台灣也能有專屬的Google Health服務？

ZDNet記者蔡宜秀／台北報導 2009/03/18 05:00:00

看官們請別誤會，本文不是要獨家掲露Google台灣有計劃將目前僅運用在美國的Google Health搬至台灣，至少，截至今日還未聽到Google台灣有邀約台灣醫療(健康)單位參與該平台的動作；本文要討論的議題是，台灣民眾有沒有可能跟 美國民眾一樣，有個免費的開放性醫療管理平台紀錄個人健康資訊。

開放性醫療管理平台知易行難

在討論台灣民眾是否也能擁有專屬的開放性醫療管理平台前，讓我們先一同來看看Google怎麼作：

Google Health係一個能讓民眾將自己的電子病歷等醫療紀錄放置於其上的開放性醫療管理平台； 而且，透過與醫療業者合作的方式，Google Health亦有提供各式健康管理服務，如健康紀錄(Profile detail)、重要的用藥紀錄(Import medical records)、瀏覽健康服務(Explore health services)、分享個人檔案(Share this profile)與線上搜尋醫生資訊(Medical contacts-find a doctor)等。

圖說：Google Health的服務型態

Google Health的出現不僅有助於實現Health 2.0(由民眾自行管理自己的健康資訊)，亦有助於活絡健康照護產業。對使用者來說，Google Health等同是個人的健康小管家，因為該平台可提醒使用者用藥時間以及視使用者需求提供醫療相關資訊等；對使用者的親朋好友來說，Google Health則是一個助其了解使用者健康狀況的好幫手，當然，前提是使用者願將其放置在Google Health上的健康資料分享給親朋好友；對醫療業者來說，Google Health的出現，除有助於其曝光，亦可避免其陷入醫療人手不足的窘境。

Google Health不易在台推行。Google Health雖好，但我認為短期內Google台灣不大可能將Google Health服務搬到台灣來，理由很簡單：尚未中文化、不是每個人(如老年人等)都有能力使用這些免費的「線上」健康管理服務，以及Google台灣上哪 去找願意與其合作的醫療(或健康)單位等。

事實上，就算前面三個問題都解決了，也還有法規(醫療法與醫師法等)問題存在，如醫療法規定病歷等資訊只有病患的直屬醫生與照護人員可 看。

學術單位已開始規劃專屬台灣民眾的開放性醫療管理平台

Google Health不易推行不代表台灣民眾無福享受─嶺東科技大學正致力於研發一套開放性的醫療管理平台。

「無論使用者是使用哪種終端感測裝備，以及至哪家醫療院所就診，都可將上述醫療資訊匯至嶺東科大的醫療管理平台上。」嶺東科技大學資訊 網路系系主任陳志明表示，鑒於台灣健康照護產業欠缺一套開放性的醫療管理平台，嶺東科技大學遂以強調開放性的IBM Maximo為核心，以及自行研發出的居家閘道器(OSGi)等技術為輔，建置出一套可用來監測、紀錄、維護(健康檢查)、保養(看診)、追蹤與警示使用 者(受照護者)的生(心)理狀況的開放性醫療管理平台。

嶺東科大是以所有民眾為目標市場。「除了老年人口需要醫療管理平台進行健康照護，小孩子等也有此需 求」他指出，雖然嶺東科大以健康4U計畫申請教育部補助時，是以銀髮族為該平台的首要服務對象，但鑒於每個人都需要一套醫療管理平台，遂計畫於其後將平台 開放出去，讓每位台灣民眾都可以透過該平台管理自己的健康狀況。

圖說：嶺東科技大學建立的開放性醫療管理平台架構示意圖。

有開放平台也很難活絡台灣的健康照護產業─尚未建立完整的產業生態鏈

在「鴻海進軍健康照護產業 會產生什麼漣漪？」一文中，我已簡單描述過台灣健康照護產業的一些狀況，諸如台灣的健康照護產 業因日趨小型化(私人化/區域化)導致健康照護服務無法互通、非所有醫療單位都有能力提供所謂的健康照護管理服務、欠缺具體可明的獲利模式，以及現行的醫 師法與醫療法的部分規定有礙健康管理產業發展等，而且，就連鴻海集團的加入，也無助於解決上述所有問題，更何況是嶺東科大？

「開放平台有助於建構完整的產業生態鏈，至少有拋磚引玉的功效，」陳志明指出，台灣的健康照護服務產業之所以沒有任何堪稱具體的商業營 運模式，與醫療單位提供的健康照護服務多走向小型化、區域化有關。

他解釋，小型化、區域化除意味著使用者無法將現在使用的A家健康照護服務攜至B家去外，對提供終端感測儀器與心理諮詢輔導等醫療相關服 務的業者來說，小型化意味著使用人數不多，使用人數不多則意味著業者可從中獲利的比例有限，在這樣的狀況下，為取得政府科專補助的醫療業者多半是抱持觀望 的心態，在看健康照護市場。

嶺東科大將師法Google Health解決商業模式不明等窘境。第一步是以城鄉包圍鄉鎮的方式解決一線醫療院所不願釋出民眾就診資料等問題：透過與二線醫療院所 合作的方式，如大甲李綜合醫院與埔里基督教醫院附設愚人之友基金會等，讓民眾適應與接受健康照護服務，累積一定的使用人數後，即可向一線醫療院所商討釋出 民眾就診資料一事。

陳志明指出，在解決民眾無法取得健康資料這個問題後，嶺東科大打算透過整合醫療管理平台與電子商務平台的方式，賺取虛 擬醫療商城營運費用與廣告刊登費用，「嶺東科大打算師法Google Ads機制，推出使用者點擊後方計價的廣告收費模式。」他說。

僅有嶺東科大拋磚引玉還不夠。首先，嶺東科大雖建置出開放性醫療管理平台，並試著提出一套看來頗具 體的商業(獲利)模式，但未必有助於活絡台灣健康照護產業；理由是，法規依舊侷限了健康照護產業發展，再加上，嶺東科大雖有意將研發出的醫療管理平台開放 出去，但仍處於「想」這麼做而非「已經」這麼做的階段。

台灣的健康照護產業到底有無搞頭？答案是有，但市場經濟規模有多大─待議。

台灣的健康照護市場尚未起飛。近幾年來，伴隨老年人口逐漸增加，以及台灣政府的加持，確實有不少業 者(醫療院所與相關的軟硬體業者)競相投入該塊市場，只不過，礙於服務不可攜(與醫療院所的本位主義有關)、銀髮族不大會操作ICT產品、醫療法與醫師法 等法規限制，以及使用者仍對健康照護服務的資訊安全有所疑慮等，真正買單的使用者數目仍不多，使用者不多，商機自然有限。

鴻海集團與嶺東科大的加入有可能改善使用人數不多這個最根本的問題。由於鴻海集團本身的使用者(員 工)就夠多，因此，即便鴻海集團與訊聯合資成立的康聯生醫科技最後沒將健檢中心開放給一般民眾使用，光就鴻海集團這個使用單位，即有一定的經濟規模；至於 嶺東科大，雖然其尚未全面對外開放其研發的開放性醫療管理平台，以及招募到許多願意至該平台上開設虛擬醫療院所(商城)的業者，但其的出現，確實是有助於 活化台灣的健康照護產業─至少目標市場已從原先著重的銀髮族擴展到全民。

透過策略聯盟活化健康照護產業生態─提供整合式醫療服務。由於健康照護產業所涉及的服務種類極多且 廣，絕非單一醫療業者可以提供，因此，業者能否放開心胸，尤其是一線醫療院所，透過策略聯盟提供整合式醫療服務，亦將左右市場規模；畢竟，當醫療服務可與 保險、保全、娛樂、教育、金融等服務進行搭配銷售時，比較有機會吸引使用者買單、甚至是提升醫療服務的使用率。

事實上，台灣的醫療業者多已明瞭策略聯盟的重要性，如三軍總醫院、惠普和年代數位媒體於去(08)年底發表的「M-Taiwan應用推廣計畫」階段成果：「M-Life全視界生活網」及 「M-Care全民行動照護網」等，只不過，老話一句，因為服務不互通，所以，買單的使用者有限，但該問題或許在開放性醫療平台問世後，即可解 決。

蔡宜秀，一個非科班出身但卻十分熱愛IT的媒體人，打從2005年底成為IT媒體人後，一直是以軟體線為 主，直到2007年底才開始接觸伺服器等硬體產品......一路走來，有人說她是披著乖順羊皮的大野狼(因為有些時候的用字較為辛辣？！)、有人說她是 個認真的媒體人......她自己覺得，她是站在喜愛與認同IT的角度上，與大家一同分享所見所聞，所以，在這裡，你不會看到硬梆 梆的新聞式報導，你會看到的是，她，蔡宜秀對IT產業的觀察與想法~

Progress along developmental tracks for electronic health records implementation in the United States

(Health Research Policy and Systems 2009, 7:3)

David W Hollar School of Medicine, The University of North Carolina, Chapel Hill, USA

Received: 19 September 2007
Accepted: 16 March 2009
Published: 16 March 2009

Abstract

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.

The electronic version of this article is the complete one and can be found online at: http://www.health-policy-systems.com/content/7/1/3

Google makes health service publicly available

By RACHEL METZ, AP Business Writer
Mon May 19, 10:24 PM ET

NEW YORK - Google's online filing cabinet for medical records opened to the public Monday, giving users instant electronic access to their health histories while reigniting privacy concerns.

Called Google Health, the service lets users link information from a handful of pharmacies and care providers, including Quest Diagnostics labs. Google plans to add more.

Similar offerings include Microsoft Corp.'s HealthVault and Revolution Health, which is backed by AOL co-founder Steve Case.

Google Health differentiates itself from the pack through its user interface and things like the public availability of its application program interface, or API, said Marissa Mayer, the Google executive overseeing the service.

Mary Adams, 45, a Cleveland Clinic patient who participated in the Google Health pilot, said that she was initially concerned about the privacy of her medical information.

Still, she felt safe enough to enroll and has been using the service for about six months, linking it with an online health management tool from the Cleveland Clinic and adding information on prescriptions and doctors to her online profile.

"I hate pieces of paper lying around my house, so I love the fact that i can log on with my normal Google login info and see everything at a glance," she said, adding that with its public availability she'll try to get her sister to use it.

The service, still a non-final "beta" version, does not include ads. But Mayer said Google doesn't plan to start placing them to support the site. A search box on Google Health pages leads to standard Google search results pages, where there are advertisements.

Besides importing records from providers, users can enhance their password-protected profiles with details such as allergies and medications, they can search for doctors and they can locate Web-based health-related tools.

Mountain View-based Google Inc. views its expansion into health records management as logical because its search engine already processes millions of requests from people trying to find information about injuries, illnesses and recommended treatments.

Before this public launch, Google stored medical records for a few thousand patient volunteers at the nonprofit Cleveland Clinic.

The health venture provides fodder for privacy watchdogs who believe Google already has too much about the interests and habits of its users in its logs of search requests and its vaults of e-mail archives.

Pam Dixon, executive director of the World Privacy Forum, said services like Google Health are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPAA.

Dixon's group issued a cautionary report on the topic in February on such third-party services.

Passed in 1996, HIPAA set strict standards for the security of medical records. Among other things, the law requires anyone seeking a patient's records by subpoena to notify the patient and give the patient an opportunity to fight the request.

By transferring records to an external service, patients could unwittingly make it easier for the government, a legal adversary or a marketing concern to obtain private information, Dixon said.

"We are in uncharted territory here. A privacy policy, I don't think, is enough to protect what needs to be protected in a doctor-patient record," Dixon said.

Mayer said, however, that users medical records "are generally speaking as safe with Google as they would be with a HIPAA-regulated entity."

During a webcast Monday, she said users' health information is stored at Google's "highest level of security" on computers that are more secure than those used for the company's search functions.

Mayer said in an interview with The Associated Press that Google will not aggregate users' health information across services so activity on the health service will not show up in search results.


Source: Yahoo News
On the Net:http://www.google.com/health

U.K.: Sharing e-health info requires patient consent

BY Bob Brewin
Published on Dec. 20, 2006

Sharing medical information in electronic health records in England will require explicit patient consent, the United Kingdom Department of Health (DOH) said earlier this week.

The decision followed the release of a task force report on the National Health Service Summary Care Record. The record includes individual patient EHRs that sit at the core of a 10-year, $10 billion NHS project to serve 50 million patients in Britain with a system that connects 30,000 health care professionals.

The DOH said it plans to have general practitioners upload patient information contained in the Summary Care Record to the NHS HealthSpace portal. Patients will then be able to correct or amend their records and offer explicit consent for their records to be shared or opt out of sharing.

“After a realistic period, it would be assumed that those patients who have chosen not to view their summary care record are giving implied consent for it to be shared in appropriate settings,” according to DOH.

The Guardian reported that Lord Warner, the U.K.’s health minister, provided an ironclad guarantee at a press briefing this Monday that patient information would not be uploaded or shared without specific consent. If patients “don’t want their information uploaded, they can stop it before it is uploaded,” he said.

The Summary Care Record Task Force, which included representatives from DOH, the British Medical Association (BMA), emergency medical services, and hospitals and universities, said it considered patient consent on the use of electronic records the key issue of its work.

Dossia, the electronic health record project launched early this month by major American employers Applied Materials, BP America Intel Corporation, Pitney Bowes and Wal-Mart, will allow patients to opt in to the system and then decide what information to share and with whom.

James Johnson, chairman of the BMA, said the task force’s report was the first of its kind to look at the ethical and practical implications of sharing electronic summary care records and should help address patients’ anxieties about the use of their records.

While patients can bar sharing of their medical information, Sigurd Reinton, chairman of the London Ambulance Service NHS Trust, urged them to consider the consequences of their actions.

“In thinking about their options, I hope people, especially the elderly and vulnerable, will bear in mind that if we have your information, then paramedics, for example, will be able to offer the best possible treatment,” Reinton said. “It is the elderly and the vulnerable who may miss out if they have to formally opt in.”

Members of the Summary Care Record Task Force consulted with officials of the Veterans Health Administration in the U.S. to learn how the agency handles patient consent in its Veterans Health Information Systems and Technology Architecture (VistA) system. The task force said it decided not even to consider the compulsory model of VistA electronic records in the U.K.

DOH said with its acceptance of the recommendations of task force, it now plans to move forward with the rollout of Summary Care Records next February to early-adopter general practitioners.

Source: GovHealthIT
http://www.govhealthit.com/article97170-12-20-06-Web