How to use Dr. Google to improve communication with patients

The BMJ Open Journal published an observational study on the searches carried out on Google by patients presenting to an emergency department.

Digital media capture and document an increasing segment of people’s lives through the sites they visit and the contributions they make to social media. Many of these digital traces reflect health. Facebook, Twitter and Instagram posts can reveal health-related behaviours, symptoms or diagnoses.

But while there is no lack of examples of aggregate use of research data to understand health phenomena, such as Google Flu Trends, launched in 2008, which aimed to link influenza epidemics to influenza-related symptom research, it is much more difficult to study individual-level associations, since research histories and personal health conditions are private and require individual-level consent for observation.

To study this phenomenon Jeremy M Asch, David A Asch, Elissa V Klinger, Justine Marks, Norah Sadek and Raina M Merchant, carried out an observational study to answer three questions about patients presenting to an emergency department:

  1. will patients share their research data so that they can be analyzed in association with their electronic medical records?
  2. Is there a variation in health-related researches that leads to visit the emergency department?
  3. What are patients looking for?
  • From March 2016 to March 2017, researchers turned to patients seeking treatment in a large urban hospital emergency department, asking them if they were interested in participating in the search and if they had a Google account.
  • They were informed that only past searches would be retrieved, that they could review their Google search data before sharing it with the research team, and that the team could not access searches made following recruitment. Participants were eligible for a lottery drawing with a 2% chance of receiving a US$40 gift card. All patients provided written consent to be considered eligible.
  • Using a laptop, RAs navigated to where participants were asked to download zip files of their Google usage data. The downloaded search files contain time-stamped reports of what users typed into their Google search bar, independent of the browser used. Of note, many users stay logged into Google because they use Gmail or other Google applications that are facilitated through log in. Participants were then able to view their own data and determine if they wanted to share the file with the research team.
  • Of 703 patients approached in the ED, 411 (58%) agreed to participate in research of whom 334 (81%) reported having a Google account; 165 of those patients (49%) consented to share access to all EMR data in our health system and all prior Google searches. The final cohort included 103 participants; none censored any of their search history data.
  • The 103 participants yielded 591 421 unique search queries (average 5,742; range 2-51,751); 37 469 (6%) were health related. Eighty-six participants carried out research in the 7 days prior to the first aid visit; 15% were health-related. Among these 86 patients, 54 (63%) proportionally searched for more for health-related topics in the 7 days preceding access to the emergency room; 46 (53%) sought information related to their main disorder (e.g., ‘How to relieve sinus pressure’ with a main ‘Headache’ disorder); Thirteen patients (15%) sought indications or other logistical information about the emergency room or other health care facilities. Most of the searches before a visit to the emergency room reflected non-health related topics.
  • The study revealed a high rate of participation in research that may surprise in a context of great concern for privacy in internet use and health data.
    Many of the participants’ searches were health related, suggesting an opportunity to better understand patients’ knowledge, attitudes and behaviours about health about the health information they were searching for. These searches also reveal gaps in traditional health communication. One participant searched ‘how big is a walnut’, followed by ‘what is a fibrous tumour?’
  • A review of the EMR revealed the patient had been told of a walnut-sized fibrous tumour at a previous hospital encounter, but the later search histories suggest the message may not have been understood on its own. Search histories reveal otherwise invisible gaps in patients’ understanding.
  • Health-related searches doubled prior to an ED visit, suggesting an opportunity to better understand patients’ concerns before seeking care in an acute care setting. More specifically, in the week before visiting the ED, 15% of participants searched for location or logistical information and 53% searched for clinical information relevant to their visit. Participants often searched for health-related topics multiple times prior to making the decision to visit the hospital. These findings suggest an ability to anticipate demand even for patients visiting the ED.

    In retail contexts, search terms currently direct targeted advertisements, taking advantage of anticipated demand. One can imagine predicting the demand of hospital services in the same way advertisers predict sales. Search terms predictive enough of serious illness to suggest emergency care or predictive enough of benign illness to suggest avoiding such care. By knowing what patients search for prior to a hospitalisation, we can gain a better understanding of how to respond to what matters most to patients.

    Although the stakes and costs of false positive and false negative errors would be considerably higher than with misdirected advertising, Google already provides in the United States information about suicide prevention services when search terms suggesting that suicidal intent is entered.

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