PHR: WILL CONSUMERS REALLY HAVE A CHOICE? THE NEW ENTRANTS INTO THE PERSONAL HEALTH RECORDS (PHR) MARKET MAY PROVIDE COMPETITION.

Sept. 8, 2008 | By Barbara A. Cox and Marysol Imler

Since 2004, the US has been energized in trying to develop and provide personal health records (PHR's) for all consumers. During the last 4 years, many models have emerged. Several of the models have failed for a variety of reasons, including lack of a sustainable funding model. In addition, many of the interoperable health record models have not included the involvement of the individual consumer -- the person for whom these models are intended to be used by.

Over the last year, a new type of solution provider entered the PHR market. Different than the typical vendor that has been known to service the health industry, these solution providers are vendors known for addressing the consumer market. The new entrants (Google Health, Microsoft HealthVault and Revolution Health), may provide the type of competition and consumer controlled model that will help the industry evolve at a more rapid pace than what has been happening to date. With these new vendors, will control be transferred from the care provider to the consumer as it should be if health care is going to transform?

WINDS OF CHANGE
Are these products bringing about a refreshing change to the industry? While these products are much easier to use and implement than the traditional federated or scattered model of clinical data integration that has consumed the nation over the last 4 years, they appear to be in the first generation of product releases. Hopefully, the industry will see better things to come.

Microsoft, Google and Revolution Health are intended to support the consumerism wave in giving the individual a choice about the products they choose to use and the groups or people that can view their information. For an individual to receive full value for these products, they must have interoperability with that person's care providers' clinical systems. Unfortunately, the consumer is still limited by whether or not their own personal physician groups choose to participate with these products. Physicians and hospitals around the country are making choices on which platform to align with, and it is doubtful that an organization will choose to participate with multiple platforms.

Until the platforms achieve interoperability, a consumer will not truly have choice in the matter of determining which set of products they want to use. For instance, if your physician is associated with the Cleveland Clinic, you can receive the full value of having your data transferred into Google and populated with other services participating with Google, or you can choose to populate the data manually. Then, the individual is limited by the functionality provided by Google. Should you want to use a service that is associated with Microsoft HealthVault, you will be out of luck unless you choose to manually load the data yourself, which presents another set of challenges with providers regarding the accuracy of the data.

HOW ARE THE PHR PRODUCTS DIFFERENT?
Microsoft HealthVault is truly a platform. With this solution, business partners provide the application functionality. HealthVault is the keeper of the consumer demographics information and personal profiles to establish security and user identity. The consumer then chooses to use or buy services from a number of different vendors who provide value to the individual.

Google Health has a light-weight PHR embedded with its platform. The platform also has personal demographics and a personal profile for security and personal identity. While Google also has business partners in which an individual can choose to use, there is a limited supply of PHR solutions available.

Revolution Health is a robust PHR with a lot of educational content to add value for the individual. It is positioned as a tool to help employers and their employees. However, when conducting research, it was difficult to view the data integration possibilities with providers due to technical difficulties on the Web site.

CONSUMERS AND CHOICE
What will have to happen for consumers to have choice? The vendors and the care providers must evolve to support a consumer controlled environment. Consumers need to communicate to their care providers about the tools they want to use. The care providers will set up the link in their system and automatically send the clinical, administrative and financial data to the designated choice. For a seamless transmission of data to occur in a cost effective manner, the data transmission will need to follow strict standards that every vendor will adopt. Today's standards are left to the interpretation of the organizations interacting.

When the industry agrees to adopt a consumer control approach, then consumers will have choice. Until that time, the care providers are still in the driver seat, even with the new emerging consumer platforms that Microsoft HealthVault, Google Health and Revolution Health provide.

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Read original article.
Barbara A. Cox is Senior Principal, Noblis Center for Health Innovation. Marysol Imler is a Consultant for Noblis Center for Health Innovation.

Google Health beta -- What's really new and different?

May 23, 2008 | Google Health beta -- What's really new and different?
By David Kibbe

From his role as Director of Health IT for the AAFP, co-creator of the CCR and with his involvement behind the "NDA firewall" with the Google Health team, David Kibbe probably has a better vision than most about what's new and different with Google Health. And he is indeed optimistic.

Much of the discussion about Google Health beta's recent launch as an online PHR or healthURL seems to me to miss the point about what is really new and different. Here's how I see it:

1) Computability. What Google Health does that no other platform is yet capable of doing is to make personal health data both transportable AND computable. Right now, this is the news. By supporting a subset of the Continuity of Care Record (CCR) standard for both inbound and outbound clinical messages, Google Health beta makes it possible for machines to accept, read, and interpret one's health data. It is one thing to store health data on the Web as a pdf or Word text file, for example one's immunizations or lab results, where they can be viewed. It is a giant leap forward to make the data both human and machine readable, so that they can be acted upon in some intelligent way by a remote server, kept up-to-date, and improved upon in terms of accuracy and relevance. That is what the CCR xml subset supported within Google Health beta achieves for the consumer that is really new and different; this is what HealthVault and Dossia are to date missing.

Right now, those web services are only mildly useful and sort of "toyish" -- allowing the user to create a meds calendar and get email reminders (ePillBox), or setting up preferences for health and medical news searches (MyDailyApple), or suggesting alternative medications to the ones you now take (SafeMed). But disruptive innovations are often considered simplistic and compared to toys when they first emerge (remember the first Apple computer?) and there is no stopping these developers and these partner companies from making their services more intelligent, more useful, and more convenient to the consumer. Which brings me to ....

2) Rapid design evolution. Google Health beta has established a robust and growing community of programmers and developers eager to attach their widgets, services, and full-scale apps to the Google Health beta juggernaut. Most of the public doesn't see this activity, because it is hidden behind the Google NDA that the developers have to sign, swearing themselves to secrecy about what's going on at Google Health. But it is an enthusiastic, really smart, and tirelessly innovative group of people who have been attracted to the Google Health platform. They are going to help Google's engineers rapidly evolve the design of Google Health over the next few months and years, in ways that are completely impossible to predict, depending mainly on how fast Google Health's operators are willing to move. Design creates value, and value causes infrastructure to change. Modularization of the entire EHR and PHR space may now be possible.

While I recognize that most of the commentary about Google Health beta and Microsoft HealthVault will concentrate on privacy concerns, barriers to data entry, and questions about whether mainstream health data sources will participate or not, I think the disruptive potential has already been unleashed. Watch what happens as the Google Health platform modules and component services grow and start to interact with one another. Read original article.

Google to store patients' health records

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the internet search leader. The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service, which won't be open to the general public.

Each health profile, including information about prescriptions, allergies and medical histories, will be protected by a password that's also required to use other Google services such as e-mail and personalized search tools. Google views its expansion into health records management as a logical extension because its search engine already processes millions of requests from people trying to find more information about an injury, illness or recommended treatment.

But the health venture also will provide more fodder for privacy watchdogs who believe Google already knows too much about the interests and habits of its users as its computers log their search requests and store their e-mail discussions.

Prodded by the criticism, Google last year introduced a new system that purges people's search records after 18 months. In a show of its privacy commitment, Google also successfully rebuffed the U.S. Justice Department's demand to examine millions of its users' search requests in a court battle two years ago.

Pilot project has uncertain timetableThe Mountain View-based company hasn't specified a timetable for unveiling the health service, which has been the source of much speculation for the past two years. Marissa Mayer, the Google executive overseeing the health project, has previously said the service would debut in 2008.

Contacted Wednesday, a Google spokesman declined to elaborate on its plans. The Associated Press learned about the pilot project from the Cleveland Clinic, a not-for-profit medical cente founded 87 years ago. The clinic already keeps the personal health records of more than 120,000 patients on its own online service called MyChart. Patients who transfer the information to Google would still be able to get the data quickly even if they were no longer being treated by the Cleveland Clinic.

"We believe patients should be able to easily access and manage their own health information," Mayer said in a statement supplied by the Cleveland Clinic. The Cleveland Clinic decided to work with Google "to create a more efficient and effective national health care system," said C. Martin Harris, the medical centre's chief information officer.

Google isn't the first high-tech heavyweight to set up an online filing cabinet in an effort to make it easier for people to get their medical records after they change doctors or health insurance plans.

Health services go online
Rival Microsoft Corp. last year introduced a similar service called HealthVault, and AOL co-founder Steve Case is backing Revolution Health, which also offers online tools for managing personal health histories.

The third-party services are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPPA, said Pam Dixon, executive director of the World Privacy Forum, which just issued a cautionary report on the topic.

Passed in 1996, HIPPA established strict standards that classify medical information as a privileged communication between a doctor and patient. Among other things, the law requires a doctor to notify a patient when subpoenaed for a medical record. That means a patient who agrees to transfer medical records to an external health service run by Google or Microsoft could be unwittingly making it easier for the government or some other legal adversary to obtain the information, Dixon said. If the medical records aren't protected by HIPPA, the information conceivably also could be used for marketing purposes.

Google, which runs the internet's most lucrative ad network, typically bases its marketing messages on search requests and the content on web pages and e-mail contained in its computers. It's not clear how Google intends to make money from its health service. The company sometimes introduces new products without ads just to give people more reason to visit its website, betting the increased traffic will boost its profits in the long run.

View Original CBC News Article © The Canadian Press, 2008

IT Executives Tout Technology To Transform U.S. Health Care

Representatives of three major IT firms said that consumer technologies could transform U.S. health care and its delivery, Government Health IT reports. The IT executives spoke at a National Cancer Institute-sponsored symposium, called "The Future: Consumer Health Information Technology."

Adam Bosworth, former director of Google Health, said failure to leverage IT has hampered the dissemination of medical research, stunted the growth of evidence-based medicine and focused doctors on sickness rather than keeping patients healthy.

He added that IT could have an immediate impact if the health care model was altered to give patients ownership of their medical data and allow researchers to more easily test new protocols.

Bill Crounse, Microsoft's worldwide health director, said that among advanced nations, the use of health IT in the U.S. ranks among the "worst of the worst."

The United Kingdom spends 10 times as much as the U.S. on health IT, according to Bradford Hesse, chief of the Health Communication and Informatics Research Branch at the National Cancer Institute.

Bern Shen, chief health care strategist at Intel Digital Health, predicted that technology-enabled health care could move from hospitals and medical centers to the home similar to how computing evolved from mainframes to personal computers.

All the panelists agreed that the Internet in recent years has empowered health care users (Pulley, Government Health IT, 12/11).

Doctor Google and Doctor Microsoft; if not them, who?

via HealthBlog on Aug 14, 2007

Bill Crounse, MD Worldwide Health Director Microsoft

The Internet is abuzz today following a New York Times article by Steve Lohr about Microsoft's and Google's designs to change the game in healthcare. Readers who follow this Blog will understand very well where I come down on all of this. As a country, maintaining the status quo in our broken healthcare system (which really isn't a system at all) just isn't a viable option. We spend about twice as much money per capita on health than any other nation on earth, yet the US ranks far behind other countries in many of the ways we measure the overall health status of a population.

Do I think that some kind of universal, government-run healthcare fix is the answer to all of our problems? Absolutely not! One of the things I have learned as I have traveled around the world these past few years is that providing timely, cost-effective, equitable healthcare for an entire population of people is challenging no matter what payment system is in place. Healthcare is expensive and it doesn't matter whether the payor is government (we pay), employers (we pay) or private citizens (again, we pay); many of the miracles of modern healthcare have become so expensive and so out of the reach for people of ordinary means, there's just not enough money in any system to apply them universally and equally to every citizen. Therefore, healthcare always has been and always will be rationed in some way.

So, if how we pay for healthcare has flaws no matter what system is in place, we must find better ways and better systems to deliver more affordable and accessible care. I've taken a few hits for my positive stance on retail clinics, home health, patient self-service, physician-patient e-mail, personal tele-health services, and other modalities to provide health information and medical services in ways besides those that our current "system" provides. Many of my physician colleagues are on a war path against retail clinics. They are calling every state legislator and pulling out every tool in their regulatory armamentarium in an attempt squash the movement, but they will ultimately fail.

Prohibition doesn't work. Retail clinics will thrive or falter based on the quality of services they provide and the value that their customers perceive. The whole reason this movement has gained a foothold is because medical professionals haven't been listening to their patients. Patients want healthcare to behave like other industries. It really doesn't matter who's paying the bill. We are all paying the bill, and we expect more than we have been getting considering how BIG that bill has become.

Doing something about this will take more than coming up with new ways to pay for healthcare as it is presently delivered. We need new care delivery models, staffing models, business models, and a bevy of contemporary information and communication technologies to truly revolutionize American medicine. Neither Google, nor Microsoft nor any of the other companies mentioned in Lohr's article can be your doctor, nor should they be. But these companies can and should help us with the technologies that will be needed to change the game. If not Microsoft or Google, then who?

Google's Personal Health Record Initiative

The social-networking revolution is coming to health care, at the same time that new Internet technologies and software programs are making it easier than ever for consumers to find timely, personalized health information online. Patients who once connected mainly through email discussion groups and chat rooms are building more sophisticated virtual communities that enable them to share information about treatment and coping and build a personal network of friends. At the same time, traditional Web sites that once offered cumbersome pages of static data are developing blogs, podcasts, and customized search engines to deliver the most relevant and timely information on health topics.

Google Health, codename “Weaver”, is Google’s planned personal health information storage program. Google’s Vice President of Engineering Adam Bosworth lobbies for the program for quite a while now. Adam said the current US health care system is challenged when it comes to “supporting caregivers and communicating between different medical organizations.” Adam went on to say that people “need the medical information that is out there and available to be organized and made accessible to all ... Health information should be easier to access and organize, especially in ways that make it as simple as possible to find the information that is most relevant to a specific patient’s needs.” Adam adds that this – making information accessible – happens to be along Google’s mission.

The New York Times today writes that “about 20 percent of the [US] patient population have computerized records – rather than paper ones – and the Bush administration has pushed the health care industry to speed up the switch to electronic formats. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.” But, the NYT continues, initiatives like the one by Google “would give much more control to individuals, a trend many health experts see as inevitable.” A prototype of Google Health has now been shown “to health professionals and advisers,” the NYT reports.

To find out just what you might be able to see in a future Google Health service, take a look at these screenshots from Google’s prototype which have been sent in here. As prototypes go, certain approaches of the program may change, and the specific interface may or may not be kept like this in a final release. “We’ll make mistakes and it will be a long-range march,” the NYT quotes Adam Bosworth.

To see more Screenshots of Google's new Personal Health record initiative, please visit http://blogoscoped.com/archive/2007-08-14-n43.html

For more information, please visit http://blogs.zdnet.com/Google/?p=135