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Health gets personal in the cloud

Google Health Beta and Microsoft's My Health Info

Healthcare is one of the biggest industries in the world. The United States spends over 17% of its GDP on healthcare and the issue of the industry’s future is being hotly debated in Congress. Whatever happens to other elements of health reform, health information technology will play a key role in moving us towards the goal of bending the cost curve and improving quality and clinical outcomes. A Personal Health Record (PHR) is one way that patients can have some control of their own health data, while providing an interoperable platform for sharing relevant clinical data between providers. Healthcare is changing rapidly and there are some important trends worth watching.

Healthcare in the near future will be quite different than it is today. Web enabled technology is already changing the way medicine is practiced. As the digital nation comes of age we will see new opportunities, and new challenges, bringing healthcare in America into the 21st century. Health consumers will come to expect they will have control over their own health data. Having secure, interoperable access to clinical data will allow patients to partner with their care providers in new ways incorporating Web 2.0 principles.

For example, Google announced at the Health 2.0 conference that they have entered into a partnership to provide telehealth services through their Google Health platform using MDLiveCare. With the integration of MDLiveCare technology, Google can provide a service that offers patients access to doctors from remote locations, via webcam or telephone, into its personal health record offering. This will be particularly valuable for those who are caring for their loved ones from far away. My family is scattered around the country and caring for our mother with advanced stage Alzheimer’s was quite a challenge that would have benefited from this type of service.
Here is a screenshot of Google Health:
google-health.jpg

“Patients remember less than 25% of what they’re told when they consult with a doctor,” said Bob Smoley, CEO, MDLiveCare, in the statement. “By directly synchronizing the information that’s shared…we’re able to provide patients with a convenient solution to review their physician or therapist encounters.”

“We strongly believe that the patient has the right to control their own health data,” said Product Manager of Google Health Roni Zeiger, MD a practicing Internist who also works in urgent care. “You can now request an online consultation with a physician. At the end of the visit the doctor documents the encounter and it is immediately sent to your Google Health account and you will have a complete record of the doctor’s notes.”

Also, Microsoft has introduced My Health Info as part of HealthVault. My Health Info is an interactive and customizable dashboard that allows people to view all their health information: Blood pressure, blood glucose, BMI, immunizations, allergies, lab results, medications, steps walked, health articles and more, in a single, organized, and convenient location. It connects with HealthVault so information updated in one product is automatically updated in the other. This service offers tools and widgets to upload, organize and monitor health information stored in their personal HealthVault accounts. The service also allows people to research medical concerns, read the latest health news, gain guidance from medical experts, learn about nutrition, and monitor conditions such as high blood pressure or diabetes.

This is the main screen for My Health Info:
myhealthinfograb.JPG
“As consumers are increasingly being asked to manage more of their health and wellness, they are looking for solutions that help them navigate an overwhelming amount of information, enabling them to take control of their personal health data,” said David Cerino, General Manager of Consumer Health in Microsoft Health Solutions Group. Marguerite Yeo, Director of Product Marketing for Microsoft HealthVault told me about Online Care deployed by Hawaii Medical Service Association (HMSA) an independent licensee of the Blue Cross and Blue Shield Association. Online Care, enhanced by Microsoft Healthvault, allows patients to see physicians immediately, through live consultations via Web or phone. By providing access to doctors anytime in the patient‘s home, health plans like HMSA have the opportunity to shift healthcare to less expensive care settings when appropriate.

Another company that is doing some interesting work in this area is Practice Fusion. Practice Fusion is a free, Web-based electronic health record service for physicians. They recently announced the launch of Patient Fusion, their new PHR, at Dreamforce 2009 in San Francisco, salesforce.com’s user and developer conference.

“The healthcare and life sciences community is a rapidly growing sector,” said Clarence So, Senior Vice President of Strategy, salesforce.com. “The Force.com platform allows companies like Practice Fusion to quickly innovate around a common objective for improving health.” Through Patient Fusion, doctors grant patients instant access to their medical records, medications and immunization history. Updates to the patient’s records are available in real-time in the cloud. Patients will also be able to schedule appointments, request prescription refills, email their physicians, and, most importantly, share their data with other providers at any time.

Here is a shot of the main Health Manager screen:
Thumbnail image for myhealth_screenGrab.png

They also announced ChartShare, a feature which allows users to have real-time access to patient records in a familiar and interactive format. All authorized users can access records simultaneously. This enables care providers to share clinical data and allows real time collaboration and consultation.

“Practice Fusion continues to innovate in the healthcare market by offering a free Web-based PHR that is an extension of the practitioners’ EHR. We’re unlocking the physician EHR to give patients access and control over their own health data,” said Ryan Howard, the CEO of Practice Fusion. He also told me, “The January release of Patient Fusion will allow the same ability that physicians now have using ChartShare for portability of data on the patient side.”

Whether it is by using a platform like Microsoft HealthVault or Google Health, or a SaaS model EMR/PHR like Practice Fusion, the options for patients and providers to coordinate care using Web 2.0 technology is making great strides. We will increasingly see platforms that provide virtual visits with care providers, and greater use of the web for tasks like making appointments, medication and therapy reminders, and making payments. I look forward to the day when I can login for a consultation with my doctor as easily as I Skype with my friends around the world. The future of healthcare is here, and it is beginning to be distributed.

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  • http://www.mdlivecare.com Bob Smoley

    Brian, you are right on target. At MDLiveCare, not only do we treat physical health, we have an extensive network of licensed therapists to treat all sorts of behavioral health issues from the comfort and privacy of one’s own home. By partnering with Google Health, patients can now view all of their live consult information from their Google Health account. The immediate benefit will be a significant increase in treatment and medication compliance which will significantly reduce excessive healthcare costs.

    We are committed to providing convenient and affordable healthcare.

  • http://ahier.net Brian Ahier

    Robert Rowley, MD wrote an interesting piece in The Healthcare Blog: “Is ‘Cloud Computing’ Right for Health IT?” which brought up issues of security and safety with health data being stored in the cloud.

    However, there may be some that think storing health data in the cloud is actually less secure…

  • http://www.patientprivacyrights.org/site/News2?page=NewsArticle&id=7607 It is the patients data

    “Practice Fusion subsidizes its free EMRs by selling de-identified data to insurance groups, clinical researchers and pharmaceutical companies and by placing medically relevant ads within the EMRs, Howard said.”

    This is hardly the model most consumer and privacy experts support. Is this article part of their social media strategy?

  • David

    You’ll see excitement of health insurance companies for electronic health records disappear if they are forced to stop denying coverage for pre-existing conditions. The only reason they are excited about electronic health records is so they can deny coverage more effectively…

  • Katie Roda

    The healthcare landscape is definitely changing & the insurance companies are going to have to change with it rather than resist. I disagree with other comments that the goal of payors is to just use EMRs to deny care. Many savvy payors are fully engaged in the online health record space. I anticipate that those who succeed in the payor space will be those who embrace these technologies & see the opportunity to drive down costs through serving patients that are more engaged in their care. Interesting read!

  • http://e-patients.net e-Patient Dave

    I’m disturbed by the insane, paranoid assertions people someone seems to make every time someone does anything new in healthcare. I know there are abuses but far more important to me is that the effing system isn’t getting the job done, pardon my French. The ship is sinking, and people are DYING for lack of care. We will be paralyzed to the bottom of the ocean if we block every attempt to change anything because of money and privacy fears.

    I’m no fool about this – almost two years ago I wrote the totally skeptical What’s next, Google Health? about privacy concerns, ulterior motives, etc. But a year later I wrote I’m putting my data in Google Health. Why? Because after my first year of studying healthcare, I concluded that the system is incredibly impacted and intractible, and the door is wide open for disruptive alternatives: people from OUTSIDE the impacted system, to walk in and demonstrate how wrong the establishment is when it whines “We CAAAAN’T do better. Healthcare is too HAAAAARD.”

    Well, watch. There’s a great big swarm of bumblebees headed this way. You know, bumblebees – the things that don’t know it’s impossible to do what they do.

    Except really, this is not complex: the WHOLE problem is that healthcare is a full twenty years behind the rest of technology. Look, just today in FierceEMR, they asked “What would you do if an EMR went down?” Pardon me, but what a bizarre question to ask in 2009: airline reservation systems solved this at least ten years ago (they USED to go down – now they don’t), and the same has happened in other industries.

    In that article, it was a broader issue of all power going out – the EMR went out, including, I presume, all lights and machines. Yikes. Glad they had a paper backup plan.

    But aside from total power outages (INCLUDING their backup generators – like a nuclear catastrophe -)

    At the TEPR+ conference in Palm Springs in February, one speaker the first morning was an executive of the AMA. He told a horror story of how his own EMR database was lost, and his SQL Server guy couldn’t get the data back. He was followed on stage by Adam Bosworth, founder of Keas, co-inventor of XML, father of Microsoft Access, etc. Adam said “Haven’t you heard of cloud computing? I run my whole company in the cloud. We don’t OWN a server, and we don’t do backups. The cloud company does the backups.”

    Salesforce.com has 16 server centers around the world, and publishes its uptime statistics. Their ENTIRE business depends on being absolutely failsafe reliable. The chart at http://trust.salesforce.com/trust/status/ shows, for instance, that server EU0 had a slowdown (not outage) on 11/12, from 6:05pm to 6:19pm. On 11/11, server NA6 had degradation for 3 hours. Compare that with the AMA guy, whose clinical data was lost for 6 weeks (took $17k to get it back) and whose billing data was NEVER recovered.

    I wouldn’t run an ICU on cloud computing, because sometimes the internet gets slow. But ordinary everyday business operations, you betcha.

    The other thing I took away from TEPR+ is that clinicians largely HATE how existing EMR systems work. People from outside healthcare largely don’t know how to build a stupid, hard to use system, because in other industries you can’t sell stuff like that.

    At the PHAT conference Monday at the Harvard School of Public Health I said “There’s a SCUD missile headed for this room, and nobody knows it.” It’s plain old ordinary modern computing, invading healthcare.

  • Adam

    I’m getting my parents plugged into Google Health (and eventually myself).

    I worried about the privacy issues and then I thought about it.

    The concept of “privacy” is particularly laughable in the Healthcare realm.

    Without real access to your records, YOU don’t know your own medical information. All the clerks, insurance companies, technicians, doctors and nurses that even see you for 3 minutes know it.

    How can something be private when everyone except you knows the information?

    At least with something like the Google Health I’ll know what it is all these folks are looking at :)

  • Garrett

    Adam,

    I never thought of it like that, but that’s really a good point.

    I for one welcome our Google overlords. Honestly, if Google is Skynet, I almost wouldn’t mind because it’s just that freaking cool.

  • http://ahier.net Brian Ahier

    I understand the concern about selling de-identified data. Data that is de-identified can often be re-identified and used for marketing or even more nefarious purposes.
    Datamining companies, such as IMS Health and Verispan, will often purchase and collect doctors’, dentists’, and nurse practitioners’ prescription information, or prescriber-identifiable data in order to sell to research institutions, private companies, or pharmaceutical companies. Using a process called detailing, they analyze the data to identify trends enabling them to tailor their marketing of prescription drugs to individual prescribers. In an effort to protect the privacy of prescription information, several states have enacted statutes that limit pharmaceutical datamining activities and provide prescribers and consumers with more control over their prescription information.
    One method of protecting an individual’s identity often employed by companies is the redaction of social security numbers (SSNs), either in whole or in part. Social security numbers are considered personally identifiable information (PII) and are one of the most highly sought after sensitive pieces of individualized data by identity thieves. Although consumers may believe that redaction of SSN is an adequate privacy measure, it has been shown that it is possible to predict social security numbers.
    In their 2009 study, Carnegie Mellon professors Alessandro Acquisti and Ralph Gross demonstrate through a two-step process how SSN is easily predicted by knowing an individual’s birth date and geographic location. First, the researchers analyzed public records in the Social Security Administration’s Death Master File (DMF) to examine statistical trends in the assignment of SSN for those whose deaths were reported to the Social Security Administration. Second, combining these patterns derived from DMF analysis with an alive individual’s state and birth date (which can be found on various offline sources, such as voter registration lists, or online sources, such as social networking sites), Acquisti and Gross identified the first 5 digits for 44% of DMF records from 1989 to 2003 and complete SSNs in less than 1000 attempts for 8.5% of the records. Acquisti and Gross found a strong correlation between birth date and all nine digits of an SSN, a correlation that increases for individuals in less populous states. These results have important consequences for the living population in the United States, as they imply that millions of SSNs for individuals whose birthdates are known can be identified.
    I have actually received direct mail marketing for pharmaceutical products and I zealously protect my health information. I am concerned that that re-identification of anonymized personal data is not only possible, but a common marketing practice. I suggest everyone join the efforts of HealthDataRights.org and join in the efforts to give consumers control over their own health data.

  • http://notmysecondopinion.blogspot.com Clinton

    I am a med student in Hawaii and a physician I work with had this to say about “Online Care” run by HMSA:

    “How will a physician get coverage if something goes wrong? No one, not even HMSA is offering malpractice insurance to cover Online Care.”

    The worry is that doctors who perform medicine without directly interacting with the patient may miss something incidentally that may lead to a bad outcome. Given a long enough period of time, a BAD OUTCOME is a reality… and a potential lawsuit is a risk that a physician has to take.

    In the brave, exciting new frontier for medicine (Online!) lurks those who would exploit the system. Hackers, lawyers, pharmaceutical companies come to mind. Patients, docs and nurses may not be familiar with the system enough to protect themselves!

  • http://healthcareitstrategy.com Paul Roemer Healthcare IT Strategy

    Brian, you continue to pick interesting issues. My take on this is probably far-afield from the mainstream. I think the Dark-Side, firms like Google, Microsoft, and Oracle look at the confusion and lack of planning in terms of what the final EHR/PHR platform will look like and they simply drool.

    With hundreds of EHR vendors and RHIOs and RECs and standards groups all operating independently, all aiming at an undefined target, which group is best positioned to solve this platform problem, the Dark Side, or the Blind Side?

    The Dark Side’s plans are underway and visible through their PHRs. Like the tip of an iceberg, I bet that most of what they are doing to own this space is presently unseen. Practice Fusion, if their product attacks enough customers will be devoured, or they will be ignored.

    RECs, RHIOs, Meaningful Use, Certification, a lack of standards, and no network are large red flags from the government saying “we don’t know where we’re going, but we’re making real good time.”

    The Dark Side knows exactly where they’re going. They don’t need a network; they have one. The Internet. There are those who argue HIPAA and security. HIPAA and security can be more readily handled on a network that’s been up and running for twenty years and was built by the military than they would be under anything developed off the cuff under Washington’s leadership.

    Now for the Deathstar issue–ownership of the data. The question is are ownership and possession one in the same? I bet they will not be. I’d also bet that five years from now somehow that Dark Side will have at least access to it.

    I can’t prove any of this, but I’d love to sit in on the strategic planning committees of the Dark Side. I bet some or all of this is underway. The Blind Side may be blind-sided.

  • Ryan

    Apart from the three players mentioned here, there are some more players in this field. There are more than 20 providers currently offering PHRs and then you don’t know how many companies are getting ready to release their own PHR. It seems every company in the healthcare industry wants to be ‘in’. There must be some standards and interoperability among these providers so patients can takes their data from one vendor to another

    If you scroll down to the bottom on this page, you will see the list:
    http://www.phrreviews.com/

  • http://healthcareitstrategy.com Paul Roemer

    Here are a few more thoughts just to Emerilize the discussion—to kick it up a notch. Not only do I think the national EHR market is ripe for the taking by a big three like Microsoft, Google, and Oracle, I’ll go so far to suggest that when the dust settles in 5-7 years, the N-HIN, the National Health Information Network, will be a regulated combination of a handful of those firms.

    As for the other firms offering or planning to offer PHRs, permit me to suggest the following scenario. Let’s say I am in charge of Google’s so far somewhat nonexistent healthcare line of business. One of my goals would be to have more users of my PHR than any other firm.

    Why does this model make sense? Two ways, both of which come from the cable/telco business model. Rule number one, content is king. In cable, it is shows like HBO and Discovery. In healthcare it is data; patient data, effectiveness data, disease data.

    Reason number two, the cable/telco model values the businesses based on the number of assets. What are the assets? Subscribers. You and me. Each body adds somewhere between five and ten thousand dollars to the valuation model of a Comcast or Verizon. Downstream, some valuation will be placed on each PHR subscriber.

    So, back to the example of me running Google’s healthcare offering—if you don’t like Google as an example, insert your favorite firm. If I’m Google, am I troubled by the fact that other firms are building their own solutions? No, and here’s why. The difficult part of the business model is adding users, adding subscribers. Why not let a bunch of firms do the business development work for me, do the dirty work to get the users, and then just devour those firms? Once I own them, I convert them to my platform. Do I then get some ‘ownership’ or right to use the data? That would certainly be the business goal.

    One million users valued at five thousand dollars adds five billion in valuation. Ten million adds fifty billion. Ten billion is about 2.5% of the US market. Do I stop at the border? Of course not.

    By the way, while all this is going on, Google, MS, or whoever will also be creating standards and be building or buying up EHR firms.

  • http://www.vacationsong.net/ Ajeet

    The problem with cross border tele medicine is that it does not address issues related to medical jurisprudence and malpractice. Unless these issues are addressed, such initiatives are just going to help out as a fringe service.

  • Brian Ahier

    Does the Surgeon General and HHS partnering with Microsoft HealthVault spell the beginning of the end of Google Health?

    http://fcw.com/articles/2010/02/25/surgeon-general-microsoft-healthvault.aspx