The Health Guide is a single purpose platform to facilitate telehealth by collecting data from devices (heart rate, weight, glucose, etc.) and securely transmitting the data for remote monitoring by a clinician or other caregiver. Intel also states that the Health Guide will also enable secure email communication and delivery of health-related content to the end user (consumer). This is the second product to come out of Intel's Digital Health Group, the first being a clinician-centric, mobile computing platform, the MCA.

The release of Health Guide follows last month's announcement by Intel of the social caregiver's website, ConnectingforCare, which was formed in partnership with the National Family Caregivers Association. This site is still very immature and lacking critical content thus begging the question - Do we really need another social community website such as this when we are already inundated with numerous, healthcare centric social sites?

Reading through some of Intel's documents (caution PDFs) on their health care evolution and design philosophy, it is clear that Intel has every intention to move from a passive player in the market, supplying microprocessors (chips) to any and all takers, to becoming a direct developer, marketer and seller of devices such as the Health Guide. Intel sees a huge opportunity in the telehealth market to serve an aging baby boomer population that will increasingly use technologies such as this to manage their health, in conjunction with their physician, from the comfort of their home.

Savvy move on Intel's part as there is indeed a significant opportunity and I see no single dominant player in the market today. Sure, Philips is there as well as Omron and Panasonic, along with GE giving it a close look but no one has taken a commanding lead. Thus, there are no formidable barriers to a new entrant such as Intel. It is still a wide open market.

But in reading the announcement I am struck by the lack of reference on Intel's part as to how the Health Guide fits into the broader context of care and in particular, electronic records, be they PHR, EMR or EHR. No reference whatsoever on this front which has me quite puzzled as Intel is a key partner in the Personal Health System (PHS) Dossia, which Colin Evans, formerly of Intel, is now leading. This raises a number of questions:

• How will the Health Guide fit into a consumer's existing PHR such as one from RelayHealth which already has secure physician-consumer communication embedded in the PHR?
• Similarly, how will Health Guide interface to a solution like ICW's LifeSensor PHR that has a significant number of interfaces to existing biometric devices?
  
• How might Health Guide integrate into a clinician's existing workflow and EMR solution and if the clinician offers a patient portal, will Health Guide automatically populate the patient portal with biometric data and any communications that occur electronically?
• What might be the connection between the Health Guide and a PHS. For example, Microsoft's HealthVault is in many ways similar to Health Guide (at least from a software perspective) in that it offers secure communication of biometric data to a secure server for storage and retrieval? Are these competing solutions or complimentary?

In making the announcement of FDA approval, Intel also stated that the product would not be released to market until late this year or early next. That should give Intel enough time to further clarify the positioning of Health Guide and address the questions above. Otherwise, despite all the bells & whistles, Health Guide will struggle.

For a more positive spin on the Health Guide, here's a brief interview with the Health Group WW Director of Marketing and Sales.

There are some changes taking place, however, that may start showing physicians the money and encourage EMR adoption.

First is the move to electronic prescriptions (eRx). I'm still not sure what value an eRx is to a small physician practice versus a standard paper script. Maybe some savings in workflow, certainly some time savings in eligibility checking, but nothing substantial, particularly for a small physician practice. Where physicians may benefit is when insurers, such as CMS start demanding eRx, or at least provide some type of incentive that encourages its use. CMS was heading down that road by proposing the elimination of prescription faxes in 2009, but after an uproar, has pulled back from that position. In time, eRx will have a modest impact on HIT adoption. (Note: The recent proposal by the DEA to allow the use of eRx for controlled substances removes one of the major obstacles that many physicians have often complained about regarding eRx.  New England Journal of Medicine just published an article today on eRx and that adoption is accelerating, which was covered by The Star-Ledger in NJ)

Secondly, is the pay for performance (P4P) push. In the recent post on the SafeMed deployment at Beth Israel, clearly there was an incentive for physicians in that network to use the SafeMed solution for radiology selection as BCBS of MA was providing significant P4P end of year payments if goals were met. This is but one unique story out there in the P4P realm and I am sure there are numerous others. Sure, one can say that P4P does not require an EMR, but my bet is that increasingly, EMR systems, due to their ability to accurately record data that can later be readily sorted, sifted and analyzed, will lead to P4P programs built around such EMR reporting capabilities. Depending on the incentives, be they carrots or sticks, P4P initiatives will have a significant impact on HIT adoption.

The third is reimbursement for e-Consultations, typically done via secure email communication. Companies such as RelayHealth and Medem have been leaders in this market providing physicians a platform to communicate with their customers. Some EMR vendors also provide this capability within their patient portal solutions, Epic's My Chart is a good example. If done right, for the right audience (consumer segment) there is a lot of potential here to drive EMR adoption as e-Consults put money directly in the physician's pocket.

The only problem with e-Consults is that until quite recently, it was rare that physicians were reimbursed. This is changing rapidly:

1. In early 2008, Aetna and Cigna jumped in stating that they would begin reimbursing physicians for e-Consults.
2. In late June, as part of its formal launch, American Well announced it had signed on BCBS of Hawaii as its first major customer. (Note, American Well is a start-up looking to create a "healthcare marketplace" where one can go online and receive direct medical consultations with certified physicians that are a part of the marketplace). Physicians are paid for providing these e-Consults.
3. In early July, the Center for Medicare and Medicaid Services (CMS) announced its proposed rule changes for 2009. Within these rule changes, CMS is proposing new codes that will reimburse for follow-up inpatient consultations done via telehealth. As CMS is the single largest payer in the industry what they do reverberates across the industry. Thus, it will not be surprising to see most other payers begin reimbursing physicians for e-Consults.

eRX, P4P and e-Consults, combined will accelerate the adoption of EMR as there are clearly opportunities here among these three for a physician to either save money (eRx) or make money (P4P & e-Consults). Not all physicians nationwide may necessarily benefit, but the vast majority will, if they are thoughtful in their EMR selection and implementation strategy.

For an example of a not so wise adoption of HIT, turn to this story that appeared yesterday in the WSJ blog.

But some common and very real arguments from physicians have been:

1. The evidence is inconclusive as to how effective eRx truly is in minimizing adverse drug events.
2. eRx systems often do not work as promised, ultimately creating more work for the physician.
3. Without an ability to write eRx for controlled substances, the physician is left to juggle two systems simultaneously; paper scripts for controlled substances, and eRx for other medications.
4. The benefits of using eRx are not typically seen by the physician but by the payer.

But within the week, two big things have happened that may alleviate a couple of these concerns.

Last week, the DEA (I'm sure under a lot of pressure from HHS) released proposed regulations for eRx of controlled substances. This will address problem number 3.

Today, the two big eRx services, RxHub and SureScripts announced that they will merge. This will help address problem number 2.

Combining these two with the aforementioned changes to Medicare reimbursement has real potential to drive physician adoption of digital systems such as eRx and more broadly, EMR.

This is excellent news for the consumer as it has the real potential to drive adoption and use of digital systems in the physician's office thus liberating clinical information from a paper-based system to one that is digital. Once in a digital format, the consumer will be in a better position to take direct control of their personal health records.

Very serendipitous timing of the article as just last week I had the pleasure to meet with Dr. Richard Parker, the medical director for Beth Israel Deaconess Physician Organization (BIDPO). It is BIDPO who works directly with the 1,500 or so physicians that are affiliated with BIDMC throughout eastern Massachusetts. The purpose of the visit was to follow-up on a conversation I had in late May with SafeMed's CEO, Richard Noffsinger, regarding their partnership with Google Health.

While Noffsinger related to me many of the unique attributes and features of SafeMed during our call, I wanted to hear first-hand from one of their customers as to their experiences with the SafeMed platform. A few weeks later I was sitting in Dr. Parker's offices.

Background on SafeMed:

• Physician founded (Ahmed Ghouri) in 2000 as a clinical decision support (CDS) platform. But like many a technologist founded company, big on technology and addressing needs, but short on go to market strategy.
• July 2007 saw Hicks Equity Partners make a significant investment. Time to ramp up that go to market strategy and Richard Noffsinger was recruited.
• Core to their CDS platform is the Rules Engine. Platform also provides a comprehensive thesaurus and is optimized for extremely fast processing speeds. I'm quite sure that Google Health was intrigued by all three of these features, which are a very nice fit for their PHR platform.

Leveraging SafeMed at Beth Israel:

BIDPO was approached several years ago by BCBS of Massachusetts to consider using SafeMed as part of a Pay for Performance (P4P) program targeting imaging. BCBS/MA offered to sponsor initial deployment and outlined for BIDPO that there could potentially be several million dollars in P4P payments if deployment went according to plan and P4P targets were met.

The problem BCBS/MA was having was that as imaging technologies were proliferating, physicians were often prescribing tests that had not shown efficacy. This resulted in significant cost overruns, similar to what the NYT article alluded to. BIDPO physicians, for example, had over 2,000 different radiological studies at their disposal which they could potentially order. Unfortunately, this plethora of choices led physicians to not always choose the most appropriate tests for a given condition and patient profile.

The physicians had a few headaches of their own as well. In an effort to crack-down on run-away imaging costs, insurers were requiring pre-authorizations. This was, and continues to be with some insurers, a time consuming and subsequently frustrating process.

To address these problems, BCBS/MA introduced BIDPO to SafeMed sponsored deployment of the solution, which is now fully integrated with BIDMC's homegrown EMR. Today, BIDPO is in its third year of using the solution with all imaging orders for BCBS/MA members processed through the SafeMed CDS. Dr. Parker was kind enough to give me a live demo of the SafeMed solution at BIDPO and it was impressive.

First was the ease of use. In looking to perform a radiological test on a patient, the physician enters the type of condition being tested for (one can even use layman terms), say severe headache and the SafeMed thesaurus automatically guides the physician to which tests may be most appropriate based on the patient's profile (takes into consideration medications, allergies, weight, age, and numerous other parameters).

A selection of radiological options sorted in ranking order by evidence of efficacy. Cost information is also provided as well as alerts (in red) of any technologies that show risk based on patient profile. When a physician clicks on a given test, a brief informative summary of the test is provided including where it is most appropriately used and why. Upon selecting a test for the patient based on this information, approval is virtually instantaneous. (Remember, this is for BCBS/MA members only, for other plans, BIDPO physicians must still go through a lengthy pre-authorization process that takes on average 15 minutes/transaction.)

Throughout the demo, the SafeMed CDS was blazingly fast in delivering results. Note, nothing in this demo was scripted - Dr. Parker did demos on anything I asked him to, in real-time.

As with any technology deployment, there was initial resistance by some physicians and there were bugs in the system that took about six months to work out. Now, Dr. Parker claims, they have 100% adoption and use by physicians of the system who are all benefiting from those P4P bonuses from BCBS/MA.

Benefits Seen to Date:

When asked what kind of benefits has BIDPO seen from the use of SafeMed, he broke it down into the following:

• Physicians are getting instant approvals to their radiological requests, making life easier (Note, in addition to being integrated to the BIDMC EMR, SafeMed platform is also a part of their CPOE.)
• Physicians are also getting a nice little P4P payment at the end of the year. Since deployment, the system has met P4P targets each year.
• Patients are safer as physicians are making better decisions regarding which tests to use for a given condition and patient profile. Within BIDPO, 50% of all radiological orders are placed by internists and general practioners who typically do not have as much experience as specialists in various applications and best practices radiological tests.
• Approximately 1,000 radiological transactions/month are run through the SafeMed CDS. Typical time to get a pre-authorization the industry standard way is 15 minutes. With SafeMed, pre-authorization is immediate. This quickly adds up to 1.6 FTE (full time employee), who can be better deployed doing something more valuable like attending to a patient.

The Big Loser:

As with anything, where someone gains, another loses and with P4P initiatives such as this, it is no different, which gets back to that NYT article:

In the case of BIDPO's use of SafeMed, the radiological department at BIDMC has seen a measurable drop-off in revenue creating some internal friction. Dr. Parker readily acknowledged this and in thoughtful reflection stated that many changes are occurring in healthcare, this just being one example with many more on the horizon. One can not sit back and await these changes to come to them. Rather, one must take initiative, as to wait puts the entire organization at a competitive disadvantage and subsequently at risk.

Now, how does this all relate to consumer-facing healthcare IT?

SafeMed is now "running under the hood" at Google Health, driving the medication checking algorithms for potential adverse effects of multiple medications. SafeMed joins quite a few other applications and services that provide similar capabilities such as A.D.A.M., Drugs.com (using Cerner), Drug Digest, and DoubleCheckMD. What is attractive about the Google Health-SafeMed partnership is that Google has signed agreements with a large number of pharmacy companies and pharmacy benefits management firms (PBMs) allowing the consumer to automatically load their medications into their Google Health account where they can readily check their meds for any adverse interactions.

Matthew Holt, co-organizer of the Health 2.0 conference did test drive of Google Health, including the SafeMed platform in Google Health and found the current solution lacking, particularly the UI and how information was presented. More than likely, the problem lies in SafeMed not fully completing the drug interaction platform prior to launch. This is a common issue with Beta or early releases and will in all likelihood be resolved over the next few months. What will be more interesting longer-term is to observe how SafeMed may expand beyond medication checking into other critical areas that may be useful for consumers. Not sure exactly what those might be, but SafeMed does have a powerful rules engine that is very fast making it attractive for Web-based apps. Being agnostic, SafeMed could become a key ingredient in other personal health applications (PHAs), becoming not just a CDS, in the clinical sense, but also a CDS in the consumer sense.

But this gets back to one of the features in the BIDPO deployment that I found so intriguing and also raises challenges for SaferMed. The BIDPO team that led that deployment spent many hours building out the meta-data and decision support capabilities for their SafeMed radiology solution. SafeMed will be challenged to find partners with a similar willingness to do such heavy lifting in other markets such as the consumer market. Not sure Google is up to the task. Hopefully, SafeMed has a few other partners who are.

And if you are interested in the CBO Report that is referenced in the interview, the CBO Director's Blog has a good post on the content of that report.

One of the most interesting aspects to this announcement is Covisint.  For those who may not remember the  dot-com hey-days of the late nineties, Covisint  was originally formed by the Big Three automakers with the purpose of creating a common architecture for e-Procurement and other supply chain enhancing functions.  Covisint never really did take-off, despite massive spending by the Big Three and Tier One suppliers.  Big problem came up when the automakers discovered that many of their pricing, contracts, and materials information were actually very proprietary and thus not suited for Covisint.  That left Covisint with commodity type products to attend to and there were simply not enough at sufficient margins to sustain the model.

Maybe their venture into healthcare will be more promising.  Covisint certainly has the secure data exchange angle well-covered.  Look to the AT&T/Covisint deal in Tennessee to understand more of where this may be going.

Will look into it further and possibly do a more in-depth report if warranted.  For

An exceedingly small percentage of consumers, probably 1% at most, will bother to do the self-entry of all the information necessary to make a truly viable and useful PHR (e.g., medications, lab results, images, clinical notes, etc.). Ideally, much of this data would be drawn automatically from a physician's EMR to populate a PHR. This is exactly what Google Health is trying to accomplish with its linkages to Cleveland Clinic and Beth Israel as well as HealthVault's own efforts with Kaiser and several other hospital networks to come e.g., Beth Israel, MedStar, New York Presbyterian.

But Houston, we have a problem.

Very few physicians actually use an EMR. This week, the New England Journal of Medicine (NEJM) released an excellent paper on the adoption of ambulatory EMR solutions. The base of the report is a survey of over 2700 physicians at the end of 2007 and into early 2008. The NEJM found adoption for a fully functional EMR at an abysmal 4% of respondents and a measly 13% adoption for a basic EMR solution, giving us a total of less than 1 in 5 physicians using an EMR.

Number one hurdle to adoption - Cost. I'd argue it has nothing to do with cost and everything to do wih value. Simply put, EMR solutions have typically not provided sufficient value to justify the investment.

But we are headed in the right direction.

Some 16% of survey respondents stated that they have purchased an EMR solution but have not deployed it and another 26% stated that they intend to adopt an EMR solution within the next two years. Thus, if these physicians follow-thru with their plans we will see EMR adoption exceed 50% by 2010.

What does that mean to the PHR market? Continued slow, direct consumer adoption of PHRs and for that matter maybe even Personal Health Systems, without some serious incentives. Businesses (employers, payers and providers) will be providing those incentives for the foreseeable future.

The most astonishing data that the survey flushed out is the level to which patient portals are facilitating care (see figure/table below). Some pretty impressive numbers on the ability to deliver better, preventative care and minimize adverse medication reactions through the use of such systems.

New York Times did a nice article on the NEJM paper that's worth reading for another perspective.

From the Technical Track:

Quite a bit of information provided, most of it designed to update the audience on progress the HealthVault team has made since the initial launch last October. There is a lot of repetition in the various technical decks, so if you are going to choose one to download, go with the HealthVault Architecture Overview as it really has all you need to know, with one minor exception.

As for key messages in the technical track, they are as follows:

• Greatly simplifying the sign-in/sign-up process for the consumer (I tested it and it really is a substantial improvement). Also making more general improvements to the UI (user interface).
• Build-out of data types with 20 new ones since launch and 12 more pending. This is quite important for developers of personal health applications (PHAs) that will sit a on top of HealthVault. Still, looking at those data types that they have today, it is hard for me to understand the logic of the choices made. Comes across as somewhat of a free-for-all. Most likely driven by existing partner needs.
• Ability to directly connect to clinical data. This is through their work with such partners as AllScripts, KRIPTIQ, and Eclipsys. Still no Cerner, GE, McKesson and most importantly, Epic, who did not even send a representative. Remember, its Epic's My Chart that powers the Kaiser patient portal My Health Manager that Kaiser and Microsoft will be working on together to link My Health Manager to HealthVault.
• Restatement of basic design principles: Inclusive of standards, Commitment to "Openness" (they have signed on to the Open Specification Promise (OSP)) and CodePlex support (supporting both Java and Ruby).

The most interesting slide in all the technical session slides was the following one (it is not in the Architecture Overview slide deck, but one titled: Platform Adoption) that lays out their overall platform strategy. This gives an extremely clear picture of their thinking and where they are headed.

For example, Consumers are put one target market of six shown, though one may argue that the "Employer" column may share much in common with the Consumer. And what is quite puzzling is: Where are the payers? It oul seem to this analyst that if you are targeting employers, the leap to supporting payers is not that big as employers and payers have very similar needs, particularly when it comes to managing population health and encouraging healthy behaviors.

From the Business Track:

While I found the technical slides to have some real nuggets of information, was quite surprised at the dearth of information found in the business session slides. Most of the information was very simplistic. With all the marketing muscle at Microsoft, I expected something better.

But in and amongst the weeds, I did come across some very interesting information in the presentation entitled: "How We Make Money".

This slide deck begins with a shot of the MSN.com Health & Fitness site, with a HealthVault widget from the American Heart Association embedded on the site demonstrating personalization, how they intend to leverage existing Microsoft properties and sell Web property "real estate" to partners. This theme was extended to the HealthVault search engine.  In this case it looks like Microsoft intends to re-brand HealthVault Search as a subset of the Microsoft existing search engine,  live.com

It appears that Microsoft intends to have HealthVault be subsumed into these existing properties, which see far more traffic then HealthVault does today. I did a quick Alexa analysis comparing first three health-centric websites, HealthVault, RevolutionHealth and WebMD. HealthVault doesn't even show-up in the rankings.

Did another Alexa analysis, this time adding live.com and msn.com (couldn't get a read on the sub-site health.msn.com) and as one would expect, these two properties see lots of eyeballs, which could give far greater exposure to the HealthVault property/brand.

Remains to be seen if that will ultimately be the case, but HealthVault clearly is not getting much traffic today, so it certainly can't hurt. But then again it may have the affect of diluting the HealthVault brand.

But this is where all those partners come in (there are 36 software partners and 9 device partners up and running today). In a somewhat brazen and even arrogant manner, the HealthVault folks are adopting a marketing strategy that they refer to as an "ingredient branding strategy" Think Dolby, Intel Inside, etc. What they are looking to do with the ingredient strategy is have all their partners put the HealthVault label (web tile for websites, logo on device packaging) and let the partners push the HeathVault brand.

This is ludicrous.

In a market as small, immature and nascent as this one, with so many challenges ahead, it is hard to believe that Microsoft is depending so strongly on its partners to take the HealthVault brand to market. Really quite bizarre and something they should rethink.

Tomorrow, will have see the last post on this event and will have highlights from interviews wth several who attended this event.

While I normally focus on consumer-facing apps, can't help but comment on this story as I know Oracle quite well (and many of the companies it acquired) from my days as an IT analyst leading the Enterprise Group for the manufacturing centric analyst firm, ARC Advisory Group.

So is this possible/probable?

Well, yes and no for the following reasons:

Yes

• Oracle is very savvy at making acquisitions work, no one does it better in the enterprise software market than Oracle.
• Oracle, unlike major competitor SAP likes making acquisitions, its core to their growth strategy.
• They need new markets to achieve target growth projections as their existing markets, while still having opportunities, are mostly at the mid-tier and lower levels and will not be enough.
• Healthcare sector is increasing spending on IT, faster than most other large market sectors.  It is also a very large market.
• They have existing presence in healthcare as most large healthcare enterprises are already running on top of Oracle databases.

No

• Healthcare is a difficult, fragmented market with few large entities (target customers) among providers.  There are no GMs or Fords or Dow Chemicals to conquer, therefore cost of sales will likely be high.
• Healthcare is full of regulatory requirements and lots of customization of software.  Oracle is not a fan of customized solutions and for years has aggressively promoted an out of box solution approach.
• This sector has not seen much consolidation - there are far too many EMR solutions today.  Maybe a big play by Oracle will help to rationalize the market, but right now it appears too early for them, unless of course they acquire a couple of leading players serving different tiers of the market e.g., buy both Cerner and athenahealth.
• This market has yet to demonstrate that it is truly a global market, which limits growth to North America for the time being.  Granted, that is still a big market, but its not like manufacturing where distributed product development and manufacturing has occurred for years and systems, process and software has been developed to support such activities.

Opinion:

Oracle will make a play in the healthcare market as it is one of the few markets remaining that does not have a large, true enterprise software vendor of the likes of Oracle or SAP (Note: SAP has seen some success in the native German healthcare sector but little here).  A company like Cerner is an obvious choice, but to be successful, they'll need to make more than one acquisition to develop a significant presence.  Oracle may also come at it from the health plan side, though Trizetto, the dominant player here was recently acquired and unlikely to be available, unless of course Oracle pays a princely sum.

Oracle will make a play, but it won't just be Cerner, or similar large EMR vendor, it will be several.

And what might some of those spending priorities be? John Halamka, the other CIO on the panel gave quite a laundry list that includes:

• Getting non-affiliated doctors on-board in using an EMR throughout the New England region. He did a recent post on that one.
• Addressing the demand for data storage. Demand now far exceeds his budget despite Moore's law and he sees no slow down for the foreseeable future.
• Insuring secure communication throughout the network.
• Tackling security. They push back an attack on their system every 7 sec. (BTW, that works out to be some 12,300 attacks per day, or 4.3M/yr). While Halamka is using various commercial Spam filters, unfortunately these solutions today are too restrictive. Why? As it turns out, physicians use a lot of anatomical terms that Spam filters readily tag. He has 4 FTE on staff doing nothing but IT security.
• Providing the best decision support tools at the point of care. The knowledge is coming in so fast and furious, he does not see any single entity being abl to address it. Recommends a "knowledge cloud" model.
• Compliance - never ending list to contend with that seems to only grow over time.
• Creating dynamic websites (internal & external facing) using new tools (ala Web2.0). This summer they will release new portals that incorporate social networking, dynamic content, etc. to create a richer, more cogent user experience.
• Disaster recovery - 4x redundancy is the norm for his operations.

At one point during the first session, conversation veered off into the old, what about RHIOs. Conversation concluded when one of the panel members simply stated that even a successful RHIO, of which there are few, will struggle to stay afloat as there is not enough "low hanging fruit" for them to address that will sustain them long-term. That statement ended the conversation on RHIOs.

During the Q&A for the first session I shot up my hand and asked what about Pay for Performance (P4P), quality and pricing transparency (was quite surprised that this was not keeping them up at night, plenty of other CIOs are reporting otherwise). Both stated that yes this is a big issue and continues to drive many of their priorities. Halamka made mention that one P4P initiative represented some $22M to BI, so quite obviously, it became the number one priority for his group. I bet he'll be seeing many more P4P initiatives in the future as this issue is not going away, only growing.  Maybe next year he'll report that it is keeping him up at night.

The second session of the event focused on consumer healthcare IT. Again, most of the discussion was dominated by the two CIOs on the panel.

Both Halamka and Nigrin are in full support of the PHR concept and complete consumer control of their own record. Each are taking steps at their respective institutions to make that happen.

At Children's they are still in the process of rolling out the PHR across the various practices, having only started the roll-out recently. They are using their home-grown solution, Indivo, which is the same solution underlying Dossia. In speaking with Nigrin after the event he stated that they are predicting relatively high adoption rates as in Nigrin's words "there is no one more motivated than a parent caring for their child with an illness".

Over at Beth Israel (BI), they have provided consumers with the tethered PHR portal PatientSite for several years. Halamka stated they get 40,000 visitors/month to the site. At BI they make it mandatory that all MS patients use PatientSite to facilitate care. Among primary care physicians (PCP), roughly 30% of PCPs are using a PHR with their patients. Another interesting point he made was that they have not actively pushed the PHR concept on many of the specialists at BI as they often only address episodic care events. Thus, chronic care specialists and PCPs are the focus for internal PHR adoption and use.

As part of their commitment to patient control of medical records, Halamka stated that they will interface to any leading Personal Health System. They have enabled Google (though reports are it is extremely limited version of one's record), are working through the final steps to enable HealthVault and they are currently working with Dossia as well. While they may have gone live first with Google, there does not appear to be any overt favoritism.

Nearly universal belief among all panel members (to which I concur) that we are very early in the adoption and use of PHRs and it is difficult to say today how all this will play out. Patrick Boyle from IBM and David Hendren from Catalyst Health Ventures both stated that the current healthcare system is seriously broken, costs are unsustainable and drastic changes are needed. Part of the solution will be for the consumer to take a more direct and active role in managing their health. Boyle went on to relate how IBM has been using its internally hosted PHR (happens to be WebMD based) to drive down their healthcare costs, which are currently about half of the industry average with big savings coming from their ability to negotiate better rates with insurers. With the practices and incentives they have implemented at IBM via the PHR, they are able to go to insurers and provide clear evidence that IBM employees represent a lower health risk than say some company that does not provide such tools to their employees. IBM's success has not gone unnoticed and is just one factor in the large ramp-up in PHR activity among employers, an issue covered in depth in our recent PHR Report.

Well, things are getting even better! When I was 20 something I came up with, designed and developed a concept for an Electoric Medical Record system (EMR). My wife and I had only been together for 3 months and I was invited to a meeting with Lockheed Martin. I did a small demo of a concept that wasn't working and was offered a team to build it and $8MM, yes $8 Million! I stood there and turned it down in less then 5 minutes due to who the companies main customer was, the US Gov. I couldnt guarantee that your medical records wouldnt be "looked into"

Fast forward a bit to an older guy I raced (I know, I know) in my car one evening. His $90,000+ Mercedes and my R32 VW. Lets just say I won. I run into this guy again this past Sunday. He is the Chief of Staff for two hospitals in a major retirement area here in Florida. I chuckle and tell him about my story. He asks, just like most do. Why I haven't done anything with it? I don't have the funds to build it. I have to take care of other bills and family. He then tells me he is going over to the CEO of the hospitals house for dinner. Ok.........

I call him on Monday to thank him for a mentally stimulationg conversation on Sunday and that I really enjoyed it. He tells me that my name came up no less then 6 times during the evening and the CEO, CTO and a few other big name guys want to talk to me about my concept and look into giving me the funds into getting it built.

HUH? What just happened?

I'm not about to complain. I'm the visionary guy. I come up with the ideas, get them rolling then hand them off to people a hell of a lot smarter then me to actually run a company.

So, sometimes when things don't look at that great. They all seem to fall in line one way or the other. There's no telling if anything will come of me meeting with these guys. But it doesn't hurt to try.

Written in a glorious bureaucratic style that is guaranteed to put you to sleep in 5 minutes or less, the report lays out two primary goals for ONC in the next 5 years, Patient-focused Healthcare and Population Health. Based on that quick scan, did not see anything that surprised me. The bigger question though is if this is a five year plan, is it but a wasted effort seeing as there will be a new administration in place in about 8 months? We'll have to wait and see.

For a more in-depth review and commentary than what I've provided here, drop by this site.

Broken up into two parts, the first addressing what keeps hospital CIOs awake at night and John Halamka, one of the panel members should provide some interesting commentary. But it is the second session that really interests me: Is the Consumer the Next Big Healthcare IT (HIT) Buyer? Honestly, not all that impressed with who they have on the panel to address that particular subject, but I'll sure make my presence known commenting from the audience should the conversation run astray or like many I have heard of late, be ill-informed.

Will put up a post tomorrow with key take-aways from the event.

In some respects he is correct. Today, it is far too difficult for consumers to have an independent, untethered PHR, or in the case of HealthVault, a data repository for their records as the consumer must frequently load up all the data via self-entry. Even getting claims data into an untethered PHR is difficult, but it appears that insurers are moving a little faster in that direction than most providers.

But this is changing and the change will accelerate over time as more Integrated Delivery Networks (IDNs), and large hospitals networks (Beth Israel Deaconess, Cleveland Clinic, Medstar, and even maybe Kaiser) begin to provide their customers with an ability to load their medical records up to a 3rd party service thereby enabling portability and consumer control of their records.

Getting back to HIStalk...

In a desire to set the record straight, at least from my vantage point which arguably is well-informed, I provided a fairly lengthy comment on HIStalk in response to comments that preceded it to clear the air. Admittedly, the tone is sharp but after awhile, I really do tire at the amount of dis-information and illogical assumptions that are bantered about.

1) Google & MS are businesses, they are public companies, they have shareholders, so of course they have a business case for defining and supporting their efforts in healthcare, including these consumer plays. I don’t have a problem with that at all as long as they are up front about it, which they have been to date. Actually see their entry into the market as raising the overall quality, security and privacy of PHR solutions going forward, which is a very good thing.

2) In speaking with numerous 3rd party PHR vendors as part of compiling the recently released PHR Market Report, these vendors universally reported that EMR vendors refuse to play ball. The EMR vendors drag their feet in opening up their systems, even when their customers ask them to. No EMR vendor has a vested interest (ie business case) to support opening their systems. Unfortunately, standards are not mature enough nor adopted widely enough to make it happen either. These vendors will be kicking and screaming till the end. Google and Microsoft have the clout and resources to change this dynamic, which we are now beginning to see.

3) Epic MyChart and any other EMR consumer portal certainly has advantages, but all patient portals are tethered and always will be to the host EMR. These systems do not provide a longitudinal record of health for the consumer and should the consumer move, change physicians, whatever, its not like the consumer can easily take that tethered PHR and all the data in it with them. Google and Cleveland Clinic as well as BIDMC are providing portability and from what I hear, much to the chagrin of Epic. Epic hates this!

3b) In addition to the tethered issue, patient portals also do not capture the full health record for those who may have multiple physicians.

3c) And let us not forget the disintermediation of healthcare with medical tourism and retail clinics. An EMR-centric patient portal can not and will not address this issue.

Many changes are afoot and as I outline in our market report, the entrance of Google and MS into this market has some extremely broad ramifications across the entire healthcare sector that I don't believe we can even begin to imagine in our wildest dreams.

Stay tuned, "The Revolution Will Not Be Televised"

McKinsey Highlights:

• Market today is only 60-85,000 consumers worldwide. McKinsey uses a very strict definition for medical tourist including only those that travel some distance for care.
• 40% seek the most advanced treatment, often traveling to the US. Roughly 75% of these medical tourists come from two regions, Middle East and Latin America.
• 32% are looking for better quality of care and typically travel from developing countries.
• 15% seek faster care for medically necessary procedures.
• 9% seek lower costs for medically necessary procedures. In this category, 99% of the medical tourists originate from the US.

Barriers:

• Incorporating medical tourism options as part of payer network.
• Establishing common, universal metrics to assess quality of outcomes.
• Addressing continuity of care/follow-on treatment.
• Overcoming inconvenience of travel

Market Potential:

• $10,000. differential in cost is the tipping point. An aortic valve replacement in the US costs in excess of $100,000. In Asia, average cost at an international hospital is $12,000, providing plenty of opportunity for shared savings.
• If payers jump onto bandwagon (and it appears they are), potential number of US medical tourists could jump 100x to over 500,000 consumers/year.

Fast Company Highlights:
Less focused on metrics, article looked closely at the success of Thailand’s Bumrungrad Hospital, expanding upon its interview with the hospital’s former marketing director, Ruben Toral. Toral, a North Carolina native joined Bumrungrad in 2001 and was instrumental in helping this hospital double patient flow to 430,000 by 2006. Toral has gone on to start MedNet Asia, a software start-up to assist payers doing business with Asian hospitals.

What was particularly interesting about this article was the number of quotes from various corners, including payers (UnitedHealth Group), large providers (former head of Harvard Medical International), employer (Blue Ridge Paper Products) and a union (AFL-CIO rep.) to name a few. This provided a more qualitative view of the market, its potential, where it may be headed, what we might see in the future, e.g., payers sharing cost savings with consumers should the consumer elect to go overseas for treatment, and of course barriers.

Closing Comments:
Though there is a lot of talk about medical tourism, it is still just talk. Until it becomes far easier for the average US consumer to evaluate, choose and engage with an offshore medical institution, the market will not take-off. Sure, there are plenty of intermediaries in the market today willing to help arrange your travel to some foreign destination for that surgery you need, but trying to determine who is reputable and can be trusted is not all that easy. (Do what I did - Google "medical tourism". You'll get some 2.3M hits - not an easy ask wading through that list, even with the paid ads to find a reputable firm to go with!).

From the Fast Company article, though, it certainly appears that payers (and their employer customers) are looking very closely at medical tourism to control costs and may well lead the effort to provide consumers with these tools for evaluating options, including providing a list of pre-screened facilities and assisting them with their travel arrangements.

There is also the significant issue regarding continuity of care. I have yet to see any clear, established models that insure such continuity after discharge from an offshore hospital. Is there a role here for a consumer’s PHR? Maybe so.

Using their PHR, a consumer could share their US-based records with an offshore surgeon in advance, use the PHR (if the capabilities exist) for secure communication with that physician and likewise, upon discharge, the offshore hospital could then upload directly to the consumer's PHR their complete digital records from the procedure for sharing with their care providers back home. (Note, many of these offshore facilities use state-of-the-art HIT. For example, Bumrungrad Hospital in Thailand, one of the leaders in medical tourism deployed their home-grown EMR, Global 2000, seven years ago. Microsoft purchased Global 2000 last year and its now part of Amalga.)

On thing in clear, change will come. It is now more a matter of where (which procedures), when (just how fast it will take-off) and what will be the broader ramifications to the traditional healthcare market in the US. As a doctor recently wrote in an editorial about New England grocer Hannaford’s move (with Aetna’s assistance) to provide employees incentives to have knee and hip surgeries done in Singapore, this is but a canary in the coal mine.

Certain statements in this news release may contain forward-looking information within the meaning of Rule 175 under the Securities Act of 1933 and Rule 3b-6 under the Securities Exchange Act of 1934, and are subject to the safe harbor created by those rules. All statements, other than statements of fact, included in this release, including, without limitation, statements regarding potential future plans and objectives of the companies, are forward-looking statements that involve risks and uncertainties. There can be no assurance that such statements will prove to be accurate and actual results and future events could differ materially from those anticipated in such statements. Factors that could cause actual results to differ materially from those in the forward-looking statements include, among other things, the following: general economic and business conditions; competition; unexpected changes in technologies and technological advances; ability to commercialize and manufacture products; results of experimental studies; research and development activities; changes in, or failure to comply with, governmental regulations; and the ability to obtain adequate financing in the future. This information is qualified in its entirety by cautionary statements and risk factors disclosure contained in certain of Patient Access Solutions Inc. Securities and Exchange Commission filings available at http://www.sec.gov.

In less than six months, the SARS virus wreaked havoc on lives, families and economies. During that dangerous time, health care professionals worked exhausting hours behind the scenes in an attempt to track and contain the disease. Their tools? Excel spreadsheets, coloured Post–it notes and paper files.

Dr. Barbara Yaffe, the director of Communicable Disease Control at Toronto Public Health, played a crucial role in the SARS response as incident manager. The process, she says, was hindered by an obsolete system called RDIS, which stands for Reportable Disease Information System. "The limitations of the system made it impossible to link contacts with cases and follow up contacts, so we used an Excel spreadsheet. We ended up using lots of files and even Post–it notes, and that's not really a very good way to run an outbreak of a serious illness."

The organization's internal information technology staff quickly put together a database for their use. However, the database didn't extend to other points of care, and each health unit had to create its own system. "A few years before SARS, I was on a provincial committee that made recommendations on the need for a new information system for communicable disease control in Ontario. The recommendations were not approved because of the costs, but it ended up costing the system much more in the end because they didn't have it in place," says Dr. Yaffe.

"Everywhere you turned, there were issues with not having adequate system ability," says Dr. McGeer, a survivor of the disease. "At one stage, we actually had to discard some lab samples because they had been coded for privacy reasons, and we lost the link with the name. Things were lost in the chaos."

As difficult as the challenge of tracking cases and contacts was, there was another information element entirely missing. "There was a relatively small number of SARS cases. When the pandemic comes, the truth of the matter is that tracking contacts is not going to be an important effort," says Dr. McGeer.

To save lives in a pandemic, she says, tracking the epidemiology of the disease is critical. "We're going to want to know who is getting it. Is the hospitalization rate higher in kids, adults or older people? How late in the disease are people presenting to the hospital? What complications are they having? What is our best management of cases to prevent a large number of deaths?"

In 2003, there was no system in place that would allow that process to occur. "I do all of my banking online now. When I fly on a plane, I can get my boarding pass online. In health care, we're still on pieces of paper. Our inability to manage information in health care has become, for me, a really glaring example of a failure in the system. We need to fix it."

The lessons of the SARS crisis have been taken to heart. A Public Health Surveillance IT application (Panorama) that addresses the information technology gaps identified is currently under development. The B.C. Ministry of Health is managing the project, with every province and territory collaborating on its application and design. Canada Health Infoway has invested in this pan–Canadian project. When complete, public health officials from across Canada will be better equipped to manage information in the event of infectious disease outbreaks.
Reported In Canada Health Infoway

I remember when the relatively small contract research industry found large software providers like Microsoft and IBM suddenly appearing at tradeshows.  While they lacked the clinical experience, they had data processing expertise.  BPOs entered the scene and the rest is history.

I, for one, would be delighted to have all my medical records accessible from one place.  But I also believe that I should be able to own that information.  When you think about it, it seems strange that it has taken so long to get this far.  It's a bit like your credit report.  You can't make it up or change it in your favor, but you can take steps to correct it when the information is wrong.  Also like a credit report is the fact that institutions can use the information against you.  This is another core concern of EMRs.  Could a potential employer or insurance company deny you based on the information?