both alarming and wrong. Where did they come from?

Itturns out that they came from the billing codes and associateddescriptions used by the hospital to bill the patient's insurancecompany. These descriptions, from the International Classification of Diseases (ICD-9),often do not accurately describe a patient because the right ICD-9 codemay not exist. So the doctor or hospital administrator choosessomething that is "close enough" for billing purposes. In other cases,the assigned code is precisely what the doctor is trying to rule out,and if the patient turns out not to have that often scary diagnosis, itis still associated with their record. Google Health faithfullydisplayed the data we received on Dave's behalf. We and Beth Israelknew that this type of administrative data has its limitations but feltthat patients would find it a good starting point. Too often, this iswrong.

At Google, we are constantly learning important lessonsfrom our users. Two days after we learned about this issue, I met withBeth Israel CIO John Halamka, the patient's physician Dr. Danny Sands,and e-Patient Dave himself. We agreed on a reasonable plan: Beth Israelwill stop sending ICD-9 billing codes and will instead only send toGoogle Health the free text descriptions entered by doctors. BethIsrael is also working with the National Library of Medicine (NLM) to associate those free text descriptions with a more clinically useful coding system called SNOMED-CT,so that we can offer patients useful services like automatic druginteraction checking. The result will be more accurate and usefulinformation in patients' Google Health profiles.

This week, all four of us were also at a conference called Health 2.0in Boston. Dave's story, and the lessons we all learned, were the focusof much discussion. We are grateful to Dave for his openness andpassion for making things right. We're also glad this happened becausewe and many others now better understand the limitations of certaintypes of health data and we are working with partners to improve thequality of the data before it gets to Google Health and our users. Welook forward to sharing what we learn with the broader community. Wealso learned that the patient community is surprisingly interested inunderstanding these data issues. Dave and his doctor Danny Sandscollaborated on an informative postabout different data vocabularies used in different aspects ofhealthcare. The patient-controlled "data liquidity" that Google Healthsupports is clearly an important part of the future of health care. Weare more committed than ever to putting consumers in charge of theirown health information.