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.

Online Health Info System Is Unveiled by Microsoft: Privacy and Security top list of concerns.

Microsoft Corporation has released a new software product and free Web-based platform that allows individuals to collect, store, and share their electronic medical records. HealthVault is intended to allow people to access their medical records through any device, regardless of the health care provider or insurer. Microsoft has also developed HealthVault Search, a new Internet search engine that helps people find answers to health questions, learn more about topics important to them, confidentially store information they discover, and act on that knowledge to improve their health and wellness.
HealthVault Search also intuitively organizes relevant online health content, allowing people to refine Internet searches to more efficiently find information.

Empowers Consumers
Experts say technology can play a key role in helping solve the problem of "health care fragmentation," the dividing up of a single patient's providers and records between several organizations and locations, and can empower consumers by giving them more control over, and information about, their health care.

"A system like HealthVault can help put patients in control of their own health care by putting information and access directly in their hands, instead of forcing them to go through various intermediaries," said Jeff Emanuel, research fellow for health care policy at The Heartland Institute and managing editor of Health Care News.

"A functional market must be based on empowerment of the consumer, and the health care market is no different," Emanuel said. "Telemedicine and health care technology allow consumers to control their own treatment and records, thereby giving them a stronger hand in their care."

Security Measures
While developing HealthVault, Microsoft consulted privacy advocates, such as the Coalition for Patient Privacy, along with online security experts. HealthVault keeps a log of each time a record is written, changed, or read, which means users can view an audit trail in their personal HealthVault account at any time. Microsoft's HealthVault systems and databases are safeguarded with extra precautions, such as isolating data center traffic on a virtually separate network, and keeping servers in physically separate, locked cabinets. All data traffic to and from HealthVault and its solution providers is encrypted. The system's backup data are also encrypted, and its transportation is logged every time a record is accessed, uploaded, or downloaded.

Privacy Concerns
Not everybody feels confident about Microsoft's ability--or intent--to protect patient privacy. Some analysts point to the system's privacy policy as a sign it is still vulnerable to the targeted disclosure of private information. The policy says, in part:"Microsoft may access and/or disclose your personal information if we believe such action is necessary to: (a) comply with the law or legal process served on Microsoft; (b) protect and defend the rights or property of Microsoft (including the enforcement of our agreements); or (c) act in urgent circumstances to protect the personal safety and welfare of users of Microsoft services or members of the public" (emphasis added).
"Privacy concerns are consistently shown to be one of the public's biggest worries as health care moves toward a digital future," said Emanuel. "Microsoft's reservation of the right to disclose personal medical information if company officers see such a disclosure as being in the company's best interest is worrisome.

"Security of information should be a primary focus in technological endeavors such as these," Emanuel continued. "Despite the best of intentions, lapses in security can occur, and information can be inadvertently released. Purposely disclosing personal health information is far worse than that.
"Regardless of the reasons for disclosure, the results of such a violation of privacy can be devastating," Emanuel said.

Published In: Health Care News | June 1, 2008 | The Heartland Institute

Microsoft launched the beta version of HealthVault in October 2007. The site was officially launched this February, and in April it was opened up for wider use. Click here to learn how Microsoft® HealthVault™ helps Physicians and hospitals better connect with patients.

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).

What the @#$% is an Azyxxi?

There’s been a lot of scuttlebut around Microsoft's acquisition of a technology (and company) known as Azyxxi from MedStar Health in Washington, D.C. To clarify, Azyxxi (according to their website) is "a unified health enterprise platform that helps improve cross-organizational access and insight to clinical, administrative, and financial data."

What Pain Points Azyxxi will address in Healthcare IT?
o Improvements are needed in clinical information acquisition, storage, retrieval, sharing, and presentation—an important goal in any health care strategy.
o As we move toward the future, an important first step is simply to get all existing data into the hands of clinicians and other health care professionals.
o In today's hospital enterprise, already-existing information may not readily be available when and where it is needed.
o Best-of-breed systems lack integration, creating an environment in which information is hard to access and harder to aggregate for optimal value.
o Clinicians and administrators need access to data that enables the most informed decisions around patient care and operational performance.

The Microsoft Azyxxi solution
Health care professionals could benefit from the ability to quickly pull this data into a consolidated and customized view, to help enable informed decisions and peak performance. Azyxxi focuses on improving clinical information acquisition, storage, retrieval, sharing, and presentation. Azyxxi sits across most current best-of-breed systems in the hospital. It aggregates patient data so that clinicians can get an instant picture of the data in the hospital's systems. There's no waiting for archived information. Azyxxi aggregates relevant data for one, nearly instantaneous, view. Healthcare workers can maximize the value of information to help make the most informed decisions. Informed decisions can help save your business money and—most importantly—help save patient lives.

Architecture
A hospital or health system typically has a configuration of best-of-breed IT systems that operate independently of each other. One system controls imaging, another manages emergency room systems, yet another addresses operating room management and the list goes on. Azyxxi sits across most current best-of-breed systems in the hospital and aggregates patient data so that clinicians can get an instant picture of the data in the hospital's systems at any time. The information is viewed and analyzed according to the individual needs of the user. Azyxxi customizes the results to help enable the most informed decisions and best patient care.

Existing IT State
You have hard-working, disparate information systems that cannot coordinate to feed you an integrated view of results. This results in frustrated clinicians and administrators who may not have access to all the data they need. Traditional enterprise-wide health IT systems have evolved from transactional systems. In these systems data is organized and locked in strings that have been created to resolve a specific transaction request. System requests are slowed down by the inability to search on individual data components, as the search request must move through all the transaction codes in the system to identify the relevant data pieces—an inefficient process in a business that may depend on timely decisions to help save patient lives.

Why Microsoft Azyxxi is different?
It's seemingly built on a federated-database model similar to MEDSEEK. Your clinicians and administrators need integrated and customized views and analysis of clinical, financial and administrative data. Azyxxi was developed as a solution to data storage and search issues, integrating across multiple best-of-breed health IT systems. It does not replace them.

Results for your health organization
Data is divided into multiple components, clearly identifiable within each transaction. This means the data can be re-organized into multiple buckets to answer a wide variety of queries. Search is fast because it does not require scrolling through thousands of transactions to source the data. Detailed queries and analysis become easier the more you use Azyxxi, as you increase your potential to leverage existing criteria sets and views.

Azyxxi's flexible federated architecture means that it can be customized any number of ways, depending on the user's needs. Much like competitor Medseek's "eConnect" platform, views and workflows can be optimized over time as workflows evolve, making it increasingly valuable the more that it is used. For more information on Microsofts Azyxxi solution, please visit:http://www.azyxxi.com

Age and culture as impediments to the adoption of healthcare IT

by Bill Crounse, MD | Worldwide Health Director, Microsoft

A friend sent me a link to an article written for SearchCIO.com by senior editor, Kate Evans-Corriea. Ms. Evans-Corriea's article entitled "Age Does Matter" reflects on what she says was a common theme at Gartner's recent Symposium ITxpo. That theme is perhaps best captured in a quote from Gartner analyst, Tom Bittman, who says, "It's not the technology; It's not the process that's holding us back. It's the culture".

As I read the article, I couldn't help but think about a conversation I had just had with a colleague who currently serves as a hospital CIO. He expressed to me his total frustration with hospital culture and healthcare providers. In fact, he is so frustrated that after ten years on the job he is looking for another position; this time likely in another industry.

His hospital had recently purchased a very advanced surgical management system that included anesthesia scheduling and work-flow automation. The anesthesiologists at first welcomed these new tools, although one of the docs had initially pushed back because he had designed his own solution that he thought was a lot better than the vendor solution selected by the hospital. Even so, after a few weeks using the new system, several of the older and most influential members of the anesthesia group simply proclaimed that they didn’t like what the hospital had purchased and would be going back to using their old paper processes. And, as my colleague noted, "that was that".

A similar scenario had recently played out in the radiology department. The mammography unit was asked to start using the hospital's digital PACS system. They prepared the docs for the fact that their productivity could initially fall by as much as 30 percent until they got used to the new tools and work-flow. The docs agreed to give it a try, but as soon as their productivity actually did take a nose-dive, they rebelled and refused to use the new system. I know what you may be thinking. Screw the doctors! Tell them they have no choice but to use the new systems. As a doctor and a former hospital VP/CIO and CMIO, I know it's not that easy. Those doctors are the life blood of the hospital. It took years to recruit the physicians who run the mammography unit. And the anesthesiologists? They along with their powerful surgeon allies are responsible for most of the hospital’s profit margin.

The CIO also told me about his hospital's struggle to implement an electronic charting system in nursing. He said the VP of Nursing gives the initiative good lip service, but her first in command is a 50 year old nurse who has never worked anywhere else, and there’s a lot of passive-aggressive behavior going on in the rank and file. Since the nurses are all employees, you might think administrators could just lay down the law and mandate the use of the nursing documentation system. But you would be naïve to think that. The average age of nurses working at the hospital, especially as managers and unit leads, is 50-plus. There’s a huge nursing shortage with lots of vacancies in posted positions. They have a powerful union. It’s hard to tell them what to do.

I share this because it is so typical of the culture in healthcare, and not only here in America. It speaks volumes on the issue that Gartner is drawing to our attention; it isn’t so much about the technology as it is about the culture, and the need for more carefully orchestrated change management. Of course some of these hassles will resolve as the “dinosaurs” retire. But based on what Gartner is saying the age and culture issue won't go away. Instead of “why must I use this computer instead of my paper” the argument will become “why must I use this (fill in the blank) instead of my computer"?

Posted by Bill Crounse, MD | Worldwide Health Director, Microsoft
http://on10.net/Blogs/bcrounse/age-and-culture-as-impediments-to-the-adoption-of-healthcare-it/

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?