Posts Tagged ‘consumer’

As many who read here know, one of the biggest challenges I’ve discussed regarding consumer adoption of PHRs is making these systems simple and automated.

Simple – as in the example of what Google has done to create a great, yet simple to use  interface.

Automated – to automatically populate a consumer’s PHR with pertinent health data, regardless of data source, be it pharmacy, doctor, hospital, lab, you name it.

While I do not mean to discount the fine work Google has done to create a simple intuitive user interface, honestly, this is not all that hard to do.

What is extremely hard and will remain a challenge for PHRs, the vendors who create them and subsequently consumers for the foreseeable future is getting that data into a PHR automatically, rather than having to do self-entry.  But how does one get their hands on that data?

Yes, there are issues with standards adoption and more broadly, healthcare IT adoption among providers.  But it is also an issue of control.  Whoever controls the data, controls the relationship.  Thus, many a healthcare stakeholder will be reluctant to fully release such data to the care of the consumer for their PHR, even though by right, it belongs to the consumer.

Like myself, Dana Blankenhorn over at ZDNet has been in the IT industry for a number of years and like me, not just healthcare.  Dana posted a great piece on the issue of data control this morning that is well worth the read for he really hits the nail on the head as to what the real issue is and the Teutonic struggles that lie ahead between all the various stakeholders that are fighting for the mind-share and ultimately control of the consumer relationship.

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Today, the World Privacy Forum released a report, Personal Health Records: Why Many PHRs Threaten Privacy. Both the 16 page report and a shorter, 5 page consumer advisory report can be found here. There was also an article today referencing the report in the San Fransisco Chronicle.

While the report does not give names of any particular PHR vendor (I could certainly name a few egregious examples), the report does make it clear that a consumer is at risk of having their privacy compromised if they are not careful.

Research for our upcoming PHR report ( due out by end of May 2008 ) concurs with this finding and it is also something I have brought up in the past. Having over the last few months reviewed countless web-based PHR solutions and where possible, their privacy policies, I have found almost zero consistency. This issue will continue to plague the industry until they, as a group, define what are best privacy and security practices and begin policing themselves through some form of industry-sponsored certification process. (Note: The existing HON certification is a joke.)

Microsoft for example, is in a perfect position to sponsor such an initiative and insure that all partners adopt the same strong privacy and security policies that Microsoft is using for HealthVault. Unfortunately, Microsoft has yet to step-up to the plate on this one, which is shameful.

My Recommendations to the PHR Industry:

Microsoft – Take a leadership role and require that all HealthVault partners adopt the same privacy and security policies that you are using. Better yet, work with Dossia and Google as well to create a common set of standards and compliance policies for the industry and a mechanism to implement them and police them. (Please refer to later post, Microsoft Comes Clean on Privacy, which commends Microsoft for taking a pro-active stance on this issue.)

PHR vendors – Establish a semi-independent organization that will create a set of best practice standards for privacy and security. Give this organization the power to use these standards as the basis of a “Good Housekeeping” seal of approval certification process for PHR vendors. This organization will fully vet PHR solutions going well beyond what HON does today. Those that comply, get a prominent seal to display on their website. Microsoft, Google and Dossia, maybe you could be lead sponsors to form such an organization.

Both of the above will take sometime to implement so what should PHR vendors do today? Here are my top seven suggestions:

  • Make your privacy & security policies clear and understandable.
  • Have them visible and not hidden down at the bottom of your homepage with a small font “Privacy” link.
  • Allow the consumer to download your policies e.g., provide them as a PDF.
  • State clearly how any data may be used.
  • State clearly opt-in/opt-out policies and procedures.
  • Detail how records are stored and where and what are your policies for records removal.
  • Specifically state how you support portability and the process by which a consumer can retrieve their records and move them to another PHR of their choosing.

I’m sure I’ll think of more steps PHR vendors can take later, but taking these steps would be an excellent starting point. Unfortunately, I have yet to find site that supports all of the above suggestions.

If the industry does nothing, they will be leaving it to the government to create privacy regulations. My fear here is that such regulations may not achieve lofty privacy goals and instead have the perverse affect of killing an industry that is only beginning to get some traction.

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In conducting research for the upcoming study on the personal health record (PHR) market, I have had the opportunity to view and demo many a PHR solution. There is an exceedingly wide range of solutions with an equally wide range of capabilities and services now available. Unfortunately, far too many PHR solutions are embarrassingly simplistic and even some of the more prominent solutions are nothing more than a re-purposed physician’s electronic medical record (EMR) rather than a dynamic, interactive environment that actively promotes good health practices, i.e., something a consumer will want to use, versus something that makes physician’s life easier.
Welcomed change is coming though as young, innovative PHR companies enter the market and some encumbents aggressively build-out their platforms. Such examples include:
  • Protocol Driven Healthcare Inc. who is leveraging their strong health risk assessment capabilities and analytics engine to assist users in taking a proactive approach to improving their health.
  • VitalChart, a young PHR company founded last year with plans to combine social networking (e.g., communities) with PHR capabilities.
  • PatientsLikeMe who is providing very rich, specific chronic disease templates and communities, though they are empathic in stating they are not a PHR, but I differ in their opinion.
  • FollowMe has taken their base platform and is re-purposing it to serve distinct communities including those with diseases (PHRs for diabetes and hydrocephalus) and their most successful PHR offering, Mi-VIA which serves migrant workers and their providers.
  • Several PHR vendors are incorporating physician search and ratings services via partnerships with such companies as HealthGrades.
  • And there is a growing and almost universal trend across PHR vendors to replicate WebMD’s model of providing rich content via partnerships with such content providers such as the Mayo Clinic and HealthDays among others.


I am not arguing that we throw out the base functionality that all PHRs, regardless of vendor should have: A common template based on the CCR standard that any physician will readily recognize. What is needed, however, for broader adoption of PHRs across the consumer continuum, is a far richer and engaging experience. Several PHR vendors recognize this and are taking action. Those that do not will experience declining use, enrollment and revenues. These companies, if they wish to remain viable in this rapidly changing market, need to aggressively pursue a partnership strategy for the market is simply moving too fast today for them to build it on their own.

For slightly different perspective:

Over on one of the healthcare IT industry’s most popular Blogs, HIStalk, frequent commenter “Art” provides some interesting commentary today on the rapidly evolving nature of PHRs and healthcare-centric social media tools used by consumers. His commentary particularly focuses on what all of this may mean to healthcare providers and other traditional stakeholders in this sector.

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Despite not having a personal health record (PHR) platform in the market, Google continues to get a lot of play in the press, at conferences and in the blogosphere. Not too surprising considering Google’s size, massive capitalization and the simple fact that over 50% of all Internet searches originate from its site and search is where most consumers start when going online for health related issues.

But with all the talk of Google and what Google might mean to the personal healthcare market when it eventually does introduce a product, one has to wonder: Okay, what might Google’s personal health solution look like and what features might it provide?

Brief History
This past summer, Google gave some hints on its personal health intentions when some screenshots of a prototype were inadvertently released.  The prototype did not stretch the imagination beyond what one might find in any reputable solution in the market and Google went back to the drawing boards. In and amongst this, Google’s health group leader, Adam Bosworth left the company, which seems to have slowed internal development efforts, or at least signaled a pulling back from the lofty goals that Bosworth often pontificated upon.

In the ensuing months, Microsoft got the jump on Google introducing its own consumer centric personal health platform (PHP) HealthVault and the employer led consortium, Dossia, is back on track with their PHP development via a partnership with Children’s Hospital Informatics Program (CHIP) the developers of Indivo. These two platforms will compete with Google for mind-share and subsequently, market share in this immature market.

Looking Ahead, What Might We Expect
Google has been quite secretive about its future intentions, though in speaking with some who are on Google’s advisory panel, I’ve been told that Google’s plans are impressive, which got me to thinking, can one make an educated guess as to what Google may offer? The answer is yes, and you do not need to look far.

As discussed before, one of the major stumbling blocks to PHRs has been an inability to provide sufficient scale. Microsoft’s HealthVault and Dossia bring such scale within their PHPs for the smaller personal health application (PHA) vendors (e.g., PHRs, disease management, health & wellness, etc.) to leverage. Google recognizes this and will provide a similar platform, albeit with a Google look and feel.

And what might that look and feel be? iGoogle is your answer.

iGoogle is a service allowing a consumer to create a personalized webpage. But iGoogle is becoming much more than that and is well on its way to becoming a platform. Within iGoogle one can create an unlimited number of tabs iGoogle-home.jpg.

Each tab can become a topic specific environment where one can add various “Gadgets” of one’s choosing from a vast library within the iGoogle Gadgets site.


When viewed from what an iGoogle PHP might look like, it is easy to imagine a set of health related tabs that may be self-generated (gadgets can be easily added or removed at anytime) after one establishes an account and enter, or have their health data automatically retrieved to populate one’s iGoogle PHP.

For example, if one has a chronic condition such as diabetes, a diabetes tab might automatically present itself with such gadgets as diabetes news/research feed, a diabetes monitoring application that retrieves data from a glucometer, a nutritional guide, a medication alert, etc. Another example is a family’s primary health manager, typically the mother, who tracks the family, and in particular the children’s health. In this case, tabs might represent each of the family members and within each tab, far more services could be offered beyond stale templates of a medical history, but include advice on dealing with a teenager’s emotional swings, having automatically identified such based on the age of the child. The possibilities are nearly endless, provided the data is there.

And that is the one piece in the puzzle that is still difficult to determine – exactly how will Google get a consenting consumer’s personal health data, secure it, and keep it updated? Without this data, Google’s PHP will be of limited value and not see broad adoption. Google clearly recognizes this as they have put together a Blue Ribbon Advisory Group, of which some are deeply involved in healthcare IT standards development. Google will also need strong partnerships with the holders of the data an issue that has yet to be fully resolved from a policy perspective. Again, that advisory panel will assist here as well, but even with that assistance, it will take a long and concerted effort on Google’s part to see this succeed.

Google is in good company, however, as others most notably Microsoft and Dossia face the same challenges. And thankfully for the market, all are on record stating they recognize the challenges and are committed to their separate initiatives for the long road ahead.

Now, should we place any bets on who gives up first?

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Was just over on my Gmail account and there was this discrete little advert at the top of my screen about the five top things to never say at work.  No problem with that, as I see such little advice teasers all the time in these quick sound-bite, better yet, word-bite messages in Gmail.  What really struck me was that this advert was not from some job search firm like one would expect such as Monster, dice or TheLadders, no this came from Revolution Health.

Looks like Revolution Health, who has struggled to establish a presence in the personal healthcare space is really stretching its boundaries to be relevant to some aspect of an individual’s life.  Then again, maybe this posting is relevant to its primary source of income today, employers who are rebranding Revolution Health for their internal health and wellness services for employees.

Rather than putting out such rather simplistic drivel, Revolution Health and its constituency would be better served if they focused on more relevant topics like having a truly useful hospital search tool that tapped into existing databases to provide information not only on which hospitals can perform a given procedure, but what the relative costs and quality metrics are as well.  Such information is beginning to pop-up in a number of state-led initiatives such as this example from Massachusetts on congestive heart failure.

Now that’s relevance!

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There is a ton of health-related information out there on the Web, but getting to it is not always easy. Sure, there are any number of health-specific search engines e.g., Google, Healia, HealthVault, Praxeon, WEGO, Yahoo to name a few.  Each has a slightly different angle to them, but honestly, we probably now have more health search engines than the market can support.  But what I find most puzzling is that with all these solutions out there, I can’t find one that answers these basic questions quickly and simply:

  • What should I consider in looking for a doctor and/or a clinic/or hospital?
  • How good are the doctors in my area?  Who comes recommend and why (beyond what a neighbor may tell you)?
  • What is the quality of care provided by local hospitals for various, common procedures?
  • What is the cost of that care? How does that cost compare to others in the region?
  • What should I look for in evaluating health insurance coverage?
  • How should I manage my medical records and if I wish to use a PHR, how do I evaluate the multitude of offerings today.

All these questions are (or will be) increasingly common as consumers are asked to shoulder a greater burden in their healthcare decision making via the new push for consumer driven healthcare (CDHC).

An attempt has been made at addressing this challenge here in Massachusetts by The Partnership for Healthcare Excellence.  While I congratulate them on their efforts to provide a website that attempts to answer many of the questions above, I find it provides only nominal value-add.  this site really falls short of what it could be as it is very simplistic and more of an aggregation of links that send you off into the proverbial wilderness.

Hopefully, what we are seeing here today is a very early beta version and that future enhancements are forthcoming that will move this site beyond simplistic links by leveraging some of the newer tools on the Internet to provide more interactive functionality.  Then they will have something that not only helps me get answers to those questions above, but does so much more readily than what can be done today.

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