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PHR Platforms Race: HealthVault Updated, Consumer Interest Still Unproven

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Are the massive investments in PHR finally paying off? Microsoft is still betting they will, consumer engagement is still uncertain.

Last two years brought unprecedented interest in Personal Health Records (PHRs). Started in healthcare industry outlets the excitement crossed over into traditional media and the expectations are high.

Over the last year I have written a few pieces about the new PHR platforms from Microsoft and Google, outlining some of the challenges they need to address to achieve adoption and viability, which you can find here:

Recent update from Microsoft deserves another look:

First of all, I would encourage you to check out the announcement by Sean Nolan, the Chief Architect of HealthVault, outlining a product tour for new users as well as the commentary by John Moore of Chilmark Research.

John and Sean have a great overview of the new HealthVault features, which I believe are on the right track to increase product usability. Improvements to login are especially welcome, as the strong focus on privacy and security comes at the usability cost. As a user, I remember my frustrations with having to change my Windows Live password to the acceptable level of strength. Support for Open ID is helpful, though this might only be a start.

Microsoft is clearly committed to investing in the platform and is working with industry partners who are developing 3rd party applications. The billion dollar question however still remains the same: Do consumers and providers care enough about PHR to actively participate?

What do we need to look at? Metrics, metrics and metrics!

The grand visions of PHR for every consumer accessible by every physician have been around since nineties and have not changed that much. Despite a truly novel approach by Microsoft and Google of treating PHR as a platform, these platforms will be worth only as much as the number of people using them. Using them ACTIVELY and not just registering for an account and forgetting about the service. Engagement requires more than usability (which is simply the price of entry). The platform along with its applications must provide ongoing value.

Neither Microsoft nor Google published any consumer usage data

This might be forgivable given the early stage of their PHR platforms. But on the other hand, HealthVault has been around for a year and Google Health is nearing half-a-year milestone. While the products have been launched to the public, the main focus of both Microsoft and Google seems to have been recruiting industry partners. But still, if consumer adoption is strong, why not brag about it?

I would go out on a limb and say that PHR experience (of any kind) is still not close to being interested and compelling to John Q. Public. In the absence of official data, we have to go by anecdotes. Fortunately, the recent piece in Modern Healthcare has the key factoid from John Halamka, CIO at CareGroup Health System—parent of Beth Israel Deaconess Medical Center (BIDMC):

Still, PHRs aren’t attractive to everyone, even those partial to Google, such as the young and healthy, Halamka says. But they are of high value to providers such as himself, an emergency room physician. “Often I’m flying blind,” he says. “I would hope that a PHR would help.”

The key to Google Health’s success is making sure that users don’t have to input information themselves, but rather be able to access critical data at the click of a mouse. For instance, 40,000 patients at Beth Israel Deaconess have PHRs, but only 42 patients have added any information to those files, Halamka says.

That only 1 in a 1000 patients who bothered to enroll for PHR would care to take any action upon it speaks volumes about viability of a personally-managed health record. After all, the media attention around the concept has been huge and BIDMC, Google and Microsoft went out of their way to promote these programs. Unfortunately we are still stuck in the experimentation phase.

But what about all these huge PHR market projections?

Be careful who you listen to and how you interpret the data! While we keep hearing about huge (and valid) numbers of people who "search for health information" and "visit health websites", PHRs and many other consumer-directed tools require a lot more commitment than just looking for health info. So while the hundreds of millions of health searchers are real, few of them engage further.

The opportunity for PHR platforms still exists. The question is whether it will take one, five or ten years to bear fruit.

UPDATE: Microsoft demonstrates they understand the need to nurture new "PHR killer apps", in their recent partnership announcement with Scripps, Navigenics and Affymetrix to collaborate on personalized genomics.

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Comments (2)

Submitted by John@Chilmark (not verified) on Tue, 10/07/2008 - 7:14am.


As always, a good thoughtful post which I mostly agree with. Agree that adoption is slow and will remain so for at least another year or two. And of course agree that to be successful, the PHR must provide some significant value to the end user, ultimately integrating into their daily lives much like the cellphone or ATM card is today. Not to say that you'll use the PHR with the same level of frequency, simply it will be become just a part of your everyday activities.

We have a ways to go, but there are some promising signs and this is where we may differ.

First off, the BIDMC PHR is crude and the IT grp there will readily admit that they have done nothing with the site in nearly 5 yrs - that is a huge amt of time in the IT/Internet arena. Thus, they are a poor example of consumer engagement.

Better example is Kaiser-Permanente which now quotes consumer PHR adoption within their network of 33%. Look north to Group Health and adoption has exceeded 50%. Even local Boston employer, EMC, an early proponent of employer-sponsored PHR has adoption at 50%. Clearly, consumers will use a PHR if it provides value. Unfortunately, most do not, but this will quickly change due to competitive forces.

Secondly, while Google has some simple PHR functions, HealthVault does not. Hard to call either of these a true PHR. They are but data aggregation platforms (Dossia is as well) that will serve data up to a PHR, much like a utility company provides the electricity, but it is the lamp/lightbulb (or in this case the PHR app) that provides the light.

Third, HealthVault folks will readily admit that they are not targeting consumers at this time, instead focusing on partnerships to create an enriching ecosystem. In fact, what I hear from others is that Microsoft is looking to partners to drive consumer traffic/engagement with the platform - a huge marketing blunder in my view. As for Google, hard to say where they are at. After an initial, early splash, they have gone quiet - appear to be severely resource limited.

And as for Metrics - I'm with you 100%! We need some clear definitive metrics on PHR adoption and use to determine what is and more importantly, what is not working. Unfortunately, have yet to find a funding source for such research, but I still keep looking.

Submitted by hippocrates on Tue, 10/07/2008 - 12:01pm.


I agree this is not all "doom and gloom", but perhaps "too early to tell". Still to me it is somewhat frustrating to see lack of actual activity data. I hope both Microsoft and Google will have good news soon!

Interesting to see your numbers on Kaiser and Group Health, though I wonder what the percentages refer to. If (as I suspect) this is just percent of people who enrolled to have a PHR this does not tell us much. The real question is how often are records accessed, what are the specific features used, how often, etc. To be impressive, the absolute numbers do not have to be high, but need to show the specific impact on how PHR is making a difference: for patient, physician, institution, app developers and platform owners. The benefit has to outweigh the cost of time and money.

Platforms have a lot of masters to serve to be successful! Still there are patterns to look for - most platforms tend to have a few big "killer apps" that dominate their usage (e.g. office suites on desktop operating systems, hit games on Xbox, etc). We have yet to see which apps will produce such hits for PHRs. I know Microsoft is making all the right moves (with BeWell Fund), but we have yet to see how these applications shape up.

In the end, if anyone has the wherewithal to do this, it would be Microsoft. Even though the problem they are tackling is so hard!

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