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Posts Tagged ‘Wal-Mart’

Following closely on the ill-fated demise of Google Health, fellow Personal Health Platform (PHP) provider Dossia announced last week a major upgrade of their platform with the release of Dossia Health Manager. We received a deep product dive at the end of last week and spoke with Dossia’s new CEO, Mike Critelli this morning. Initial take: Health Manager is a restart for the the oft-times struggling Dossia. Following is part one of our assessment.

Background:
Dossia was founded what seems like nearly a century ago but in reality, five short years in 2006. (Maybe we need to measure the PHR market like dog years with every human year representing 20 PHR/PHP years.) In 2007, Dossia chose the Indivo platform, which was developed at Children’s Hospital – Boston, as the basis for its future PHP. One could easily argue that Dossia and the Indivo platform it was developed on was the precursor for both Google Health and Microsoft’s HealthVault.

Beginning with six founding members, all large self-insured employers including among others Intel, AT&T, and Pitney Bowes, Dossia struggled to get the platform live but was finally able to pull it off for member Wal-mart in October 2008. The PHR partner for Wal-mart on the Dossia platform was WebMD. Reports we received from the field on this deployment were not encouraging as it appeared that there was a major push to demonstrate the value of Dossia and we all know what happens when things get pushed before they are fully baked. Dossia learned a lot in that first deployment and has proceeded ahead in a more methodical fashion and now has 6 of the now ten founding members live on Dossia. Unfortunately, Critelli was unwilling to state how many employees of founders are using Dossia today, which makes one assume that the majority of these current deployments are in pilot stage.

In addition to getting Dossia live, Dossia has struggled to attract new employers. In the five years since its founding, only four new employers have joined. This raises the larger question: Can Dossia become a viable entity? Jury still out on that one but based on what we saw last week and our conversation with Critelli this morning, Dossia is on the right track.

Dossia Today:
Let’s start with the new Health Manager.

As we have argued countless times on this website, no one, absolutely no one is interested in a digital file cabinet for their personal health information (PHI). But what they, call them patients, employees, consumers, citizens, whatever do desire is a system, a platform that allows them to leverage their PHI to better manage their interactions with the healthcare system as well as potentially manage their health or the health of a loved one. Ideally, such a platform is intuitive to use (Google Health was quite good at this), readily imports data from a multitude of sources (HealthVault excels here), and provides a number of tools that leverage one’s PHI that are simple to select and use. This is a core competency of WebMD’s own private portal offerings (sold to payers and employers) and is Dossia’s chief competitor.

With the release of Health Manager (will be available to employers this fall), Dossia has brought together a fairly compelling, self-contained and comprehensive solution that should prove attractive to employers. This may be the first serious threat to WebMD’s dominance in the employer market and as we have reported before, WebMD has been milking their private portal business for a couple of years now, has seen contraction and is vulnerable.

The Dossia Health Manager starts off by providing the user the opportunity to chose from among a number of different apps to engage including the usual list of health content, medication manager, an immunization tracker, even the free text4baby app. One will also find, via partners, the Healthcare Blue Book to provide procedure pricing transparency, AmeriHealth for telemed as well as some social media/gaming functions that employers can leverage to incentivize healthy behaviors.

Once the various apps and functions are chosen by the user, the user is presented with a dashboard that is customized to their specific needs. As with most PHRs and PHPs, a given user can take on the role of family CMO (chief medical officer) and with the consent of other family members, view their records as well.

Having seen earlier versions of Dossia, this is an absolutely huge step forward for them in the creation of a simple to use and simple to understand PHP. What is particularly nice about Health Manager is that it provides the user a fairly selective, but complete set of core functionality. The Dossia has taken out some of the mystery and challenge that confronts many a consumer when they attempt to use one of the other PHPs in the market, specifically: which application should I use to manage this aspect of my health? Good luck trying to do that on HealthVault as the the choice (there are 23 PHRs to chose from) is a bit overwhelming and ultimately paralyzing.

But in providing this capability, Dossia has made a conscious decision to tread into the PHR waters themselves providing base PHR functionality. So long WebMD (that relationship with Wal-mart dissolved some time ago) and so long other PHR providers looking to ride atop of the Dossia platform, you’re likely to not get invited to the dance (unless of course you can get an employer customer of yours to demand such from Dossia, which is the case for Intel, who is also using Mayo’s Embody Health). Chilmark sees this as a logical and needed progression for Dossia as employers do not want a multitude of apps to manage for health and wellness initiatives, they want one comprehensive, easy to understand and deploy solution. Dossia is now prepared to deliver on that need.

Our next post will dig deeper into the business of Dossia and its go to market strategy, which to date has been, shall we say less than stellar.

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Round Two: A Dossia Update

dossialogoLast Friday had the chance to meet up with the folks at Dossia, the personal health platform (PHP) formed by a consortium of employers. Purpose of the meeting was to get a deep dive update on Dossia and learn more about what they have done in the last year or so since they went live with Wal-Mart in fall 2008.

Since that go-live, Dossia has been fairly quiet, though they did announce two new “founding members” and released the open API this past summer. But frankly, not much to write home about.

Despite being the first “out the door” PHP, several months ahead of Microsoft’s formal announcement of HealthVault in early October 2007, Dossia has floundered.  First was the break-up with their first development partner, Omnimedix which led to Dossia forming a relationship with Children’s Hospital, Boston to use the open source Indivo PHP.  After nearly a year of work with the Indivo team, Dossia finally had WebMD linked into Dossia.  This integration between WebMD and the core Indivo-based Dossia platform was done under some pretty tight deadlines to meet Wal-Mart’s aggressive roll-out schedule – as part of their annual fall health fairs for employees across the country.  The push led to a less than ideal integration with the WebMD, an integration that could not be readily duplicated with any other third party independent software vendors (ISVs).  Thus, Dossia’s desire to build an ecosystem of apps on top of their PHP was put into stasis as the Dossia team focused on the Wal-Mart roll-out.

A year later much has been learned.

Dossia discovered that Indivo V3.2 was not fully scalable to meet large enterprise needs.

The Indivo platform was developed by Harvard Med School academics to test the concepts and policies associated with a patient-controlled health record system.  Prior to Dossia’s adoption of Indivo, the platform had seen small scale implementations at Children’s Hospital, MIT’s on-campus hospital and at Hewlett-Packard in association with a flu vaccination study. In each of these implementations, no ecosystem of apps was deployed via a common and open application programming interface (API).  This is understandable as Indivo was structured to test concepts, not necessarily structured for large scale commercial roll-out.

Since last fall, the Dossia team hired a completely new team of developers (size of Dossia team on par with Google Health ~15-18 FTEs), completely re-architected their platform to meet scalability requirements, addressed user interface (UI) issues (Indivo lacked a modern, intuitive interface), and developed a stable API that ISVs could use.  On October 15th, the new platform/UI went live.

The new API was released at the end of June and there are now 20 ISVs modifying their apps to sit on the Dossia platform.  As of today, in addition to WebMD, Dossia has eClinicalWorks (eCW is used in Wal-Mart’s retail & corporate clinics – don’t forget that eCW is also being sold through Sam’s Club), Healthtrio, Medikeeper and Metavante, who had acquired CapMed, live on the platform.

Indivo platform did not adequately address the myriad of state laws relating to record consent and sharing for teenagers.

Last year’s Wal-Mart roll-out was targeted at just employees. No incentives were provided, it was completely left up to the employee as to whether or not they wished to participate.  While Wal-Mart obtained “favorable” adoption, a key desire of employees was to have a Dossia account not only for themselves but also for their dependents. This desire led to some fairly significant challenges for Dossia in providing the appropriate consent structure for teenage dependents where State laws vary significantly.  These new consent requirements were built into the new platform as well.

Employers wanted support for dental records.

Another request from employer consortium members was the ability to support dental record data.  As part of the platform rebuild, Dossia has also embedded a dental data schema.  To the best of our knowledge, Dossia is the only PHP who has this capability today.

User interface needed to be simpler, more intuitive to provide easy access to personal health information (PHI).

During the meeting, Dossia provided a demo of its new interface, which was very simple to navigate, ranking on par with Google’s and a more intuitive experience than that of HealthVault.  Dossia has a slight advantage here in that employers define which apps employees have access to and upon sign-up populate an employee’s account with their claims and pharmacy benefits management (PBM) data.  For either Google Health or HealthVault, most consumers must go through the actions of loading their own data, choosing their own apps, etc., to establish a viable and personally value producing account.  This is similar to the adage “with freedom comes responsibility.”

Challenges Remain:

Dossia has made impressive progress since its initial launch last fall.  They have addressed the scalability issue, they have finally released an open API for ISVs to create an ecosystem of future apps and several other consortium members will be going live on the platform in the near future.  Despite these gains, challenges remain.

Where’s the lab data?

While Dossia has the ability to support clinical data in either CCR or CCD formats, today they are only importing claims and medication data from PBM firms.  Dossia, like Google Health and HealthVault does not support images today.  In somewhat of a surprise, Dossia also does not currently support lab data imports from either Quest or LabCorp.  This is a surprise for two reasons: First, viewing labs online has been found to be one of the most desired attributes of a a personal health account and secondly, both Google and Microsoft can import lab data from either of these national testing labs that represent some 80%+ of all labs done in the US.  If Google and Microsoft can do it, why not Dossia?

What’s the value proposition for employers?

Chilmark still struggles to understand what the value proposition is an employer to adopt the Dossia platform for their employees. Yes, Dossia may be a non-profit looking to provide a common platform that will provide employers more flexibility in the health-related tools (PHRs, HRAs, wellness apps, etc.) they can offer their employees to better manage employee health and wellness, but is that enough? Today, few employers see the strategic advantage of providing even the simplest of such tools (e.g. a WebMD account, an online wellness program, a disease management program that actually works, etc.) to their employees. If it is difficult for them to see value here, how can they realistically make the leap to considering a health platform with an ecosystem of apps?

And the value prop for employees is…?

Yes, the interface is much improved and yes, PHI data is automatically imported into an account and an employee’s Dossia account is fully their own, but beyond that, why would an employee sign-up to have an account? What other attributes and services does Dossia provide that are attractive to a consumer? According to Kaiser-Permanente and others, those who adopt and use such system use them to look at their lab data and conduct simple transactions such as Rx refills and appointment scheduling, all features that Dossia does not support.  So again, the value for a consumer in using Dossia is?

A couple of suggestions:

Rev up the marketing engine

If Dossia’s claims are indeed true, that the platform is stable, scalable and open to third party ISVs to build-out the ecosystem, then it is time for Dossia to become more aggressive on the marketing front.  Who better to market Dossia than its consortium members?

To date, Dossia’s consortium members have been extremely quiet and they are arguably, Dossia’s strongest marketing partner.  But if Dossia’s founding members are not out there promoting the platform, clearly stating the value proposition they see in being a member and even, as in the case of Wal-Mart, begin talking about the successes they have seen since launching Dossia, then how is any other employer suppose to buy-in to the concept?

And a concept it is for there are few in the industry today, including health benefits management firms and consultants, that fully understand what the ecosystem/PHP model represents and the value it may deliver to employers over the long-term.  The best advocates, the best marketing Dossia can receive at this critical juncture, is the vocal support of its members. So where are they?

Get the labs

Ability to access, view and share lab data is one of the top features that early adopters of PHRs and PHPs appreciate.  Dossia needs to get this issue addressed immediately. End of story.

Delivery a value proposition that employees will appreciate and use

Critical to the success of the most popular personal health systems in the market today are their ability to support transactional processes.  While it would be extremely difficult, if not impossible for Dossia to support such functions as appointment scheduling, Rx refills, eVisits with one’s primary care doctor, there is one transaction area where they could excel: providing health-related financial decision support tools.  Such tools would provide support for health savings accounts, plan deductables and balances, pricing transparency for common procedures, medications, etc., special employee health discounts, and the list goes on.   There are a number of interesting apps now entering the market that provide such capabilities and Dossia would be wise to focus on these ISVs providing an added level of assistance to get them on-board quickly.

Wrap-up:

Walking into the briefing, expectations were quite low for what we might hear from Dossia. Their quiet, reclusive nature, lack of partners, and seemingly little progress being demonstrated to the market left one thinking that Dossia will fade over the next couple of years.  The briefing put many fears to rest.  Dossia is proceeding ahead at a careful measured pace and has accomplished much over the last year.  It is far too early to count them out.

But will Dossia ultimately succeed, will they be a force to be reckoned with will they become a key market influencer?

Still too early to tell.  The platform is stable, the API is there for third party ISVs and with Dossia representing over 8 million potential users (employees) this is a market nearly 3x the size of the most popular PHR today, that of Kaiser-Permanente – a very sizable and attractive market for most any ISV.  But without strong vocal support (marketing) by executives of its consortium members, Dossia will struggle to make its presence known, struggle to clearly articulate its value proposition and struggle to influence the market and subsequently drive market adoption among employers on behalf of their employees.

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top-ten-goldOne of the nice things about all the writing done over the past year is that one can go back, apply some analytics and see exactly what topics/posts were popular over the past year.

So, drumroll please…

Following are the Top Ten Posts at Chilmark Research for 2008 with brief commentary:

10) Zagat Physician Rating Goes LiveThere are now a plethora of physician rating services with this being but one example.  Unfortunately, this service is restricted to Wellpoint members.  Based on what we’ve seen from most payers in their seeming inability to truly engage consumers/members, doubt this Zagats service is getting much traction.

9) Wal-Mart EMR Mandate Implications: Wal-Mart is a massive presence in any of the markets it enters.  Their decision to chose a single EMR solution for all of their retail clinics reverberated throughout the market.  Now that Wal-Mart is rolling out the Personal Health Platform Dossia among its employees, one can expect eClinicalWorks to be closely tied to Dossia as well.

8 ) Oracle+Cerner=Opportunity: Rumors come, rumors go and some seem to take on a life of their own, resurfacing on a firly regular basis.  The rumor that Oracle will acquire Cerner does have some logic to it, but with the current financial mess, this won’t happen anytime soon.

7) Defining a Functional Model for PHRs or How Many Cooks Does it Take: This post took a critical look at the three functional models: one by HL7, another from the Robert Wood Johnson Foundation’s Project Health Design and the third from the payer organization AHIP.  We’re not too keen on any of these models as it is the market that will define a functional model that delivers value, not academics which predominate the first two groups or one from the payers, which have selfish self-interests at heart.

6) Google Health Goes Live: Post went up the day that Google formally released Google Health to the market.  A belated launch, some eight months after Microsoft released a pre-mature HealthVault.  Google Health will slightly more mature than HealthVault coming out of the gates, as seemingly stalled. See post in the Number 5 spot.

5) HealthVault Surges, Google Health Flounders: After all the anticipation for Google Health and the pending battle royale for mind-share between Microsoft and Google for the hearts and minds of health concious consumers, the battle is turning out to be boring. Google is following its common laissez faire approach to developing its service (very thin on resources being deployed) while Microsoft is investing significantly, and it shows.

4) Mobile Health on the iPhone: Since the launch of the 3G iPhone earlier this year we have seen an incredible number of health & wellness apps showing up on the AppStore, which number well over 400 today.  Recently, Apple redesigned the site to make it easier to see which apps are most popular.  Loads of opportunity remains for those that are creative as most apps are pretty simplistic.

3) eClinicalWorks Tight-lipped on the Wal-Mart Deal: This post followed on the heels of Number 9 above.  eClinicalWorks is one of the EMR darlings for smaller practices which remains a relatively untapped market.

2) Walgreen’s Ups Ante in Retail Health: In March, Walgreen’s made the dual move of acquiring both I-trax and Whole Health Management, two providers of corporate campus health clinics.  What seemed like a good move then, may now be one that they are regretting as employers continue to downsize and trim costs.  If Walgreens would have waited (and they could get the $$$ in this tight credit market) they would have been able to pick up these companies for a song today. Alas, hindsight is always 20-20.

and the Top Post in 2008 was…

1) Google’s Schmidt Outlines Health Platform: We all knew Google was going to release some form of PHR in 2008.  We even saw some early screenshots back in August of 2007 when a few presentation slides slipped into the public domain.  But after those slides, we heard nothing, saw nothing, but knew it was coming.  Thus, when Google’s CEO, Eric Schmidt took the stage as a keynote speaker at HIMSS, we waited in anticipation and Schmidt did not disappoint.

And that dear readers is what YOU, found most interesting at Chilmark Research, that is if we not include the post where we announced te release of our iPHR Market Report Executive Summary.  We were absolutely thrilled with how popular that post was (it far exceeded the number 1 post on Google above) and even more thrilled at all the people who have downloaded this Ex. Summary (nearly 400 downloads for all corners of the globe, at least all continents, withthe exception of Antactica, we’re still waiting for that one to come in.

Thank you all for visiting, reading and commenting. We value your input and hope in return, we have provided some valuable analysis on the market.

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In what seems like ages since the first announcement of the formation of Dossia, the third platform play for personal health information (the other two being Google Health and Microsoft HealthVault), Dossia has moved from a an extremely limited pilot of ~20 Wal-Mart employees (guinea pigs) to now become a part of Wal-Mart’s 2009 health benefits package for all employees. Employees will be provided a personal WebMD PHR with WebMD sitting on top of the Dossia utility data service. Wal-Mart issued a tepid PR yesterday announcing a number of health & wellnesses programs for their employees with the Dossia announcement showing up at the bottom of the list.

Dossia issued its own announcement (caution PDF), but again, thin on the details.

Today’s Health Data Management article does contain the most complete information I have found as they did talk directly to Dossia CEO, Colin Evans about the Wal-Mart roll-out.

Looking over this material, a few questions immediately come to mind:

Is the data in the PHR fully portable should I leave Wal-Mart? If yes, how would I go about exporting it to say a Google Health account?

If I leave Wal-Mart, can I still maintain my Dossia/Wal-Mart PHR? If yes, is there a cost to maintain the service?

What access will my employer have to the PHR? How is my privacy assured? What safeguards are in place?

Why only Wal-Mart, after all there are several more employers involved with Dossia? When will the other employer sponsors roll-out a Dossia/PHR service to their employees? What really puzzles me here is that Wal-Mart is rolling this out before Intel, one of the original founders (Wal-Mart came later). Intel has been a very strong and vocal proponent and actually has a number of Intel staffers on loan to Dossia, including Colin Evans. Logically, I would have predicted Intel to be the first to provide a Dossia service to their employees.

The big $100,000. question though is:

Can Dossia move fast enough to create a compelling platform that delivers sufficient value to the rest of the consortium members (and future members)?

Since its initial announcement in late 2006, it has taken Dossia nearly 2 years to get to this point and from what I have read, about the only difference between Dossia and a health plan-sponsored PHR is that with Dossia, employees get portability of their claims and medication data if they should switch heath plans. (Note: health plans claim they can now do this via the AHIP tech standards released last summer, but to date, none have actually done it.) Beyond that though, don’t see much else and this is after nearly two years of development. Granted they did have a false start with Omnimedix, but still this seems like an awfully long time to deliver such basic functionality.

Which leads to a broader question:

Will Dossia be sustainable?

Dossia was announced nearly a year before HealthVault. Back then, this was new, this was novel. Now, it looks like an also ran. With payers beginning to show a willingness to allow a member to export claims data to either HealthVault or Google Health, thereby giving them complete control over the record without potential for any employer interference, what added value does Dossia bring? Will an employee be willing to pay the small subscription fee for a PHR like CapMed, Medikeeper, Medem or NoMoreClipboard, which can be found on Google Health or HealthVault rather than going with the one their employer is offering that sits atop Dossia?

Right now, in its current version, Dossia isn’t offering much to differentiate itself in the market. That’s not to say they can’t, nor that they will not be sustainable. They have an excellent platform in Indivo Health, and they have some excellent personnel on-board, but they are going to have to hit the after-burners to be more competitive and provide a more compelling value proposition (offering/ecosystem) to their consortium members and ultimately consortium employees. If the value proposition is indeed compelling, only then will Dossia begin to create a self-sustaining, virtuous cycle that will lead to more consortium members and subsequently more software developers/vendor offerings within Dossia that further enrich the ecosystem.

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Yesterday, mega-pharmacy chain Walgreens announced that it will acquire I-trax and Whole Health Management. With this acquisition, Walgreens is moving beyond its recent venture into retail clinics in its stores, to clinics hosted on-site at major employers.

walgreens2.jpgThe adjacent figure, which I found in their investors’ presentation, makes it quite clear that Walgreens is moving beyond the pharmacy model in delivering care to the consumer and could well become a major competitor to more traditional care providers such as physician practices, hospitals, etc.

walgreens1.jpgBased on Walgreens’ numbers, it also looks like an attractive market with a lot of upside growth opportunities.

Both I-trax and Whole Health Management have created a wide range of service offerings for the delivery of care and each have an impressive list of clients (in excess of 180) that include BMW, Continental Airlines, Disney, Goldman-Sachs, Nissan and Toyota. Both acquired companies provided very similar on-site health services including primary care, pharmacies, health risk assessments, disease management and wellness coaching.  In acquiring these companies, Walgreens extends the Brand from your neighborhood to your workplace and gets a jump on both CVS and Wal-Mart, who are each still focused on in-store health service offerings.

One of the interesting aspects of the two acquired companies is that when I looked through their respective websites, I did not see any references to digital health records, in particular Personal Health Records (PHRs). Curious as many PHRs in the market today have offerings that include health risk assessments, education, disease management, in short, similar offerings, albeit via the Web, that I-trax an Whole Health are offering.  This got me to thinking about a previous post I did on whether or not WebMD was an acquisition target nd if yes, who potential suitors might be and why. I did get a harsh comment on that post, but maybe “Jake” also missed something. There are a wide range of potential suitors for WebMD, including one of these large retailers.

For example, a company like Walgreens could see a lot of upside by adding WebMD to its stable of offerings for employer clients. WebMD would bring additional employer clients, an Internet-based service that dovetails nicely with existing solutions and another vehicle for branding and marketing. Then again, a company like CVS or Wal-Mart might also benefit. So, add another one to the list of potential buyers for WebMD. Would give these three a medium-high probability of acquiring WebMD as the synergies are certainly there, particularly for Walgreens.

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Most recent post on the Wal-Mart/eClinicalWorks go to market announcement.

Just gave a call to eClinicalWorks regarding the announcement last week in the WSJ that they will be the standard EMR for all of Wal-Mart’s retail clinics. Was looking to get more background on the deal and what it might mean to eClinicalWorks going forward as follow-on to my post last week. They gave me a rather curt response stating that any such inquiries must be taken up with Wal-Mart. Appears that the leak by the WSJ was a surprise for them.

eClinicalWorks was, however, kind enough to point me in the direction of another article published in the NY Tmes last week which you will find here. Although the article does not mention eClinicalWorks, it does provide further background on their plans and relationship with Revolution Health, who will run many of the clinics through their division, RediClinics. With Revolution Health’s involvement, makes me wonder if they to will make a play to have these patients sign-up for the Revolution Health PHR (which by the way is one of the worst I’ve demo’d). One of the more interesting bits of information in this article is Wal-Mart’s finding that some 55% of visitors to these clinics do not have medical insurance.

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Wal-Mart, over the last few years has been aggressively moving into the healthcare market with one of its first big moves being the selling of some generics for $4/prescription. In an investor call last month, Wal-Mart went further hinting that it wishes to enter the pharmaceutical benefits management (PBM) market. A couple of good posts on the implications of this move can be found here, and here.

And more recently I reported the modest roll-out of the Dossia Personal Health System (PHS) among some 20 Wal-Mart employees.

Now, Wal-Mart has sent another signal to the market. It is common knowledge that Wal-Mart is establishing retail clinics in its stores. Wal-Mart is also forming partnerships with healthcare clinic operators for these in-store, retail clinics. What is new is that in this morning’s Wall Street Journal, in an ever so brief article, Wal-Mart stated that it will mandate that all retail clinics use the same electronic medical records (EMR) system from eClinicalWorks. With Wal-Mart projecting some 2,000 retail clinics by 2014, (currently according te the WSJ there are ~55 in operation) this is certainly a big win for eClinicalWorks. Hopefully, those projected new clinics won’t suffer the same fate as the 23 that recently shut-down within Wal-Mart.

But what will be even more interesting, at least from my vantage point, is to see how eClinicalWorks will inter-operate with the Dossia platform. It is virtually a foregone conclusion that these two systems will have to inter-operate at some level to serve Wal-Mart employees that are using Dossia and the convenience of Wal-Mart’s clinics.

And beyond Wal-Mart employees, might Dossia also become a platform for Wal-Mart retail clinic customers?

That is a tough question to answer for as of today, Dossia is being supported and built by a consortium of like-minded large employers that are looking to serve their employees. Beyond these employees, Dossia has made no commitments to serve the broader public, i.e., Wal-Mart’s clinic customers. This may provide an opportunity for Microsoft’s HealthVault or Google Health to enter. It will be important, therefore, to follow eClinicalWorks own PRs for any signals that may portend what PHR/PHS a Wal-Mart customer may be offered.

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