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.