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Archive for the ‘PHP’ Category

As part of the process of setting our broader research agenda at Chilmark Research, we do a significant amount of secondary research combined with more limited, but highly focused primary research. We use this research to identify the “white spaces” where there appears to be a demand for some thoughtful, in-depth research and reporting that only an analyst firm such as Chilmark can provide. During that process, however, we often uncover some interesting trends similar to the HIE Snippets of the previous post.

Chilmark continues to follow the patient engagement realm, from mHealth Apps to PHRs, patient portals and personal health platforms such as Dossia and HealthVault. Recently, we have been receiving a significant number of inquiries from healthcare organizations that are developing IT strategies to meet Stage 2 meaningful use criteria to provide patients online access to their personal health information (PHI). We are also beginning to hear very early rumblings by a few forward thinking organizations on the use of new technology platforms, particularly mobile, to more deeply engage patients in managing their health in conjunction with impending value-based contracts. There have also been several announcements lately of roll-outs of Epic’s mobile patient engagement platform My Health. Lastly, earlier this week we had the pleasure to attend GE Healthcare’s Centricity Business National User’s Conference where we sat in on several patient engagement presentations. Following are some of the trends we are seeing that will be foundational to our future research on the topic:

HIE Vendors not up to task: A number of large healthcare organizations that have grown organically and through acquisition have a multitude of legacy IT systems from numerous vendors (not everyone is going Epic) in place. These organizations are now looking to link these systems together with an HIE solution and while they are at it, want to be able to provide patient access to their PHI. Problem is, most leading HIE vendors that have proven solutions for interfacing to multiple systems typically have poor patient-centric solutions. There are exceptions to every rule and companies such as RelayHealth and Kryptiq offer quite capable patient portals combined with secure messaging. But for those HIE solutions that lack such capabilities, healthcare organizations are having to look elsewhere to fulfill this need which is bringing business to MEDSEEK and Intuit Health.

Patient Portals interface first to transactions: Several of the presentations at the Centricity event were given by organizations with distinct clinical and administrative systems. Maybe it was just the venue, it was a Centricity Business Users’ Conference after all, but in each presentation on patient engagement the patient portal was driven from the admin-side. Sure, the portal could provide labs and some basic clinical data but it was really designed to help with the pre-registration process, appointment scheduling, secure messaging and Rx refill requests. Each organization we spoke to have plans to bring clinicals (some had Epic for clinicals, others Cerner) into the portal in the future to facilitate care processes for the truly sick, but that is a second order priority. This raises the question: Will front-end admin solutions, like Centricity’s Business Suite, become the core patient portal at the expense of those developed and offered by those from the clinical side of the fence?

Still in very, very early stages of mHealth App adoption: As mentioned previously, a number of organizations (Group Health Collaborative, Kaiser-Permanente, Stanford, UPenn Medical Center, etc.) have announced the release of an mHealth App for patient engagement, virtually all of them, My Chart instances. These releases are basically a mirroring of what is being done with patient portals mentioned above – enable transactional processes. We have yet to see anything, at any organization that has gone beyond pilot stage (e.g.WellDoc in Baltimore) in the deployment of a mHealth App to address a large at-risk population. This is puzzling for as we move to value-based contracts and accountable care, healthcare organizations will need to seriously rethink how they deliver health to chronic disease patients not just in the exam room, but at the patient’s home, in their car at work, wherever they may be to ensure compliance. mHealth can play a very effective role here but organizations’ reluctance to adopt is a chicken and egg scenario. There is not enough evidence to prove efficacy of mHealth Apps but if they don’t adopt, the evidence will not present itself. This will eventually break-thru, the question now is simply, when? And based on what we have seen in healthcare IT adoption to date, it could be a much longer wait than many VC firms and entrepreneurs currently have in their financial models.

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While we receive many comments on this site to various postings, we received one this week that really caught our attention for a three reasons:

1) The author, Dr. Louis Siegel, speaks with some authority having not only been a practicing physician for many years but also an innovator/entrepreneur with a patent to his name and is now working to improve diabetes care via IT.

2) He takes a hard nose look at the practice of care, the apathy of patients and the need for a more engaging dialog between patient and provider that can begin with a common, shared and complete record. This sounds quite similar to our own argument to throw out the now dated and artificial terms of EHR and PHR to settle on one term, the Collaborative Health Record or CHR. 

3) In several conversations this week with a number of organizations regarding Monday’s post, one common theme has emerged: A significant cultural change needs to occur within the medical community if we wish to truly engage the patient as a critical, hell the most critical, member of the care team. That cultural change needs to begin with information sharing, information equality and it needs to begin with the clinician encouraging the patient to become an informed and knowledgable patient. 

Therefore, having contacted and asked for permission, which was readily granted, Chilmark has taken Dr. Siegel’s comment and moved it to the more visible and prominent position, that of a guest post. Dr. Siegel puts forth the challenge that the culture of care delivery and the apathy of patients needs to change as only then will we see broader adoption and use of patient engagement tools that go beyond simplistic marketing and towards shared decision making and ultimately, better outcomes.

Dr. Siegel:
Let me say a few things from the perspective of a physician, and one who has lectured on encouraging people to invest time and intellect in their health.

First, there is what I call the ‘Wall of Apathy’. People, alas, recklessly, dangerously, and wrongly, entrust their physicians with their healthcare and health facts. The Wall is very steep.

The Wall is steep because doctors like it that way and work to keep it that way.

What patients don’t know won’t kill them (‘them’ are the doctors).

Medicine is a closed society and the fundamental principle that a person’s health truths (labs, opinions, reports, etc..) are first the property of the person and second the property of providers has been negated and refuted at every turn by the healthcare profession and healthcare industry. Remember medical errors is the fifth leading cause of death so the last thing a doctor wants is a patient nosing around.

Both of these, the Wall of Apathy and the Closed Society explain why the PHR does nothing more than ‘crack’ the health truths door open a little and still keeps the patient out of the loop. PHRs are only a token, they provide little of the facts a person needs to know if their care is adequate and conforming to standards of care.

The whole notion of a PHR is a ridiculous attempt to share the person’s whole medical record pie. That is why there is no traction.

Healthcare delivery is created to be provider-centric not patient-centric and as such the record of a person’s healthcare is created to be the same way.

Forget PHRs and get ‘crackin’ on opening up a person’s entire record on a shared platform that is both provider and patient accessible and readable.

Being able to email your doctor and seeing an image of your labs does nothing to inform you of the fact that your prostate hasn’t been checked in three years and your last PSA, though in the ‘normal’ reference range is double the last one and possibly worrisome. Coding that is not difficult.

People would be horrified if their quarterly investment report was only a phone call from their broker’s assistant saying ‘everything is fine, let’s check in three months’ (no report, no on-line viewing, no quarterly calls), but are quite content to receive a call from their doctor’s secretary saying ‘the results of your blood work are fine’, and leave it at that.

How do you know that report she looked at was yours? It isn’t always.

Finally, medical reports reporting (what your doctor gets from labs, pathologists, radiologists, specialists etc.) is chaotic, non-standardized, and riddled with critical information buried deep inside that never sees the light of day, or the doctors or the patient’s eyes. Trust me on this.

One pathology report a patient I consulted on showed me a copy of a report their doctor received that had a big box checked ‘NORMAL’ and in the smallest font a sentence that said ‘Our criteria for normal is four malignant cells. This patient had three.’ The doctor looked at the box and missed the fine print. The patient read it, however.

Forget the notion of personal health records and rid ourselves of the notion that only SOME of my medical records are mine and some are my doctors. ALL my medical records are both personal, and mine.

After that, let’s get our IT heads together to work organizing the craziness in medical record reporting and dismantle the coveting of medical records by doctors and institutions and write smart systems that match diagnoses to standards of care and analyzes those records for errors of omission, trends, etc.

We can start with chronic diseases, like diabetes and others for which standards of medical care exist.

Let’s have a shared-care concept of care that shines the light of day on each person’s health truths.

All patients have that right.

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PHRs are much like the tides, news about them ebbs and flows. Right now, with the relatively recent demise of Google Health, Dossia’s attempts at rebirth, and the significant inquiries we are receiving regarding meaningful use requirements to host a PHR (patient portal). But in and amongst all this Chilmark has heard on more than one occasion the following statement: “The problem with PHRs is that they are a technology in search of a market.”

This statement is simply wrong for the following reasons:

1) As we have said countless times before in previous posts, very few people are interested in a digital filing cabinet for their health records. Unfortunately, many PHRs in the market today are just that, digital filing cabinets. In this case it is not an issue of a technology in search of a market, it is just a bad product that really has no market.

2) Technology adoption does not occur for its own sake, it occurs when there is perceived value by the user that leads to adoption. PHRs, PHPs (personal health platforms), patient portals, etc., is certainly a technology, that when well-designed, and implemented can deliver significant value and subsequently see high adoption rates. Just look to Kaiser-Permanente’s instance of MyChart, where patient adoption is well over 40%. Up in the Pacific Northwest, the Group Health Collaborative (GHC) is seeing PHR adoption that is well over 50%. That’s a market!

While there is indeed a PHR market, the market is immature and likely to remain so for the foreseeable future. The market is unlikely to be found in stand-alone PHRs or PHPs where it is incumbent upon the end user to populate the system and establish the critical links with the broader healthcare system (borg) to drive those high-value transactions. Rather. the near-term market for PHRs will be with those systems that are tethered to a healthcare provider, be it an individual practice, a hospital or large IDN such as Kaiser or GHC that have the critical linkages for transactional processes such as appointment scheduling, Rx refill requests, email consults. etc.

Unfortunately, for those with complex conditions, who have a multitude of doctors and/or specialists, these patients will be burdened with having a multitude of PHRs (patient portals) to visit to view their records and when desired, invoke a transactional process. The dream of one complete longitudinal patient record will remain such, just a dream especially for those who are in greatest need of one such record, our sickest, most needy patients.

And one last point…
Why are organizations such as KP and GHC seeing such high rates of adoption while many other organizations do not? Quite simple really, these organizations have built these patient portals (PHR) and the tools they provide into the clinician workflow and actually have clinicians encourage patients to use the PHR. Most organizations we have spoken to have failed to grasp this critical point, and maybe they really do not care, they’re just checking off the meaningful use box of requirements that must be met.

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Since it’s founding five years ago Dossia has been able to entice only four companies more to join. Dossia is not exactly setting the world on fire and reeling in the multitude of large, self-insured employers to its ranks, which is particularly disturbing in light of the fact that virtually all employers are struggling with reining in spiraling healthcare benefit costs. This raises the obvious question: Just how viable is Dossia long-term? Following up on our previous post where we provided an overview of the new Dossia Health Manager, we’ll now dig into Dossia’s business model, corresponding market needs and ultimately the viability of this personal health platform (PHP).

Yesterday:
Dossia was founded in 2006 as a consortium of six large, self-insured employers that would invest in the development of a PHP for their employees. In 2007, Dossia chose the Indivo platform to be its future PHP and in 2008, Dossia finally went live with its first employer Wal-mart, albeit as a trial. In this first roll-out, the Dossia platform itself was not much more than a data aggregator bringing together an employee’s claims and pharmacy benefits management (PBM) data together that was then used to populate the WebMD PHR which Wal-mart had chosen. In an effort to get Dossia up and running there were a number of short-cuts taken in this deployment that created less than an ideal user experience. Wal-mart had also made the decision to not provide incentives that would promote employee engagement. A clunky user interface combined with lack of incentives resulted in a less than stellar success for this first roll-out of Dossia.

But this first deployment taught Dossia and consortium members a number of lessons:

  1. The system must provide easy sign-on and be intuitive to use.
  2. The sponsoring employer needs to have a  robust communications process to educate employees on the platform, its value and why it is in their (the employee’s) interest to sign-up.
  3. Financial incentives really do work and are necessary in the first years to gain critical mass of user adoption and ongoing incentives will be needed to promote longer-term behavioral change.
  4. Privacy is not as big an issue as one may think. Yes, of course its important, but if there is a clear message to employees that their employers will never ever see their personal health information (Dossia is very adement in support of this) employees are willing to use the service.
  5. A data repository with an ecosystem of apps is not enough. Employers want a solution, not something that they have to put together themselves.
  6. Ultimately, the PHP must provide the user with functionality that is useful and engaging. This may seem like a no brainer but you would be surprised at just how many PHR-like apps fail to do this well.

With these lessons Dossia moved forward to what we now have today.

Today:
Of the now 10 founding member, six are now live on Dossia and two more will go live later this year. The depth of deployment at individual employers was not revealed to Chilmark during our two interviews with Dossia so one would assume that these deployments are in a wide range of stages. Mike Critelli, Dossia’s CEO though did state that one company has seen 50% adoption among its employees, which is impressive (the power of financial incentives – there must have been some good ones).

With the new Health Manager, which will be released this fall, Dossia has a much more compelling solution to take to market. It will be interesting to see if Dossia will have any success targeting WebMD accounts, an obvious first line of attack. When we spoke to Critelli, we asked him how he intended to take Dossia to market and expand beyond the confines of the original founding membership of ten. Critelli does indeed have a plan.

  • They’ll seek-out those companies that have been proactive in the health benefits field; those early adopters of new solutions, new health benefits models.
  • Those companies that are targeted will need to have very senior level management engagement (e.g. C-suite, line managers, etc.). Dossia has found that approaching procurement departments or human resources is by and large a waste of time. Not too surprising. In research Chilmark conducted last year on employer trends we found that many an employer CFO is less than happy with HR & procurement in their attempts to rein in healthcare costs and are starting to take direct control.
  • Seek out those who support the need to provide financial incentives (small incentives to promote initial sign-on and on-going incentives to promote long-term engagement).
  • Ensure the target employer is willing to back a thorough and complete communications process to educate employees on why signing on to Dossia is in their interests as well as that of their employer.

A logical GTM strategy that does align with the employer market.

Tomorrow:
Even with new leadership, a new, redesigned platform that is a more complete solution, Dossia is far from out of the woods. If WebMD is any barometer, (they’ve seen contraction in their employer market for the last couple of years) the employer market may hold such solutions as highly suspect and not a long-term contributor to bending the proverbial healthcare cost curve. Dossia will need actually proof points from existing members as to the value and utility of using this PHP to proactively engage employees in managing their health. To date, Dossia employer members have been reluctant to come forward in support of Dossia, with either anecdotal evidence (percent of employees signing on, level of engagement, etc.) nor hard evidence (bending that cost curve) though it is likely too early for those latter numbers. Bottom-line though is that Dossia founding members need to step-up to the plate in support of Dossia with their own pronouncements, results, press releases and interviews with the press.

Then there are the health benefit consultants that play a very influential role in helping large employers in designing a health benefits strategy. It will be important for Dossia to make in-roads here engaging and educating these influencers to ultimately win their support of Dossia as a viable alternative to similar solutions such as WebMD.

Dossia’s PHP is far from finished and the next critical component needed is an ability to help employees better manage their Health Savings Accounts (HSA). A nice feature of the new Health Manager is the Healthcare Blue Book, which provides procedure pricing transparency. So the next logical step is how do I pay for these health services. With the ever increasing trend towards greater employee cost sharing and use of HSAs, Dossia needs to get that financial management piece in Health Manager in the next version and frankly we’re a little surprised to not have seen it in this version..

Employers today spend on average $8K/yr/employee on healthcare insurance. On top of that, employers spend on average an additional $1K/yr/employee on “discretionary” healthcare-related activities, e.g., a PHR, various health & wellness promotions, incentives, etc. It is that discretionary spend that Dossia will target and this is a potentially rich vein to tap. But getting back to the beginning of this section, Dossia will need to provide employers, who have increasingly become disillusioned by all the various programs they’ve tried before with questionable success, with clear proof points as to the efficacy of the Dossia solution. Dossia would be wise to sit down with those founders, have a heart-to-heart talk and begin the process of collecting those proof points and taking them to market first.

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Following closely on the ill-fated demise of Google Health, fellow Personal Health Platform (PHP) provider Dossia announced last week a major upgrade of their platform with the release of Dossia Health Manager. We received a deep product dive at the end of last week and spoke with Dossia’s new CEO, Mike Critelli this morning. Initial take: Health Manager is a restart for the the oft-times struggling Dossia. Following is part one of our assessment.

Background:
Dossia was founded what seems like nearly a century ago but in reality, five short years in 2006. (Maybe we need to measure the PHR market like dog years with every human year representing 20 PHR/PHP years.) In 2007, Dossia chose the Indivo platform, which was developed at Children’s Hospital – Boston, as the basis for its future PHP. One could easily argue that Dossia and the Indivo platform it was developed on was the precursor for both Google Health and Microsoft’s HealthVault.

Beginning with six founding members, all large self-insured employers including among others Intel, AT&T, and Pitney Bowes, Dossia struggled to get the platform live but was finally able to pull it off for member Wal-mart in October 2008. The PHR partner for Wal-mart on the Dossia platform was WebMD. Reports we received from the field on this deployment were not encouraging as it appeared that there was a major push to demonstrate the value of Dossia and we all know what happens when things get pushed before they are fully baked. Dossia learned a lot in that first deployment and has proceeded ahead in a more methodical fashion and now has 6 of the now ten founding members live on Dossia. Unfortunately, Critelli was unwilling to state how many employees of founders are using Dossia today, which makes one assume that the majority of these current deployments are in pilot stage.

In addition to getting Dossia live, Dossia has struggled to attract new employers. In the five years since its founding, only four new employers have joined. This raises the larger question: Can Dossia become a viable entity? Jury still out on that one but based on what we saw last week and our conversation with Critelli this morning, Dossia is on the right track.

Dossia Today:
Let’s start with the new Health Manager.

As we have argued countless times on this website, no one, absolutely no one is interested in a digital file cabinet for their personal health information (PHI). But what they, call them patients, employees, consumers, citizens, whatever do desire is a system, a platform that allows them to leverage their PHI to better manage their interactions with the healthcare system as well as potentially manage their health or the health of a loved one. Ideally, such a platform is intuitive to use (Google Health was quite good at this), readily imports data from a multitude of sources (HealthVault excels here), and provides a number of tools that leverage one’s PHI that are simple to select and use. This is a core competency of WebMD’s own private portal offerings (sold to payers and employers) and is Dossia’s chief competitor.

With the release of Health Manager (will be available to employers this fall), Dossia has brought together a fairly compelling, self-contained and comprehensive solution that should prove attractive to employers. This may be the first serious threat to WebMD’s dominance in the employer market and as we have reported before, WebMD has been milking their private portal business for a couple of years now, has seen contraction and is vulnerable.

The Dossia Health Manager starts off by providing the user the opportunity to chose from among a number of different apps to engage including the usual list of health content, medication manager, an immunization tracker, even the free text4baby app. One will also find, via partners, the Healthcare Blue Book to provide procedure pricing transparency, AmeriHealth for telemed as well as some social media/gaming functions that employers can leverage to incentivize healthy behaviors.

Once the various apps and functions are chosen by the user, the user is presented with a dashboard that is customized to their specific needs. As with most PHRs and PHPs, a given user can take on the role of family CMO (chief medical officer) and with the consent of other family members, view their records as well.

Having seen earlier versions of Dossia, this is an absolutely huge step forward for them in the creation of a simple to use and simple to understand PHP. What is particularly nice about Health Manager is that it provides the user a fairly selective, but complete set of core functionality. The Dossia has taken out some of the mystery and challenge that confronts many a consumer when they attempt to use one of the other PHPs in the market, specifically: which application should I use to manage this aspect of my health? Good luck trying to do that on HealthVault as the the choice (there are 23 PHRs to chose from) is a bit overwhelming and ultimately paralyzing.

But in providing this capability, Dossia has made a conscious decision to tread into the PHR waters themselves providing base PHR functionality. So long WebMD (that relationship with Wal-mart dissolved some time ago) and so long other PHR providers looking to ride atop of the Dossia platform, you’re likely to not get invited to the dance (unless of course you can get an employer customer of yours to demand such from Dossia, which is the case for Intel, who is also using Mayo’s Embody Health). Chilmark sees this as a logical and needed progression for Dossia as employers do not want a multitude of apps to manage for health and wellness initiatives, they want one comprehensive, easy to understand and deploy solution. Dossia is now prepared to deliver on that need.

Our next post will dig deeper into the business of Dossia and its go to market strategy, which to date has been, shall we say less than stellar.

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A little over a week ago Google stated that it was putting a stake through the heart of their personal health platform (PHP) Google Health. We at Chilmark had been expecting this for some time, it was just a manner of when it would become official. Thus, we were somewhat taken aback by all the publicity surrounding this final chapter with our own post on the topic receiving well over 40 comments and link-backs (that may be a record – thanks everyone for contributing to the story). With the closing of Google Health, we postulated in that post that Microsoft really had no other worthy competitor that will challenge them to continuously make enhancements to HealthVault. We may have spoken prematurely.

Stepping in to take the place of Google, is none other than an ol’school EHR company (and one of the largest), Cerner, who provided their own commentary on the demise of Google Health and their future intentions. Last week we had the opportunity to talk with the Cerner Health and learn more about those intentions but before getting to that, some quick background.

Taking a different tack:
Cerner has been in the HIT business now for 31+ years having grown to one of the leading EHR vendors in the market. You’ll usually find their systems (EHR: Millenium) in large healthcare organizations. This sector of the EHR market is seeing fierce competition as Epic seems to pick up one win after another at the expense of others, including Cerner. While continuing to go head-to-head with Epic, it appears that Cerner has also chosen to take a different tack, adopting a philosophy of: if you can’t beat them straight up, change the rules of the game.

In this year’s Annual Report, co-founder and chairman Neal Patterson spoke of Cerner’s origins, its staying power in the market but most importantly, the desire to transpose Cerner from a “care company” to a “health company” stating his belief that

…the business of health may eventually become a bigger business than the business of care.

In conversations with several Cerner executives, it becomes pretty clear that this company is truly looking to remake itself into one that adopts an open approach to not only sharing information (Cerner was very instrumental in the Direct Project) but provides a foundational “network of services” to enable “communities of care.” Those communities can be within a city, a region, an employer or a State. On the HIE front, Cerner recently won the Missouri State contract (not too surprising, it is in their backyard) but Cerner is also looking to land additional multi-stakeholder, HIE contracts with their partner Certify Data Systems. Unlike virtually all other EHR-derived HIE solutions, Cerner’s is actually pretty open and can interface readily with any EHR provided the EHR uses common data standards (e.g., CCD, CCR, etc.). But what may be even more interesting then what they have done in the HIE market, is what Cerner intends to do in the broader consumer market.

Cerner Health:
Last year at Health 2.0 a couple of representatives of Cerner made a fairly simple but engaging presentation on some of the gaming concepts they were developing which reminded one of some of the earlier developments at what is now Humana’s defunct skunkworks, Crumple It Up. Though a bit gimmicky, the presentation caught one’s attention as it was certainly out of character for any EHR vendor, let alone one of the leaders.

Now, some nine months later Cerner announced its intention to take Cerner Health beyond what Google Health was (not too hard to do). The leadership team at Cerner Health graciously hosted a call with Chilmark Research to further discuss exactly what those intentions are which are outlined below:

Provide a wide range of health & wellness services for employers.
Cerner has been eating its own “dog food” for the past year using Cerner Health to promote health & wellness among their employees who to date have lost a combined 12 tons of fat (take that Biggest Loser). This weight loss program will be rolled-out across Cerner’s home town of Kansas City (employers, providers, etc.) in two weeks. Cerner Health will target a number of other health & wellness areas, with programs that include built-in incentives. Clearly, Cerner is targeting WebMD in the employer market, a market that has seen very few comprehensive solution suites and WebMD has been milking that market for a longtime and is vulnerable.

Facilitate population health management – address “communities of care.”
For some time now, employers and payers have been looking to better manage their populations to lower medical loss ratios (MLRs). Providers will be looking to do the same as they take on a greater share of the risk via new contracts (e.g. BCBS-MA’s Alternative Quality Care contract) and future Accountable Care Organizations (ACOs). Cerner Health intends to serve both employers and provider needs in this regard with “Health Graphs,” a conceptual analytics framework that combines multiple data streams to provide an accurate view of population health at the community level. The Health Graphs concept is still a bit fuzzy (as are most data analytics models to address this issue) but what we do like is the focus on communities. To be truly successful at addressing population health, one must operate from that community level. Cerner Health correctly perceives health as a community issue where within a given community, be it an employer, a hospital, a specific condition, a town, a region, etc., there are unique needs requiring a focused approach.

Provide a PHP with an ecosystem of third party apps and go direct to consumer.
Cerner Health will go head-to-head with HealthVault by offering a PHP with a published software development kit (SDK) for third party independent software vendors (ISVs) by year-end. This will enable an ecosystem of applications to potential sit on top of the Cerner Health stack. Currently, the SDK is undergoing testing with a limited set of beta ISVs to fully flush-out capabilities, documentation etc., before a broader roll-out. In addition to releasing the SDK at year-end, Cerner will also open the doors to any and all consumers/patients to store their personal health information (PHI) on the Cerner Health PHP. Similar to HealthVault, Cerner Health will support all leading data standards, Project Direct protocols, and certainly allow one to upload their Blue Button files to the PHP.

The big challenge for Cerner on the PHP front is soliciting ISVs to join. Many will perceive Cerner as a competitor to their own initiatives and one should not expect competing EHRs (Allscripts, eClinicalWorks, Epic, GE, Nextgen, etc.) to readily partner either. Where Cerner Health draws the lines of what it intends to take to market and what it will look to partners to provide remains unclear. In what is still a very immature market, this is not necessarily a bad thing but it will prove challenging for Cerner to build-out that ecosystem on the PHP without clearer articulation of intentions.

The Wrap:
Cerner’s entry into the health market is a bold move and hardly a slam-dunk. Reading between the lines, Cerner Health has an extremely broad charter that will likely bring it into competition with a wide range of vendors outside its traditional EHR haunts including Microsoft, Intuit and WebMD to the multitude of disease management firms and of course population health analytics firms such as Ingenix, Thomson Reuters, SAS and IBM. Have they bitten off more then they can chew? That’s a very real possibility. But one thing this company does have going for it is staying power and one would be foolish to discount them this early in what will be a very long race.

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The recent post on Google Health going into the deep freeze has solicited a number of emails, including some from the press. In one of those emails a reporter had spoken to several industry thought leaders to garner their opinions which follow:

Consumers will not sign on to most Personal Health Platforms (PHPs) or services due to the issue of trust.
Leading researcher and developer of an open PHP.

Provider sponsored PHPs and patient portals will dominate the market for they offer services that patients/consumers want such as appointment scheduling, prescription refill requests, etc.
Leading CIO who is also actively involved in HIT policy development.

The only people who care about a PHP, PHR, whatever you wish to call it are those who are struggling with a life-changing illness.
– Co-founder of leading site for those with serious illness to gather and share experiences.

Chilmark’s thesis is an amalgamation of the last two statements (we’ll get to the first one shortly).

By and large, people do not care about their healthcare until they have to, either for themselves or a loved one. Even then, if they are very sick, it may be far more than they are capable of to set-up and maintain a PHP. These systems are still far too hard to create and manage, let alone trying to get doctors and hospitals to feed complete records and updates into them in some automated fashion. There may be an opportunity in providing a system for baby boomers to help manage their aging parents health issues from afar. We have yet to find a PHP, PHR, whatever you wish to call it that ideally fits this market need and may be an opportunity for an enterprising entrepreneur.

As we have stated many times before, consumers are not terribly interested in a digital file cabinet for their records. What they are interested in is what that data can do for them, particularly on the transaction side. In the “what’s in it for me” category, consumers seek convenience in all aspects of their lives. If they are presented with a system that not only grants them access to their records, but helps them schedule appts, directly communicate with their care team via email, do Rx refill requests, etc. then you’ll see some adoption. THis supports the statement of the healthcare CIO above.
But even then it may not see strong adoption if clinicians are not strong advocates of its use. In deference to the first comment above from the researcher, trust does matter and patients/consumers do trust their doctors. If the doctor encourages use, adoption will follow.
Unfortunately, sites like Google Health, HealthVault and Dossia  as well as a slew of other independent PHR companies are one step removed from these types of transactions and their use is not actively encouraged by clinicians, leading to anemic adoption rates. And even within healthcare organizations, there is often not strong support among clinicians for patients to use the organization’s sponsored, tethered PHR.
Will the HITECH Act, meaningful use requirements, the move to bundled payments based on quality, the establishment of Accountable Care Organizations, the creation of individualized care plans, the desire to transition to true patient-centered care, will any of these initiatives change the market dynamics for PHPs, PHRs, etc.? One could hypothesize yes, of course. But we’ll go back to the preceding paragraph: Until physicians/clinicians actively promote the use of such systems by their patients and the systems themselves become far easier to use and address specific consumer/patient pain points, the growth prospects for this niche market will remain flat-lined.

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