There are few places with such a high concentration of conceited, arrogant know-it-alls than Washington, D.C., but Silicon Valley may best even the Beltway gang. I've seen a lot of bluster, a lot of unearned publicity, plenty of buzzwords and, in many cases, little actual success in winning over customers or addressing a real problem in healthcare.

Sure, there are exceptions. With the iPad, Cupertino, Calif.-based Apple has captured the imagination—and the dollars—of perhaps a quarter of all physicians in the U.S. Practice Fusion, of San Francisco, has shaken up the ambulatory EMR market by offering a free, advertising-supported product that has successfully targeted a badly underserved segment, namely small physician practices. And Epocrates, based in San Mateo, Calif., claims 1.3 million users for its mobile and point-of-care medical reference and educational tools.

But there have been plenty of failures, too, some of the spectacular variety. Fitting into the latter category is Google Health, the personal health record that Google has decided to abandon after four uneven years of trying to figure out how to fix healthcare.

My hunch tells me Google never really had a plan to make anything out of Google Health. I'm thinking back to the 2007 World Health Care Congress in Washington, when Google was rumored to be developing some sort of PHR product. Adam Bosworth, then a Google vice president, gave a stirring speech about how his mother died due to a series of medical errors, exacerbated by multiple breakdowns in communication between her healthcare providers. He then asked attendees to tell him and other members of the "Google health team" problems they were looking to solve.

I took that to mean, "We want you to do our R&D for us, and do it for free. And we'll fix everything because we're Google."

It took almost a year, until February 2008, when then-Google CEO Eric Schmidt gave a keynote address on the final day of the annual HIMSS conference in Orlando, Fla. There, Schmidt outlined his vision for Google Health before an audience I heard was estimated at 6,000 people. (But months later, a Google spokesperson denied to me that Schmidt actually "introduced" Google Health at HIMSS08. The official introduction didn't actually take place, I was told, until May 2008. Whatever.)

Like so many other "untethered" PHRs—not directly connected to an EMR—Google Health was unable to build critical mass. "There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts. But we haven’t found a way to translate that limited usage into widespread adoption in the daily health routines of millions of people. That’s why we’ve made the difficult decision to discontinue the Google Health service," Google said in the blog post that announced the wind-down of Google Health.

Google posted the news at 11:01 a.m. PDT on June 24. That's after 2 p.m. on the east coast, late afternoon on a summer Friday, when plenty of people have already checked out for the weekend, either mentally or physically. In one last stroke of self-flagellation, the post referred to Google Health and Google PowerMeter—another service the Internet search giant is shutting down—as "trailblazers in their respective categories."

Sorry, Google didn't blaze any trails in PHRs. The real trailblazers are the dozens of other, smaller companies that have been working on various forms of PHRs for as long as 20 years. Some names: Access Strategies, CapMed, ActiveHealth Management, MEDecision, Health Capable, MyMedLab, NoMoreClipboard.com, Good Health Network.

I could continue, but I've said plenty about Google already. There are other Silicon Valley culprits. After Bosworth left Google, he started up Keas. In February 2010, at the first mHealth Initiative conference, Bosworth gave a rather convincing argument about why Keas would be different from Google Health, Microsoft Health Vault or other PHRs because it incorporated care planning and actionable advice.

Keas got a publicity bump from a puff piece in the New York Times. But the product never caught on with the public. Perhaps it was the company's moniker, named for the kea (pronounced "kay-ah"), a bird native to New Zealand. I've heard Bosworth pronounce Keas like "case," but it's pretty easy to mistake it for "keys" or, worse, "chaos," not exactly the image one wants to project for a health product. And I wonder why Silicon Valley seems disconnected from the real world.

Last week at the Healthcare Unbound conference in San Diego, I saw yet another example of Silicon Valley arrogance, courtesy of mobile health and health 2.0 incubator-accelerator Rock Health. Rock Health, founded by Harvard Business School students and alumni and based in San Francisco, has a goal of bringing non-healthcare technological thinking to healthcare.

"We are trying to focus on the technology itself and are looking to find technologists," Managing Director Halle Tecco told MobiHealthNews in March. "We are trying to bring in really great developers and programmers and encourage experimentation and out-of-the-box thinking about healthcare." OK, that makes some sense. Healthcare is a broken industry and could use some disruptive innovation.

But it's possible to go too far. On a panel at Healthcare Unbound, Tecco made a point of noting that Rock Health only had one person on staff with any healthcare experience at all. She showed slides illustrating the laid-back atmosphere at Rock headquarters, as if that has anything at all to do with addressing the many problems healthcare faces.

Tecco repeatedly referred to investments as "plays," suggesting that Rock Health is little more than an investment house with no clear understanding of the emotional aspects of healthcare. She stated that consumers are "obsessed with data," which is why she believes that m-health is becoming more location-based, more passive, more data-driven and more user-friendly.

Mobile health is moving in all those directions, but not because consumers are obsessed with data. The problem is, with a couple of exceptions, Rock Health so far has been targeting the young end of the market. It's a demographic that includes many without health insurance, and even those who are insured can't always be counted on to take care of their own health. Those that do probably are more interested in fitness apps than in actual healthcare. That's good, but that's not where the bulk of the country's $2.5 trillion in annual healthcare costs come from. The frail elderly and people with chronic diseases are the expensive patients.

As I reported last week, companies like Ideal Life, based in Toronto, and Great Call, from San Diego, have found success in producing easy-to-use technologies that simplify the lives of the old and sick. Silicon Valley has some smart, innovative people, but sometimes it seems like they are, as critics of former President George W. Bush liked to say, "all hat and no cattle."

Healthcare needs better.