I don't think that HIPAA or fees had much to do with it. HIPAA's focus is on healthcare providers and their business associates. Google Health was the patient's repository and there's no restriction on what the patient does with their records after they have been given them by their providers.
I stopped following Google Health a few years ago. I might have the details wrong - it's been a while since I thought about them:
- I never understood their security model. If I remember correctly - you could give people access to particular results but you couldn't (for example) put in a rule that said "Always share my blood test results and medications with person X". You could share them explicitly after they were added - but it's easy to forget to do this.
- The mechanisms for input/output were awkward. They supported a subset of the ASTM's CCR. One of the things that they stripped out was the Source element - so a physician would never know the origin of a particular observation. This wasn't very useful. They also stripped out identifiers in the CCR that third parties could have used for synchronization of observations. Perhaps observations could have been matched up by date/time and values - but since they had also simplified how observations could be recorded it just wasn't a very platform-friendly design.
- The search/sort mechanisms for data were very awkward. It was more of a repository of documents than it was a database for medical observations. This make it awkward to build services on.
- I don't know anyone that could explain their business model to me. I know that it confused many people at several hospitals that spoke with.
I wish that Google had done something deeper and more interesting here - the healthcare industry certainly could use a shakeup. If they offered something compelling I'm sure they could have charged for it and had a business of sorts.
I suspect (but this is pure speculation) that they really wanted do to the right thing with patient privacy but they couldn't figure out how to structure a system that protected patients while providing a healthcare/business model that hospitals and primary care providers trusted. Anything that was of sufficient power to build a good platform from probably was too complex for patients to handle. By handle here I don't mean that they couldn't use it - but they probably would make mistakes that would be embarrassing for them or that might expose google to some legal liability.
For example - apparently some state laws permit parents to have complete access to their children's medical records. But when the medical treatment starts to have anything to do with the sexual activity of the minor (say - birth control pills) the parent's no longer have automatic access. Suppose that the system was designed perfectly but then the family moved to another state with different rules. I'm not saying that this couldn't be built - but it's not a trivial effort and I don't know how the costs/liabilities get distributed.
I would love Google to jump into medical informatics in a big way but it's a big commitment to something that is outside of the search and advertising industries. A product that could link primary care providers, hospitals, and patients together would be huge. I don't know where the insurance companies would fit in here - I'd prefer single payer (!) - but I think Google would need to build something of at least national scale and there's a lot of interests to be balanced.
I think that Google Health was a test - a small perturbation to the existing system and they wanted to see what would happen. I'm guessing that they learned it was a big mess :-).