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vcArticle in today’s NY Times that looks at where the Silicon Valley Venture Capital (VC) firms are likely to place bets in 2009. Some highlights and our comments follow:

1) Article starts by saying almost anything Web2.0 that is ad-supported and free to the consumer will fall out of favor.  No argument there.  This new reality will not be limited to just Web2.0 companies but encompass Health2.0 firms as well.

2) Venture Capital firms are not too crazy about funding iPhone/smartphone apps and instead are investing in mobile hardware/infrastructure plays.  They are much closer to this market than we are, so maybe they know something we don’t.  From our vantage point, however, we see plenty of opportunities for new mobile apps, thus remain bullish on smartphone apps, particularly those targeting health & wellness.  Despite some 400+ health apps for the iPhone, most of those apps are simplistic, me-too apps and only a handful truly capture the imagination.  On top of that, there are the platforms for Google Android, Nokia’s Symbian, Blackberry and even Microsoft Mobile.  None of these other mobile platforms have come close to replicating the AppStore, but if they do, watch out.  There is still a deep vein to tap here that the article and maybe some VCs fail to see.

3) Despite not seeing much opportunities in the mHealth, VCs do see a lot of promise for healthcare apps, especially, at least the article infers, consumer-facing apps.  While we would like to share their optimism, we are skeptical that quick returns will come easy for several reasons including:

  • Consumer adoption is a challenge on two fronts, education to drive motivation/adoption and privacy,
  • Liquidity of health information is still in the dark ages and
  • Mixed response among care providers.  While some encourage use of such tools, there is a significant number of care providers who are not supportive and even discourage consumer use of these tools.

Yes, there are opportunties here and yes, IT is still fairly new to healthcare, but there are some deep structural issues to overcome. VCs looking to invest will need patience, something that is rarely found.

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In a brief article late last week, trade magazine Healthcare IT reports that federal funding for healthcare IT initiatives  appears to have stalled.

Can’t say as I am all that surprised.  This is after all an election year, a time when many government activities get put into stasis to await the next administration.  Combining this news with that of the recent HIMSS CIO Leadership survey, it looks like 2008 will be a lean year for many an HIT software vendor.  Still a lot of system installs though so the consultants should fair better.

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Over on the eZine, Health Data Management there is a poll asking whether or not your software vendor was upfront about the hidden costs of implementing their software. Guess which way the poll is leaning?

Over two-thirds of respondents state that no, their software vendor was not upfront about hidden costs!

At first, one may be appalled at such a percentage, but it is not that surprising. First, it is not always apparent for anyone, vendor or customer, as to what the full costs will be to implement a given software solution. There are “hidden costs” related to customization of workflow for a given facility, there is training, there is that ever sticky issue of adoption and use, and there is the productivity drop while users familiarize themselves with the new software. I am sure others can list their own hidden costs that they have had to address as well. Thus, it may be unreasonable to put complete blame on the vendor as many parties are culpable.

Within the IT space and among industry analysts, it is fairly common knowledge that the total costs to implement any solution is typically about 10x the cost of the software itself. Yes, this can be a very big number but few would ever get the go ahead from management if they told them what would ultimately be the sunk costs to adopt a new software package.

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Have you ever come home from a strenuous work-out famished and can find nothing in the cupboards or the refrigerator to satisfy your cravings? If so, then you have some idea of what I experienced on HealthVault.

Getting into HealthVault was a work-out. It all began with the need to establish a Microsoft Windows Live ID account, which is really just a re-branding of the universally disliked Microsoft Passport. Why Microsoft, do you feel you compelled to continually entrap us with such things as this? Claims of added security are unconvincing as I certainly do not have to go through such a process as this for my on-line bank accounts or Fidelity account, both of which are VERY secure.

Once I got into HealthVault, low and behold the cupboards were bare.

Upon entering, one finds a fairly clear, crisp and consistent layout with tabs across the top to get one started. First, you are prompted with a simple process to establish your account by creating a record. Records for loved ones can also be created at this time or later. Each record has a simple file structure that includes: Health Info, Document Library, Sharing, Programs, History and Profile.

The HealthVault experience begins with one creating a profile for a given record. The profile asks for very basic contact information, nothing more. It does not ask for one iota of health-specific information and therein lies one of the most fundamental problems with HealthVault today.

As a platform, it is but a repository of data. HealthVault relies on your documents that you might upload to your HealthVault account and its partner network to provide all health-specific data through connections to their applications and Web services, which HealthVault refers to as “Programs.” Thus, it is incumbent upon the consumer to create a health-centric ecosystem, including selecting HealthVault partners that are pertinent to their needs. This is a very arduous process and not recommended for the feint-of-heart.

Why so arduous?

First, it is not easy to determine which Programs one may want to add. Secondly, wouldn’t it be nice to know which Programs are actually worth subscribing to? Hey Microsoft, how about a user’s ranking system for these partners with comments ala Cnet? Third, you do not stay in the HealthVault environment when you pick a partner, instead, you hop out of HealthVault to a partner’s website. Once there, it is not at all consistent across the various partners as to how to connect the Program to HealthVault. For some, like the American Health Association’s blood pressure monitoring it was pretty straight-forward. For others, such as Healthy Circles, Peaksware or US Wellness it is a completely different story. When you arrive on their site, there is nothing that points you in the direction of how to incorporate their Program into HealthVault. With the majority of these sites, about the only thing I could easily find was their press release referencing their partnership with HealthVault. Not much help there!

Why Microsoft did not demand that partners create a separate landing page for anyone coming from HealthVault to a partner’s site to insure consistency and quality of the experience is a mystery to me. This is a monumental shortfall of HealthVault today and I cannot imagine any consumer having the patience I did in trying to navigate through this morass.

Another significant shortfall is that there are only 7 partners providing Programs for HealthVault and the majority are very small, niche players who are riding Microsoft’s marketing coattails. Sure, some of them may make it, but as a consumer, I’d be very cautious enlisting most of them until they get some traction in the market. Where are the bigger players Microsoft?

Not is all lost and there are indeed some redeeming features of HealthVault including the Sharing and History features as well as their privacy policies.

The Sharing feature of HealthVault allows one to establish specific guidelines on what health information in their record they are willing to share with outside parties such as another family member, their physician, a fitness coach, etc. Today, sharing is pretty basic and is tiered into three levels of access: View, View & Modify and Custodian. Custodian is very similar to administrator privileges on one’s computer. Within the next few weeks, Microsoft states that they will be updating Sharing capabilities to allow for sharing of data within user defined time-ranges, e.g., you may want to provide access for only 15 days to insure privacy. Microsoft also will be adding a “tagging” feature allowing one to tag very specific data and information for sharing (or keeping private), rather than granting full access to all information in one’s health record.

The History feature will also be useful as it tracks the complete history of not only their interaction with HealthVault, including uploads of data from health monitoring devices or an update of the record from their physician, but also all others who may have access to their HealthVault record. Therefore, one can quickly see whether or not their physician has visited their HealthVault record and even if they made any changes to the record. This is much simpler than trying to dig through one’s record to see what is new. Important to note that only the Custodian of the record has access to History, which is to insure privacy.

Microsoft has also taken great pains to insure the privacy and security of HealthVault and all who use it. Adopting the policies first put forth by the early pioneers at Children’s Hospital of Boston and MIT, the developers of one of the first Web-based personal health platforms (now called IndivoHealth), Microsoft is putting the consumer in control of their health records. Microsoft’s privacy policy clearly states that they will not, for any reason (unless legally-bound), share your information for any purposes. All data that is exchanged between a consumer and HealthVault is encrypted via https. Data is stored in encrypted format in servers that are logically and physically separate from other Microsoft Web service offerings (e.g., Hotmail). At anytime, a consumer can ask to have their HealthVault account, or a given record deleted. Microsoft also claims that all partners will adopt similar privacy policies. Congratulations Microsoft on promoting a privacy policy that puts the consumer firmly in control of their health information.

In conclusion, despite excellent privacy policies and some other nice features (Sharing and History), I find that HealthVault Beta is NOT consumer ready. It is incomplete on a number of levels, confusing at times and is not user friendly. As it is today, HealthVault Beta is best used to attract partners to enlist and not much else.

I am not entirely writing off HealthVault. On the contrary there is potential here but it is going to take time for that potential to develop. An important factor in HealthVault’s long-term success is contingent on the partners (both quality and quantity of partners) that Microsoft can enlist to build critical mass on the HealthVault site. Microsoft also must address the shortfalls I’ve pointed such as the user experience, which today is simply unacceptable.

Microsoft has taken a bold leap here with HealthVault, a leap that redefines the PHR market. But that bold leap also brings a lot of expectations and the Microsoft HealthVault team has quite a ways to go before they meet the expectations of this potential consumer.

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I came into this review with very high hopes, hopes that Microsoft, with its vast resources and market clout, would make a major splash in the rapidly evolving consumer health IT (HIT) market. I was thinking BIG. Big grand schemes, a monster of a Personal Health Record (PHR) solution that would provide all a consumer would ever wish for and solve all the ills that exist today in this very young market. Yes, I was quite Pollyannaish.

HealthVault didn’t even come close to what I imagined.

HealthVault is NOT an application. HealthVault is NOT a PHR. Instead, HealthVault is a Personal Health Platform (PHP), a platform upon which other applications may reside. And that distinction has created a lot of confusion for most in the media and even knowledgeable people in the HIT market (myself included). We all had assumed that Microsoft was announcing a long anticipated PHR and getting the jump on its major competitor, Google.

I received an in-depth briefing from Microsoft last week on exactly what is and is not HealthVault, what their strategy is and how that is reflected in the product. I have also spent some significant time on the HealthVault site and several partner sites that are listed on HealthVault. Here are my impressions.

One of the most powerful features of HealthVault is that as a platform, it allows for an ecosystem of consumer-centric applications to be made available wherein the consumer can pick and chose which applications are best suited to their specific needs for their personal health. It is nearly unlimited as to the possibilities of what types of personal health applications may be found in the future on HealthVault. Today, there are 16 partners up and running and Microsoft claims that there are over 40 total who have signed-up to participate in HealthVault.

As an ecosystem of applications all residing on the same platform HealthVault can, theoretically, insure a level of interoperability and data sharing across the applications, For example, a consumer may use the ActiveHealth PHR solution while their physician uses Allscripts EMR. Since both Allscripts and ActiveHealth are a part of HealthVault, a doctor could easily provide a patient their medical record to their ActiveHealth PHR through HealthVault. Of course there are a host of privacy issues that must be addressed, but it can be done.

Where this really gets interesting though, and what I believe is the most brilliant aspect of Microsoft’s HealthVault strategy, is when one starts coupling home-care medical devices to HealthVault thus enabling telemedicine. During the briefing, Microsoft gave a pretty slick example that combined the use of a blood pressure monitor with the American Heart Association’s (AHA) tracking and charting software and a physician’s EMR to show how a consumer could take scheduled, periodic blood pressure readings, have them automatically recorded (Bluetooth) into their computer and fed directly into their HealthVault, then charted into the AHA application and lastly, on a predefined schedule, automatically push that data into the patient’s electronic medical record (EMR) at their physician’s office for subsequent review and follow-up by their physician. Quite an impressive demo and ultimately, this may be the Trojan horse that gets medical practices to really begin adopting EMR software to better manage chronic care patients.

Microsoft has also made a very savvy move by focusing on the platform, rather than the application(s). In doing so, Microsoft has been able to elevate itself above the market fray, leaving that to others to battle it out in the trenches. This market is still extremely immature and no one is quite sure how the market will develop and coalesce in the coming years and which applications will experience broad acceptance in the market. By choosing to focus on the infrastructure, via a platform play, Microsoft is taking a path with much greater potential for success than just going out and trying to create another PHR, or some other consumer-centric, health application.

But the trick here for Microsoft will be to get those ISVs (independent software vendors) to configure their applications for HealthVault and insure that these ISVs comply with the main operating tenants of HealthVault for not only interoperability, but also privacy and security. Also, since HealthVault will enable a consumer to consolidate all of their personal health information into one central repository that they have complete control of, who ultimately has control of the consumer relationship? This is one of the BIG issues today in this market. Providers want it, employers want it, payers (insurance companies) want it, Microsoft wants it, other ISVs want it, but who gets the relationship in the end?

For example, one of HealthVault’s partners is ActiveHealth, a division of Aetna who is responsible for Aetna’s own PHR, ActivePHR, which is purportedly used by some 800,000 Aetna customers today. One of the nice features of ActivePHR is that Aetna automatically updates a customer’s PHR with claims data. Of course, should a customer decide to leave Aetna, they would also leave their ActivePHR behind as this PHR is tethered to their Aetna policy. Now the question becomes: If I am using ActivePHR and set-up a HealthVault account, can I then move all my data in ActivePHR, including Aetna claims data, to my HealthVault account? This is not just a question for tethered PHR’s such as ActiveHealth’s, but pertains to virtually any application and a consumer’s data that may reside both within HealthVault and on an ISV partner’s site. Who ultimately has control of the data and therefore how truly “portable” is a consumer’s HealthVault account and the data contained therein?

It is still early in the evolution of HealthVault. In fact so early, that Microsoft readily admitted to me that this announcement was more to get potential partners excited about the opportunity that HealthVault may present to them rather than an announcement for the consumer. It may also have been Microsoft’s intent to get a press release out quickly and get a jump on their competition down in Silicon Valley. What is apparent though is that the HealthVault platform today is far from ready for the general consumer.

I’ll go into much greater detail on that in my next post where I’ll talk about my own experiences with the HealthVault platform.

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Quick 7min podcast of interview IT blogger Robert Scoble had with Stanford Childrens Hospital pediatrician Christopher Longhurst who also works within the IT dept of this hospital.

There is a much longer 47min version over on Scoble’s blog.

[podtech content=http://media1.podtech.net/media/2007/10/PID_012773/Podtech_StanfordDoctorEC.flv&postURL=http://www.podtech.net/scobleshow/technology/1644/editors-choice-stanford-it-doctor&totalTime=460000&breadcrumb=cb17ce880de94e919dc0c619eaf62294]

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