HealthVault & NY Presbyterian – Closing the Loop on Care

Today, New York Presbyterian (NYP) will announce a significant move forward in care coordination.  Working with Microsoft for over a year, these two have co-developed an impressive platform called MyNYP.org.  MyNYP.org is a consumer facing PHR solution for NYP customers that combines attributes of Microsoft’s two leading healthcare solutions, consumer-facing HealthVault and provider-facing Amalga.

In addition to using Microsoft’s Unified Intelligence System (UIS) Amalga, to aggregate and present patient data to physicians, it is also using Amalga to aggregate and push such information into a customer’s/patient’s MyNYP.org PHR account.  In doing so, NYP is providing the consumer the ability to access and export all of their NYP clinical records into their personally controlled HV account (see figure below).  This provides the consumer with the gold standard of health data, clinical, with the portability and data management capabilities of HV.

While NYP serves some 20% of population in New York City. The roll-out of MyNYP.org will occur in stages with the platform first being made available to cardiology and cardiac surgery patients.

The impetus for MyNYP.org was NYP’s desire to “close the loop” of patient care upon discharge.  During my briefing with Microsoft execs I was presented the following scenario:

A customer of NYP is scheduled to have a procedure performed at an NYP facility.  The customer goes to their MyNYP.org account, which may have been previously established for them and enters pertinent data into their account to share with the NYP care team prior to the procedure (note, this could even include advanced directives that they have put in the HV account).  The information provided by the customer is used by the care team within NYP for advance planning to insure that the procedure goes smoothly.

Upon discharge from the facility, the customer is provided all the usually printed information including discharge summary, instructions, meds, etc.  This information is also available to the customer for them to export to their MyNYP.org account along with labs, clinical notes, EKGs, and other pertinent visit summary information which the customer can later share with their PCP. This scenario, “closes the loop” between, consumer, NYP and the ambulatory practice contributing to care continuity. All record transfers from NYP to a customer’s MyNYP.org/HV account are initiated by the consumer, supporting consumer consent & control.

Therefore, the MyNYP.org will address both the inbound informational needs of the facility prior to a visit as well as outbound needs of the consumer and their care team residing outside of NYP.  New York Presbyterian made it a point to stress that a key objective is to get visit summary information back into the hands of referring physicians, a growing issue for all hospitals.

Now a skeptic may say: “What’s the big deal?”

Here’s the deal:

MYNYP.ORG supports full portability and control of personal health records by the customer/consumer.

Many hospitals and IDNs currently offer a tethered-PHR with an oft-cited example being the excellent work done by Kaiser-Permanente with their MyChart, which now has customer adoption approaching 50%, an absolutely huge percentage.  Thing is, virtually all such tethered-PHRs are simply a consumer portal into the EMR to view their records.  The consumer has no real control of the PHR regarding access or portability – it is “locked” to the hospital.  Such silo’d PHR models do not support care continuity nor consumer control.  If you go to a competing hospital or a physician not associated with the hospital/IDN, it will be extremely difficult to share your records with them, unless of course one were to just share their password – not a great idea.

Combination of Amalga and HealthVault addresses vexing problem of aggregating data from disparate apps.

Most hospitals and IDNs have a huge collection of legacy software scattered across their facilities which can make it exceedingly difficult to aggregate and present a complete record of a customer’s history.  Yes, there are Master Patient Index (MPI) solutions and various interface engines and the like that try to bridge across and link all of this data to provide a complete record, but tying that to the patient-facing EMR portal/PHR is challenging to say the least.  Part of the success of KP’s PHR is that they are running their operations on a single EMR, EPIC and subsequently using the EPIC PHR, MyChart.  Most hospitals and IDNs resemble NYP, which has instances of Eclipsys, Misys, Cerner, GE Centricity and a host of other clinical apps.  Bringing together the capabilities of Amalga, as the aggregator with HealthVault as the PHR is an extremely attractive and compelling solution for virtually any medium to large-size hospital or IDN with a complex IT environment.

Relinquishing control to consumer supports care continuity in the community.

Consumers go to those facilities that provide the best and most convenient care.  Sometimes that may be the PCP, other times a retail clinic, if necessary a specialist, and occasionally a hospital.  The healthcare market is rapidly evolving to provide consumers with even greater choices, the problem is, with an increasing number of venues, there is no central entity responsible for aggregating all of health data, which is critical for care continuity.  The only one best suited to aggregate and manage the multiple records that result from all of these interactions is the consumer (although vast majority of consumers do not know that yet – but that is fodder for a future post).  Clearly, NYP sees this and is taking the necessary steps to assist their customers with better managing their health records in support of care continuity regardless of who ultimately provides that care.

Quick Note on HIPAA:

Amalga is installed within the firewall of NYP and thus this solution’s deployment at NYP clearly falls within the definition of “Business Associate” and is a covered entity in new HIPAA guidelines of ARRA legislative language.

HealthVault and its use as the technology foundation for MyNYP.org, however, (as the figure above shows) sits outside the firewall of NYP. This combined with the fact that a MyNYP.org acccount is completely controlled by the consumer, leads to an interpretation that Microsoft HealthVault does not fall under HIPAA compliance.

Impact to the HIT Market

Like many before them, Microsoft sees clearly one of the key findings of our 2008 iPHR Market Report; the direct Business to Consumer (B2C) model for PHRs is extremely difficult to make work (if not impossible) today.  Thus, they are now actively pursuing a Business to Business (B2B) model and are adding additional PHR functionality to the core HealthVault platform.

Microsoft is clearly looking to monetize all the resources it has put into HealthVault and is now going direct to market with a base PHR platform for the provider market.   This puts Microsoft in direct competiton with other provider-based PHR solutions, such as Epic’s MyChart.  Microsoft is likely to see success among providers with highly mixed IT environments.  (Note: in two conversations today at HIMSS, was told that the provider market has been particularly “hot” as of late for PHR vendors.  Seems as providers have “gotten religion” and are now looking to more deeply engage with their customers/patients.)

Microsoft may also begin looking at other markets.  Naturally, other PHR markets seem logical to attack, particularly the employer market thus coming into direct competition with WebMD. The RHIO/HIE market, however, is another market where the combination of Amalga and HV may create a compelling platform.

But Microsoft’s offering is far from complete.  A glaring hole is transactional processes.  One of the challenges that Microsoft faces is how to fold in those critical transactional processes, such as eVisits, online appointment scheduling, prescription refills, etc. into their solution.  Last year, Microsoft did announce a partnership with RelayHealth who certainly has the knowledge and capabilities to enable such functionality, but to date we have seen nothing materialize from that partnership.

Direct from NYP, ala the Microsoft PR folks, is the following video that interviews various NYP senior staff and executives as to why they put together MyNYP.org.   A little long, but well-worth the time.  This is the future direction of health – “the orchestration of care” which includes active participation of the consumer.  Congratulations NYP on this ground-breaking effort.

[youtube=http://www.youtube.com/watch?v=RcuAsnhK-7w&hl=en&fs=1&rel=0&border=1]