HealthVault & NY Presbyterian – Closing the Loop on Care

by | Apr 6, 2009

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 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 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 will occur in stages with the platform first being made available to cardiology and cardiac surgery patients.


The impetus for 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 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 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 account are initiated by the consumer, supporting consumer consent & control.

Therefore, the 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, however, (as the figure above shows) sits outside the firewall of NYP. This combined with the fact that a 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   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.



  1. Brian

    “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 competition with other provider-based PHR solutions, such as Epic’s MyChart. ”

    I think the real competition is between EMR vendors (Amalga vs Epic instead of HealthVault vs MyChart). Once the EMR vendor is selected, organizations are likely to take the path of least resistance when it comes to patient portals and untethered PHRs. For Amalga customers, that probably means HealthVault. For Epic customers, that probably means MyChart (tethered) and Lucy (untethered).

    This announcement seems like it boils down to only slightly enhancing the Amalga offering by now optionally including HealthVault connectivity out-of-the-box.

  2. Linh C. Nguyen, MD, MS, MMM


    You have not commented on NHIN. They recently launched as an open-source. Any thought of which one an EHR vendor will interface with, HealthVault VS NHIN? Will a provider choose an EHR that interface with NHIN or HealthVault or both? Who can you trust? With Almaga, will EHR vendor work with HealthVault? LCN.

  3. Roberto Ruggeri

    @ John:

    A small correction to your otherwise excellent read on the news. It is Amalga UIS or Amalga Unified Intelligence System. The distinction is important as clinical is just a portion, albeit an important one, of what we address.
    For Amalga UIS, data is data, whether clinical, financial or otherwise.

    @ Brian:

    Amalga UIS does not compete with Epic EpicCare, Cerner PowerChart or other HIS/Inpatient Clinical Systems.
    Amalga UIS will generally complement those systems in ways that they were not designed to address.
    The complement that Amalga UIS brings to HealthVault is a simplification in the process of gathering the information from multiple, disparate CIS and making it easier to send it to HealthVault, managing the connection and receiving the information back from HealthVault is the consumer whishes to do so.
    The connectivity to HealthVault is just one of the many benefits of Amalga UIS for healthcare organizations.

    Full disclosure: I am the director of product management for Amalga UIS at Microsoft. Hope this post helps clear some the questions.

  4. Gerry Higgins, Ph.D.


    Just a slight correction – the NYP Hospital network serves 21% of the population of New York City, not New York State.

    Cheers- Gerry

  5. John

    I agree with Roberto that Amalga UIS does not compete with EMR solutions, but rather relies upon those solutions and other apps found in a medical facility to aggregate and present data. Quite similar to other Business Intelligence (BI) solutions such as Business Objects.

    As for HealthVault+Amalga, do believe this provides a very compelling solution for mixed environments that have a number of legacy clinical apps. It may no compete with MyChart, which is commonly, almost exclusively, found at facilities using nearly the entire Epic stack, but HealthVault will likely be formidable competitor to “Lucy”.

    I do not hold much hope for NHIN. FOSS or not, there are simply too many issues, particularly regarding data governance/ownership to make NHIN work. Putting control directly in the hands of the consumer, ala HealthVault, eliminates those data governance and ownership issues. As I like to state in talks I give:

    “The Health Clouds will Rain on the NHIN Parade.”

    As for who/what will the EHR vendor link to/support, that all depends on what the market wants. Vendors will simply follow the money.

    Thanks for your reply and pointing out the need for correction, which I have done. Hope to meet you at the upcoming HV Developer’s Conf.

    Thanks for clarifying NYP’s service catchment as being just NYC. Have likewise corrected this as well.

    To all,
    Thanks for reading and more importantly, commenting. Gives me the inspiration to keep writing.

  6. Roberto Ruggeri

    @ John

    I will be happy to meet you at the Connected Health Conference in June. Feel free to contact me directly or through Bert.

  7. Herman Cummins

    Following receipt of your letter I opened an account on MyNYP. What I found was the results of blood tests, nothing on procedures, medications, or diagnoses. Will there be additional information provided later? If not, then this site is not very useful since one can obtain the blood test results in the hospital.

  8. John

    Herman, thanks for providing some commentary on your own personal experience and it reminds me of some the early comments I received from those who went to export their personal health information (PHI) from a hospital (BIDMC) to Google Health and were surprised with the lack of records actually transmitted.

    In the case of BIDMC, the initial export was a very limited data set of one’s PHI which in the ensuing months has increasingly included a more complete portion of one’s record. Such may ultimately be the case at NYP who initially launched myNYP to target cardiac patients upon discharge insuring that their PHI went with them as part of the discharge process and would be available to a patient’s primary care physician for subsequent follow-up. In time, I am confident that like BIDMC, myNYP will begin addressing the needs of its broader population of patients/consumers as the new federal requirements for meaningful use of an EHR will require such from myNYP for them to receive reimbursement.



  1. ICMCC Website - Articles » Blog Archive » HealthVault & NY Presbyterian - Closing the Loop on Care - [...] two leading healthcare solutions, consumer-facing HealthVault and provider-facing Amalga.” Article John Moore, Chilmark Research, 6 April [...]
  2. A Little Imagineering at NYP | Coded Style - [...] way, and there have already been some great write-ups, particular in the New York Times and on the Chilmark…
  3. Tune Up Your PC » Post Topic » A Little Imagineering at NYP - [...] way, and there have already been some great write-ups, particular in the New York Times and on the Chilmark…
  4. HealthVault Moves Over the Border « Chilmark Research - [...] New York Presbyterian’s use of HealthVault and Amalga for demonstrates HealthVault’s move in to the provider market. [...]
  5. Providers Taking Closer Look at PHRs « Chilmark Research - [...] settings and thereby reduce re-admissions within the critical 30 day window after discharge.  The recent launch of is…
  6. The Borg Lives in Healthcare « Chilmark Research - [...] Now this is not necessarily a bad thing for Microsoft or the broader market but it does signal some…
  7. Microsoft’s Amalga & HealthVault Land LTC Provider « Chilmark Research - [...] a provider of long-term care (LTC) and like services for the elderly and disabled.  Similar to the New York…
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