In late November, the Robert Woods Johnson Foundation (RWJF) announced the release of a hosted version of the Project HealthDesign Common Platform Development Environment (CDE). The CDE is an outgrowth of the broader Project HealthDesign initiative that began in 2006 (prior to HealthVault, Google Health and in close proximity to Dossia’s launch) wherein a number of academic research institutions who had received competitive grants set out to develop new consumer-facing personal healthcare apps (PHAs). Early in the development of these apps it was discovered that PHAs had a number of common requirements (e.g. registry, authentication, basic data storage of med lists and personal observations). This led RWJF to fund the development of the Common Platform, built with Open Source tools (J2EE, MySQL, etc.) which was released to the public at large in June.
Despite spending millions of dollars on the development of novel personal healthcare apps (PHAs) and the build-out of a common platform for shared services in support of PHAs, it is unlikely that this investment will gain much traction in the market, remaining by and large an academic exercise.
Why the pessimism?
As much as Chilmark would love to say that the CDE is a great idea that will be met with broad adoption and use, we just don’t see that playing out for several reasons:
1) Google Health & HealthVault. It wasn’t that long ago that both Google Health and HealthVault were nothing but rumors. At that time the PHA/PHR market was in funk with numerous apps being developed, but few gaining much traction in the market and the path to market was convoluted. The concept of a CDE was a welcomed one and demonstrated foresight on the part of those leading Project HealthDesign. But PHA development is now coalescing around the major commercial platform plays of Google and Microsoft and a third platform (CDE) that has little market visibility will wither.
2) Marketing. RWJF is a great source of funding to push the envelop on what might be in regards to PHAs but getting beyond the academic funding exercise to the promotion and marketing of the results of their funding is lackluster at best. They simply do not have the gravitas in the market, they do not get the ink and subsequently, few even know of the CDE, let alone have accessed the code (according to RWJF, since June ’09 there have been 38 downloads altogether of either the compiled or source code for the CDE – hardly a stampede by developers of PHAs).
3) Smartphones. The advent of the iPhone with its thousands of medical, health & wellness apps, the more recent introduction of Google’s Android mobile OS, and the onslaught from virtually every other mobile app OS to have its own “AppStore” has completely changed the equation of what consumers will ultimately use as the input device for their online health information. From collecting ODLs to granting access to personal health information (PHI) on the fly the smartphone will become the modality of choice within the next 5 years. This is where the market for consumer-facing healthcare apps is headed and likewise, where developers will be focusing the majority of their attention and of course limited resources.
Not all is lost, however, and there are a couple of scenarios where the CDE may play an important role.
1) Clinical Research. Within the academic arena there is a significant amount of clinical research occurring, for example clinical trials, where there is a strong need for apps that assist in recording progress or lack thereof in a given clinical trial. A flexible, open source platform such as the CDE has many of the core functions that could be used in support of a clinical trial. Its ability to be easily configured to a given trial may also prove highly advantageous in certain scenarios.
2) Large Institutions with a Capitated Audience. Colleges and Universities have begun exploring how they can use PHRs in support of delivering better, more proactive healthcare to their students as well as minimize upfront workloads of manual entering students’ health histories. Within these environments, the CDE may find a ready market of those willing to adopt the platform in support of their internal initiatives. Long-term Care facilities may also find the CDE of use, though this is a smaller opportunity as compared to that of the digital natives occupying today’s dorm rooms across the country.
3) International Market. Beyond the US borders are numerous countries who also struggle with delivering consumer-centric healthcare apps. The RWJF CDE can provide a robust platform for developers in these countries to build apps in support of their citizens. Being Open Source and freely available also allows these countries to take the CDE into their own hands and modify it to meet the unique cultural needs and requirements of their country. It is here where Chilmark Research sees the most promise for the RWJF CDE. Our only hope is that someone else sees this opportunity as well.
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Thanks for the review of the CDE that came out of Project HealthDesign and I agree with your assessment – it’s not likely to gain much traction in the commercial world. Nor is it intended to. We commissioned the development of the platform to aid with the prototyping of personal health applications (see http://www.projecthealthdesign.org/overview-phr/projects) that our grantees were doing. It was never intended to compete with HealthVault or Google Health – in fact an explicit goal of Project HealthDesign was to stimulate the marketplace to develop PHR services along the platform/apps model that you know so well. However, because of our commitment to making all of the Project HealthDesign work available under open source, Creative Commons or public domain arrangements, we have released it and are supporting it (through early 2011) for those who wish to experiment with it. The niches you mentioned are great suggestions — thanks for your thoughts.
A complete summary of Project HealthDesign products is available at http://www.projecthealthdesign.org/products_open.
I’m happy to add my thanks to Steve’s for John’s analysis and to make a few additional points regarding Project HealthDesign and it’s scope of work . The first round of Project HealthDesign, supported by the RWJF with additional support from the California HealthCAre Foundation, supported three key, interrelated activities: nine grantee teams who each developed a novel personal health application, an ethics/legal consultancy service that helped grantees identify and explore (and sometimes resolve!) the novel ethical and legal issues raised by innovation in personal health record space, and the development and deployment of the “Common Platform” — a web- based resource developed first to be responsive to the common data management needs of our grantees and later distributed widely under the LGPL open source license. Our recent release of access to a developer’s environment provides a new opportunity for those interested in the technical side of PHR’s to ‘kick the tires’ and program against the common platform, to see how its services might be of use. We encourage all to remember that this is a developmental/test environment. Sujansky and Associates are available to answer brief questions about how the system works; we encourage those who want to test out the system to consult the documentation available at http://www.projecthealthdesign.org/common_platform/cp_overview — Please let us know about your experiences!