E-health records are quite the hot topic these days, what with Google and Microsoft actually teaming up to create privacy standards for health information online, and the push toward e-health records from the government. But as I've mentioned before -- and reader comments tend to validate -- they aren't going to become ubiquitous overnight.

Because even before such initiatives as Google Health or HealthVault will be of much use to patients, the health care providers have to be on board. From what I've read and heard, there are two overarching obstacles to wider adoption of such systems by health care providers.

First, and of most concern, is cost. E-health records systems are expensive, no doubt prohibitively so for many organizations. As one reader who participated in a (now-defunct) e-prescribing pilot program commented:

...[W]e discovered that it was difficult to justify using a PDA and a wireless network -- which required training, could break, could go down, or could have other difficulties -- to replace a free prescription pad (provided by a pharmaceutical company) and a free pen (provided by a different pharmaceutical company) and a zero-length learning curve.

And that was just an e-prescribing program, not a comprehensive e-records system. How should health care organizations justify such cost -- especially since training a generation of less than tech savvy physicians would perhaps be more difficult than training the up-and-coming generation. (As IT Business Edge's Ann All highlighted recently, the latter has grown up with e-mail, cell phones, Facebook and 24/7 connectivity.  Many of them expect such technology in the workplace.)

Secondly, assuming there is some way around the cost issue, either through government subsidy or convincing the insurance companies to share the cost burden, there is the need for interoperability. Because, let's face it, how are the hospitals and doctors' offices and insurance companies and pharmacies and other entities to which patients authorize the release of their information going to share it if they are using different technology based on different standards?

And what if the personal health information platform a patient chooses -- be it from Microsoft, Google or some as-yet-unknown vendor -- is not compatible with the e-records systems the  patient's providers use? Is the patient forced to choose the other platform? Worse yet, if the patient's health care providers do not use e-health records yet, is that patient out of luck, aside from manually entering his or her own records into the online system?

The Healthcare Information Technology Standards Panel is focused on precisely those issues, and it has recently released interoperability specifications addressing such things as reporting lab results, managing medication, and patient access to their own records (a.k.a. consumer empowerment). It's a step in the right direction. But what I can't seem to find out is whether or not Google and Microsoft are implementing such specifications in their own efforts to provide online patient information. They may be. If so, that's great. If not, we may end up with a bunch of systems that can't talk to each other anyway.