Archive for the ‘PHS’ Category

This week, Microsoft’s HealthVault added a number of new enhancements to its platform including support for mobile access (only Windows 7 today, but they plan to launch support for Android and Apple’s iOS within the next few weeks). Wonder how it will look on the iPad? HealthVault will now auto-reconcile CCR and CCD data feeds from one’s physician or hospital. According to HealthVault’s Chief Architect, Sean Nolan, the previous process by which a HealthVault user’s records were place in a waiting area until the user manually initiated the reconciliation was creating some issues with keeping a HealthVault current with the latest test results, med lists etc. And lastly, one can now log-in to HealthVault using their Facebook account credentials. No, your HealthVault account is not compromised wherein all your friends on Facebook now know all the intimate details of your health. The log-in let’s you avoid the cumbersome Microsoft Live sign-in process and having just tried it out, it works like a charm.

Must admit to not having visited HealthVault in some time. The user interface is so much clearer, cleaner and simply refreshing than the past graphical user interfaces (GUIs) of HealthVault. Simple blue and black elements on a white background. Doesn’t get much simpler or easy on the eyes than that. One could even argue it is now ahead of Google Health in the GUI wars, but let’s not give up on Google just yet, you’ll see why shortly.  But still waiting for HealthVault to at last let there be user reviews of the multitude of partners they now have on the site (counted 16 different PHR solutions). Chilmark Research has been following this market for several years now and are familiar with most of those partners but for someone who does not have such knowledge, where in the h*ll do they begin? Still an issue and a growing one at that. Time for the HealthVault crew to get on this issue immediately and deploy something similar to the ratings feature on Apple’s App Store, it’s long overdue.

A few weeks back we wrote of Google Health going into a cryogenic state, not dead mind you, just don’t expect any new features anytime soon. But one of the nicer features in Google Health is the ability to enter, track and trend just about anything you want. A few weeks back we were fiddling around with one of the more popular patient aggregation and sharing sites and became frustrated with the lack of flexibility to create trending charts that are of interest to us to share within a community. And this was a site that just went through a major overhaul to allow for the creation of more disease communities. Puzzling and we went to look elsewhere.

Remembering our demo of the “new” Google Health nearly a year ago we went to create our own trending charts. These were extremely easy to set-up. Now if only Google could figure out a way to enable users of this platform to initiate and create a disease community similar to PatientsLikeMe we’d be in business. Opps, that’s right, Google Health is frozen in time.

So when we were cruising around HealthVault, we thought we would try the same exercise. No problem entering lab data but for the life of us we could not create charts of that data to view trends. Now this could be just user error on our part and we simply failed to find the function that would chart entered lab data as HealthVault does support charting for other parameters (e.g., weight, blood pressure, etc.). Or it may be that HealthVault is expecting you to turn to one of their many partners to provide such functionality. But that takes us all the way back to who of the multitude of partners does one choose from? If you click labs, you’ll get 23 options. Argh.

In all fairness, Microsoft and the HealthVault team really have made tremendous headway and advances to the platform since its inaugural (and painful) launch some 3.5 years ago. But they still have a ways to go to get to the point where it truly becomes a very easy, simple platform to engage (and by engage we also mean the process of selecting and engaging one or more of the many partners that sit on top of the HealthVault platform). We look forward to the next series of announcements from Sean and his team.

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Google Health has seemingly been stuck in neutral almost from the start.  Despite the fanfare of Google’s Eric Schmidt speaking at the big industry confab, HIMSS a couple of years back, an initial beta release with healthcare partner Cleveland Clinic and a host of partners announced once the service was opened to the public in May 2008, Google Health just has not seemed to live up to its promise. Chilmark has looked on with dismay as follow-on announcements and updates from Google Health were modest at best and not nearly as compelling as Google’s chief competitor in this market, Microsoft and its corresponding HealthVault.  Most recently we began to hear rumors that Google had all but given up on Google Health, something that did not come as a surprise, but was not a welcomed rumor here at Chilmark for markets need competitors to drive innovation.  If Google pulled out, what was to become of HealthVault or any other such service?

Thus, when Google contacted Chilmark last week to schedule a briefing in advance of a major announcement, we were somewhat surprised and welcomed the opportunity.  Yesterday, we had that thorough briefing and Chilmark is delighted to report that Google Health is still in the game having made a number of significant changes to its platform.

Moving to Health & Wellness

Today, Google is announcing a complete rebuild of Google Health with a new user interface (UI) a refocusing on health & wellness and signing on additional partners and data providers.  Google told Chilmark that the new UI is based upon significant user feedback and a number of usability studies that they have performed over the last several months. Rather than a fairly static UI (the previous version), the new UI takes advantage of common portal technologies that allow the consumer to create a personalized dashboard presenting information that is most pertinent to a consumer’s specific health and wellness interests and needs.  So rather then focusing on common, basic PHR-type functions, e.g., view immunization records, med lists, procedures and the like, the new UI focuses on the tracking of  health and wellness metrics. This is not unlike what Microsoft is attempting to do with MSN Health and their health widgets that subsequently link into a consumer’s HealthVault account, though first impressions lead us to give a slight edge to Google Health’s new UI for tracking health metrics.

A particularly nice feature in the new Google Health is the consumer’s ability to choose from a number of pre-configured wellness tracking metrics such as blood pressure, caloric intake, exercise, weight, etc.  Once a given metric is chosen, the user can set personal goals and track and trend results over time.  There is also the ability to add notes to particular readings, thereby keeping a personal journal of what may have led to specific results. And if one cannot find a specific health metric they would like to track, the new platform provides one the ability to create their own, for example the one in the figure below to measure coffee consumption. Nice touch Google.

On the partnership front, Google is also announcing partnerships with healthcare organizations Lucille Packard Children’s Hospital, UPMC and Sharp Healthcare and has added some additional pharmacy chains such as Hannaford and Food Lion among others.  On the device side, Google has the young Massachusetts start-up fitbit (novel pedometer that can also monitor sleep patterns) and the WiFi scale company, Withings.  On the mobile front, Google has added what they say is the most popular personal trainer Android app, CardioTrainer and mPHR solution provider ZipHealth (full disclosure, I’m an advisor to the creators of ZipHealth, Applied Research Works) which has one of the better mPHR apps in the market.

If any metric is a sign of pent-up consumer demand for what Google Health will now offer it may be CardioTrainer. In our call yesterday, the new head of Google Health, Aaron Brown stated that they did a soft launch of CardioTrainer on Google Health by just putting a simple upload button in CardioTrainer that would move exercise data to a Google Health account.  In two weeks, over 50K users have uploaded their data to Google Health. Pretty incredible.

Challenges Remain

Chilmark is delighted with what Google has done with Google Health.  The new interface and focus takes Google Health in a new direction, one that focuses on the far larger segment of the market, those that are not sick and want to keep it that way through health and wellness activities.  Today, within the employer market, there is a major transition occurring with employers focusing less on disease management and looking towards health and wellness solutions that keep their employees healthy, productive and out of the hospital. Google may be able to capitalize on this trend provided it strikes the right partnership deals with those entities that currently serve the employer market (payers and third party administrators).  Chilmark will not be holding its breath though as to date, Google has not had much success in the enterprise market for virtually any of its services.

And that is one of many challenges Google will continue to face in this market.

First, how will Google readily engage the broad populace to use Google Health?  Google has struggled in the enterprise market, regardless of sector, and will likewise struggle in health as well, be it payers, providers or employers. Without these entities encouraging consumers to use Google Health (especially providers as consumers have the greatest trust in them), Google Health will continue to face significant challenges in gaining broad adoption and use of its platform.  But as the previous example of CardioTrainer points out, Google may have a card up its sleeve in gaining traction by going directly to the consumer through its partners, but it will need far more partners than it has today to make this happen.

Second, the work that Google has done to re-architect the interface and focus on wellness, particularly the tracking and trending of biometric or self-entered data is a step in the right direction, but Google has not been aggressive enough in signing on device manufacturers that can automatically dump biometric data into a consumer’s Google health account.  Yes, Google is a member of the Continua Alliance but Continua and its members have been moving painfully slow in bringing consumer-centric devices to market. HealthVault, with its Connection Center, is leaps and bounds beyond where Google is today and where Google needs to be to truly support its new health and wellness tracking capabilities.  Google’s ability to attract and retain new partners across the spectrum of health and wellness will be pivotal to long-term success.

Third, Google has chosen not to update its support of standards and remains dedicated to its modified version of CCR.  While CCR is indeed a standard that has seen some uptake in the market, Chilmark is seeing most large healthcare enterprises devoting their energies to the support of the CCD standard.  In our conversation with Google yesterday we mentioned this issue and Google stated that they are hoping the VA/CMS Blue Button initiative will take hold and provide a new mechanism by which consumers retrieve their healthcare data and upload it to Google Health.  The Blue Button is far from a done deal and has its fair share of challenges as well. Google is taking quite a risk here and would be better off swallowing the CCD pill.

In closing, Chilmark is quite excited to see what Google has done with their floundering Google Health.  They have truly hit the reset button, have a new team in place and are refocusing their efforts on a broader spectrum of the market.  These are welcomed changes and it is our hope that with this new focus, this new energy, Google will begin to show the promise that we at Chilmark have always had for this company to help consumers better manage their health.

9/24/10 – Earlier this week, I was interviewed by SearchHealthIT.com. They have created a podcast of that interview that provides further “color” to the Google Health Reset story.

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The European Union (EU) is struggling with many of the same healthcare issues as the US, aging population, ever increasing costs of care and the need to move to new modalities of care.  This is one of the key take-aways from a recent EU-sponsored report: Reconstructing the Whole: Present and Future of Personal Health Systems.  This report looks at the present state of Personal Health Systems (PHS), assesses gaps (technology, process & culture) and lays out what is required to meet the “promise of PHS” by the year 2020.

The report takes a very broad brush to what is PHS including IT, sensors, diagnostics, and drug development (personalized).  This is a big report at some 240pgs and unfortunately is one of those reports that is all too big and all too academic to be useful to the average healthcare wonk.  But tucked within this future, sitting-on-the-bookshelf and collecting dust report are a couple of tidbits worth mentioning.

On pages 79-86 are a series of gap analysis tables (20 in all) addressing a wide range of areas associated with PHS.  Below is the Table addressing Patient Decision Aid Tools.

While the above gap analysis tables are instructive, they are not terribly “deep” and at times come across as superficial – thus would make good fodder for a “high-level” presentation to a less informed audience.

Arguably the best Table is found towards the end of the report titled: Six Domains of Implementation Gaps.

The table clearly lays out what are the future challenges to broader adoption and use of PHS.  The key take-away here is the surprising similarity between the US and its EU counterparts in the deployment and use of PHS, despite what are very different healthcare system models.  Which raises the question: Will such uber-players in the Personal Health Platforms (PHP) market, e.g., Dossia, Google Health and HealthVault create the systems and platforms required to support PHS data requirements?  HealthVault’s move into international markets, (Canada and Thailand) signal yes, but will providers, payers and ultimately consumers join in?

Still more questions then answers at this early juncture in the development of consumer-focused systems and platforms.  But there is a ray of hope in the global commonality of challenges faced that will lead to increasing attention and subsequently resources dedicated to bridging the gaps, addressing these challenges to create more effective and efficient care delivery models.

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doctor-computerProf. David Blumenthal, the new head of ONC, makes some disturbing comments regarding the Stimulus Bill, HIT and HITECH Act  in his article in the New England Journal of Medicine (NEJM). The article is not completely off-base as he does a very good job of describing the basics of the HITECH Act, its intentions and some of the very real challenges that the feds face in actually executing on the language of the Act.  But there are a couple of areas where Blumenthal’s interpretation of the Act raises concerns.

The first pertains to HITECH Act language regarding extension of HIPAA compliance to Google and Microsoft where he states:

It extends the privacy and security regulations of the Health Insurance Portability and Accountability Act to health information vendors not previously covered by the law, including businesses such as Google and Microsoft, when they partner with health care providers to create personal health records for patients.

At this time, neither Google or Microsoft provide the PHR to a hospital who then provides it to their customers.  Rather, the current model that both Google and Microsoft are using is one that supports portability of the consumer’s health record allowing the consumer to invoke an export of their records from the hospital to one of these Personal Health Systems (PHS), of course provided the hospital establishes a link to a PHS.  Our interpretation is that in this scenario, HIPAA does not extend to Google or Microsoft, as the consumer drives the transaction of data flow.  Hopefully, others in HHS will convince Blumenthal of this as well as otherwise, such HIPAA extensions may thwart portability and subsequently consumer engagement and ultimately control of their records.

The second Blumenthal comment that caught us off-guard pertained to the term “certified EHR” where he states:

ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.

While we certainly agree with Blumenthal that defining the critical terms of “certified EHR” and “meaningful use” is paramount and must be done quickly, yet judiciously, his views on certified EHR, as defined above are downright frightening for two reasons.

First, he condones the work of CCHIT as certifying the minimum capabilities for EHR.   Minimum capabilities?  If anything, those minimum capabilities are already restrictive in defining use of specific standards and models that do not provide the flexibility for true innovation.

What is even worse though, is that Blumenthal appears to want to extend certification requirements to “user-friendly” and defining how “quality and efficiency” will be embedded within an EHR.

User-friendly? There is simply no way you can certify such – end of story.  Let the market define what is user-friendly by what a doctor or hospital chooses to purchase.

Quality? Maybe, just maybe you can ask for the simplest of quality metrics to be recorded within the EHR, but highly doubt that is something you want to certify.  Would it not be better to simply verify quality actions supported as part of meaningful use reimbursement?

Efficiency? That is certainly not something you can certify and falls in the realm of implementation (process mapping/workflow) and training.  You can’t certify that!

Suggesting that we tighten the certification process is heading in the wrong direction.  Instead, we need to actually relax the certification process to encourage innovation in the HIT market allowing developers to create solutions that will truly provide value to their users while concurrently meeting the broader objectives of delivering better care and better outcomes.  Creating light certification criteria and focusing more on what outcomes we wish to see occur as a result of broad HIT adoption is where Blumenthal and his staff need to focus their energies.  To do otherwise will lead to a stifling of innovation, stalled HIT adoption among physicians and ultimately a poor investment of the tax payers’ dollars, which we can ill-afford.

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top-ten-goldOne of the nice things about all the writing done over the past year is that one can go back, apply some analytics and see exactly what topics/posts were popular over the past year.

So, drumroll please…

Following are the Top Ten Posts at Chilmark Research for 2008 with brief commentary:

10) Zagat Physician Rating Goes LiveThere are now a plethora of physician rating services with this being but one example.  Unfortunately, this service is restricted to Wellpoint members.  Based on what we’ve seen from most payers in their seeming inability to truly engage consumers/members, doubt this Zagats service is getting much traction.

9) Wal-Mart EMR Mandate Implications: Wal-Mart is a massive presence in any of the markets it enters.  Their decision to chose a single EMR solution for all of their retail clinics reverberated throughout the market.  Now that Wal-Mart is rolling out the Personal Health Platform Dossia among its employees, one can expect eClinicalWorks to be closely tied to Dossia as well.

8 ) Oracle+Cerner=Opportunity: Rumors come, rumors go and some seem to take on a life of their own, resurfacing on a firly regular basis.  The rumor that Oracle will acquire Cerner does have some logic to it, but with the current financial mess, this won’t happen anytime soon.

7) Defining a Functional Model for PHRs or How Many Cooks Does it Take: This post took a critical look at the three functional models: one by HL7, another from the Robert Wood Johnson Foundation’s Project Health Design and the third from the payer organization AHIP.  We’re not too keen on any of these models as it is the market that will define a functional model that delivers value, not academics which predominate the first two groups or one from the payers, which have selfish self-interests at heart.

6) Google Health Goes Live: Post went up the day that Google formally released Google Health to the market.  A belated launch, some eight months after Microsoft released a pre-mature HealthVault.  Google Health will slightly more mature than HealthVault coming out of the gates, as seemingly stalled. See post in the Number 5 spot.

5) HealthVault Surges, Google Health Flounders: After all the anticipation for Google Health and the pending battle royale for mind-share between Microsoft and Google for the hearts and minds of health concious consumers, the battle is turning out to be boring. Google is following its common laissez faire approach to developing its service (very thin on resources being deployed) while Microsoft is investing significantly, and it shows.

4) Mobile Health on the iPhone: Since the launch of the 3G iPhone earlier this year we have seen an incredible number of health & wellness apps showing up on the AppStore, which number well over 400 today.  Recently, Apple redesigned the site to make it easier to see which apps are most popular.  Loads of opportunity remains for those that are creative as most apps are pretty simplistic.

3) eClinicalWorks Tight-lipped on the Wal-Mart Deal: This post followed on the heels of Number 9 above.  eClinicalWorks is one of the EMR darlings for smaller practices which remains a relatively untapped market.

2) Walgreen’s Ups Ante in Retail Health: In March, Walgreen’s made the dual move of acquiring both I-trax and Whole Health Management, two providers of corporate campus health clinics.  What seemed like a good move then, may now be one that they are regretting as employers continue to downsize and trim costs.  If Walgreens would have waited (and they could get the $$$ in this tight credit market) they would have been able to pick up these companies for a song today. Alas, hindsight is always 20-20.

and the Top Post in 2008 was…

1) Google’s Schmidt Outlines Health Platform: We all knew Google was going to release some form of PHR in 2008.  We even saw some early screenshots back in August of 2007 when a few presentation slides slipped into the public domain.  But after those slides, we heard nothing, saw nothing, but knew it was coming.  Thus, when Google’s CEO, Eric Schmidt took the stage as a keynote speaker at HIMSS, we waited in anticipation and Schmidt did not disappoint.

And that dear readers is what YOU, found most interesting at Chilmark Research, that is if we not include the post where we announced te release of our iPHR Market Report Executive Summary.  We were absolutely thrilled with how popular that post was (it far exceeded the number 1 post on Google above) and even more thrilled at all the people who have downloaded this Ex. Summary (nearly 400 downloads for all corners of the globe, at least all continents, withthe exception of Antactica, we’re still waiting for that one to come in.

Thank you all for visiting, reading and commenting. We value your input and hope in return, we have provided some valuable analysis on the market.

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With a poor track record to date getting Regional Health Information Organizations off the ground, the Office of the Coordinator of Health Information Technology within HHS is now looking to expand the National Health Information Network (NHIN) to exchange data with both Google Health and Microsoft’s HealthVault.

But first the Feds look to be scaling back their broad ambitions from a massive NHIN that incorporated (and funded) public and private entities with state and local RHIOs in a federated-type network. This is not working RHIOs seem to be collapsing about as fast as new ones are created as most do not have a sustainable business model. Now the Feds are focusing on what they can control forming a multi-agency initiative (includes such entities as the VA, Dept of Defense, Indian Health Services, CMS, CDC, etc.) to develop NHIN-Connect. The objective of NHIN-Connect is to create an information exchange gateway that these federal agengies can use to exchange electronic medical records. Couple of weeks ago, long-time Government contractor, Harris, won their first healthcare contract for $6.1M for the first phase NHIN-Connect. Please, don’t even get me started on why these contractors are allowed to keep feeding from the federal trough, even when show little experience – talk about a good ol’boy network.

Getting back to Google and Microsoft, this admission by the Feds to open and connect to these two consumer platforms clearly points the way as to how the future of NHIN will develop. It will not be in the control of the federal government, but consumers and those that serve them. But this does bring up a couple of questions as well. For example:

  • What about Dossia, will they be seen in the same light as Google and Microsoft by those leading NHIN initiatives?
  • When we start looking at privacy and security, how will Google and Microsoft address as the proxy for consumers in the broader context of population health studies that the CDC and NIH may want to do against aggregate data in the NHIN?

There are few easy answers and the questions are many. Ultimately, it may be Google and Microsoft (and Dossia) who end up calling the shots as they will be closest to the end consumer and those in Washington DC promoting NHIN will simply follow in their footsteps.

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Aetna is pretty aggressive on the personal healthcare front.

First they buy ActiveHealth Management.  Granted, ActiveHealth’s main target is not the consumer (disease management is their core competency), but they did introduce an online PHR early last year.

Secondly, Aetna has partnered with all the major personal health systems (PHS) plays which include Dossia, Google and Microsoft’s HealthVault.  A key part of these partnerships what often goes unnoticed is that Aetna is providing their customers data portability with the ability to store their Aetna-sourced health record data (claims data, and possibly medication and lab data) on any of these platforms.  The consumer is not tethered to Aetna.

And today they announced SmartSource, an embedded health search tool that leverages Healthline.  There is a quick little video within the Aetna PR that demonstrates what SmartSource actually does that is well worth viewing, at least once you get past the tacky beginning.

What I like about SmartSource:

Nice integration of medical search functional within a consumer’s PHR.

Clean interface for the consumer, at least according to the demo.  Maybe Healthline could learn something here.

Highly targeted search information that directly leverages a customer’s PHR .  Particularly slick was the ability to search on a condition, then look at cost of treatment based on location (your zip code), followed by list of physicians in one’s locale and their fees for treatment.  Now that’s a very nice feature that I would readily use, if needed.

Where I have some concerns:

Though Aetna claims that information that they may be able to gleam from your searches and PHR will not be used against you in future premiums, claims, etc., how will they assure such from occurring?  Is there an outside advisory or audit board that will insure such will not occur?

How much utility will this provide to the consumer versus comparable solutions from Google Health or HealthVault.  Even if the previous trust concern is addressed, Aetna may well struggle to assure their customers that they are safe using this tool, when other options exist.


Aetna is making some bold, aggressive moves to provide the consumer both flexibility and tools to better manage their health  While bold, they are quite necessary as to date, adoption of health plan sponsored PHRs has been quite weak.

And Aetna is not alone.  WellPoint has a number of initiatives as well, including the partnership with Zagat for physician ranking.  UnitedHealth, has been almost as aggressive as Aetna, having acquired PHR provider HealthAtoZ, formed the Optum Health Division and like Aetna, announced that consumer health data would be in their control, thereby supporting portability.

The PHR market, as predicted, is getting a lot of press this year.  Are these health plans now coming to market with compelling enough PHR offerings that will result in a ground swell of consumer adoption?  That really is the bottom-line.

If you seek more info on this story, NY Times has an article today and The Health Blog has a podcast interview with Healthline’s CEO, West Shell.

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