Posts Tagged ‘Blue Button’

Yesterday, I was in Washington DC to attend ONC’s Consumer Health IT Summit. While having high hopes for some breathtaking new developments, ultimately walked away disappointed as this event ultimately devolved into a Blue Button promotional event. Now I have nothing wrong with some promotion, after all my background is heavily steeped in marketing. What I do have a problem with, as an analyst, is major hype around any concept, technology, etc. that is not balanced with some serious, thoughtful critique.

There were times when I thought this event felt more like a channeling of a Health 2.0 event with the clarion call of “Give me my damn data” being chanted. At times like that I had to pinch myself to remember, no, I’m in the grand hall of the Hubert Humphrey Building. Of course the multiple, large portraits of past HHS Secretaries hanging from the walls was also a clear reminder of exactly where I was.

But despite some shortcomings, the event was focused around what may be the government’s (VA & CMS) finest contributions to promoting patient engagement – the Blue Button. The Blue Button was first released in 2010 by the VA to allow veterans to gain access and control of their personal health information (PHI). CMS later released their own version of Blue Button that allowed beneficiaries access to their claims data. The VA thought Blue Button would be a success if they saw 25K Vets use this capability. The VA passed that number long ago and now, two short years later, the doors have literally been blown off that original estimate with some one million patients now using Blue Button to gain access and control of their PHI.

That is a phenomenal rate of adoption especially when one considers what they actually have access to.

A Blue Button download does not give one a well formatted easy to read file of their PHI. No a Blue Button download is nothing more than a simple ASCII text file and when you look at such a file dump, it isn’t pretty. Thankfully, ASCII has been around since we were hunting the great wooly mammoth during the ice ages so just about any piece of software (e.g., legacy EHRs and claims data bases) can easily create an ASCII file and developers can likewise take an ASCII file and repurpose that text into something fairly legible.

One company doing just that is Humetrix who I first met at the HDI Forum in June. They were also present at this event where they gave me a quick demo of their latest version of iBlueButton – a nice piece of mHealth software that takes the ASCII file from a Blue Button download and reformats it into a very easy to read and decipher file that a consumer can share with their care team. There is even an iPad version designed specifically for physicians, which gets to my next point.

Whenever I am in the company of physicians, I often ask them how they are coping with the changes taking place and specifically adoption of HIT. Had one such conversation Sunday while I was doing the charity Jimmy Fund Marathon walk for cancer research. On this walk there are always quite a few oncologists and nurses and seeing as you’re walking for a good many miles, plenty of time to talk.

I asked one oncologist about HIT adoption at Dana Farber and meaningful use to which he quickly replied: “Meaningful use is the bane of our existence right now.” So I asked further: What problem could HIT really solve for him? He had a ready answer: “Rather than a new patient showing up with a mound of paper records that I must laboriously review, I want a digital version of a new patient’s record with labs, pathology, images, meds, etc. all readily laid out so I can make a more rapid assessment to define a treatment plan for that patient.”

Now we could wait until all the HIEs are in place, all DURSAs are signed resulting in frictionless data flows between healthcare institutions. We could wait until every certified EHR for Stage Two is deployed and physicians start using Direct messaging. We could also wait for patients to request under Stage Two that their provider transmit records to another (still not sure how complete those records need to be to meet Stage Two). Or we could enable Blue Button, educate the public and let them take direct control of their PHI and share it with whom they see fit. Plenty of options but if we really want to change healthcare, the last one is the most impactful, the most viable, but unfortunately like the others, it will take some time, though likely less than getting those DURSAs signed.

Getting back to yesterday’s event and my disappointment, following is what I would like to see in the future:

Honest and frank discussion on giving patients access to their records. The American Hospital Association was in vehement opposition to the Stage Two rules on patient access to their records. Let’s put them on stage to explain why, to give that contrarian viewpoint, to provide balance.

Enlist providers to discuss the benefits and challenges of giving patients access to their records. How does patient access to records change the conversation of care? How does it impact the workflow of a practice? What fears may physicians have and how do we address them?

Fewer panels of talking heads and more real world perspectives. The event had a wonderful moment when a Vietnam veteran talk about his healthcare challenges and how Blue Button contributed significantly to his self-management. Let see more of that, e.g. a Medicare patient using Blue Button.

And my biggest disappointment of all had nothing to do with this event – it had to do with Stage Two.

If indeed the feds really believe in the Blue Button the same way they believe in Direct then why the h*ll did they not directly put it into the certification criteria for EHRs. Clearly something went amiss and it is unfortunate.

Thankfully, many vendors have stated they will support Blue Button in a forthcoming release including Allscripts, athenahealth, Cerner, Greenway, and many others. Our last HIE report also found just over 25% of vendors profiled intend to support Blue Button in 2012. There is momentum here already, now we just need to on-board physicians to talk to their patients about the value of having access to and control of their PHI for as we move to more capitated models of care, the engaged patient may indeed be the miracle drug to rescue our healthcare system from financial collapse.

Addendum: Have received feedback regarding Stage Two and patient access to their records so let me clarify. Stage Two does indeed grant a patient the ability to access, view and transmit their records. This is incredibly powerful, especially with the push towards standards and the transmitted file being in a CDA standard format. As Keith Boone so clearly articulates, the content package that is transmitted under Stage Two is a fairly complete, summary document of care received and an individual’s health status. But Stage Two does not support an ability to transmit a full and complete longitudinal record. It is my understanding that the Blue Button, at least the instance at the VA, allows a patient to download their complete record thus why I took the argument down the path I did. 

In time it is my hope that the Blue Button becomes a symbol, as Keith puts it, “a verb,” that all will understand instinctively – click this, get your data and move on. Other services will take that data dump, transpose it the way you want it for the purposes you intend. The technology and standards behind it will simply become irrelevant to the user. It just works. Getting there will be the task of the S&I Framework workgroups. I wish them God’s speed in accomplishing that task for the benefit of all citizens.

Many in both the private and public sectors are working hard on that vision – keep up the good work!

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When Chilmark Research was founded, the primary area of focus was healthcare IT that was consumer facing, consumer enabling – tools that would help consumers better manage their health and the health of loved ones. This led to our first major study on Personal Health Records (PHRs) published in May 2008. But alas, I was idealistic in the belief that there was enough interest in this area, enough of a market to sustain and grow this young company. Sure, there are loads of small companies trying to make a consumer health play and there is certainly plenty of hype surrounding it but at the end of the day when one takes a close look at this market one finds a multitude of small companies struggling to break through. Exceedingly few companies have been able to really capture the consumer market potential and scale to a size that would support the kinds of services that Chilmark Research offers. This led to a rethinking of what Chilmark Research would focus upon.

Stepping back and looking at the market one sees several critical technical gaps:

  1. Lack of Data: Despite all of the incredible medical advances taking place and the amazing technologies that are being used today to practice medicine, the industry as a whole is a laggard in adoption of IT. One can point the finger in many directions but the bottom line is that there is simply not a lot of clinical, personal health information (PHI) in a readily computable digital format that a consumer can tap into.
  2. Data Liquidity:  A consumer’s PHI, even when it is in digital form is most often scattered across a multitude of silo’d applications making it virtually impossible for a consumer to readily and securely access and manage their complete health records using the data contained therein to personally guide them to make better health decisions. There are a number of contributing factors at play here, primary among them lack of clear standards & terminology as well as reluctance of healthcare organizations to release data to the consumer.
  3. Ease of Access: Providing the consumer with “on-the-go” access to their health information allowing them to easily call up or input data to their personal health system, via a mobile device. Today, most mHealth apps in this category are rudimentary and it is not necessarily the fault of the app developer but often the lack of good data as a result of points 1 & 2.

Effectively combining the above can lead to “actionable knowledge,” the ability of a consumer to make informed decisions regarding their health, or that of a loved one, at the point of need – when it matters most. Now whether or not consumers actually use such technology remains to be seen. Yes, according to Pew Charitable Trust over 80% of consumers have used the Internet to search on a health topic but it is one thing to do a search on say a symptom and quite another to actively manage your health. There are examples of deep consumer engagement, such as the one we profiled at Howard University, but these remain more the exception than the rule.

Addressing the three critical gaps above will take time and it will begin within healthcare organizations of all sizes. It is for this reason that Chilmark Research re-directed its research to have a primary focus on technology adoption among providers. (Note: We will continue to address other areas such as employer views of health & wellness initiatives, consumer adoption, etc., it just will not be primary to our research). This new focus has resulted in two recent reports: mHealth in the Enterprise and HIE Market Report. Over the course of the coming year Chilmark will continue its focus on these two critical areas for ultimately they will lead back to addressing the critical gaps mentioned above.

Circling back to the title of this post, despite our rather pessimistic view of consumer adoption of health and wellness applications we are encouraged by a couple of recent initiatives.

First is the Blue Button initiative that was developed by the VA and CMS. This simple concept allows one to easily download their records has received the support of a number of organizations including both Google Health and Microsoft’s HealthVault. Now if one were to apply the Blue Button to State HIE initiatives a consumer could theoretically be able to aggregate their full longitudinal record from all the hospitals and physicians they may have seen in their region, their State, download it via a State HIE’s Blue Button to their desktop, their PHR, their Google Health or HealthVault account.

Second is the Direct Project. Unlike its predecessor, NHIN CONNECT, the Direct Project was from the outset charged to do one simple thing, replace the ubiquitous fax machine in physicians’ offices by providing a secure means for physicians to share clinical information via the Internet. Nothing fancy, nothing slick, just simple, secure email combined with a physician directory service. While this is fairly simple, what is exceedingly cool and potentially quite powerful is a featured now built into Microsoft’s HealthVault wherein a HealthVault user gets a secure assigned email address that they can share with their doctor. When that doctor goes to use Direct Project to send records to another physician as part of a referral process, he can also cc the patient and the records will also be sent to the consumer’s HealthVault account. Beth Israel Deaconess’s CIO John Halamka has already implemented this at his institution and we look forward to the day when this will become common practice across the healthcare sector.

Both of these initiatives have been released in the last six months but their broader adoption across the healthcare sector is not assured. It is our hope that future Meaningful Use requirements that are released for Stages 2 & 3 encourage physicians and healthcare organizations to adopt and use both the Blue Button and Direct Project in their day-to-day practice to ultimately make the consumer a more active participant in their health. This could indeed finally bring us to the cusp of a groundswell in consumer adoption and use of more advanced tools to better self-manage their health and the health of those they hold dear.



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Moving from an event focusing on HIE/REC initiatives by various States, the next two events, HealthCampSF and Health 2.0, took data liquidity to new heights.  Having the CTO of HHS, Todd Park, kick things off at HealthCamp by channeling Oprah and discussing/promoting the Clinical Health Data Initiative (CDHI) as well as the Blue Button sure got things started. But that was only the beginning. The organizers of Health 2.0 really out-did themselves this year, certainly making up for last year’s event, with a highlight being the Code-a-Thon challenge wherein teams of developers joined together to use freely available data (e.g., CDHI) to create new, novel and potentially useful apps.  While these developers only had a few days to put together an app, their efforts, while a little rough around the edges, were creative and demonstrated what might be possible once we bring some liquidity to health data.

But there are certainly examples where an abundance of data, or at least data sharing can run amuck and likewise there are examples, such as the Code-A-Thon and others at the Health 2.0 conference that exemplify what may be done with data if it is applied in a streamlined fashion.

An example of the former was the Accelerator Demo.  In this mock demonstration an elderly woman and her adult child navigated the ins and outs of the healthcare system through a multitude of consumer facing healthcare-centric apps. (FYI: Health 2.0 Accelerator, or H2A for short, was created to facilitate data sharing across the multitude of consumer-facing healthcare applications). Unfortunately, rather than showing how a consumer can readily and easily use such apps, leveraging data to facilitate their interaction with the healthcare system this demo completely bogged down becoming almost impossible to follow.  After watching this demo it was quite easy to see why most of these Health 2.0 apps have failed to catch hold. Each app is trying to performing some unique function.  Consumers don’t want that, won’t adopt that.  What they want, what they need is a solution that addresses several needs in one neat, tight package (app).  Today, it seems that only WebMD comes close to addressing this need. Unfortunately, it often seems that WebMD is more interested in only maximizing advertising dollars then delivering on this need through further development of their solution suite.  But maybe that is just a clear signal that this is still a very immature market with very low rates of adoption and thus not worthy of significant investment.

That’s not to say a number of companies aren’t trying to change this, see a wealth of opportunity and are investing for the future.  Unlike past Health 2.0 events where Microsoft has played a small role, this year the folks from Redmond were quite active in a number of panels, demos and the like. Adobe was also there having participated in and won the Blue Button Developer’s Challenge sponsored by the Markle Foundation and Robert Wood Johnson Foundation. Adobe’s winning entry allowed for the automatic creation of a PDF document upon downloading a Blue Button file (Blue Button files are currently flat, ASCII files).

Nearly perennial speakers at Health 2.0 conferences past have been AllScripts CEO, Glen Tullman and athenahealth’s CEO, Jonathan Bush speaking on their respective views of clinical HIT issues. This year neither took the stage, but Cerner did. Unlike their clinical HIT brethren, Cerner did not wax poetically on interoperability, meaningful use and the like but instead gave a presentation on their Personal Health Record (PHR) system, Cerner Health as well as a new game-like platform, Cerner Active that promotes and tracks physical activity. These systems are interlinked with each other and likewise with the host EHR – again letting the data flow across these systems in the promotion of health and wellness objectives.  While the interface/GUI of Cerner Health and Cerner Active still require additional work, the overall system architecture is well executed. Unlike what is arguably the best PHR from an EHR company (Epic’s MyChart) today, Cerner’s PHR is fully portable. Granted, this is a modest distinction as all EHR-based PHRs will be required to provide a level of portability in the future under Meaningful Use Rules, but it is good to see one of the largest EHR vendors take a proactive stance. So Epic, when will you open up?

The Cerner demo that showed data flowing back and forth from the EHR to the PHR got me thinking that these two terms, EHR and PHR are no longer relevant.  Hold on to your hats folks as it is now time to introduce a new acronym, drum roll please…

The CHR for Collaborative Health Record

Language is a powerful tool. By using the terms EHR and PHR we subconsciously, and even consciously, create divisions within a care team. On one side we have the patient, family and loved ones using the PHR,  On the other side is the clinicians with their EHR.  These divisions are becoming increasingly artificial and have the very real potential of hindering care rather than promoting it. While legislative laws have been written using the terms PHR, EHR and the like, it is high-time, before we get to far down the road of HITECH and Meaningful Use, that we begin talking about a larger vision of the future, one where a CHR is the core of HIT initiatives and future planning.

Now this was my fourth Health 2.0 conference and the best one to date.  With over 1,000 participants (it was a packed house) all appearing to have an active interest in changing/improving the healthcare system and along the way, make a business out of it, the Health 2.0 is easily the most exciting and innovative event in the HIT market, albeit with a heavy tilt towards consumer-facing apps.  But like Ben Rooks, an equity analyst who does an occasional post for HIStalk, the event makes one schizophrenic. You get excited by all the energy in the air, the innovative concepts being presented, but become quickly dis-heartened when you pull back the covers to find just another innovative idea/product, but not a company. Most presenters do not have a well-structured and viable path to market outside of the all too common Freemium model, a model that only seems to work in massively scalable markets.

There are always exceptions and one presentation that caught my attention was that of Will Barkis from Bill-Doctor. This company certainly did not have the polish of Castlight Health, nor did it have the some $80M in VC funding that Castlight received.  What Bill-Doctor did have though was a solution to solve a very real consumer and healthcare system problem, bill negotiation and payment. The solution addresses this issue in a very simple and straight-forward manner that will serve both sides of the bargaining table – doctors/hospitals get paid more then what a collection agency will gather and consumers get a more reasonable, negotiated bill to pay.  Bill-Doctor’s revenue model is also has a very compelling and will turn a profit quickly. If I could, I’d bet on this horse to show. (Note: I contacted Will re the Bill-Doctor website. He informed me that it is not live yet but was gracious enough to provide the slide-deck demo which is provided at end of this post.)

But what I find most troubling in the multitude of presentations I saw and discussions I had during the breaks was the lack of hard evidence that these creative solutions actually make a difference. The hard work of tying these ideas, these products, these concepts to outcomes, to improvements in quality of care delivered, to demonstrable returns on investment just aren’t there. Granted, some of these companies and products are very new to the market, but others have been at this for several years now and still, where is the evidence that these solutions actually make a difference? I can’t recall a single presentation where such hard evidence was presented.  Until that occurs, the Health 2.0 event and those that participate will remain more of a side show, dare a I say the freak show, while the main event occurs under the big top at a three ring circus such as HIMSS.

Don’t get me wrong, the Health 2.0 event is exciting, the ideas truly innovative and the organizers of the event have done a very good job putting together an event that covers the broad spectrum of health. If you want to see what the future may look like, this is definitely an event to attend. My concern rests with the need for hard-core impact analysis rather than the fluff and anecdotal evidence that is presented.  Without such evidence, broader buy-in and subsequently market adoption will remain elusive for those presenting at Health 2.0

Above mosaic picture was taken in the Mission area of San Francisco.  Was staying there in a small studio apartment I found through Airbnb – a great site if you are on a budget.

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In about an hour’s time I will head downtown to participate in yet another Commonwealth of Massachusetts HIE Consumer Workgroup meeting. The workgroup, formed by the Secretary of Health last Spring, is charged with insuring that the strategic HIE and more broadly, HIT plans for Massachusetts be inclusive of consumers’ future needs.

Now what those needs may be creates some challenges. The workgroup, representing a number of constituencies in the Commonwealth, has struggled to reach consensus oas topics have ranged from simple consumer education, via brochures in doctors’ offices, to providing consumers ready access to personal health information that may be aggregated within the context of an HIE to addressing consent on the sharing of PHI within the context of care delivery. On many of these topics we are flying solo as there is very little to draw upon as to best practices from other states as we are all, by and large, in the same situation now that some half billion plus of federal dollars have been handed out to states to create these HIEs. And let’s not even start on the regional sharing of PHI and consent thereof – a whole other can of worms.

But today’s meeting will be particularly interesting as the two Co-chairs of the HIE committee will be presenting to our workgroup the strategic plan that has been laid out for the statewide HIE.  Unfortunately, that plan at least in the short-term (Note: I have a TON of respect for John and what he does- simply amazing work) has completely ignored the consumer (I have come to prefer the term citizen as indeed it is the citizen of the Commonwealth, the citizen of the USA that is paying for all of this through their tax dollars) component.

In today’s meeting I hope to elevate this issue as there is little reason not to include the citizen, even at this early stage, in the HIE plan. There are a number of potential solutions, from creating a simple citizen portal on the HIE for them to view their PHI, to considering deploying the Blue Button on the HIE thereby allowing the citizen to download their PHI and place in a safe repository of their choosing and many options in between.

It is time that we stop the myopic focus on clinicians and what the HITECH Act can do for them and begin to focus on the public, the citizen, and what the HITECH Act can do for them.

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The Personal Health Record (PHR) market is fraught with challenges. First there is the issue of getting personal health information (PHI), which is most often not in a common digital, computable format such as a CCD or CCR-based file. Even when PHI is in a common data standard, such as administrative data (claims data), that data can be fraught with errors that would confuse even the wisest and most knowledgeable of patients.  Then there is the issue of simply getting the data from an institution. Many institutions have a patient portal allowing a patient to access and view their PHI (most often a limited subset of the patient’s complete record) but very few institutions actually support PHI portability, though that will change with new meaningful use guidelines (Stage One: patient to receive digital copy of records upon request).

And last, but certainly not least is the issue of consumer education and engagement.  Yes, consumers are turning to Dr. Google in ever increasing numbers to get a second opinion, but very few consumers proactively manage their PHI. After several years of studying the PHR market, it is still extremely difficult to tease out what exactly is holding back consumers from taking a more proactive approach, but our hunch: Like most things in life, the value proposition for the average consumer to use a PHR to proactively manage their health has not materialized.

Value = Reward – (Effort + Risk)

Ideally, reward far exceeds the combined effort and risk to perform a given action, in this case create and maintain a PHR.  Now plenty has been written on the subject of privacy and security of PHI (the primary “risk” factor in self-management of PHI) and Chilmark has made its views known in the past so we will not dig into that rat’s nest.  Simply put, technology and regulations are in place to insure privacy provided they are used and regulations are enforced.

The effort side of the equation is basically; what effort does it take to create and maintain one’s PHI.  If you want to do it digitally today, good luck – its truly a mess out there and not for the feint of heart. But the situation may change quickly in the future if a couple of critical activities truly take hold.

First is the the success of EHR adoption via the HITECH Act. If institutions, large practices and even smaller primary care practices take advantage of this program (far from a done deal, especially for small practices), consumers will be able to obtain a digital copy of their PHI.

Second is the initiative being led by the Veterans Administration (VA) and the Center for Medicare and Medicaid Services (CMS) called the “Blue Button” initiative.  President Obama first brought attention to this in a speech on August 3rd, but it was not until last week that the VA formerly announced the vets who use MyHealtheVet (the VA’s own PHR), would be able to download their PHI to their computer via the Blue Button.  CMS is slightly behind in its roll-out, but both the VA and CMS state that the Blue Button will be fully operational by early October when they will do the “Big Launch” at the Health 2.0 conference in San Francisco.  In conjunction with that launch, the Markle Foundation and Robert Wood Johnson Foundation have announced a “Developer’s Challenge” to see what great innovative ideas software developers may have for a consumer who now has his PHI via the Blue Button (there are already 9 companies who have signed up for the challenge).  The Markle Foundation has also released a very good policy paper (full disclosure, Chilmark Research was on the committee that helped put this paper together) that addresses issues that other institutions should take into consideration should they choose to adopt the Blue Button for use by their patients.

The Blue Button, should it become ubiquitous on health institutions’ patient portals (or for smaller practices, simply on their website), payer-based PHRs, employer-based PHRs (often just a PHR provided by payer), and even regional or state-wide HIEs, the effort that it would take for an average consumer to gather their data to create a longitudinal record could be simplified significantly.  Going back to our equation above, the value would subsequently be amplified.

But the devil is in the details and details abound.

As wonderful and simple a concept such as the Blue Button is, it is by no means straight-forward.  First off, the VA’s Blue Button sample data set (ASCII files) is based on clinical data, whereas CMS data is administrative (claims-based).  These are two quite different data sets and how we roll these out to the broader public will create some significant challenges, particularly, as in the case mentioned previously, CMS data is filled with errors. This may partly explain why CMS is taking more time to evaluate its approach to providing access to claims data via the Blue Button.

Then there is the issue as to how broadly the Blue Button will be adopted. Payers have been notorious in their reluctance to make consumer data truly portable.  In 2009, payers did make the important move of supporting data portability between plans (ASC X12) of PHI, but whether or not that data can be relinquished to a consumer for them to control is something left to individual payers to decide and to date, most have been extremely reluctant to relinquish control.  In a recent conversation with an AHIP technical head, Chilmark asked about their opinion of the Blue Button; needless to say, their response was not one of strong endorsement, more a wait and see.

And that may be the future of the Blue Button – Wait and See.

It is a bold step forward by this administration to ultimately drive value back to the citizen in providing citizens a relatively easy process to gain access to and control of their PHI and for that they are to be congratulated.  It is our hope here at Chilmark Research, that rather than sit on the sidelines and play a wait and see game that a wide range of organizations, from payers, to providers (e.g. true leaders in the PHR space such as Kaiser-Permanente, Group Health, etc. as well as the laggards) to software developers (from the largest EHR vendors to those small innovative start-ups that have signed up for the developers’ challenge) all take a proactive role in support of the Blue Button as frankly, there is no better option then this one on the horizon that will support true consumer access and control of their PHI.  Maybe the Blue Button is just what the nascent PHR market needs – we certainly see it as a possible key factor in the future development of this market.

Margalit Gur-Arie has written a very good post, slightly different slant on the subject as well which is worth the read.

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In Monday’s post, Chilmark reflected upon a piece that Peter Hudson, co-founder of Healthagen, the developers of mHealth app iTriage wrote for mobihealthnews. In that article, Peter talked about the utility of an mHealth-based PHR (iTriage recently launched such capabilities), but in our post, we countered that today, it is still far too difficult for a consumer to pull together their personal health information (PHI) to create a truly longitudinal record. This will likely stunt the efforts of companies such as Healthagen who are trying to offer consumers a PHR – the hassle factor is still far too great to overcome.

Now we will look at the red hot space of Health Information Exchanges (HIEs).

As local, regional or even statewide aggregators and distributors of health data to facilitate care coordination, HIEs have the potential to play a pivotal role in helping a consumer create and manage their PHI. Now that does not mean that the HIE has to offer the consumer a PHR per se, but what an HIE may be able to do is offer the consumer an ability to have a portal view into their PHI that resides within the context of a given HIE. Better yet, why not have as a condition of receiving some of that federal largesse of $564M for state HIE programs that these HIEs support “Blue Button” functionality allowing a consumer to readily download or export their PHI to wherever the consumer desires.

Ah, but we digress.

The purpose of this post is to extract a couple of data points from our forthcoming HIE report as they pertain to consumer engagement. Unfortunately, it is not a pretty picture.

As part of our market survey of twenty HIE vendors, we asked them a number of questions with regards to what consumer-centric capabilities did their HIE solution support. Fully eighty percent of those interviewed had either modest (15%) or weak (65%) consumer offerings.

The following table provides a brief snapshot of those HIE vendors that have what Chilmark considers strong consumer engagement tools. Two of those vendors, Kryptiq and MEDSEEK are somewhat difficult to classify as an HIE in the traditional sense, thus you will not find them running under the covers at your local RHIO. Microsoft is still new to the HIE market with one HIE live in Milwaukee and another in D.C.. While Microsoft’s platform offers these HIEs the potential for bi-directional communication with HealthVault, that capability, to the best of our knowledge has not been tested at either of these HIEs. Also, it is important to note that the Microsoft HIE solution offers little with regards to support for transactional processes (appointment scheduling, Rx refill, eVisit, etc.). RelayHealth is the remaining HIE vendor that actually has some of the more robust consumer tools in the market (they received fairly high ratings in our previous iPHR Market Report), so this is not too much of a surprise.

Now it is not necessarily the fault of laggard HIE vendors that today, their solutions offer weak consumer tools. Frankly, the market has not asked for them. Even as recently as last year when the various HIT policy committees were meeting in Washington to set policies for the HITECH Act and the funding to come, the committee on HIEs, in one of their seminal meetings, completely ignored the consumer role in an HIE. Shameful.

But this will change in due time. MEDecision and Carefx are building out their consumer-facing capabilities and we are sure others will add consumer functionality in time, most likely via partnerships or an occassional acquisition as market is moving too fast for an internal build-out. in the meantime, those vendors that have this capability bring to market competitive differentiation.

While this is all well and good, another development is also taking place, NHIN Direct – something that Microsoft’s chief architect, Sean Nolan mentioned in his comment to our Monday post. What role might a secure, lightweight communication system play within the broader context of HIEs, aggregated PHI, consumer access and potentially control of their PHI? A lot of questions to ponder that we will be looking into further over the next few days

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