Meet Lisa. Lisa is a mother of two children, whose mother, coping with diabetes and asthma, lives with her. Microsoft's recently released free personal health record system, HealthVault, was created with someone like Lisa in mind. HealthVault can enable Lisa to upload her mother's peak-flow and glucose readings to her computer and share them with doctors. She can track her children's immunizations, allergies, illnesses and doctor's visits; search for information on illnesses and save to the HealthVault "scrapbook" what she finds. As "custodian" of this health data, Lisa sets who sees what; for example, her daughter's track coach can see only relevant fitness information, and her son's doctor sees only his information. And she can choose add-ons from HealthVault partners. For example, Lisa could select the "in case of emergency" application and print out cards for her family to enable emergency room personnel to see crucial health information. (When she searches HealthVault for information, Lisa also will see advertisements which support the program's business model.)"
The Lisa's of the world represent what Peter Neupert, Microsoft corporate vice president for Health Strategy and former CEO of Drugstore.com, would call a "family health manager”. And family health managers are crucial to the success of HealthVault.
HealthVault was designed for such family health managers who want simplified interactions with their healthcare providers. HealthVault, Microsoft's first foray into the consumer health space (it has already been a software provider to hospitals and health care providers) has ambitious goals, said Neupert at the product launch: "The real promise is can we connect all of the providers, all of the hospitals, all of the pharmacies, all of the imaging labs, so that it's easy like today banking is easy. It is possible to make it easy for people to take their data from the source data providers, and put it in a simple area where they can manage it." The question is: Can HealthVault advance such a goal?
Health care information today is on the whole a fragmented maze that both consumers and healthcare providers must spend time and money navigating. But with privacy fears, doctors' distrust of patient-initiated health information and difficulty getting user traction to overcome, Microsoft will face an uphill battle in using HealthVault as a key to connecting health care silos.
Spotlight on healthcare IT
HealthVault's debut comes at an important time for healthcare information technology. The day after HealthVault's launch, contracts totaling US$22.5 million to nine health information exchanges to begin trial implementations of the Nationwide Health Information Network (NHIN) were announced by Health and Human Services Secretary Mike Leavitt. The move is designed to advance the federal government's goal of most Americans having access to secure electronic health records by 2014. Less than a week later, on October 10, the eHealth Initiative - a consortium of health care representatives that advocates better health care through IT - unveiled its eHealth Initiative Blueprint. The blueprint is the action plan and shared vision of over 200 healthcare representatives on policies and strategies for achieving its vision.
These moves by HHS and the eHealth Initiative point to the need for simplification and guidance in what is an incredibly complex landscape. They also highlight the currently fragmented market Microsoft has entered, and the difficulty the company faces in getting physician support. Such support is not required for a personal health records system to work if the only intention is to keep the record locked away on a home personal computer. But that support is crucial if the product is to realize its promise to consumers: making managing healthcare information easier.
The battle for healthcare provider buy-in
Judging by the adoption rates of electronic health records - the clinicals records used by healthcare providers - that won't be easy. Just 24 percent of doctors use electronic health records (EHRs, also called electronic medical records), according to a study by the health care philanthropic group the Robert Wood Johnson Foundation. And although data is poor on the percentage of hospitals using electronic health records, the report estimates 5 percent of hospitals use computerized physical order entry systems, a form of electronic medical records.
Electronic medical records are to personal health records (PHR) what a doctor's charts are to family health folders tucked away at home. In the latter, it is the patient who controls the information, and because of the idea of a PHR many healthcare providers distrust the concept as a clinical tool.
To truly be useful as a bridge across the silos of health care, a personal health record such as HealthVault would need to receive buy-in from doctors as well. But that will be difficult; healthcare professionals need electronic records that are useful to them, not only to patients, according to some healthcare IT practioners. A useful personal health record would need to be clinically accurate and available to different technology platforms that healthcare organizations use.
"In order for it to be a good electronic record, it has to have clinical relevancy, one record that goes across the continuum of care," says Bert Reese, CIO of Sentara Healthcare.
Paul Contino, VP of IT at Mount Sinai Medical Center in New York agrees. "[Microsoft doesn't] have the data sources that are needed," he says, noting that primary care physicians have some of the most valuable clinical information - and these time-strapped offices are the hardest to convince to participate in data-sharing systems like HealthVault."
Microsoft officials say they are working on these problems. To increase HealthVault's relevancy to doctors, clinical information (usually as a PDF) can be uploaded to the system. In addition, Microsoft is developing verification methods that ensure information has come untampered from a physician or a medical facility, says Sean Nolan, chief architect for Microsoft Health Solutions Group. Microsoft has also sought broad industry support. More than 40 applications and devices are expected to be available through HealthVault through partnerships with the American Diabetes Association, American Heart Association, Johnson & Johnson LifeScan, the Mayo Clinic, New York-Presbyterian Hospital among others. In addition, Microsoft says HealthVault is built with a platform that can be adapted to work with any health data standard and the company expects the ability to communicate with any widely used health information protocol.
Beyond the support required from healthcare providers, HealthVault needs users - ike those family health managers Neupert spoke of. On the surface getting people to buy-in would seem a low-hanging fruit. In a 2006 survey of 1,003 Americans by the Markle Foundation, 65 percent of respondents said they are interested in accessing their own personal health electronically. And 90 percent said they considered it important to track online their symptoms or changes in health care.
But while Americans say they are interested in electronic personal health records, two other studies show that consumers aren't actively participating in such systems. Only 11 percent of Americans currently use a personal health record to keep track of their medical and health history, according to a survey conducted by research consultancy Ipsos Mori for Aetna healthcare and the Financial Planning Association.
This despite the estimated 70 million who have access to basic PHRs through their health insurers, according to Aetna. The survey polled 2,100 adults 18 and older and found that 64 percent of respondents said they do not know or are unsure about what a personal health record is. A similar study conducted by IDC's Health Industry Insights found that 83 percent of 1,095 consumers surveyed have never used personal health records in either electronic or paper form. The primary reason for not using a personal health record, according to the survey results, is lack of awareness.
Contino, the IT executive from Mount Sinai Medical Center, says the Microsoft approach and others like it are asking a lot of consumers as they gather information. He feels consumers would pay for access to a personalized medical information portal, as opposed to Microsoft HealthVault's ad-supported model (searches yield relevant ads). But, he says, the health provider has to make it easy for the consumer. "If I have to collate all the information, why would I pay?"
The P word: privacy
Even those who are aware of personal health records, have another issue with personal health records: privacy. The Markel survey found that 80 percent of Americans are very concerned about identify theft or fraud and 77 percent are concerned about the possibility of their information getting into the hands of marketers.
The public overestimates the security of personal information in the current system, says Dr. Ashish K. Jha, an assistant professor of health policy at the Harvard School of Public Health. Speaking earlier this year at an event to highlight the Robert Wood Foundation's findings, Jha said: "You can walk into a hospital with a white coat, go to the medical records room and pull out somebody's chart relatively easily. It's very hard to do that with electronic records that are designed well."
Micrsoft says it has put stringent security and privacy safeguards in place. As testatment Nolan points to the blessing HealthVault has received from Dr. Deborah Peel, founder of the consumer advocacy group Patient Privacy Rights.
"We knew that it was pretty important that [HealthVault] be something people could trust, so we set out clear strong privacy guidelines," says Nolan. The company worked with the Coalition for Patient Privacy, which advocates putting patient privacy at the core of the healthcare IT system, to develop its product. For example, a central tenant to the coalition's stance is that "patients own their health data and should control who has access to their personal health records."
Nolan says the user's control of all personal information in HealthVault accounts illustrates Microsoft's commitment to privacy. The consumer has complete control over what information goes into HealthVault, and who sees what. (HealthVault can be opened selectively by the controller of the record, or the "custodian" who sets access and security of the record.) Microsoft says it will never use a consumer's HealthVault information in a commercial way without getting his permission. In addition, the transmission of "sensitive personal information, such as a credit card number" is protected with secure socket layer (SSL) protocol. And although users will see ads based on their current search, searches will not carry from one visit to the next. In addition, HealthVault's systems protect data by isolating its data traffic onto a virtually separate network and servers that are located in different locations and in locked cages.
Projecting the impact of HealthVault
Janet Marchibroda, CEO of the eHealth Initiative is optimistic about what HealthVault's significance might be. "What Microsoft's announcement does is put pressure to provide consumer access to health information." Once people knock on your door, and they find out you're not electronic or have no interoperability there will be pressure to deliver those things." As for consumers' privacy concerns, she points out that what was unthinkable not too many years ago - online banking or purchasing, for example - has become commonplace. Likewise, HealthVault has one potential answer to consumer frustration over lost time and money in the Kafkaesque maze of the current healthcare system. "The key part is having consumer applications like this connect to the real places where I get care."
Francois de Brantes, national coordinator for Bridges to Excellence, a health care quality reform organization, also thinks Microsoft's HealthVault has the potential to have a profound effect. "One of the things that excites me about Microsoft's HealthVault is that they've made inroads with provider organizations." Adoption of HealthVault, he thinks, could serve to both push the electronic record discussion forward, as well as push legal issues around health information ownership.
All that hinges on what kind of buy-in HealthVault gets. If users do not trust in HealthVault's privacy and security safeguards, Microsoft will be facing an uphill battle. "A trusted third-party [to using PHRs] is key. The consumer views of Microsoft are somewhat negative," says Contino, adding that "a lot of other companies will have the same problem." Contino guesses a trusted third-party will be a hospital or medical provider, as opposed to an insurer or software company.
Reese agrees that a trusted electronic health information system will come from hospitals and healthcare providers. However, he does think that software giant's presence in the personal health records space may push forward the discussion of electronic health records more generally. "Microsoft in this space might get the conversation up on the national landscape," he says. However, "it's in no way a sustaining step."
John Glaser, CIO at Partners Healthcare, says Microsoft's entry into this space is "an interesting move. The personal health record is a complicated space and we are still learning about the importance of these applications, the provider willingness to integrate with them and consumer desire to have one."
Ray Campbell, CEO of Massachusetts Health Data Consortium, comprised of key New England health care organizations and which provides comparative data and promotes electronic standards, echoes that cautiousness, "The Microsoft announcement is - like every other personal health record announcement - just an announcement. There are a lot of people with a lot of faith in personal health records, but nobody has been able to convince patients of the value of using an online system. My attitude is to wait and see what the adoption numbers look like."
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