Let the Data Flow: Part Two

Moving from an event focusing on HIE/REC initiatives by various States, the next two events, HealthCampSF and Health 2.0, took data liquidity to new heights.  Having the CTO of HHS, Todd Park, kick things off at HealthCamp by channeling Oprah and discussing/promoting the Clinical Health Data Initiative (CDHI) as well as the Blue Button sure got things started. But that was only the beginning. The organizers of Health 2.0 really out-did themselves this year, certainly making up for last year’s event, with a highlight being the Code-a-Thon challenge wherein teams of developers joined together to use freely available data (e.g., CDHI) to create new, novel and potentially useful apps.  While these developers only had a few days to put together an app, their efforts, while a little rough around the edges, were creative and demonstrated what might be possible once we bring some liquidity to health data.

But there are certainly examples where an abundance of data, or at least data sharing can run amuck and likewise there are examples, such as the Code-A-Thon and others at the Health 2.0 conference that exemplify what may be done with data if it is applied in a streamlined fashion.

An example of the former was the Accelerator Demo.  In this mock demonstration an elderly woman and her adult child navigated the ins and outs of the healthcare system through a multitude of consumer facing healthcare-centric apps. (FYI: Health 2.0 Accelerator, or H2A for short, was created to facilitate data sharing across the multitude of consumer-facing healthcare applications). Unfortunately, rather than showing how a consumer can readily and easily use such apps, leveraging data to facilitate their interaction with the healthcare system this demo completely bogged down becoming almost impossible to follow.  After watching this demo it was quite easy to see why most of these Health 2.0 apps have failed to catch hold. Each app is trying to performing some unique function.  Consumers don’t want that, won’t adopt that.  What they want, what they need is a solution that addresses several needs in one neat, tight package (app).  Today, it seems that only WebMD comes close to addressing this need. Unfortunately, it often seems that WebMD is more interested in only maximizing advertising dollars then delivering on this need through further development of their solution suite.  But maybe that is just a clear signal that this is still a very immature market with very low rates of adoption and thus not worthy of significant investment.

That’s not to say a number of companies aren’t trying to change this, see a wealth of opportunity and are investing for the future.  Unlike past Health 2.0 events where Microsoft has played a small role, this year the folks from Redmond were quite active in a number of panels, demos and the like. Adobe was also there having participated in and won the Blue Button Developer’s Challenge sponsored by the Markle Foundation and Robert Wood Johnson Foundation. Adobe’s winning entry allowed for the automatic creation of a PDF document upon downloading a Blue Button file (Blue Button files are currently flat, ASCII files).

Nearly perennial speakers at Health 2.0 conferences past have been AllScripts CEO, Glen Tullman and athenahealth’s CEO, Jonathan Bush speaking on their respective views of clinical HIT issues. This year neither took the stage, but Cerner did. Unlike their clinical HIT brethren, Cerner did not wax poetically on interoperability, meaningful use and the like but instead gave a presentation on their Personal Health Record (PHR) system, Cerner Health as well as a new game-like platform, Cerner Active that promotes and tracks physical activity. These systems are interlinked with each other and likewise with the host EHR – again letting the data flow across these systems in the promotion of health and wellness objectives.  While the interface/GUI of Cerner Health and Cerner Active still require additional work, the overall system architecture is well executed. Unlike what is arguably the best PHR from an EHR company (Epic’s MyChart) today, Cerner’s PHR is fully portable. Granted, this is a modest distinction as all EHR-based PHRs will be required to provide a level of portability in the future under Meaningful Use Rules, but it is good to see one of the largest EHR vendors take a proactive stance. So Epic, when will you open up?

The Cerner demo that showed data flowing back and forth from the EHR to the PHR got me thinking that these two terms, EHR and PHR are no longer relevant.  Hold on to your hats folks as it is now time to introduce a new acronym, drum roll please…

The CHR for Collaborative Health Record

Language is a powerful tool. By using the terms EHR and PHR we subconsciously, and even consciously, create divisions within a care team. On one side we have the patient, family and loved ones using the PHR,  On the other side is the clinicians with their EHR.  These divisions are becoming increasingly artificial and have the very real potential of hindering care rather than promoting it. While legislative laws have been written using the terms PHR, EHR and the like, it is high-time, before we get to far down the road of HITECH and Meaningful Use, that we begin talking about a larger vision of the future, one where a CHR is the core of HIT initiatives and future planning.

Now this was my fourth Health 2.0 conference and the best one to date.  With over 1,000 participants (it was a packed house) all appearing to have an active interest in changing/improving the healthcare system and along the way, make a business out of it, the Health 2.0 is easily the most exciting and innovative event in the HIT market, albeit with a heavy tilt towards consumer-facing apps.  But like Ben Rooks, an equity analyst who does an occasional post for HIStalk, the event makes one schizophrenic. You get excited by all the energy in the air, the innovative concepts being presented, but become quickly dis-heartened when you pull back the covers to find just another innovative idea/product, but not a company. Most presenters do not have a well-structured and viable path to market outside of the all too common Freemium model, a model that only seems to work in massively scalable markets.

There are always exceptions and one presentation that caught my attention was that of Will Barkis from Bill-Doctor. This company certainly did not have the polish of Castlight Health, nor did it have the some $80M in VC funding that Castlight received.  What Bill-Doctor did have though was a solution to solve a very real consumer and healthcare system problem, bill negotiation and payment. The solution addresses this issue in a very simple and straight-forward manner that will serve both sides of the bargaining table – doctors/hospitals get paid more then what a collection agency will gather and consumers get a more reasonable, negotiated bill to pay.  Bill-Doctor’s revenue model is also has a very compelling and will turn a profit quickly. If I could, I’d bet on this horse to show. (Note: I contacted Will re the Bill-Doctor website. He informed me that it is not live yet but was gracious enough to provide the slide-deck demo which is provided at end of this post.)

But what I find most troubling in the multitude of presentations I saw and discussions I had during the breaks was the lack of hard evidence that these creative solutions actually make a difference. The hard work of tying these ideas, these products, these concepts to outcomes, to improvements in quality of care delivered, to demonstrable returns on investment just aren’t there. Granted, some of these companies and products are very new to the market, but others have been at this for several years now and still, where is the evidence that these solutions actually make a difference? I can’t recall a single presentation where such hard evidence was presented.  Until that occurs, the Health 2.0 event and those that participate will remain more of a side show, dare a I say the freak show, while the main event occurs under the big top at a three ring circus such as HIMSS.

Don’t get me wrong, the Health 2.0 event is exciting, the ideas truly innovative and the organizers of the event have done a very good job putting together an event that covers the broad spectrum of health. If you want to see what the future may look like, this is definitely an event to attend. My concern rests with the need for hard-core impact analysis rather than the fluff and anecdotal evidence that is presented.  Without such evidence, broader buy-in and subsequently market adoption will remain elusive for those presenting at Health 2.0

ADDENDUM:
Above mosaic picture was taken in the Mission area of San Francisco.  Was staying there in a small studio apartment I found through Airbnb – a great site if you are on a budget.

[scribd id=39431077 key=key-2o873wvfuzqjly9zfio2 mode=list]