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Posts Tagged ‘PHI’

Chilmark Research tends to shy away from the thorny, nearly intractable issues of privacy and security of Personal Health Information (PHI) (we’ll leave that to the lawyers and policy wonks to figure out). However one thing is very clear: As we continue to conduct more and more of our daily activities, both business and personal, via some form of digital device all those little messages, those bits and bytes of data we create are being collected by someone, somewhere to create a more accurate profile of us. In my own case, how else would my favorite site for weather (weatherunderground) know I’m an outdoor enthusiast and have a banner ad for backcountry?

Despite our reluctance to tread into this domain, it is one of extreme importance.  The healthcare industry is undergoing a digital transformation at roughly the same time as consumers increasingly use an ever wider set of digital tools from social media (twitter, facebook, etc.) to text messaging services (txt4baby) to various health & wellness apps on smartphones and even biometric sensors (Nike+, fitbit, Withings, etc.). We’re not sure where all this will lead but at the very least, the public needs to gain a better understanding of how their digital bits and bytes are being used and maybe begin to think twice as to how and where and with whom they share their PHI.

Today, we found one such educational tool, an animated video by Michael Rigley which is quite powerful using MMS as an example.

If this is what the telecoms can now do with a simple MMS, just imagine what they might do with some of that rich health-info you may be communicating.

As an aside, Dr. Searls is doing some interesting work at Harvard Law’s Berkman Center on the concept of VRM, (Vendor Relationship Management). Much of the principles he outlines could easily be transposed to the healthcare sector and the management of one’s PHI.

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Since its initial launch to much fanfare, Google Health has struggled to be relevant.  Since its formal launch in May 2008, Google Health has not dedicated the resources to build out this platform into a truly engaging ecosystem of applications to assist the consumer in managing their health or the health of a loved one.  Rather than build out new features, support a broadening array of standards, focus on the necessary business development that is required to establish partnerships, Google has taken a laissez-faire attitude to this product/service never dedicating more than a handful of engineers to the effort and most often flexing in outside vendors, such as IBM who built the module to bring in biometric from Continua compliant devices.

Rumors are now floating about that this lack of relevancy, this lack of a true commitment to Google Health has led to that oh so fateful executive decision – pulling the plug on Google Health and either letting the team go or reassigning them to other divisions within the organization.  With maybe 25 employees max at any one time working on Google Health, this will not have major implications internally, but it may have some broad repercussions in the industry that include:

Without a viable competitor, will HealthVault languish in its efforts to provide a truly clean, easy to engage and use platform?
Google Health’s interface and ease of interaction has always been one of its key features. Unlike Microsoft’s HealthVault, which initially was a beast to try and use, Google Health from the start was simple, intuitive and dare one say it, almost fun to use.  Though HealthVault has come a long way in improving the user experience, it remains a more trying experience. With Google Health put on the proverbial shelf, will HealthVault no longer be pushed as hard to continuously improve the user experience.

Perception that Personal Health Platform (PHP) market is dead.
Markets do not exist if there are no competitors. If the rumors are true, what we have left are Dossia, the private, employer-based platform and HealthVault.  These two alone do not constitute a market, therefore, can we now boldly state that there is no market for consumer-based PHPs?  Market would seem to say yes, though Chilmark has a hard-time admitting as much as we have been strong proponents of the PHP concept.  It may simply be that this market is still extremely immature as the consumer is not well-educated in the value in managing their own personal health information (PHI), nor is such information in easy to access and use digital form factors.  History is littered with great inventions by great inventors who ended up in the poor-house simply because the timing was off, This may indeed be the case for PHP.

Lack of options for small, consumer-focused independent software vendors (ISVs).
Dossia takes a very cautious approach to adding ISVs to its ecosystem, basically choosing those that their employer members wish to have available for their employees.  Microsoft has been quite aggressive in adding an increasingly wide array of ISV partners to create a fairly rich ecosystem.  Problem is, some ISVs are reluctant to work with Microsoft for whatever reason.  Without Google as an option, they are left with few options.

Could stall innovation.
Similar to the first point wherein Google Health’s attractive and easy to engage interface was a welcome relief to our experiences with HealthVault which subsequently put the pressure on Microsoft to improve the user experience, without Google pushing the innovation envelop in directions that Microsoft or to a lesser extent Dossia may not have pushed, we are now left with the very real possibility of not seeing truly new, innovative models for how consumers can gain access to, use and leverage their PHI to improve their health as well as their interactions with the healthcare system.  This may ultimately prove to be the biggest repercussion in this nascent market of consumer health IT.

It is critical to state that though, if rumors prove true – Google has disbanded its Google Health team, that does not mean Google Health is dead.  What it does mean is that Google Health has been put into stasis, that we will not see any new innovations, we will not see an expansion of its support of standards beyond the bastardized version of CCR that Google Health currently uses and the number of new partners, be it those providing data (payers, providers, etc.) or using it (ISVs), joining the Google Health ecosystem will trend to zero.  Sure, one can still store their PHI on Google Health and one will be able to able to use one of the existing ISVs, just don’t expect much more than what we have today going forward.

So without Google Health to keep the boys and girls in Redmond on their toes, might we continue to use the metaphor in Microsoft’s efforts to package the iPod as the metaphor for the user experience at HealthVault.  We sure hope not and many of the most senior executives at Microsoft have assured us that this will not be the case. In fact, to their credit, it was one of these executives that first guided us to the Microsoft exercise in repackaging the iPod video, so we remain optimistically hopeful.

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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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Yesterday, I had the honor to present to Sec. Leavitt and the AHIC on trends and projections for personal health information. As I had only a brief 10 minutes to work with, I needed to put together a dense set of slides to hit the high points of what is happening in the PHR market. Below is the presentation.

Several others presented as well including Carol Diamond from the Markle Foundation, Jeffery Blair from the Lovelace Clinic, Sean Nolan from HealthVault, and Will Crawford from Dossia among others. The purpose of our collective presentations and following on Q&A were to educate those in attendance on where we are today regarding the ability of a consumer to manage their PHI and where we were headed in the future. Of course, being in front of so many policy makers, it also provided us an opportunity to provide policy guidance to encourage future adoption and use of PHI.

Surprisingly, Google Health did not send anyone, though I heard they were invited. Odd, Very odd.

Makes we wonder just how committed Google is to the health sector when they cannot find an individual to represent them at such an important event. Then again, maybe it is just a certain level of arrogance at Google wherein they decided that this administration is coming to a close and the future of what AHIC will become remains uncertain. Either way, a poor move on their part.

Back to the event.

I was quite impressed with the attentiveness Sec. Leavitt showed throughout this morning session. He took copious notes and asked several thoughtful and probing questions. Clearly, he takes this issue very seriously.

Unfortunately, I am not sure I can say the same about others who were present. Several questions and comments from AHIC members were clearly designed to derail any move towards personal control of health records. The usual Fear, Uncertainty, and Doubt (FUD) issues were raised such as the specter of privacy, the consumer at risk, the physician at risk, that PHI is not important for the advancement of health, etc. There are strong vested interests among those on the AHIC committee, thus not too surprising to see so little substantive action come out of the AHIC since its formation.

Key points & metrics:

  • Privacy is on everyone’s mind when it comes to PHI, though many agree that all the consumer wants to know are answers to two basic questions:
    Who will have access to my record?
    What might the information in my record be used for?
  • At Kaiser-Permanente consumers now simply expect their physician(s) to be digitally aware and connected. Adoption continues to accelerate and their members are increasingly engaging with their physicians over the Internet. Viewing lab results online is the most used feature of My Health Manager with 1.3M results viewed monthly.
  • From Jan-June 2008, the VA’s HealtheVet PHR had 4.1M visits. HealtheVet now has over 600,000 active users.
  • Reconciliation of multiple medical records from multiple providers for an individual to create a single, coherent, longitudinal record is proving quite challenging. This is not an easy task to automate.

Final Impressions:
There are many good people at HHS and on the AHIC that are working very hard to advance the quality of care. There were several at this meeting that are beginning to believe that the PHI market may indeed be moving far faster than the ability for government to respond, which honestly, may not be a bad thing. My biggest concern is that given time, government may actually do more harm than good in that given sufficient time they would put together confining prescriptive polices and regulations that would hinder innovation and follow-on adoption, rather than foster it. This led me to close my own comments during our session with the following:

What we need today are not prescriptive policies and definitions, but guidelines. When developing policies, think as though you are putting up guardrails to help guide adoption and use of HIT rather than laying down railroad tracks.

Hopefully, they were listening.

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Next week on July 29th, I have the honor to give a presentation at the “Community Meeting” of AHIC in Washington D.C.  While the link is thin on details, it does provide one with a link to listen in on this meeting, via video webcasting.

So what is the main purpose of the meeting?

It is to provide an update to the government policy makers, including Dept. of Health and Human Services Secretary Leavitt, and the public on: “The Evolving Landscape of Products and Approaches that Consumers may use to “mobilize” (access, use, and share) their Personal Health Information (PHI)”.

My presentation will focus on what are some of the current market trends and technologies now being offered to and used by consumers for PHI.  The presentation will leverage results of our recent research report on the PHR market and our continuing research on the broader issues of consumer-facing HIT, of which PHI is a subset.

Quite an honor to be a part to this event in which I’ll be joined by such well-known speakers on the topic as Carol Diamond of The Markle Foundation, Sean Nolan of HealthVault, Jeff Blair of the Lovelace Clinic Foundation, Will Crawford of Children’s Hospital of Boston and Jerry Bradshaw, Executive Director HIN, Arkansas BCBS among others.

I’ll provide a report next week on the meeting, including the slide deck I plan to use – so stay tuned.

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