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Posts Tagged ‘Google Health’

wii-fitThe extremely popular Wii gaming system will begin connecting directly to health professionals in April.  It appears that this will be first offered in Japan combining the existing Wii Fit and Wii Balance devices with bi-directional online communication capabilities.  Moving beyond just providing the gaming devices and platform, Nintendo is partnering with NEC, Hitatci and Panasonic to provide a service whereby users of Wii Fit or Balance will be able to send their work-outs to “health professionals” and receive feedback, via email, regarding these workouts with suggestions (e.g. only 10 push-ups? do 20 next time).

Interesting concept but half-baked.  Sure, it may be nice to get some feedback on a given workout but is it really all that useful if you do not have any biometric data to go with it?  And what is a “health professional” anyway, a recent graduate of We Are Physical Therapy University?

We’ll have to wait and see what ultimately arises from this initial trial balloon.

In a broader sense, it really is a brilliant idea that may quickly move beyond the shores of Japan to North America.  We can readily foresee employers and payers adopting a Wii Health-type of service combining the Wii, with the bi-directional communication capabilities to health coaches and maybe even to a consumer’s PHR.  HealthString is one such PHR that has a heavy focus on health coaching and sells their product/services almost exclusively to employers. One can easily imagine an employer who offers HealthString to its employees combining their health coaching service and PHR with an incentive/rebate on the purchase of Wii Fit to foster healthy behaviors among its employees to improve overall population health.

Or maybe, again via a rebate program, an employer can set-up an internal team challenge using something like Limeade (another health solution targeting employers), combining their solutions with the bi-directional communication and logging of work-outs capabilities of Wii Fit to promote peer-based fitness.  Clearly, there are all sorts of permutations and scenarios of services that one can build upon with the Wii Fit and this future bi-directional communication capability.

Makes us wonder if Nintendo has had any discussions with the folks at HealthVault and their Connection Center.

Oops, HealthVault is owned by Microsoft with its competing Xbox.  Nintendo, better look to Google Health and Dossia, both would be receptive to their overtures.

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Sitting in on the webcast by Google today, most discussions is focusing on Google Health. Doing “live tweets” via twitter which you’ll find at john_chilmark

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gh1Chilmark Research is furiously working on its next report that will take an in-depth look at the three major platform plays, Dossia, Google Health and Microsoft’s HealthVault.  Shaping up to be an excellent report (in our humble opinion) with a target release date of mid-December.

One of the challenges in writing this report is taking what is a fairly new concept in IT, “Cloud Computing” and even newer, “Platform as a Service” (PaaS) and convey its implications to the healthcare sector.   Hard to do in a space that is changing so fast.

We foresee that this trend holds a lot of promise for the healthcare sector greatly accelerating the use of HIT, across the continuum (consumers, physicians, caregivers, etc.) for the simple reason that it removes the burden of infrastructure (hardware & much software) support and will likely be a hell of a lot easier to use then many of the client-server systems of today.

But we digress.

In looking at the three platform plays, we have a section in the report that addresses their operating models.  While doing research on the subject we stumbled across an excellent analysis of Google’s strategy by Nick Carr.  This is the clearest, most cogent analysis we have seen and is spot-on.

If you are even remotely interested in Google, we highly recommend reading Carr’s piece.

After reading one will quickly realize exactly why Google may be able to offer Google Health free forgoing the need for sponsored ads or selling data (even if it’s anonymized) to third parties, both fears that are frequently bantered about in the healthcare sector.  These fears appear to be ill-informed and many times are simply fear mongering by those either wanting to make a name for themselves or simply do not want to give up the data.

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8:15am, Intro done, Matthew, founder with Indu of the Health 2.0 conference announce all the countries and cross-section of companies represented. Quite amazing just how many people are here, nearly 900, considering the first Health 2.0 event was just over a year ago.

Some very very general comments from Matthew on what Health 2.0 is. What he has added to his famous bubble chart is transactions and data – basically how large data holders (e.g., Aetna or Kaiser-Permanente) are now getting into the Health 2.0 space with their massive data stores contributing to the continuing evolution in this market.

A spokesperson from PR firm, Edelman, also got up on stage to announce the release of their recent consumer study, The Health Engagement Barometer Dimitriy wrote a nice overview of the report.

9:30am, Clay Shirky keynote. He is on a book tour of sorts with his recent publication of Here Comes Everyody”, transposing his findings to the healthcare industry. Shirky states that there is already a NHIN, if not an international HIN being driven by consumers who are actively sharing and collaborating around health issues. Trust is not an aspect of technology, but one of a personal human nature. Where there is trust, information will flow. (Excellent point, so much effort is spent on the issue of privacy and security with vendors all seeking technological solutions to the problem. Unfortunately, they are putting their efforts into the wrong thing. Are you listening Microsoft, Google, payers and employers?)

Patients outnumber physicians 100:1, it will be patients that will be at the heart of healthcare change. Patient care is now beginning to occur among patients themselves rather than with physicians in small, focused organized groups around specific diseases.

What Shirky plans to follow in the future is how institutions (gave the example of orthopedic company, Zimmer) will try to thwart the growth in Health 2.0/patient communities due to perceived threat from consumers (whether real or imagine is another story). Shirky sees these efforts as quixotic.

9:00am, David Kibbe’s motorcycle tour video is now showing. Kibbe basically went across the country mostly interviewing Health 2.0 vendors beginning in my home town of Boston speaking to AmericanWell and PatientsLikeMe. Next stop was Dr. Jay Parkinson’s start-up, Hello Health with some discussion on the IT platform they are using with their customers. Adopted a facebook-type model, a doctor with 1000 friends, who happen to be his/her customers. Kibbe also dropped into a retail, Minute Clinic in TN. (Kibbe seems to ask all those he interviews: “Are you Health 2.0?” – getting a bit annoying). Not much from Minute Clinic. Road-trip stopped short when Kibbe’s motorcycle broke-down in TN. Flew to CA to interview Google Health, Healthline (Healthline CEO is lots of consolidation coming and big players jumping in). The Healthline CEO looked like the best interview, too bad it was cut so short.

10:15am Panel Session – Consumer Aggregators With the exception of Dossia, all the big boys are here: Aetna, Google, Microsoft, WebMD and surprise, Yahoo. Haven’t heard much from Yahoo in a couple of years as it pertains to health, will be interesting to get their comments. Aetna spokesperson announced the partnership with HealthVault for data portability. Microsoft spoke of their growing platform rattling off the statistics of number of devices, number of apps, etc., but no numbers as to how many users! Google talked about how they are focused on just making it easy for consumers to access and use their record data. Yahoo Healt spokesperson s brand new to the position and is now building a new team. Announced a partnership with Waterfront Media (content) and Healthgrades (physician search).

Demos by panelists:
WebMD used the Verizon HealthZone. Claims data driven PHR with HRA and risk factor analysis (what WebMD calls Health Quotient). WebMD providing structured health content and will even provide health coaching if client requests it. Phil Marshall, VP Product Development at WebMD did the demo.

Microsoft had Kaiser-Permanente give the demo. KP showed how a KP MyHealthManager customer/user would move their records to HealthVault. Using HL7 CCD for transmitting the data between the two sites. KP has put together a fairly easy process (reminds me of the BIDMC/Google Health process) to move the records. Peter Neupert got up to give the HealthVault portion of the demo – he was unable to log-in to HealthVault to conduct the demo – OUCH!

Note: After reading this post, Sean Nolan, Chief Architect at HealthVault, put together a quick post on what Peter was trying to demo up there on stage.  Not quite the same as a real life demo, but Sean is able to show and describe the steps of importing records from the Kaiser system into HealthVault.

Next up was Aetna. Unlike Neupert, he quickly logged in to the Aetna PHR. Thy now have ten active health trackers in the PHR, online coaching and of course, the Care-Engine rules engine for alerting consumers on risks. They put out over 1 million alerts to PHR members/qtr. Healthline Looking at having all 17M covered members on the PHR by the end of 2009. Currently have 6M members on the PHR and forecast 7M by end of year.

10:50am, Here comes Google: Did a demo on downloading medications from a pharmacy into a consumers Google Health account. Geez, this is boring – retty basic, unimpressive demo. Hell, they had this capability when they first rolled out Google Health, would think they would actually show something new and interesting. Another demo glitch. Pharmacy partner doing the demo got hung-up had to go into the depths of the app to make it work, something no consumer would take on. Another poor demo.

Microsoft is given another chance, again demo fails. DOUBLE OUCH!

Last up, Yahoo Health. Kerry Hicks, CEO of HealthGrades is intro’ing the demo and Michael Yang of Yahoo is not so much giving a demo, but an overview of the interface/GUI of Yahoo Health. Complete redesign beginning with physician search (embedded HealthGrades app/service). Claims Yahoo is good at data mash-ups, particularly for rating and reviewing and will apply that expertise to Yahoo Health. Will also leverage Yahoo Groups, have gateways between the various groups and Yahoo Health.

Q&A with Panel:

Aetna spends $60M a year answering physician calls regarding member eligibility. They see big savings via th PHR for members that will alleviate, if not eliminate these calls. Microsoft is not worried about the trst issue, like us here at Chilmark Research, believes that what really needs to be done is create value. Yahoo has no intention of getting into the PHR market. See themselves as a possible “swing vote” to bring visibility to the concpet without any vested interests to support one PHR or platform or another. See themselves as providing a rich environment for widgets, and add-on services to these other consumer aggregators.

Couple of more data points from Aetna:

  • Each 1% of members that move to having their EOB delivered electronically vs. snail mail represents a savings of $500K/yr.
  • Each 1% of physicians that they can get to move to self-checking eligibility of customers online vs calling in saves Aetna $600k/yr.

No wonder they are investing heavily in eTools.

Kolodner, head of Dept of Health & Human Services ONC took the stage to provide his perspective on what was said by the consumer aggregators. Not sure if it is me or not, but why do so many govt. bureaucrats give such boring presentations. Kolodner did not use any slides, but oh it was hard to concentrate on what he was trying to say. In th end what I got out of it was, let’s not move to fast, let’s focus on interoperability, let’s insure that privacy and security are preserved. Looks to me like he was defending CCHIT and its consumer-facing initiatives.

1:00pm, Search in the Long Tail Panel Session: Matthew Holt has always been a big fan of health search tools for consumers and has brought together all the big, health-centric search companies, Healthline, Kosmix/RightHealth, Healia (which Meredith acquired), and Organized Wisdom. Not much new said in opening statements, typical positioning statements, boring.

Demos:

Healthline began, really hard to see much here that would attract me to the site. Actually, would probably avoid as it presented a barrage of “stuff” and I always look for nice clean interfaces. Guess Google has spoiled me.

Healia demo, by founder Tom Eng talked about the communities feature they brought to market this past summer. Clearly looking to tap the growing disease community market. Partnering with American Diabetes Assoc for a diabetes centric community.

RightHealth (Kosmix) was next. One of the better demos and it appears that the broader public agrees as RightHealth claims to be the second most visited site after WebMD with 8.5M unique monthly visitors. Quick check shows something different. Yes, RightHealth has good presence, but in Sept. 08 it was only about 6M and WebMD is more than double that.

Last was Organized Wisdom. A lot of buzz, but leaves me wondering, Where’s the Beef? Of what I heard so far from these search providers, this company is probably in the most precarious position going forward. They did announce that they will be offering a physician rating/search service within Organized Wisdom. Now why do that instead of partner?

Healthline will also be looking to provide a physician search service. RightHealth will not, they will look to other, best-in-breed companies, to provide this service. Healia as no intention at this time to go down the physician search and rating path.

1:45pm Social Communities: Great line-up here with the CEO of Sermo, CEO of MedHelp, GM of HealthCentral and CEO of PatientsLikeMe (PLM). Sermo last year was at 40K physicians, they are now at 90K physicians. PLM is seeing very strong growth for their most recently introduced communities to address mood disorders (We had concerns as to whether or not PLM would scale effectively and mood disorders would be a real test, if not one of the hardest. Mood disorders are terribly challenging and terribly personal and there is a social stigma. PLM’s ability to overcome these challenges is true testament to the value they are delivering.) PLM is focused on addressing what treatments work in the real world for real consumers. See themselves becoming a key arbitrator of future pricing based on real efficacy.

Comments from HealthCentral and MedHelp have been pretty simplistic in comparison to comments by PLM and Sermo.

Demo-time:

Sermo leads off showing the power of community intelligence. Big question that they had to face was will physicians trust the site. Time and agin they have been able to demonstrate that the system does work. This is contributing to the viral-like growth of Sermo. Which makes me wonder, just how many of those docs on their site are from the US vs rest of world? With some 600-700K physicians just in the US, a lot of upside community growht for Sermo. BTW, that demo, nothing special but the site does look clean and easy to navigate.

Ben of PLM was next presenting data from the ALS community at PLM looking at efficacy of lithium. Was prompted by a research study in Italy that p[ointed to some possible positive impact. In the past nine months, 300 PLM ALS community members have been using lithium (this is not some sort of formal clinical trial, it’s just happening) and the data is showing no measurable imporvement. Ben went on to say that the US is getting ready to launch mulit-million $$$ clinical trials program to look at lithium for ALS. His argument is that PLM already has the data, now, totally circumventing the clinical trial process. Could this story force us to rethink how some clinical trials should be performed in the future?

MedHelp gave a demo/story of a Victoria Secrets’ bra. Seems that VS introduced a new bra and within a month, MedHelp community members began posting about a rash they were getting from wearing the bra. Problem eventually traced to a new manufacturer in China using material that would cause an allergic reaction for some. Led to VS changing the manufacturing process and sure enough, posts on MedHelp began to subside.

HealthCentral is now up. Gave several demonstrations/page views of different communities at HealthCentral. Nothing terribly new here that I have not seen on any number of health communities. But taking a look at traffic numbers, does appear that HealthCentral is doing ok and is growing in number of uniques. Took a quick drive-by of the site, much different than the other three on the panel, coming across more as a competitor to WebMD or Waterfront Media.

4:30pm Due to low battery have not been able to provide update. But coming back now for wrap-up.

Some quick impressions so far:

  • Nothing terribly new being presented. Good event for those new to this market space, but for someone such as myself, well…
  • Great networking event. While content of presentations may be thin, the audience is top notch. Lots of great contacts being made.
  • One of the big contributors to the size of the event is all the new players. This is becoming a VERY BIG DEAL. Plenty of representatives from the healthcare sector old guard (e.g., payers, pharmaceutical companies and some of the very large providers). Lot of large institutional entities here looking more closely at this market sector.

Has Health 2.0 hit the mainstream?

Sure is beginning to look like it. Then again, we’ll have to see what unfolds over the next 6-12 months as there is a tremendous amount of overlap in solutions being shown here today. Clearly, not all will make it. Actually, most won’t. Challenge for investors is figuring out which one(s) have a truly distinctive product and a good model/strategy to take it to market. Not that much different from any other investment evaluation, with the “minor” exception that one must factor in a financial crisis.

And that financial crisis will put a major crimp in any Health 2.0 company looking to go direct to consumer with a subscription model. This was a challenge before the financial crisis, now it is simply untenable.

Same goes for those looking at an ad-supported model. Online advertising is starting to see some contraction and the healthcare sector will not be immune. And those companies looking to offer their sponsors some type of completely new advertising approach, don’t count on a receptive audience. When the purse strings start to be pulled, new (i.e., risky) ideas are pulled.

Going forward, Health 2.0 companies will need these large institutional entities for sponsorship via adopting their solutions. Therefore, Health 2.0 companies will need to go back to the drawing board and look more closely at the value proposition they can provide these sponsors. As you go back to those drawing boards, think one of two things:

1. How can I save them money?

2. How can I make them money?

Word to the wise: Number 1 is always a much harder sell than number 2.

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Adam Bosworth made quite a name for himself in the healthcare space while he was leader of the Google Health initiative. All got quite strange, however, when while on vacation late last summer, Bosworth decided not to return to Google Health. And while Bosworth went into stealth mode to develop Keas, Google chose not to replace him (a mistake) and Google Health fell under the tutelage of Marissa Mayer.

Bosworth has kept a very low profile since leaving Google, but Matthew Holt was able to get an interview with him, which Matt posted today. Roughly 35 minutes long, it is a good interview to listen to if you have the time. If not, here are my take-aways, with some commentary in italics:

Despite Holt’s prodding, Bosworth gives tells little of what happened at Google that led to such a sudden departure. Bosworth claims that he decided he wanted to work in a small, entrepreneurial environment that was nimble without a lot of “processes”. This rings hollow as he worked at Microsoft and BEA prior to Google, both very big companies. I’m not sure what happened at Google, and not sure anyone will ever know the full story, but clearly, more happened than Bosworth is ready to divulge.

His new company, Keas, has 15 employees, is about 6 months old and is looking to provide consumers with the personalized information they need to better manage their health. Boy does that ever sound familiar and I could probably rattle off about 15 Health 2.0 type companies claiming to do the same thing. Bosworth will be at the upcoming Health 2.0 conference so maybe he’ll divulge more there. Right now, all I see (should I say heard) in this interview is a company with another me to product. Barriers to entry for such products are quite low, but risks are high. Just look at the Health 2.0 poster child Xoova, which appears to have gone up in flames. This whole Health 2.0 stampede takes me back to the glory dot com days when everyone was talking about how all procurement was going to move on-line and multipleon-line markets were created for various industres. There was a land-rush and the spectacular bust. We may be seeing the beginnings of something similar occurring now in the Health 2.0 market.

Bosworth sees a clear need for better consumer tools to manage their health, tools that leverage Personal Health Information (PHI). Surprisingly, he thinks there is enough digital data today (labs, medications & images) to provide significant value if it is leverage correctly. He praised the efforts of Google and Microsoft, particularly Microsoft, (hmm, that’s odd) for their efforts to collect this type of data into a consumer-controlled data repository. He also sees biometrics playing an increasing role as well. I believe this is where Keas will focus its attention – creating a solution that leverages PHI for structured search and presenting actionable information for the consumer to take preventative actions.

He sees the big adoption hurdle as not being the consumer, but the physician. Bosworth believes that a compelling motive for physician adoption and use of HIT has not been presented. Bosworth and I both agree that eVisits may be the silver bullet. Concurring with my recommendation to Sec. Leavitt in July, Bosworth stated that CMS can take a leadership role here by aggressively supporting eVisits, which may kick-start physician adoption. Gets back to the old, ‘Show me the money!”

Bosworth also commented on the privacy concerns surrounding a Google Health or Microsoft HealthVault. Some consumers will be comfortable with these offerings, others less so. He foresees more such platform plays entering the market to serve other segments of the market that do not want their PHI in a Google or Microsoft type entity, e.g., a non-profit. He also stated that for Google and Microsoft, a breach in privacy would be a disaster, thus they take extraordinary measures to insure that PHI is secure within their repositories. As I’ve stated before, I am in total agreement with his perspective on privacy as it pertains to Google and Microsoft. Do disagree on his belief that there will be a proliferation of platform plays. Simply makes no economic sense as these are expensive to build and pull a critical mass of data into, let alone establishing the multitude of partnerships to create a viable and vibrant ecosytem of Personal Health Applications (PHAs) layered on top of the platform. There will ultimately be 3, at most 4 platform plays, and that is being generous.

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In early May, the Center for Medicare and Medicaid Services (CMS) announced the “go live” of the Personal Health Record pilot for Medicare beneficiaries in South Carolina. Titled MyPHRSC, the PHR is based on technology from vendor Healthtrio (a company profiled in Chilmark’s just released PHR Market Report), with contractor QSSI doing the outreach to beneficiaries and IBM doing the project management and implementation.

Had a call recently with Healthtrio who provided more background to this story which follows.

  • This is a pilot project with a initial time-frame of 12 months, though there is a clause to extend this program an additional 24 months based on meeting certain objectives (adoption, use, capabilities, etc.).
  • Officially launched on April 4th, the first weekend saw about 100 registrants and they are now seeing about 15 new registrants/day. Assuming registration has held steady, they should hit close to 1,000 registered users by the end of May.
  • The PHR is consumer controlled and the consumer defines all access rights to the PHR.
  • PHR is populated with Medicare claims data. All other information, e.g., medications, family history, lab data, clinical notes from doctor’s visit, etc, must be entered by the consumer.
  • Healthwise is a partner in the project providing health-related content that is personalized for the user based on their health profile.
  • Extensive testing and validation was performed prior to roll-out to insure privacy and security of the PHR.
  • Feedback to date from users has been very positive.

Initial Analysis:

Not exactly a barn burner of a release. Two months in and only 1,000 users? Bet Google Health saw that many in the first couple of hours, if not much more after opening their doors. But in all fairness to CMS, Healthtrio and others involved in MyPHRSC, they are dealing with an older population that may be less familiar and subsequently less comfortable adopting and using an online PHR.

Great to see CMS adopt a strong consumer-centric policy regarding who controls access to the PHR. Also quite comforted to hear that CMS really focused on privacy and security of the platform prior to release.

Extremely surprised by the lack of functionality provided. Healthtrio assures me that much more is on the drawing board and CMS is really pushing them to deliver. But honestly, providing only claims data with some health content wrapping, that is about as simplistic as it gets for a PHR. As most seniors must deal with multiple medications, delivering the kind of functionality that Google Health is delivering today for medication management would be a HUGE STEP forward, easily increasing the utility of the solution 2-3x what they are providing today.

Bottom Line:

If more functionality is not delivered promptly, adoption of this PHR will quickly plateau and use will slowly fade as there is simply not enough there on the MyPHRSC platform to keep those consumers coming back.

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You may recall that during an interview last October with the fine folks who manage the WSJ’s Health Blog that Aetna’s CEO, Ron Williams called Microsoft’s personal health platform, HealthVault and Google Health “vaporware”.

Well, he’s at it again, this time taking another pot-shot at Google Health.

Yesterday, while speaking at the MIT CIO Symposium Williams stated that the likes of Microsoft and Google do not have an “interest in improving the system or looking for gaps in care. When the data goes there, it is really static and stored.” He then went on to promote their own “Care Engine” a technology platform that came with their acquisition of ActiveHealth in 2006. Sounds to me like another desperate attempt of the old guard in the healthcare sector simply trying to protect their turf.

With all due respect Mr. Williams, you are about to be dis-intermediated. I know it, and it appears you know it as well, though you’ll fight like hell to spin it otherwise.

Reasons Why:

First, data going into anything will always be static and stored until someone decides to do something with it. Before purchasing ActiveHealth, your claims data was as static as the next entity’s data. ActiveHealth has some excellent analytics under the hood to do analysis, but you are not alone here. Google is a master at data search, retrieval and of course analytics. Microsoft is no slouch here either. Both are just starting down this path and will quickly catch-up and surpass what Aetna provides today.  In Google’s case, for example, they will be able to tap clinical data, a much richer source of data than the claims data you currently tap with the Care Engine.

Second, the Aetna PHR, built on top of the ActiveHealth technology stack, is still new to the market (introduced in June 2007) and is still pretty thin in consumer functionality. (ActiveHealth is profiled in the just released iPHR Report by Chilmark Research). At the rate that Google is moving (and for that matter Microsoft’s HealthVault), they will quickly eclipse your offering. Is that not why ActiveHealth is already a partner of HealthVault?  Are you not hedging your bets?

Third, privacy and security issues are certainly there but honestly, you and your brethren in the payer market, despite HIPAA statues, don’t exactly have a stellar record in keeping records safe. Microsoft and Google have far more at stake here regarding breach of privacy/security (it could potentially bring down everything they’ve built to date all in one fell swoop) and will be strict guardians of a consumer’s records.

Lastly, Aetna you and other payers still struggle with the consumer trust issue as well as portability of records. Despite numerous statements by the payer community to not use a consumer’s PHR data against them, consumers remain extremely cautious and reluctant to adopt a payer sponsored PHR. Outside entities such as Google and Microsoft have no vested interests in lowering medical loss ratios (MLRs) to improve margins, like you do. Thus, they are rightly perceived as neutral and trusted to protect their (the consumer’s) best interests.

Rather than fight this tsunami of consumer-led healthcare Mr. Williams, I encourage you to embrace it as a more engaged consumer is one who will be more knowledgeable and involved in caring for themselves and their loved ones. And in the end, will that not lower your MLRs anyway?

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