As everybody has been writing and reading about this past week, Google announced the end of its Google Health PHR effective 1/1/2012, leaving the PHR space to Microsoft (MS). Other PHR platforms exist and some are very well supported, like Dossia or even MyChart (Epic), but MS seems to be the big winner with this most recent announcement from the search engine giant, especially because Google is coordinating with MS to transfer Google Health records over to MS HealthVault.
Ironically but not surprisingly, I would have thought since both MS and Google supported CCR/CCD this would have been an easier transfer process, but apparently the two companies are going to use the Direct Protocol to transfer the records.
I’ve had a bit of a crazy two weeks as I’ve been moving. I was hoping to get this post out sooner and realized as I was researching for it that everybody and their brother has written their opinions, and many of them very good, about the death of Google Health, what it means for MS, what it means for PHRs, what it says about healthcare consumers, and on and on. I’ll try to capture what others have written and hopefully add some additional thoughts and contributions to the discussions.
For starters, I tried Google Health, inputted my data, and really wanted to like it. For me, it wasn’t really the data entry that was the problem. I just didn’t have any use for it all. I’m married with kids, but fortunately we have no chronic med needs. The one big thing I wanted to keep track of was vaccination records for my kids, but I finally gave up on Google Health altogether when I started using a mobile app for immunization records that made data entry easier.
That’s the extent of my personal experience with Google Health. I don’t feel compelled to even export my records to MS HealthVault before Google shuts its Health service down permanently.
One of the obvious complaints about Google Health is that it did not integrate with the broader health care and health IT community, meaning most consumers had to enter health related data themselves. Google Health did integrate with certain partners (providers, pharmacies, labs) but a lot of the content had to be imported manually, so users were less likely to actually do it. This is a pain.
Adam Bosworth, who once ran Google Health and now has a startup called Keas that does employer-based wellness programs based around social games, attributes the failing of Google Health to not informing, entertaining, or creating social connections around health. All very valid points and fits with what I’ve been told about building consumer tools to cater to personal vices.
I also think consumers are driven by money (making it or saving it), so the inevitable comparisons to Mint for healthcare were made. Mint’s great success is because people actually save money by using the service. Something like one in 10 users make changes to their accounts based on Mint’s input and these changes result in large total dollar savings. Google Health or any PHR vendor today can’t make that claim.
Bryce Williams wrote a very good piece on health care consumers for Fast Company that highlights why Google Health, and I think all current PHRs, don’t provide users with much value. He talks about using PHR data to offer customized insurance quotes or procedure quotes, all things that Bryce thinks could motivate users to establish and maintain a PHR.
Another guest post from Dave Chase, formerly of MS Health, concludes the reimbursement systems caused the failings of Google because providers are not paid to use or communicate with patients via PHR. This again is valid if Google was something it was not — a real tool to help people improve health instead of a storage repository for health-related data. I guess some would argue that in order to provide that value, Google would need to gain enough user data with which to make meaningful associations and conclusions.
I agree resoundingly with the general sentiment that Google Health and PHRs more broadly only have value as pass-throughs and require integrated, tailored health tools built on top of their data. Most people do not want and will not use a personal health record because a health record, on its own, is without value to a consumer / patient.
I’d also argue that it is without value to the vast majority of people even when the data is interpreted or displayed in a meaningful way. I believe this is because most people are incredibly unmotivated to change behavior, even those that reduce quality of life and shorten lifespan. The minority of people that are motivated are not the big cost drivers on the health system, so tools only for them will not create great change. It reminds me of Bill Gates’ point during his keynote at the mHealth Summit, when he said something to the effect of maybe you can use mobile tools to to motivate people to exercise 92% of the time instead of 85% (I’m paraphrasing because I can’t remember the exact quote).
What, if anything, do PHRs offer consumers? I think a PHR as a personal digital version of the legal medical record is useless. We should step back and look at EHRs and access to data for providers. Most emergency docs, and many hospitalists, still treat patients with little or no access to medical records. Integrated record systems have not been a part of our health care systems for very long or don’t have universal adoption.
My point is only that access to and organization of clinical data, something central to Google’s broader organizational mission and something I hear touted as the promise of HIT, is still not a standard component of our health delivery or training system for providers, let alone patients.
OK, now I’m going to try to be more optimistic. I think we need to stop calling and thinking of repositories like Google’s and Microsoft’s as PHRs because of the association with provider EHR data. We need to see them as what they should be and as what most commentators have described them as — personal health and wellness tools. These tools should be based on user-generated (manual or automated) data and deliver specific actionable guidance and feedback from an individual’s social network. Maybe as reimbursement rules change providers will be more willing to participate with these personalized management tools, though I think providers, as a trusted source for patients, can still help inform patients about these tools without reimbursement changes.
Some have claimed that we are at the beginning of a cultural revolution that is going to see huge changes to the way people behave. I’m not sure if it is a revolution and I’m clearly more skeptical about changing behavior, but I do think there is an opportunity with the right mix of technology and strategy. To accomplish this, we need organized data and timely feedback loops to inform individual decision making. The data will come easier as low-cost sensors and data exchange standards proliferate, but I think the individualized, actionable feedback will be the bigger challenge, especially as we link it to an individual’s social networks.
In this area, as it was announcing the end of its Google Health PHR, Google may have made a great step forward for health this week as it announced its new Facebook competitor, Google+ Circles. The new social network, in invitation-only beta release, overcomes some of the major barriers to the use of social networks in healthcare by enabling users to more selectively share content. Imagine diabetes circles or weight loss circles or even provider circles populated with only approved members.
To me, this is the exciting part of personalized, engaged health care and the aspect that holds the most potential instead of making sure I have a graph of my sodium levels for the last 10 years.
Travis Good is an MD/MBA and is involved with health IT startups.
As I’m sure everybody has heard (because it seems to be the talk on every site I go to), Google Health is dead, or at least it will be on January 1, 2012. I’m writing a post for later this week discussing the demise of Google Health in the context of the broader PHR market, so stay tuned for more.
Withings gets FDA approval for its iPhone blood pressure monitor. This is one of the products that got a lot of press earlier this year at the Consumer Electronics Show. The device and associated app are very cool, as the video above shows, but I’m still skeptical about the uptake of something like this because I just don’t know the number of people that have iPhones and need a blood pressure cuff at home. Maybe it’s much more than I think?
American Medical News has a good story on mobile apps from payers. Most of the big payers have released apps for patients. At the bottom of the article is a good list of apps and associated functionality. Moving forward, payers intend to develop apps for providers "helping physicians communicate in a secure environment as an alternative to sending text messages, suggesting appropriate coding to ensure physicians are paid what they’re entitled to, and perhaps sending physicians messages alerting them to ‘gaps in care,’ such as when a patient is due for a mammogram."
Aging in place is close to hitting a tipping point. With big players like MIT and Intel/GE moving aggressively to build tools and services to help remotely monitor elderly patients, I think it’s true. I was impressed with a couple of the statistics in the article, namely that 71.5 million people in the US will be over 65 years old by 2030 and that one in four households provides elder care.
A new remote monitoring system from UCLA is found to improve weight and blood pressure of CHF patients. The system, called WANDA (Weight and Activity with Blood Pressure Monitoring System), does stuff with sensors and Bluetooth-connected devices, but the most interesting to me was the mobile app and SMS questionnaires used to subjectively assess patient wellbeing. This seems much more scalable but is not really covered in the abstract.
I stumbled on the graph above that shows iPad Internet traffic share compared to the rest of the tablet market. It’s rather astonishing to see the iPad represent over 95% of all tablet Internet traffic in all countries listed other than India. In the US, it is 97%.
Meducation wins the SMART Platform Apps Challenge. SMART is the Substitutable Medical Applications, Reusable Technologies initiative funded by the government and run out of Harvard, which aims to create a platform of interoperable health apps. Meducation takes medication histories from the SMART platform and creates usable medication instructions in multiple languages.
ONC, American Diabetes Association, and the CDC will work with two of the Beacon Grant winners to use mobile messaging to assist and inform patients with diabetes. The two communities are New Orleans and Detroit. The program will be modeled after Text4Baby with the same technology provider, Voxiva. The jury is still out on the impact of Text4Baby.
Barriers obviously still exist for remote care and this NPR story highlights them. I’d never heard of fraud as a reason to oppose telehealth.
Thirty-seven rural health facilities in Wyoming will get high-speed connectivity courtesy of the FCC and the state’s department of health, creating a statewide telehealth network.
In related news, apparently the FCC is funding rural hospitals on a temporary basis, but hopes to change that to permanent funding with a new proposal.
Travis Good is an MD/MBA and is involved with health IT startups.
The ONC announces the Investing in Innovations (i2) Initiative, "a bold new program designed to spur innovations in health IT." Examples of application are mostly around data exchange, but several are patient-centered. I imagine mobile will also be a part of this moving forward. Should we stay consistent with the VA naming and call it ONCi2?
The Bluetooth Special Interest Group approves standard profiles for Bluetooth v4 thermometers and heart rate monitors. Profiles for blood glucose, blood pressure, and weight are also on the way. The profiles will assist mobile developers building new devices for wireless monitoring and ideally create interoperability between developers and devices. Bluetooth v4 is low energy consuming, so battery life and size are less of an issue.
An online survey of 3,700 physicians finds that over 40% now have a tablet and 20% of these use it in the clinical setting. The number one use of the tablet in the clinical environment is reference, but does that mean trusted programs like Epocrates or sites like Wikipedia? (as a friend of mine claims is the case after years of reviewing hospital firewall logs). The full report is here.
HP’s new TouchPad tablet will be released July 1 starting at $499. The tablet runs webOS, formerly Palm, and is an interesting alternative to iOS and Android tablets. To be successful as a mobile health device, I think a lot of app developers will need to quickly start porting solutions to webOS.
HHS, in collaboration with the CDC, FDA, and a host of other agencies, releases a toolkit of text messages for local agencies to use for communication during hurricanes, floods, and earthquakes. I’m always amazed by the number of agencies and people required to accomplish something at the federal level.
iPhone-based clinical communication company Voalte signs its first academic center, The Nebraska Medical Center, as a customer.
Home monitoring gateway and aggregator Numera announces a partnership with HealthTrio to send data collected by Numera to HealthTrio’s PHR. The most shocking part of the release is that HealthTrio claims to have 12 million PHR users. Does anybody know how many HealthVault has?
NaviNet launches Mobile Connect for PBMs. The mobile tool allows docs to check which meds a patient is eligible for at the point of care. It also gives docs insight into medication compliance based on refill data. The release mentions CVS and Medco, which I think are two of the three biggest PBMs in the country.
The UK and parts of Africa are testing mobile smart cards as PHRs. This is an interesting concept, but at a time when I’m trying to downsize the number of cards I have to carry, it does seem to make more sense to load it on a phone or host it in the cloud, as John Halamka pointed out in the article, "Web-based personal health records in the cloud, available anywhere at any time without a card".
AHRQ announces three target areas for its HIT career development grants. I can see obvious mobile applications in each area, but the first two translate perfectly to mobile – 1) HIT for patient safety and medication management and 2) HIT for patient-centered care. I’d like to see some interesting mHealth dissertations emerge from this.
Phillips will launch a "pan India" eICU service. When I read the headline of the article, I assumed that we were going to outsource US ICUs to India-based docs like we do for radiology.
A study out of Canada, if you can call something a study based on 10 "semistructured interviews," finds that family docs have three main concerns about PHRs: 1) data management, 2) practice management, and 3) patient-physician relationship.
Travis Good is an MD/MBA and is involved with health IT startups.
In response to this week’s earlier post about healthcare organization mobile apps, Denis Baker asked: “Travis, re: iTriage. You may know but didn’t mention that HCA locked out competitors from signing up for the ‘special’ placement on iTriage.” I haven’t heard this. In my area, both HCA and other facilities have premium listings in iTriage and I know iTriage is actively selling premium listings to local providers. I’ve e-mailed contacts at both Healthagen and HCA to see if I can get an answer. Anybody else have any info on this?
In the face of Google scaling back support for its PHR, Microsoft seems poised to take the lead in the PHR space. In a recent announcement of new features, MS said it will optimize content delivery over mobile web, automate reconciliation so users don’t have to manually agree to insert new CCD/CCR records, create an SDK for mobile (Windows, iOS, Android) app developers, and begin using Facebook for signup / sign-in. It doesn’t sound like MS will be doing much with Facebook other than importing basic info for registration, but it seems logical that extensions would be made to capitalize on its connectivity.
“As a physician, you have a perspective on health topics that’s uniquely valuable to society.” When you share this valuable information over social media, follow these seven tips to avoid an expensive HIPAA violation. I think this is the key rule to follow: “If you wouldn’t say it in the elevator, don’t put it online”.
Rock Health announces it has selected the 11 startups that will get support from Rock’s five-month mentoring program. All of the winners seem to be consumer-centered and several are mobile or remote care oriented. I was surprised that I’d heard of several of them, like Health In Reach and CellScope.
HP, in conjunction with the Clinton Health Access Initiative (CHAI), will test webOS-enabled smart phones in Botswana to do real-time surveillance and analysis of malaria case trends and outbreaks. I know HP donated $1 million to build a lot of the infrastructure behind CHAI’s national laboratory systems in Africa as well as invested in mPedigree, which does drug authentication over SMS, so it seems HP is investing heavily in the mHealth in developing countries.
Pfizer, working with a company called Mytrus, gets FDA approval for the “first all-electronic, home-based study” and will use a mix of computers and smart phones to collect data from study participants. The model allows one group of clinicians to oversee all 600 participants. The study is evaluating Detrol for overactive bladder, which seems like a good condition to target for a home-based trial to allow patients to stay close to home and facilities.
A new WHO report, mHealth; New Horizons for Health through Mobile Technologies, concludes that the UK is the most advanced mHealth nation in the world because of its national, no-cost nurse line and automated appointment reminders. The report defined mHealth as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.” Maybe all those cool mHealth gadgets we’re building in the US are not the biggest bang for the buck and we should focus more on traditional call centers.
MIT launches the Medical Electronic Device Realization Center (MEDRC) in partnership with GE and Analog Devices. The center’s mission is to foster innovative technology solutions to reduce healthcare costs. It sounds like an East Coast, non-Bay Area version of Rock Health,which also has big name corporate partners, though I’m sure MIT and GE would disagree.
Above is a video overview of Device Messaging by EXTENSION, the secure, healthcare-tailored text messaging service we reported on last week. The functionality seems pretty cool as long as people have devices that have the app.
CSC, which is apparently strongly moving into HIT, releases another HIT report, Telemedicine – An Essential Technology for Reformed Healthcare, outlining how telemedicine can enable health reform and how providers can incorporate telehealth services into their practices. I only knew CSC as a defense contractor when I was living in DC.
Another story says the FDA will start providing formal guidance for mHealth developers to increase “regulatory clarity for manufacturers developing these technologies.” I’m not entirely sure what that means, but they claim to want to help developers continue to create innovative mobile health solutions. I do think some degree of FDA oversight is necessary, but hopefully it doesn’t become too much of an impediment to smaller companies.
Eastern Michigan University receives a $500,000 Michigan state grant to implement a telehealth model for evaluation and treatment of Autism Spectrum Disorders. The program will use live video.
Travis Good is an MD/MBA and is involved with health IT startups.
We’re going to stray from (and hopefully change) the normal routine with this post and subsequent posts. I really want to break up the steady flow of mHealth news summary posts, so I’m going to start integrating more commentary posts. I hope you like it, as it will be a lot more opinion and impression and less a summary of news.
The challenge with mHealth — and HIT generally, right now — is that so much is happening that it is difficult to digest all the various stories about apps, pilots, studies, technologies, stakeholders, etc.
I’m starting with a post on healthcare facility-specific mobile apps. but plan to write future posts about topics likes online scheduling services, specific mobile app categories, remote monitoring, social media in health, mHealth for providers, mobile PHRs, and other topics that seem relevant. If you have any suggestions, please leave a comment or shoot me an e-mail.
OK, why do I think a discussion of healthcare facility mobile apps is relevant right now?
I’ve seen an increasing number of healthcare providers publishing mobile apps and thought it would be of value to present them all in one place.
I’ve been in several discussions recently with healthcare organizations trying to define a mobile strategy.
A recent survey of smart phone health app users found that 26% don’t use them more than once. Of the remaining users, 74% stop using them before the tenth use. With that in mind, I think providers and healthcare organizations should seriously consider their mobile strategy before devoting resources (I’ve seen proposals anywhere from $40,000 to $110,000 for a mobile facility app) and publishing an app just to “have a presence in the app store.”
An increasing number of mobile platform and development companies are now targeting healthcare, including our new sponsor Kony.
The facility apps we’ve reported on at HIStalk Mobile include these (I’m sure I’m missing a bunch):
And of course, all of the premium listing stories for iTriage. I won’t include them here, but this is definitely a very popular route for facilities wanting some type of mobile presence.
As listed above, I’ve reported on an array of mobile applications recently published by healthcare organizations, yet I’m not sure how representative that is of healthcare facilities generally. The city I live in, which has about 2.5 million people, has no mobile healthcare facility apps, though I’ve heard the local HCA facilities are preparing to release one soon that is being developed by Red Fish Media, which to date has only done SMS ED wait time services for HCA.
Also, the majority of discussions I’ve had with healthcare organizations have not resulted in a mobile app being developed.
I think the first thing to consider when deciding on mobile strategy for a healthcare organization is to answer the question, “What is the goal?” By defining the goal, you can establish targets and understand the ROI. Some specific questions to ask about functionality and goals:
Do you want to recruit more patients to your ED and provide better access to providers and clinics?
Do you simply want to keep up with local competitors? I’ve heard this one, especially when it comes to iTriage.
Do you want to allow patients to schedule appointments or register over their mobile devices?
Do you want to empower patients with educational content and symptom checkers?
Do you want to engage patients with self-management tools like calorie and weight trackers?
Some of these are easy/cheap (facility info, education, self-management) and some are hard/expensive (appointments and registration). Most organizations I’ve spoken with have heard mobile is important and simply want a way to allow patients to access information (which is usually undefined) over mobile devices.
Now that you’ve defined the mobile strategy and set some goals, what technology options exist when considering how best to create a mobile strategy?
The most obvious, to me at least, is to simply mobile-enable the facility Web site. This is relatively cheap and allows users to access facility info (phone numbers and directions), search for providers, and get ED wait times if the hospital publishes that information. As a mobile user, this is my preference, as it enables me to access mobile-formatted material without downloading an app for each healthcare org or facility in town.
But I’m not a typical user, as Aaron Kaufman of Kony pointed out in a recent interview with Mr. HIStalk, when he said most mobile users search the app store before they try mobile web. Aaron also pointed out that the user experience and features improve considerably with native mobile apps versus mobile Web sites. Also, organizations don’t’ seem to do press releases for mobile-enabled Web sites.
After reading about the power of native apps vs. mobile Web sites, now you’re convinced you need a native app. What platform should it be built on?
My suggestion would be to build it support the big three: iOS, Android, and BlackBerry. BlackBerry is not quite as “cool” as the other two major mobile platforms and has been losing ground for awhile, but I still think a lot of smart phone users, especially older ones that happen to be large consumers of healthcare, use BlackBerry. If you can only afford to support two platforms, make it iOS and Android.
Second native app question, and this is one I’ve gotten several times from healthcare organizations: should I build my own mobile app or simply pay for a premium listing on iTriage? (which speaks to the popularity of Healthagen’s app.)
To me, these are not mutually exclusive options. Having a premium listing in iTriage is just a premium yellow page listing. It’s like saying, “I advertise on Google Maps, but didn’t bother to build a Web site” (comparing iTriage to Google Maps is a pretty nice compliment). It means iTriage users will see more information about your facility when they are looking for facilities. iTriage is expanding into scheduling and pre-registration as well. It also means that consumers searching the app store for a healthcare organization’s mobile app will find nothing.
Again, back to goals. If you want to improve the patient experience with your organization, I do not think iTriage is going to accomplish that for you. But if other local facilities are listing with iTriage, you might also want to list to assure you’re competitive for iTriage’s growing number of users.
The last question, or really a set of questions, to answer is the mobile app functionality.
For this discussion, I won’t consider mobile PHRs an option, mostly because I haven’t seen anybody do it with a facility app, though more are rolling out mobile PRHs from EMR vendors like Epic as separate apps. For facility apps, I think things like contact info, directions, and provider listings are a given, but this alone will not maximize continued usage. I think organizations are realizing this and that is why they are trying to provide value-added services, like calorie counters and blood glucose logs, as well as more tailored experiences, like OhioHealth above, into mobile apps.
I think we’ll likely see more of this type of functionality in the future to assure decent adoption of mobile apps. It’s like PHRs. I firmly believe people don’t really want a PHR, but want things like appointments and registration and the ability to communicate with providers.
One additional thought about mobile apps. Having a smart phone app or mobile Web site, even if built for the three platforms listed above, does not capture the entire mobile space. Facilities should still support SMS and automated voice messaging to reach non-smart phone users.
This is obviously a very brief overview of how a provider might address mobile strategy and a description of what other healthcare organizations are doing with mobile. The real process would likely require countless meetings, committees, proposals, and conference calls before decisions are made, but in the spirit of brevity and blogging, I’ve tried to present my accelerated version.
Travis Good is an MD/MBA and is involved with health IT startups.
