I didn't get around to writing about this at the time, but a couple weeks ago I read in eWeek about how Microsoft Explains [its] HealthVault Strategy. There are a couple of analogies I wouldn't have made myself: MS compares HealthVault to XBox and PayPal.
The goal was to provide ways for consumers to better understand their health and health information and manage that information for themselves.
Conn [Grad Conn, Healthcare and Life Sciences senior director for global consumer strategy] explained that with consumers as the aggregators and the controllers of to whom, how and when their information can be shared, the traditional health information model is turned on its head.
"Right now, the mechanism for this is through HIPAA, which dictates how to control patient privacy when patients don't control the records," Conn said. HIPAA, he said, has very clear rules that patients can request to see, copy, add to or delete any piece of health information in their record, and HealthVault uses those same procedures, but in a digital format.
So far so good. This (when properly implemented, whether by Microsoft, Google, or some other "fourth party") will accomplish in nimble form what is already one of the clumsiest and least effective of the HIPAA provisions, the portability requirements. Your health records are indeed available to you as a patient, but the care provider has the option of charging you for the cost of making a copy, and in virtually all cases will only supply the records in hard-copy format, even when an underlying EMR or EHR is in use.
Now, on to the first of the startling analogies:
"HealthVault seeks to integrate the data for an individual and provides them control over that record," Conn said. That focus on consumer control makes the HealthVault platform very similar to PayPal, the ubiquitous online payment platform, he said.
"HealthVault is PayPal for health information. PayPal allows you to store and share your financial information, if you choose to, and HealthVault works the same way," Conn said. However, he stressed that, with PayPal, users share only the pieces of their financial life that they are comfortable making available to e-commerce sites. HealthVault users are in complete control of information sharing, as well, Conn said.
OK, I guess there's a parallel here.What I think is different (or at least I hope it's different): PayPal doesn't care where the money you transfer into it originally came from or how it was obtained, but I would want to have the full provenance chain for any piece of health information stored in HealthVault.
How does the XBox analogy come into the picture?
He [Conn] said that some health care industry groups have expressed concerns that, with these forays into the enterprise and consumer health and life sciences market, Microsoft is trying to dominate the industry and siphon customers.
To counter that assertion, Conn said Microsoft was simply trying to provide a platform on top of which industry organizations and companies can develop health and life sciences technology applications and services for consumers. Conn offered Microsoft's Xbox gaming platform as an example.
"In 1999 we didn’t know anything about making games, but we knew how to make development platforms and consoles," Conn said. Microsoft then encouraged software and game developers to create games and applications that ran on the Xbox platform. By 2001, Conn said, Microsoft had a number of games to run on that platform.
HealthVault, he said, is in the same place that Xbox was in 1999. "We don't know anything about cardiology, or cancer treatment or managing diseases. But we're pretty good at storing data and making and connecting applications," Conn said.
In 1999 MS didn't know anything about games, and if indeed they knew anything about making consoles, the burden of proof lies with Mr. Conn: I seem to recall the initial XBox release was not well received by the gaming community.
That said, Microsoft's approach to new markets does generally apply. Their initial release will be a bit on the rough and clunky side. The next will be better. The third will be quite nice, and by the time they get to version 10 or 11, it will be a superbly addictive product, as happened with the MS Office suite.
Meanwhile, my fond hope is that HealthVault and Google Health will be the enablers of an EHR informatics platform that will be within the reach of the vast numbers of small private practices and rural clinics, sites with 1 to 5 practitioners. The core EHR will be free, and the snap-on tools will be cheap or free. We've a ways to go toward that milestone point, but we're unlikely to get there sooner by any other route, given the fragmented, silo-centric market for small-scale EHR/EMR systems. If anything will make this process come round right, it will be stiff competition between Google Health and HealthVault. If Yahoo! or AOL want to join in, so much the better. The key driver will be the interaction between players with deep pockets and free-to-the-user business models.