By Mike Baird, President, Customer Solutions, American Well

There are over 5,000 hospitals in the United States, each caring for the country’s growing population of more than 325 million people. Aside from integrated health systems, many of these organizations are operating independently from health plans or other health systems. This type of siloed care has become the norm in the healthcare industry, and while EHRs have improved care continuity over the years, health organizations are still largely operating on their own.

The same can be said for these organizations’ telehealth programs. More than half of healthcare executives say they have implemented some sort of telemedicine service into their organization. Many health systems and health plans launch with a direct-to-patient urgent care telehealth service, before expanding to other service lines including behavioral health, specialty care, chronic care management, follow-up appointments and more. These telehealth programs leverage the healthcare organizations’ provider expertise, clinical services, technologies and unique ties to their communities. While telehealth is helping these organizations deliver more convenient and affordable care, their programs, too, have been historically siloed. Until now, that is.

Today, some of the top health systems and health plans in the country are utilizing their telemedicine programs to connect and exchange services instantly online. Health systems or hospitals who supply healthcare services are partnering with health insurers who generate consumer demand to leverage each other’s strengths.  This sharing of patient demand and provider supply is key in driving telehealth and patient success.

Two of the nation’s top healthcare organizations provide a perfect example of this type of telehealth care convergence. Cleveland Clinic, one of the largest and most well-respected hospitals in the country, offers its telehealth services on Anthem’s telehealth platform, LiveHealth Online. Consumers in Ohio, West Virginia and Pennsylvania who use Anthem’s telemedicine platform can connect with Cleveland Clinic physicians and nurse practitioners through the LiveHealth Online mobile or web platform for live on-demand video consults.

For Anthem, this collaboration offers its members unique access to providers from one of the nation’s leading institutions, and for Cleveland Clinic, it allows the health system to extend its telehealth service visibility to Anthem’s 38.5 million members — ultimately increasing usage and attracting new patients.

New-York Presbyterian offers another innovative example of care collaboration and integration through telehealth. New-York Presbyterian is one of the nation’s most comprehensive, integrated academic healthcare systems. The system has ambitious goals for telehealth and has already integrated virtual care into its emergency rooms to provide effective behavioral health treatment and to triage non-urgent patients to reduce wait times. Through its direct-to-consumer telemedicine program, New-York Presbyterian makes its providers available on the Samsung Health Ask an Expert app, which is preloaded onto Samsung Galaxy smartphones. Through this telemedicine exchange, a consumer with a Samsung phone can have an urgent care video visit with a New-York Presbyterian provider from within the Ask An Expert app. For New-York Presbyterian, partnering with Samsung gives their telehealth program unprecedented exposure to consumers across the country, while Samsung can offer consumers access to New-York Presbyterian’s renowned providers.

New-York Presbyterian, Cleveland Clinic and Anthem are the trailblazers for this type of virtual care collaboration, and more healthcare organizations are following suit as focus shifts from fee-for-service to value-based care.  These partnerships help accelerate telehealth adoption through greater platform utilization, increased healthcare specialty choices for patients, and expanded access to care.

Recent regulations have also helped make telemedicine collaboration more appealing for healthcare organizations. The Interstate Medical Licensure Compact allows expediated multistate licenses for physicians, which means health systems wanting to extend their services over state lines can expect expedited, multistate licensure for their physicians.

Health systems and health plans have their own unique strengths; by lifting the virtual barriers of telehealth care delivery, they can leverage these strengths through thoughtful telehealth collaborations.  In turn, this is transforming the way care is delivered and received for the benefit of both patients, providers, and health systems.

This post originally appeared on September 5, 2018, as the first in a series of sponsored guest blog posts on our Convergence conference blog. 

The Connected Health Conference and its predecessor events, the Partners HealthCare’s Connected Health Symposium and the Personal Connected Health Alliance’s Connected Health Conference (a HIMSS event), aim to frame digital health advancements in the context of improving clinical care delivery as well as personal engagement.

It’s “personal” engagement because the conference recognizes that “patient” engagement only occurs in a healthcare setting. Improving health and well-being must be part of our everyday lives – or, as this year’s conference theme put it, part of “the connected life journey.”

In particular, this year’s Connected Health Conference examined digital health’s impact on getting older – a process that speakers such as AARP CMO Dr. Charlotte Yeh attempted to destigmatize by emphasizing the positive aspects of aging, including learning and building social connections. Get it right, Yeh said, and aging makes us happier – and happiness has been linked to better health and longevity.

With that in mind, here’s a recap of various digital health solutions discussed at the conference, along with Chilmark Research’s assessment of the maturity of these solutions.

Condition management: Almost mature. Multiple speakers highlighted the potential of chronic condition management solutions to provide targeted engagements and interventions, especially those that draw upon principles of behavioral science as opposed to marketing. Plus, Livongo Health announced a partnership with Alaska’s Medical Park Family Care that is notable because providers approached the vendor, with both stakeholders then approaching the payer together; this could be a sign of a shift, as payers or large employers typically initiate the conversation (and may not even get providers involved at all). If there’s a caveat, it’s solution sprawl; Dr. Adrienne Boissy of the Cleveland Clinic noted that the hospital has 27 different apps for engaging with patients; that number has to go down.

Providers don’t want artificial intelligence but, rather, the output of AI – clinical decision support, diagnostics, more personally tailored care plans, 30-day readmission risk scores, and so on – but that hasn’t stopped vendors from promoting the use of AI and machine learning.

Telehealth: Getting there. As Carla Kriwet of Philips noted, the holdup for telehealth adoption is not the maturity of the technology; it’s the clinical culture that still emphasizes in-person visits and the related struggle to define telehealth’s value-add. (Kriwet didn’t mention the regulatory and reimbursement challenges, which Twitter users in the audience were quick to point out). Plus, telehealth requires broadband access, which millions of Americans still lack. That said, physicians are a bit more bullish on telehealth and other technologies at the point of care, AMA President Dr. David Barbe said, pointing to AMA survey data he shared on stage at the Connected Health Conference.

Decision support: Getting there, slowly. Providers don’t want artificial intelligence but, rather, the output of AI – clinical decision support, diagnostics, more personally tailored care plans, 30-day readmission risk scores, and so on – but that hasn’t stopped vendors from promoting the use of AI and machine learning. The baseline ongoing challenge, of course, is bringing disparate data sets together to let AI algorithms do their thing, and then deploying them at the point of care in a timely manner, which is no small task when those data sets include months-old claims and years-old HHS reports. Oh, and don’t forget data streams from remote patient monitoring devices. Smart vendors and providers are using an API approach to address this data deluge, but progress has been slow.

Chat bots: Getting there, slowly. Conversations with bots allow engagement solutions to scale, especially for low-acuity care as well as general wellness and mood. But for every Conversa Health (where chat bot responses come from a database that also identifies whether a particular response must automatically trigger an escalation to higher-acuity care), there’s an Ada Health (where users must escalate on their own, for a $25 fee). Here, the market has yet to separate the wheat from the chaff, as is evidenced by Ada Health’s latest $47 million funding round.

Blockchain: Emerging. There is certainly potential for blockchain to provide secure data sharing, and use cases are beginning to pop up. Hashed Health is addressing provider licensure in the state of Illinois, which will help the state store up-to-date credentialing information and share it with payers; the hope is to eliminate the bottlenecks in an often-manual process. Meanwhile, MintHealth, promises a personal health record platform powered by blockchain. The presence of a unique global identifier, which blockchain enables, could let patients manage their records better than previous PHRs; plus, MintHealth plans to sell to commercial payers, who have clear financial incentives to better engage members. Even if these efforts fall flat – and, let’s face it, PHRs have a poor track record by placing too much burden on the patient – they have at least demonstrated practical examples of blockchain in healthcare.

Virtual reality: Incubating. Qualcomm and ForwardXP announced a VR simulation at the Connected Health Conference that lets users experience stroke symptoms, in an effort to help them better identify warning signs. While this could be an effective educational tool for medical professionals, we’re not sold on its viability for consumers, who would either need to use it on their own VR devices or travel to an educational session somewhere with a VR device. In one session, Dr. Brennan Spiegel of Cedars-Sinai Health System cautioned against “overpromising and under-delivering” with VR. Pain management is an effective clinical use case; giving patients the 21^st century equivalent of a ViewFinder probably isn’t.

Wearables: Incubating (still). Wearables provide data such as steps taken, exercises completed, hours of sleep, but they don’t yet provide insight – and that hasn’t changed since I wrote about it for CIO.com way back in 2014. One reason is the separation between wearable information and clinical workflows, which hampers the ability of wearable data to reliably contribute to decision support. Another is the accuracy of the data; we still earn “steps” for folding laundry or doing dishes, but not for riding a bicycle, so physicians can’t be blamed for viewing wearable data with a dose of skepticism. Finally, for all their talk, consumer device makers such as Apple, Fitbit, Google, and Samsung have yet to crack the chronic condition management market – only Nokia has, and its market share lags substantially.

The smart home: Not even close. Speakers mentioned a number of futuristic use cases, ranging from home-based robot caregivers to fall alert sensors tied to home security systems to sensors that monitor water usage, detect abnormalities, and alert caregivers of potential problems. No one mentioned which healthcare stakeholders would subsidize the high cost of this technology, train end users (including caregivers), or monitor data and escalate a case as needed. Nor did anyone mention the ROI for such technology deployments, or the impact on clinical outcomes.

Closing Thought

Ultimately, the goal of these solutions is to meet the needs of people managing their health, whether on their own or through the clinical experience. As such, these solutions need to ease their way into clinical workflows and everyday life and prove their potential to play a part in the connected life/care journey. Until then, they will simply remain stuck in the technology hype cycle.

The local Cleveland paper published a good article today that highlights the work between Cleveland Clinic and Microsoft HealthVault.  Back in November, these two announced a joint agreement to work together to test the efficacy of using consumers’ self-reported, biometric readings for improving care delivery.  In this case, Cleveland Clinic customers who are managing a chronic condition, e.g., hypertension, take periodic measurements that are fed, by way of the HealthVault repository to Cleveland Clinic’s EPIC EMR.  Once in EPIC, the physician can track and trend readings and make adjustments to treatment plan as warranted. The article gives a real world example of a truck driver, who is one of 30 early users of the service, to manage his blood pressure.

Couple of key points can be pulled from the article.

1) The consumer appreciates the flexibility to take the needed measurements when it is convenient to them and their schedule.  Might such flexibility and convenience lead to better compliance and better outcomes?  Maybe AHRQ needs to do a study on that as part of their Comparative Effectiveness largess.

2) The physician likes the ability to more proactively manage a patient’s chronic condition with use of near real-time data (at least real-time compared to standard practice).  Might this lead to better care at a lower cost through better dosing of medications and other modifications to treatment plan?

But also raises some questions:

Does the use of such systems impact payment/reimbursement schedules?  Is payment reform required to insure that a physician/hospital is reimbursed for such services that typically fall outside the domain of most payment schedules? This remains one of the biggest stumbling blocks for any telehealth program.

How does this type of system fit into the workflow of what is already a hectic schedule for most practicing physicians? Is it primarily the responsibility of the nursing staff to do the day to day monitoring and reporting and bring the physician in when readings exceed certain pre-defined limits, or is it left to the physician to oversee all aspects?  Many physicians I talk to tell me time and time again, not enough attention is paid to process and workflow.  Incorporating such a system into a practice can significantly alter the care delivery model, thus special attention needed here.

In addition to chronic care cases, what about episodic care?  Such a telehealth system may dramatically drop re-admissions after a given procedure if a patient is monitored post-discharge.  Yes, we all know how important it is to address chronic care and compliance as these are huge cost drivers to healthcare today, but re-admissions is also a significant cost and should not be overlooked.

Arguably, the best part of the article is the consumer’s apparent feeling of empowerment.  They are no longer a bystander in their care but an active participant. They are no longer waiting for a doctor’s availability or complying to a clinic’s schedule but are self-reporting based on their availability and need.  Lastly, knowing that the care provider is actively monitoring one’s progress may result in a subtle form of pressure that helps keep the consumer in compliance.

This is the future care model.  What boggles are minds is why it has taken so long for us to get here.

In an interesting twist, Cleveland Clinic and Microsoft’s HealthVault Grp announced a partnership this morning to address chronic disease management. The interesting twist is that Cleveland Clinic was the showcase beta customer for Google Health, which was announced by Google’s CEO Eric Schmidt earlier this year at HIMSS. Like their counterpart in Boston, Beth Israel Deaconess Medical Center, who was part of the initial Google Health public roll-out in May and who has since also established a link to HealthVault for their PatientSite users, Cleveland Clinic is taking an agnostic approach to the major platform plays with this agreement.

The Cleveland Clinic-HealthVault announcement is distinctive in that it focuses on chronic disease management, via telehealth, through use of HealthVault’s unique Connection Center. With some 50 devices from 9 vendors, the Connection Center allows the consumer to upload device data (e.g., glucose readings, heart rate, blood pressure, weight, peak flow, etc.) directly to their HealthVault account. In the Cleveland Clinic project, which began last week (Nov. 3rd), uploaded biometric data from HealthVault compliant devices will automatically be pushed to Cleveland Clinic’s EMR and subsequently exposed to the physician for patient tracking and follow-up.

Had a call this morning with Microsoft and one this afternoon with Cleveland Clinic who both shared further details on this announcement:

A target of 460 Cleveland Clinic patients will participate representing three distinct disease categories; hypertension, diabetes and heart failure. The roll-out is across the Cleveland Clinic Integrated Delivery Network (IDN) and not just hospital patients. Clearly, they are focusing on the big chronic disease categories that result in huge costs that many believe better telehealth monitoring can mitigate.

• Hypertension patients, of which there are 400, will measure blood pressure only.
• Diabetes patients, of which there will be 30, will use five devices to measure glucose, blood pressure, peakflow, pedometer and weight.
• Heart Failure patients, the remaining 30, will use four devices to measure blood pressure, peakflow, pedometer and weight.

Pilot will initially be for an extremely short 90 days. Cleveland Clinic expects to have all patients active within 4-6 weeks. Not sure what they can accomplish in 90 days, maybe Cleveland is just hedging their bets to see if patients actually comply with the prescribed measurement and upload regime. Assuming that all goes well, one can guarantee that this pilot will be extended for at least a year, if not longer, as that is the only way they will be able to provide some demonstrable results that are publishable (something that Microsoft emphasized) and ultimately may influence future legislation (e.g., CMS funding), health plan reimbursement (P4P), and broader adoption among other Integrated Delivery Networks (IDNs).

Devices are being provided for free to trial participants. The only requirement, beyond the obvious willingness to diligently take their measurements, is that they have a Windows-based (XP SP2) computer and broadband access. Unfortunately, many heart disease patients are among the elderly and it is questionable as to how many have this capability. Still, the point here is to demonstrate, not solve all the problems and it is a good start.

Cleveland Clinic is training patients on the use of the devices(s), and data upload process to HealthVault, that is subsequently pushed to Cleveland Clinic’s EMR. Part of that training includes clearly notifying the patient when a particular reading should prompt a call to their doctor or even 911. Along with providing the device(s) and training, the physician will prescribe to the patient their measurement protocol (e.g., 2x/day, 3x/week, etc.) unique to that individual and the condition they are managing. Patients trust their doctors so receiving the package directly from their physician during an office visit makes a lot of sense and should encourage use and hopefully compliance. It will be interesting to see how compliant patients are to the prescribed compliance regiment as this is often a critical stumbling block. Will incentives be required?

Cleveland Clinic put in the upfront effort to understand how best to incorporate this new data stream into a physician’s workflow to minimize the burden. Specifically, the physician will receive a weekly notice notifying them that their patient(s) biometric data is ready for review. One click later and the physician is in the EMR reviewing their patient’s data for that past week. Prior to this pilot, Cleveland has experimented with other telehealth systems, but none were able to provide this level of integration with the core EMR system (always a stand-alone, silo’d operation) and thus saw little adoption among physicians. This is absolutely critical! Having spoken to many physicians about the success, and most often failure of telehealth initiatives, it nearly always circles back to lack of true integration to existing practices/workflow. Looks like this pilot tackles that issue head-on.

So what is the Business Case?

Wrapped up my conversation with Cleveland Clinic’s CIO, Dr. Martin Harris, (thanks again Martin for your time) by asking him: So what is the business case for this initiative? He outlined two areas where they see a benefit to Cleveland Clinic:

Service Case: In moving to this model of combining telehealth with traditional in-office visits they intend to completely re-design the office visit resulting in a better, more engaged and customer friendly process. This process will lead to higher customer service ratings, customer recruitment and higher customer retention – all important top-line metrics. They also see a service case for the physician as such a “system” will allow the physician to deliver a higher level of proactive care with their patients. Its all about market differentiation, distinguishing themselves in an increasingly crowded market – one that will only get more competitive.

Outcomes Case: One of the objectives of the pilot is to see if Cleveland Clinic can consistently improve the outcomes/health of its chronic care patients that will result in fewer hospital readmissions and/or complications. If all goes as planned, Cleveland Clinic believes that it will be able to use these positive results to request better reimbursement schedules (more income) from health plans. This certainly makes logical sense, but to date, health plans and CMS have been reluctant to support such programs – more of a wait and see approach. Hopefully, Cleveland Clinic will start showing some impressive results in a year or so and get those health plans on-board.

Final Note:

A couple of weeks ago I poked Microsoft about their lack of support for the telehealth consortium, the Continua Alliance. Sean Nolan responded stating a primary reason was Microsoft’s desire to move quickly (consortia always seem to move at a snail’s pace). Looks like that has paid-off as Google Health and Dossia cannot, today, support such capabilities as demonstrated above, though they are on the path having joined the Continua Alliance and Google demonstrated modest capabilities at the recent Connected for Health Symposium.

Looking ahead, we forecast 2009 to be a year of pilots which begin to demonstrate the utility of the platform model (Dossia, Google Health, & HealthVault) in support of telehealth and how telehealth technology and practices are best integrated into existing clinician workflow. Look to 2010 to see actual reimbursement models and P4P programs begin to take shape in support of promotion and adoption of telehealth.

Today is the first day of the big HealthVault developers’ conference Microsoft is hosting. Purpose of the conference is to bring together the “legions” of developers that are looking to build Personal Health Applications (PHAs) on top of the HealthVault platform, what I refer to as a Personal Health System (PHS).

As with any such event, we’ll be seeing a lot of press releases come out of Microsoft and to a lesser extent, various partners.  The biggest one today is the announcement that Kaiser-Permanente will do a trial with HealthVault.  Microsoft issued a similar press release.

Why this is Important

HealthVault, Google and to a lesser extent (or at least quieter) Dossia, are all looking to create an ecosystem around which other applications and services will be built.

An ecosystem/platform model is a bit of a chicken and egg scenario. First, there is the strategy to get as many developers as possible building applications on a given platform/system. This creates a critical mass of features that will in-turn attract consumers to the ecosystem accelerating growth, presence and ultimately revenue. But before dedicating precious development resources, smaller software companies want to see if the ecosystem provider can deliver customers that may want to use their application(s), subscribing to their service and delivering revenue.  If there are few consumers, what’s the point in spending those precious resources?

To date, 3rd party PHAs have gone as much on faith as anything else assuming that Microsoft’s HealthVault group (and Google Health) would be successful in attracting consumers. After a pretty poor, at least from the consumer’s perspective, launch of HealthVault last October, it was much to that team’s credit that they were able to attract so many development partners. In a conversation I had with the HealthVault team a couple of months ago, they stated that they were in discussion with over 100 potential PHA partners and I’m sure that list has only grown. Today, they announced that there are now over 40 PHAs up and running on HealthVault. Then there is also Microsoft’s seed funding, Be Well Fund, which was oversubscribed to the point where they actually increased funding by 50% as there were so many good proposals. Microsoft is being very aggressive in developing that ecosystem.

Now it just needs to bring in the consumers, and that’s where Kaiser comes in.

Kaiser-Permanente is partnering with Microsoft HealthVault to potentially provide Kaiser’s 8.7 million plus members the opportunity to port their Kaiser records to HealthVault. While there may be 8.7 million Kaiser  members, today roughly a third, 3 million, are active users of Kaiser’s PHR, but that is still a huge number and arguably the most PHR users under any one umbrella in North America. (Note: Kaiser has done a spectacular job with their tethered PHR, My Health Manager, which is based on the EPIC MyChart patient portal. What really impresses me with the Kaiser PHR is that they continually are measuring and assessing consumer use fine tuning features to best serve both consumers and physicians. They really are setting the standard in the provider space.)

Kaiser will, like Cleveland Clinic did with Google, begin with a trial (beta) enlisting Kaiser’s 156,000 employees to opt-in to use HealthVault. It will be interesting to see just how many opt-in as in the Cleveland Clinic-Google beta, only about 16% of those presented with the opportunity opted-in.

The initial trial will run through the summer providing Kaiser an opportunity to test the platform’s ability to securely transfer records and populate a HealthVault account. Once the beta program is completed, provided its successful and there is no obvious reason why it won’t be, Kaiser will allow its 8.7 million members the opportunity to transfer their records from My Health Manager to HealthVault.

In the conference call today, which oddly enough only had two people asking questions, myself and another, I asked two questions, which were answered by Anna Lisa Silvestre, VP Online Services, Kaiser-Permanente. Note, these are not direct, verbatim responses, but basically the gist of what she communicated.

Ques: Will you be testing the transfer of complete records?

Ans: No, we will test the system by transferring an employee’s health summary that will include immunizations, allergies, medications and conditions.  We will use the Continuity of Care Document (CCD) standard to facilitate transfer of these records.

Ques: Will you consider other platforms in the future (this was my roundabout way of asking, is Google in the cards)?

Ans: Yes, we will consider other platforms in the future as this is not exclusive.  Such choices will depend on value that can be ultimately delivered to the end consumer/member.  That being said, we will not partner with every PHR company in the market but will look at a number of factors including security and privacy policies foremost among them.

Bottom-Line:

Now if I’m a developer at the HealthVault event this week, I sure would be excited hearing this news as it offers the potential for 3 million plus consumers coming on-board by the end of the year.  But is that not the Big Question – if we build it will they come?

In the Cleveland Clinic-Google beta, it appears that the majority of consumers sat back and were not willing (or didn’t see enough value) to move their records to Google Health. Sure, it may have been security and privacy issues that held them back but my bet is that it was just indifference.

It remains to be seen just how many of Kaiser’s employees and later, members will do likewise, which brings us back to the beginning: Which comes first, the chicken or the egg?  Will these PHSs and their development partners provide enough value (features) to bring in the consumer?  Will developers continue investing in creating enough interesting apps to attract the consumer and hopefully justify their investment?  We are a long ways from finding out the answers to these questions but what is clear is that some very significant players, representing large pools of consumers, Cleveland Clinic, Beth Israel and now Kaiser, are willing to offer consumers the opportunity to take direct control of their records and try these platforms for themselves. That is a start in the right direction.

Over on the ever so popular healthcare IT (HIT) rumor mongering website, HIStalk, there has been a running stream of comments since yesterday regarding PHRs that began with a comment by the owner of the site, Mr. HIStalk himself, more or less agreeing with comments by the CEO of EMR vendor Cerner. It appears that Cerner’s CEO, in a recent interview, dissed both Google Health and HealthVault calling them nothing more than “electronic shoeboxes”.

In some respects he is correct. Today, it is far too difficult for consumers to have an independent, untethered PHR, or in the case of HealthVault, a data repository for their records as the consumer must frequently load up all the data via self-entry. Even getting claims data into an untethered PHR is difficult, but it appears that insurers are moving a little faster in that direction than most providers.

But this is changing and the change will accelerate over time as more Integrated Delivery Networks (IDNs), and large hospitals networks (Beth Israel Deaconess, Cleveland Clinic, Medstar, and even maybe Kaiser) begin to provide their customers with an ability to load their medical records up to a 3rd party service thereby enabling portability and consumer control of their records.

Getting back to HIStalk…

In a desire to set the record straight, at least from my vantage point which arguably is well-informed, I provided a fairly lengthy comment on HIStalk in response to comments that preceded it to clear the air. Admittedly, the tone is sharp but after awhile, I really do tire at the amount of dis-information and illogical assumptions that are bantered about.

1) Google & MS are businesses, they are public companies, they have shareholders, so of course they have a business case for defining and supporting their efforts in healthcare, including these consumer plays. I don’t have a problem with that at all as long as they are up front about it, which they have been to date. Actually see their entry into the market as raising the overall quality, security and privacy of PHR solutions going forward, which is a very good thing.

2) In speaking with numerous 3rd party PHR vendors as part of compiling the recently released PHR Market Report, these vendors universally reported that EMR vendors refuse to play ball. The EMR vendors drag their feet in opening up their systems, even when their customers ask them to. No EMR vendor has a vested interest (ie business case) to support opening their systems. Unfortunately, standards are not mature enough nor adopted widely enough to make it happen either. These vendors will be kicking and screaming till the end. Google and Microsoft have the clout and resources to change this dynamic, which we are now beginning to see.

3) Epic MyChart and any other EMR consumer portal certainly has advantages, but all patient portals are tethered and always will be to the host EMR. These systems do not provide a longitudinal record of health for the consumer and should the consumer move, change physicians, whatever, its not like the consumer can easily take that tethered PHR and all the data in it with them. Google and Cleveland Clinic as well as BIDMC are providing portability and from what I hear, much to the chagrin of Epic. Epic hates this!

3b) In addition to the tethered issue, patient portals also do not capture the full health record for those who may have multiple physicians.

3c) And let us not forget the disintermediation of healthcare with medical tourism and retail clinics. An EMR-centric patient portal can not and will not address this issue.

Many changes are afoot and as I outline in our market report, the entrance of Google and MS into this market has some extremely broad ramifications across the entire healthcare sector that I don’t believe we can even begin to imagine in our wildest dreams.

Stay tuned, “The Revolution Will Not Be Televised”

[youtube=http://www.youtube.com/watch?v=uTCQSk2l8bc&hl=en]

Late this afternoon, Google Health Beta officially opened its doors for anyone to sign-up. While I did predict they would go live in the 2nd quarter, I was thinking end of the quarter, not the mid-point. Hat’s off to Google for moving so quickly.

As you know, I am at the TEPR conference trying to gather information and more importantly understand just why this conference is still in existence and more importantly, why it still attracts exhibitors as there is virtually no foot traffic, attendance is low and overall organization, well that is better left unsaid. Let’s just say that there is no WiFi and leave it at that.

But enough of TEPR, Google is the real story here (and far more interesting to tell). Following are some quick impressions and analysis.

What I really like:

Since I have a GMail account, sign-in to a Google Health Account was a breeze. Simply read the disclaimers (Terms of Service and Sharing Agreements), agree to them and you are on your way. – Loved It! And those disclaimers and privacy statement are similar to Microsoft HealthVault’s, forthright and easy to understand.

Out of the box connections with a number of data providers including Beth Israel Deaconess Medical Center, Cleveland Clinic, a lot of medication related services (Walgreens, Medco, Longs Drug, and Rx America). Somewhat surprising that CVS/Caremark link is not about medications, but clinicals from Minute Clinic. Likewise, you don’t get clinicals from Walgreens’ retail clinics, only meds. Odd.

They also provide ability to link to Quest Diagnostics so one can get their lab results imported into their Google Health account.

Google Health also provides an ability to link to a number of third party services, including PHR providers Medem, MyMedicalRecords and NoMoreClipboard (each of these vendors as well as Google Health is profiled in our PHR Market Report, that will be available for purchase later this week – drop an email to: info @ chilmarkresearch.com if interested), advocacy groups such as the American Heart Assoc. and LIVESTRONG.COM, Cleveland Clinic’s second opinion service MyConsult and several other services. Some charge a fee for services while others are free, all stated clearly on the Google Health site (though no actual pricing for services is provided).

The real beauty of both features above is that Google provides clear linkages to partner sites. When you click on those links, from within your Google Health account, you are taken to a secure page (https) on the partner’s site where you are clearly asked to sign-in to begin the authentication process and have your records transfered to your Google Health account, or sign-up for a service.

Unlike the less than stellar launch of Microsoft HealthVault, where you clicked on a partner link only to be sent into God knows where, Google has worked closely with this initial set of partners to make it very clear where you have landed and what to do next. Bravo Google.

The interface is clean, crisp and intuitive. Nothing to clutter the eyes/mind as you navigate around the site. This is so unlike most major PHR providers today who seem compelled to barrage you with a visually noisy website experience.

Working with partner SafeMed, the site provides medication interaction checking for the consumer to assist them with managing multiple medications and minimizing adverse drug events. Google Health is supporting such standards as SNOMED CT & ICD-9 (both used for diagnosis/condition coding), LOINC (lab data), and NDC & RxNorm (both used for medications). Google is also supporting a slightly modified form of the CCR standard (which is quickly becoming the defacto standard for PHRs), that they call CCR/G.

What still needs work:

While they have partnered with a number of pharmacy companies and a couple of providers, that is far from capturing the broader market and really making life easier for the average consumer (i.e., a PHR that can self-populate and stay updated without a lot of consumer feeding). An obvious choice is data from health insurers (payers). Payers, arguably, have the largest trove of consumer health data, data that often includes lab results, medications and treatments. Granted, claims data is not as rich as clinical data, but there are very few practices today with as sophisticated digital clinical record keeping practices as Cleveland Clinic and Beth Israel. Google will have to get payers on board to make this work.

Retail clinics, who most often are already using CCR are an obvious link/partner for Google. CVS’s Minute Clinic is a good start, but where is Walgreens’ own clinics and will Google extend out to those corporate campus clinics that Walgreens just purchased? I really can’t criticize Google for this last point as Walgreens did just acquire these clinics, but would have like to have seen Google at least, in some fashion address the employer market for these solutions.

Missing any place to put advanced directives.

No capabilities yet to assist a consumer in managing their health savings account. Be a nice opportunity for Google and Intuit to partner.

Site would hang-up on me occasionally, but that may be more of a function of this terrible hotel Internet connection, than Google.

Was not all that impressed with the search engine for finding a doctor. When I entered my doctor’s last name and city, got back a number of hits but they were all peripheral – not a single one giving me contact details or for that matter even identifying my doctor. Wasted effort for me.

Lastly, an odd thing happened in testing the link to Quest Diagnostics. When I landed on the Quest site, it requested a PIN to sign-in to begin transfer process. Well, I don’t think I even have a PIN with Quest so I backed out of the site. Yet, later, noticed on the landing page of my Google Health, the Quest banner for finding a Quest location or scheduling an appointment. Really looked more like an advertisement to me as I certainly didn’t request the banner and now have to figure out how to remove it.

Bottom Line:

While I am sure I’ll find other small quibbles regarding Google Health, all in all, it is difficult to find anything really major to dislike about this offering. My biggest gripe would be that it is too thin, both from a tools /functionality provided perspective and partners from which to import data. These are very important issues but they are also issues that Google should be readily able to address in the future if the have the mind to do so.

And is that really, at the end of the day what matters most?

Will Google and Microsoft stick it out and stay in the healthcare market long enough to see the tide change and the apathetic consumer turn into a proactive and engaged healthcare consumer. This sector is fraught with challenges which I have written about before and it is going to take time to address them. Let’s hope for everyone’s sake that these two companies have the patience to stick with it as I really do not see any other companies in the market that have the breadth of resources to make this happen.

The more I look at this market, the more I am convinced that needed change in the healthcare sector will come from the outside via greater direct engagement of the consumer in managing their health. And that will require giving the consumer the tools to do just that. Something which both Google and Microsoft are on track to provide.

Other Resources:

Google Health FAQ

Beth Israel’s CIO’s Impressions (Note: As he was part of Google’s Advisory team, you won’t find a critical, unbiased view).

The latest edition of The McKinsey’s Quarterly report has an interesting interview with Cleveland Clinic’s CEO, Toby Cosgrove. Nothing earth-shattering is revealed, but interview does give some insight into Cleveland Clinic and its operating philosophy. This provides further color, albeit implied, to the recent partnership between Google Health and Cleveland Clinic.

Note: You’ll have to go through a pretty quick and painless registration process on th McKinsey site to see the full text of the interview.