Four Misconceptions About HealthVault and the Emerging Personal Health Information Ecosystem (PHI-Ecosystem)

by Vince Kuraitis and David C. Kibbe, MD MBA 

The health care and technology worlds are still trying to figure out what Microsoft’s HealthVault (HV) is all about.  We believe that there are a number of misconceptions out there about what HV is and isn’t:

Misconception #1: HealthVault is a personal health record (PHR).

Misconception #2: People don’t trust Microsoft, so they won’t sign up for and use HV.

Misconception #3: Patients don’t understand PHRs, don’t want them, and don’t know what they’d do with them.  This is a rate limiting step to market growth for HV and its partners.

Misconception #4: By launching HealthVault first, Microsoft beats Google to the punch.

Let’s take these one at a time.

Misconception #1: HealthVault is a personal health record (PHR).

Reality:  HealthVault is not a PHR.  It’s a personal health information (PHI) platform.

HV does not have the capabilities of a PHR.  HV doesn’t organize the data.  It doesn’t manage the data.  It doesn’t verify the data.  It doesn’t analyze the data.  It doesn’t advise patients about the meaning and implications of their data.

HV is simply a place to store your PHI.

Another way to think about HV is as transactions-launching pad-in-waiting.   Most of the data about me and my health and wellness is not very useful, most of the time.  The key is going to be how HV can assist people to sift through their health data, pick out the useful bits and bytes, and then do something with them that is helpful. 

HV could be quite dynamic and interactive if Microsoft can find a way to make it easy for people to connect their meaningful and relevant health data with people and services that can use it to help change behaviors, or suggest options and alternatives, or give warnings, etc.

HV’s success will be largely dependent on its application partners.  If they build lousy applications or don’t market them effectively, there will be no reason for anybody to store information in HV. On the other hand, if applications are found to be useful, MSFT will have created a community of bird dogs for HV; the current community of 40 application partners could grow to hundreds, thousands, or even more if health care providers can eventually be drawn in.

Why didn’t MSFT just build a PHR?  We suspect that some of the motivation is revealed in the next misconception about HV. 

Misconception #2: People don’t trust Microsoft, so they won’t sign up for and use HV.

Reality: People trust Microsoft’s application partners, who will leverage this trust to sign people up for HV.

Microsoft has a reputation for unreliable software and heavy handed business practices. HarryandLouiseAfter the HV announcement, the blogs went wild with pronouncements that people would NEVER sign up for HV.

Think through the process by which people will actually “choose” to sign up for HV.  How likely is it to be a process where you sit at the kitchen table and rationally sift through your alternatives — a Harry and Louise type decision?

Not too likely. 

Rather, the “decision” to use HV is much more likely to come through HV’s application partners.  You will decide that you want to use one of the applications — a PHR, a disease management program, a fitness program, a weight loss program, or many others and even many more yet to come.  The application partner will tell you that it needs to store your PHI “somewhere” and that somewhere is HV. Now what?  Do you change your mind about the PHR, DM program, etc. that you’ve already decided you want?  While some people will do so, we expect that the vast majority will proceed, similar to the way that few people are dissuaded by or even bother to read the fine print in a software EULA (end user licensing agreement) today.

Let’s play this out even further. Long-term, if MSFT is successful, it will be your trusted healthcare providers — even your family doctor — who is presenting you with the pronouncement that they would like to store your PHI on HealthVault. How will you react then? Consent2

This trust issue is likely one of the main reasons that MSFT has built HV as a PHI platform, and not a PHR.  This strategy provides a tremendous boost to in dodging the “I don’t trust Microsoft”  bullet. It moves the heat of the privacy issue away from MSFT and onto Microsoft’s application partners. 

Misconception #3: Patients don’t understand PHRs, don’t want them, and don’t know what they’d do with them.  This is a rate limiting step to market growth for HV and its partners.

Reality: While patient engagement is desirable long-term, there are many applications of PHI that are not dependent upon short-term patient engagement with HV. The key is patient “permission”, not engagement.

Analysts cite surveys that people don’t understand what a PHR is, what to do with one, or have any reason to want one.  We can accept these findings.

However, they miss the point.  The implicit implication of these findings is that HV is dependent upon consumer engagement for adoption and success, and that’s just not the case.

We foresee a multitude of applications that can leverage HV “as-is”. There are two particularly promising categories:

a) PHI application partners that use HV simply as an enabler of a specific application.  This is a broad category, and would include applications for fitness monitoring, diet and nutrition, diabetes monitoring, etc. The commonality here is that the patient will view HV as a passive recepticle for their PHI — literally a “vault” to store information. The application vendor will want the patient’s permission to store PHI in HV, but then the application vendor will work directly with the patient.

b) 3rd party disease/care management offerings.  For example, disease management (DM) is a market segment that has reached $2 billion revenues today and which some analysts predict could grow to a $30 billion+ business. Two of the largest publicly traded DM companies — Healthways and Matria — are included in MSFT’s initial list of partners.

The DM industry is premised on the understanding that typically 5% of a population consumes 60% of health care costs.  Payers and care managers want to find today’s 5%, predict tomorrow’s 5%, and intervene to improve patient care and avoid unnecessary health care costs.

While patient engagement in gathering and using PHI to manage their care is desirable and optimal, it’s not necessary to begin creating value with HV. Again, the key is patient permisssion to aggregate PHI and to use that data to provide disease/care management offerings on behalf of the patient. HV can become an invaluable tool for these 3rd party managers. 

Today these disease/care managers are mostly private companies — health plans and DM companies.  But tomorrow it could be your doctor that’s actively coordinating care on your behalf.  The medical home model being promoted by primary care physicians puts care coordination squarely in the hands of physicians. 

The medical home model provides physicians with a care coordination fee, with the explicit intent that this fee will incentivize physicians to purchase EHRs, engage in secure messaging with patients, and employ remote monitoring technologies.

Misconception #4: By launching HealthVault first, Microsoft beats Google to the punch.

Reality: It’s not about Microsoft vs. Google, it’s about collaboration to create a new Personal Health Information Ecosystem (PHI-Ecosystem)

This is not about Microsoft vs. Google.  From Vince’s previous blog posting:

It’s about creating a new business ecosystem based on the appropriate (honoring privacy and security) free flow of interoperable and transportable personal health information (PHI) — something that doesn’t exist today.

Go back 30 years and think about creating a new market for faxes — one fax machine is useless; two allow for a point to point connection; eventually you reach a tipping point and create a network effect in the market.

Today, despite the fact that there are something like 200 PHR vendors in the marketplace, there is very little market for PHRs or more broadly for the free flow of PHI.

HV promises to change all this. This really isn’t about competition between Microsoft and Google, it’s much more about collaboration among Microsoft, Microsoft’s 40+ application vendors, Google and many others collectively working to create a new ecosystem based on free flow of PHI.

While we see a great potential for the PHI-Ecosystem, we understand that the evolution is early and unpredictable.  We welcome your comments.

7 thoughts on “Four Misconceptions About HealthVault and the Emerging Personal Health Information Ecosystem (PHI-Ecosystem)

  1. In all fairness, the ability for various vendors to work together for the greater good of all is pretty limited. Microsoft is not driving this initiative because of its interest in the greater good either, this is an avenue to get more Microsoft business for their traditional lines. Interoperability is a term used by everyone and quite loosely as we drive towards an EHR solution, across the globe today many software companies and health orginizations are striving to create the optimal solution, Microsoft is jumping at this opportunity with the hopes of establishing a defacto platform.

  2. HV is an enabler of a scenario I love. Initially, in the absence of coordinated care, patients have the opportunity to “play quarterback” getting information where it needs to go, when it needs to go. Longer term, the free flow of personal health information, HV can be an enabler of more coordinated, higher quality care.

    An more tactically, can HV and related applications save me the bother of getting my records (in some form) FedExing them to a mailroom that loses them, when I’m just trying to pay cash for a second opinion before my next surgery?

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  4. How will this effect those in the lower income brackets who are less likely to have access to the technology and the education to use a PHI, and yet, who ironically are more likely to be the ones with the types of chronic conditions whose care could best be leveraged by use of a PHI? It seems like a potentially great idea for those with money etc, but I can’t help be speculate on how this will effect parity of access to quality care.

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