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Google vs. Microsoft: PHR Wars Might Have No Winners
Featured in: Hippocrates
PHRs have been around since Nineties and failed to catch on. Do Google and Microsoft really have a chance to beat history?Almost half-a-year ago I wrote a few pieces about PHR projects from the "big boys", highlighting the launch of Microsoft health solutions and questioning the delays around Google Health.
I was wrong doubting Google's commitment to healthcare, but now that they finally announced their pilot with Cleveland Clinic, I cannot help but ask "Where is the beef?". Trust me, I am not talking about the ruckus raised over privacy issues by virtually everyone who covered the story.
Then what would I think is even more important than privacy?
Simply put, the only people who truly care about PHRs are members of the pundit class and the vendors that hope to make a business out of this technology. Consumers had a chance to demonstrate their indifference over and over again. Yes, there are all these wonderful surveys that tell us that 78% of US adults want a PHR and 26% are even willing to pay for them. Then how come PHRs have been in the news forever and most people still do not use them?
There is a huge difference between what people *say* they are going to do and what they *actually do*
PHR is one of those things. They have been around for over ten years. There are hundreds of products out there, all looking pretty much the same (just like MS HealthVault and Google Health). Who would say no to having their medical records at the fingertips in case of emergency or to move between providers? What marketing manager would not get seduced by this perceived need?
Yet, even with free PHRs out there, consumers simply do not care for spending their time to learn and use them. Who would bother entering and checking their medical records if you are healthy and would rather go see a movie? And once you get sick, you do not want to enter them either. You just want your doctors and hospitals to hand your medical records to you. But you see, the providers have different priorities that a mere piece of software just cannot solve.
PHRs' real problems are not technical, usability or even privacy. The real problem is consumer and provider motivation.
Neither Google or Microsoft are close to solving any of these problems for real. They just seem to be copying the same old approach that has failed time and again. Just because you are a big company and can put your product in front of a lot of people does not mean they will use it. You can lead a horse to water, but you cannot make him drink - unless he really likes the taste.
Reading between the lines of Google deal with Cleveland Clinic it is not hard to see how these motivation issues play out
1) What is in it for consumer?
Not much that I can see. If they already have access to their records in MyChart, what do they need Google for? Beats me.
2) What is in it for Cleveland Clinic?
Innovation PR. Perhaps learning experience of working with an Internet leader. Perhaps they got Google to actually pay them money.
3) What is in it for Google?
They finally get to say to the world that Google Health exists and get a sandbox to start learning first hand what healthcare is all about.
So again, where is the actual business incentive for healthcare providers to hand over the medical records to Google or Microsoft? Exactly. Why would they help create new middlemen to threaten their own business? Exactly. Yeah and what do Google and Microsoft bring to the table that is impossible in house? Exactly.
So I will believe in PHR business when I see it. Give me these metrics:
- How many people have signed up?
- How many are using their PHR daily? Weekly? Yearly?
- How many providers are submitting the data?
- How many providers are retrieving the data?
- How much money are PHR operators making (and how)?
Enough with hyping so-called PHR business. Show me the beef.
UPDATE: Microsoft seems to be on the right track with trying to encourage compelling PHR applications via their HealthVault Be Well Fund.
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Comments (15)
#2: Right on
Cannot agree with you more and thanks for pulling together a great list. I think though that there is a long way before we find out which of these PHAs are really compelling and useful to many people.
Microsoft might be onto something with grants to motivate innovation.
#3: PHRs
For the most part healthcare consumers feel that the services they seek they are spending someone else's money (the employer). See the post on that subject at www.healthcaresoundoff.com. When they seek service they do not care about the details, only that they get cured or get the prescription they are seeking. Essentially they are disengaged from the system by their insurer, their doctor, or any other healthcare provider. Until users of healthcare are engaged to see services intelligently, PHRs etc. will not be used. Google and Microsoft are well intentioned but until there is a need in the minds of consumers, nothing will come of the effort
#4: heres the beef !
trojanWare: http://online.wsj.com/article/SB116477185099435441.html (outline of wal-mart PHR strategy )
How do u get consumers/providers to use ur product?
answer- u employ them (or sell to them)
between WalMart, Intel, BP u have hundreds of thousands, if not millions of employees and customers
WalMart McClinics serve as the means by which people are brought into the e-system, and ultimately even subsidizing care of customers, to sell the just the PHR product could prove to be a profitable move.
so yeah why would I joeCustomer ever use product A or B? How about the same reason I make sure I have my insurance card with me, or wait dutifully 3hrs in a waiting room every time for a check-up.
If that is the only way to access care, then you will dot the i's and jump through hoops. But I think PHRs can reveal alot, retailers can drive the supply-engine to bring down costs, statisticians/programmers can datamine to improve outcomes, and clinicians can provide more effective care/treatments.
But this post is not about effectiveness of PHRs but rather strategy to implement them. On that note, I think Walmart has a winning plan.
How many people have signed up?
well between all the companies (millions), not counting all the foot-traffic from retail shoppers from the mcclinic
How many are using their PHR daily? Weekly? Yearly?
if youre an employee, you wont stop using the PHR, the retention rate among the general public is wait and see. but you go to the McClinic get little Timmy's pink eye taken care of and set up the whole family on the PHR. Are you going to keep using it? I think the answer is yes if your area hospital does, and the next time your at the ER, the nurse asks for permission to access your Walmart PHR.
How many providers are submitting the data? How many providers are retrieving the data?
in implementing the McClinics at Walmart, the retailer is partnering (paying off) local hospitals to coordinate care. (?) I am not too sure what that means other than they are making sure the partnered hospital is using the same PHR
How can they make money off this ?
well lets say the clinics and giving away free software/comptuters are a total wash. ie its like microsoft with the first xbox- a steep multi-billion dollar entry fee. There is opportunity for entry into the healthcare supply chain (with stuff that is consumed alot faster than tv's and microwave ovens)
historically, the big box retailer is good at transforming industry. in the case of manufacturing (where it was factory make and consumers buy), they where able to capitalize on democratizing the system- (consumer demand, then factory make)
The PHR just might be the gateway for walmart to transform the service industry. the analogy might be something like from artificially scarce, inefficient, high-cost to accessible, efficient, low-cost options.
-a
#5: on the money
Dmitriy,
I didn't see you at HIMSS, but I've been harping on the anemic PHR usage rate for several months myself. I raised this issue with Eric Schmidt in the Google press conference and he said something to the effect of the public will want the convenience of putting everything in one place, that Cleveland Clinic's Epic link will solve the problem of populating data, that they'll keep ads out of Google Health for the trust part of it, etc. (What happens when Google opens it up to someone without an EHR and Web portal? That remains unanswered.)
At the HITSP town hall, John Halamka said CareGroup had 2.5 mil PHRs through its portal, that it was getting 40,000 accesses per month, but that only 42 people have actually entered their own data since the thing started. Google, Microsoft, et al, you've got a lot of work to do.
#6: PHR Future
Neil,
I have gone on the travel / conference diet this year, thus did not attend HIMSS. Thanks for bringing up this excellent factoid. I think we need more transparency around actual metrics of what works or does not work.
Anon #4,
Sounds like a good plan, but I would like to see it in action. Of particular interest is how employees would get over fears of handing over their medical records to their employers. You should know the pitfalls.
Personally, my issue is that I don't want to spend the time to MANUALLY enter all of my information on my PHR and maybe miss something.. I did find one product, the EMRy Stick, www.emrystick.com which has the capability of configuring to EMR systems so that medical information can be AUTOMATICALLY downloaded to a patient's PHR. Additionally, it can also tie the EMR's together once they have the chance to configure the EMR. Currently, they are configured to Misys and are working on Centricity. Until all the current EMR's are integrated, this was the least expensive PHR I found on the market today, but had the most features.
As per my last post, we need a whole new vision of what makes PHR truly useful. Yes, obtaining the kind of clinical data found in most EMRs is important, but grossly inadequate. And while automating the retrieval of data from EMR databases is nice thing, no matter how the data get into a PHR, it's the value of total content and the usability of that information that's crucial.
Steve Beller, PhD
http://wellness.wikispaces.com
Google started to cover every domain possible, including health care where the big bucks are. It's a very good idea from their part and the quality of their software is world-wide known.
you have hit the nail on the head as the old saying goes
I thinkif google can do for healthcare what they have done for search that can only be a good thing
#12: Google
Google has started to cover every domain possible, which includes health care where the big bucks are. It's a good idea from their part and the quality of their software is world-wide known.
I guess Microsoft will be no more the king in the market after google launches its operating system in collabration with Linux
Moreover the OS will be a open source
Thanks
Is Google Local Really a Pilot Datamine? plz tell me
#15: respond
I guess that to receive the credit loans from creditors you ought to have a firm motivation. But, one time I've received a secured loan, just because I wanted to buy a bike.
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Good points, Dmitriy!
Offering a typical PHR to consumers is not, imo, very useful. As I discuss at this link, what we need are Personal Health Applications (PHAs), which are next generation consumer-centric information systems that help improve healthcare delivery, self-management and wellness by providing clear and complete information and decision-support, which increases understanding, competence and awareness.
Following a comprehensive assessment that focuses understading one's mind, body, spirit and environment, a PHA "pushes" relevant educational/instructional information the the consumer in an easy-to-use navigational user interface, rather than requiring the person to search for it.
Steve Beller, PhD