Last Friday had the chance to meet up with the folks at Dossia, the personal health platform (PHP) formed by a consortium of employers. Purpose of the meeting was to get a deep dive update on Dossia and learn more about what they have done in the last year or so since they went live with Wal-Mart in fall 2008.
Since that go-live, Dossia has been fairly quiet, though they did announce two new “founding members” and released the open API this past summer. But frankly, not much to write home about.
Despite being the first “out the door” PHP, several months ahead of Microsoft’s formal announcement of HealthVault in early October 2007, Dossia has floundered. First was the break-up with their first development partner, Omnimedix which led to Dossia forming a relationship with Children’s Hospital, Boston to use the open source Indivo PHP. After nearly a year of work with the Indivo team, Dossia finally had WebMD linked into Dossia. This integration between WebMD and the core Indivo-based Dossia platform was done under some pretty tight deadlines to meet Wal-Mart’s aggressive roll-out schedule – as part of their annual fall health fairs for employees across the country. The push led to a less than ideal integration with the WebMD, an integration that could not be readily duplicated with any other third party independent software vendors (ISVs). Thus, Dossia’s desire to build an ecosystem of apps on top of their PHP was put into stasis as the Dossia team focused on the Wal-Mart roll-out.
A year later much has been learned.
Dossia discovered that Indivo V3.2 was not fully scalable to meet large enterprise needs.
The Indivo platform was developed by Harvard Med School academics to test the concepts and policies associated with a patient-controlled health record system. Prior to Dossia’s adoption of Indivo, the platform had seen small scale implementations at Children’s Hospital, MIT’s on-campus hospital and at Hewlett-Packard in association with a flu vaccination study. In each of these implementations, no ecosystem of apps was deployed via a common and open application programming interface (API). This is understandable as Indivo was structured to test concepts, not necessarily structured for large scale commercial roll-out.
Since last fall, the Dossia team hired a completely new team of developers (size of Dossia team on par with Google Health ~15-18 FTEs), completely re-architected their platform to meet scalability requirements, addressed user interface (UI) issues (Indivo lacked a modern, intuitive interface), and developed a stable API that ISVs could use. On October 15th, the new platform/UI went live.
The new API was released at the end of June and there are now 20 ISVs modifying their apps to sit on the Dossia platform. As of today, in addition to WebMD, Dossia has eClinicalWorks (eCW is used in Wal-Mart’s retail & corporate clinics – don’t forget that eCW is also being sold through Sam’s Club), Healthtrio, Medikeeper and Metavante, who had acquired CapMed, live on the platform.
Indivo platform did not adequately address the myriad of state laws relating to record consent and sharing for teenagers.
Last year’s Wal-Mart roll-out was targeted at just employees. No incentives were provided, it was completely left up to the employee as to whether or not they wished to participate. While Wal-Mart obtained “favorable” adoption, a key desire of employees was to have a Dossia account not only for themselves but also for their dependents. This desire led to some fairly significant challenges for Dossia in providing the appropriate consent structure for teenage dependents where State laws vary significantly. These new consent requirements were built into the new platform as well.
Employers wanted support for dental records.
Another request from employer consortium members was the ability to support dental record data. As part of the platform rebuild, Dossia has also embedded a dental data schema. To the best of our knowledge, Dossia is the only PHP who has this capability today.
User interface needed to be simpler, more intuitive to provide easy access to personal health information (PHI).
During the meeting, Dossia provided a demo of its new interface, which was very simple to navigate, ranking on par with Google’s and a more intuitive experience than that of HealthVault. Dossia has a slight advantage here in that employers define which apps employees have access to and upon sign-up populate an employee’s account with their claims and pharmacy benefits management (PBM) data. For either Google Health or HealthVault, most consumers must go through the actions of loading their own data, choosing their own apps, etc., to establish a viable and personally value producing account. This is similar to the adage “with freedom comes responsibility.”
Challenges Remain:
Dossia has made impressive progress since its initial launch last fall. They have addressed the scalability issue, they have finally released an open API for ISVs to create an ecosystem of future apps and several other consortium members will be going live on the platform in the near future. Despite these gains, challenges remain.
Where’s the lab data?
While Dossia has the ability to support clinical data in either CCR or CCD formats, today they are only importing claims and medication data from PBM firms. Dossia, like Google Health and HealthVault does not support images today. In somewhat of a surprise, Dossia also does not currently support lab data imports from either Quest or LabCorp. This is a surprise for two reasons: First, viewing labs online has been found to be one of the most desired attributes of a a personal health account and secondly, both Google and Microsoft can import lab data from either of these national testing labs that represent some 80%+ of all labs done in the US. If Google and Microsoft can do it, why not Dossia?
What’s the value proposition for employers?
Chilmark still struggles to understand what the value proposition is an employer to adopt the Dossia platform for their employees. Yes, Dossia may be a non-profit looking to provide a common platform that will provide employers more flexibility in the health-related tools (PHRs, HRAs, wellness apps, etc.) they can offer their employees to better manage employee health and wellness, but is that enough? Today, few employers see the strategic advantage of providing even the simplest of such tools (e.g. a WebMD account, an online wellness program, a disease management program that actually works, etc.) to their employees. If it is difficult for them to see value here, how can they realistically make the leap to considering a health platform with an ecosystem of apps?
And the value prop for employees is…?
Yes, the interface is much improved and yes, PHI data is automatically imported into an account and an employee’s Dossia account is fully their own, but beyond that, why would an employee sign-up to have an account? What other attributes and services does Dossia provide that are attractive to a consumer? According to Kaiser-Permanente and others, those who adopt and use such system use them to look at their lab data and conduct simple transactions such as Rx refills and appointment scheduling, all features that Dossia does not support. So again, the value for a consumer in using Dossia is?
A couple of suggestions:
Rev up the marketing engine
If Dossia’s claims are indeed true, that the platform is stable, scalable and open to third party ISVs to build-out the ecosystem, then it is time for Dossia to become more aggressive on the marketing front. Who better to market Dossia than its consortium members?
To date, Dossia’s consortium members have been extremely quiet and they are arguably, Dossia’s strongest marketing partner. But if Dossia’s founding members are not out there promoting the platform, clearly stating the value proposition they see in being a member and even, as in the case of Wal-Mart, begin talking about the successes they have seen since launching Dossia, then how is any other employer suppose to buy-in to the concept?
And a concept it is for there are few in the industry today, including health benefits management firms and consultants, that fully understand what the ecosystem/PHP model represents and the value it may deliver to employers over the long-term. The best advocates, the best marketing Dossia can receive at this critical juncture, is the vocal support of its members. So where are they?
Get the labs
Ability to access, view and share lab data is one of the top features that early adopters of PHRs and PHPs appreciate. Dossia needs to get this issue addressed immediately. End of story.
Delivery a value proposition that employees will appreciate and use
Critical to the success of the most popular personal health systems in the market today are their ability to support transactional processes. While it would be extremely difficult, if not impossible for Dossia to support such functions as appointment scheduling, Rx refills, eVisits with one’s primary care doctor, there is one transaction area where they could excel: providing health-related financial decision support tools. Such tools would provide support for health savings accounts, plan deductables and balances, pricing transparency for common procedures, medications, etc., special employee health discounts, and the list goes on. There are a number of interesting apps now entering the market that provide such capabilities and Dossia would be wise to focus on these ISVs providing an added level of assistance to get them on-board quickly.
Wrap-up:
Walking into the briefing, expectations were quite low for what we might hear from Dossia. Their quiet, reclusive nature, lack of partners, and seemingly little progress being demonstrated to the market left one thinking that Dossia will fade over the next couple of years. The briefing put many fears to rest. Dossia is proceeding ahead at a careful measured pace and has accomplished much over the last year. It is far too early to count them out.
But will Dossia ultimately succeed, will they be a force to be reckoned with will they become a key market influencer?
Still too early to tell. The platform is stable, the API is there for third party ISVs and with Dossia representing over 8 million potential users (employees) this is a market nearly 3x the size of the most popular PHR today, that of Kaiser-Permanente – a very sizable and attractive market for most any ISV. But without strong vocal support (marketing) by executives of its consortium members, Dossia will struggle to make its presence known, struggle to clearly articulate its value proposition and struggle to influence the market and subsequently drive market adoption among employers on behalf of their employees.
Good article. Ultimately without the transactional process support as you mentioned, I don’t think they will be viable. The transactional processes will only become more important and ingrained in PHR’s because they add so much value to the patient and to the health care organizations.
One other note: You mentioned that Dossia’s market is 3x the size of Kaiser’s. If you want to compare apples to apples, Kaiser’s “potential” market is larger than 8 million users. Their active PHR user base is nearly 2 million. They spent several years getting to that point and had the benefit of using an EMR-linked PHR. I think it would be unrealistic to say that Dossia would get anywhere close to this, especially since they don’t link directly to any EMRs.
Thanks for the comment Aaron and you are correct, it would have been better to paraphrase Dossia’s potential market as 8M employees. If you add dependents, say multiply by 2.2, you have a total market/user opportunity for Dossia of 17.6M. Granted, Dossia will not see 100% adoption, but if they hit 30% or so, we are looking at over 5M individuals.
As for Kaiser, they state that they have some 8.2M covered lives/members and today 3.1M members use the KP PHR, MyChart. The 3.1M number represents nearly 50% of all members who have internet access.
John – have you ever tried to get your lab data into GH or HV? You note in your post that both have lab data – as if everyone who creates an account has lab data. Not nearly true. It’s a riduculous and cumbersome process, limited by physican participation and a PIN process. Hopefully Dossia will stick with their ability to seamlessly provide information to patients, without requiring users to jump through hoops.
John,
This is a very insightful article.
I agree with you that Dossia has been inwardly focused in the last two years. It is a shame. It is as if the Board of Directors of Dossia has given up on the original ambitions of the organization, down played all their strenghts (low customer acquisition costs, easier access to patient data, and highprofile markeitng thru member companies) and decided to create an inferior version of the WebMD PHR.
Dossia has a unique model, and was the first one to introduce the Personally Controlled Health Record model on a mass scale. Healthvault has stolen the show and has the momentum, although no one to date has been able to establish the transactional model for PCHR.
Maybe, once the employers are tired of this project, they can sell the brand and the infrastructure to someone who can run it effectively and make the model work.
Omid Moghadam