Beyond Binary

A screenshot of the Mayo Clinic Health Manager, which uses Microsoft's HealthVault technology.

(Credit: Microsoft)

The Mayo Clinic on Tuesday said it will build a personal health record service based on Microsoft's HealthVault technology.

The product, Mayo Clinic Health Manager, will initially focus on general pediatric and adult health issues, immunization records, pregnancy, and asthma. In the coming months, the clinic will add tools to help manage chronic conditions, such as Type 2 diabetes, high cholesterol, and high blood pressure.

"Mayo Clinic Health Manager can help patients share information more easily with their doctors and manage their own health better between office visits," said Mayo Clinic doctor Sidna Tulledge-Scheitel, who also serves as medical director of Mayo Clinic Global Products and Services.

People don't need to be a patient of the clinic to use the new tool, Microsoft said. Microsoft's HealthVault is designed to allow people to store many different kinds of health records, including digital information from its partners, data from in-home medical devices, as well as information entered directly by the patient.

Although the effort is 18 months years old, Microsoft is just getting off the ground, in terms of getting hospitals and doctors signed up. Among its recent deals is one with NewYork-Presbyterian Hospital.

In addition to the battle to get access to the data it needs, HealthVault finds itself competing against rival services, including Google Health, as well as personal health records offered by insurance plans and others.

Dell joined a growing chorus of IT companies trying to grab a bigger slice of the market for digital health care records.

The computer maker announced a series of partnerships on Monday aimed at bolstering its health care chops. At the high-end, the company announced a strategic alliance with Perot Systems aimed at selling to hospitals, health systems, and physician practices. At the low-end, Dell said Sam's Club will start selling a system for doctors to manage their records electronically, combining Dell hardware and software from eClincalWorks.

The announcements come at the start of a healthcare technology trade show this week in Chicago. The show is drawing particular attention this year because of the billions of dollars in federal stimulus money being targeted at the digitization of medical records.

The Healthcare Information and Management Systems Society, which is putting on the conference, said its annual survey found that implementing electronic medical record and computerized order entry systems was the top IT priority for hospitals and other large healthcare providers. In its survey, it found less than half--41 percent--of those surveyed have even one facility with a fully functioning electronic medical record system. That is up from 32 percent two years ago, however.

Lyles

Dell is far from the only big computer name making news at that HIMSS convention. Sun is showing off work it did to build the National Health Information Network (NHIN), while Microsoft is touting a deal with New York-Presbyterian Hospital to offer patients access to their electronic records.

As for the Dell partnership, Perot Systems' health care unit vice president, Chuck Lyles, said the deal comes just as the industry is taking off.

"Only 10 percent of the market uses (electronic health records) in some form or fashion," Lyles said at a press conference on Monday. "We really are at an inflection point in the industry."

Lyles said that virtualization should allow hospitals to digitize some of their records using existing servers. He noted that most servers inside hospitals are only being used to about 20 percent efficiency.

"Historically, hospitals have been this one server, one application environment," Lyles said.

Perot and Dell also talked about the ability to run some medical applications in a hosted, "private cloud" offering, which would lower start-up costs and help shift computing into a more variable cost.

In addition to the partnerships, Dell added a healthcare section to its IdeaStorm, electronic brainstorming tool. The discussion started with a pretty universal question--"Why can't there be a standard (global, ideally) for electronic medical records?"

An example of the kind of health records that NewYork-Presbyterian Hospital will make available to patients using Microsoft's HealthVault and Amalga technologies.

(Credit: Microsoft/CNET)

In a win for Microsoft's health care business, NewYork-Presbyterian Hospital said it will use the software maker's technology as part of a push to make digital health records available to its patients.

The hospital system will start making health records available online, initially to cardiac and cardiothoracic patients. Customers can view their records online, opt to copy them into a personal health record and then, if they wish, share that record with other health care providers.

Boyer

(Credit: Microsoft/CNET)

"These really are the patients' records," said Aurelia Boyer, a former practicing nurse, who now serves as NY Presbyterian's CIO. "It is really their data. it is not the hospital's."

However, that's a big shift for the industry, Boyer acknowledges. "Doctors and hospitals have kept those records sort of under lock and key."

The deal also marks the first time that a Microsoft customer has gone with both its Amalga technology for managing the provider's own records and at the same time tapped HealthVault to provide patient access. Microsoft but said at the time it would need to line up health care providers to provide people with the impetus to sign up for an account.

The federal government has included billions of stimulus dollars to help spur the health care industry toward digital health records.

Google is also taking aim at the space and has partnered with IBM.

Last week, GE and Intel announced a $250 million joint effort in the digital health arena, with their effort heavily focused on helping people treating and living with chronic illnesses.

At NY Presbyterian, Boyer said that the hospital has put the infrastructure in place to handle large numbers of patients, but wants to start slow to make sure it has the human factors right--educating patients, making sure they know how to secure records, etc.

"We want to make sure we watch our process and we do it well with the patients," she said. Digital heath records, she said, is a part of a broader effort to improve care using technology.

"We are attracted to empowering the patients, helping them move to health and managing their health and not just focusing on such a single episode of care," Boyer said.

Opening back health records to the patient should also help the physicians who refer people in to hospitals such as NY Presbyterian.

"Now my referring physician, if giving right permissions, can look into my Amalga record," said Steve Shihadeh, a vice president in Microsoft's healthcare unit. "One of their big complaints is I send the patient in...and I don't really know what has happened to my patient."

Starting on Thursday, residents of Hawaii will be able to pay a flat fee for a 10-minute online visit with a doctor.

(Credit: American Well)

For people in Hawaii, going to see the doctor just got as easy as booting up their PC.

The state is the first to offer online physician visits statewide, under a program that kicks off Thursday. Residents can chat with a doctor over a standard Web browser (IE 7 or Firefox 2) or carry out their visit over the telephone. Those with a Webcam can also use that to share video with the doctor. The service will be available 24 hours a day, seven days a week (with a few monthly maintenance outages during low-volume times).

Members of Hawaii's largest insurer, HSMA (which operates the state's Blue Cross and Blue Shield) pay $10 for the 10-minute consultation, while non-members pay $45.

The launch comes as the modernization of health care is taking center stage. A Senate working group is scheduled to hold hearings Thursday on the topic, with Microsoft Vice President Peter Neupert among those offering testimony.

Hawaii passed a law in 2006 that paved the way for Thursday's launch. The legislation led HMSA to look for ways to implement online health care, a search that eventually led the company to Boston-based American Well. The two companies have been working together since last June, along with Microsoft, whose HealthVault system is supported to allow patients to maintain their own health care records.

Proponents of the system caution that while it may help reduce the number of people going to emergency rooms for routine off-hours ailments, it isn't a substitute in true emergencies.

Doctors in the system are told to apply the same standards of care and address only the kinds of things that can be handled over the phone or Web. Doctors are allowed to issue prescriptions for most medications, but in some cases will not be able to offer a definitive diagnosis within the 10-minute visit.

Family practice doctor Michelle Shimizu, who has been among the doctors helping test the system, said she sees opportunities for handling things like glucose monitoring, discussing lab results as well as for unplanned queries.

"That doesn't necessarily need to be done on a face-to-face basis." Shimizu said. At the same time, she doesn't see traditional visits going away.

"I don't think this situation can completely replace one-on-one doctor's visits," she said. "It's an adjunct to that."

She's found another use for the system. Shimizu, who is in the process of moving her practice from Oahu to the Big Island, said the online option will allow some of her current patients to keep seeing her without having to hop on a plane.

In general, doctors receive $25 for each online visit they handle. They can use the Web to schedule unused time as it becomes available. Doctors, like patients, need only a phone or a PC to participate.

"The $25 has been received tremendously," said HMSA marketing Vice President Michael Stollar. "They think the fee is very fair," he said, noting that many offer phone or e-mail follow-up today without getting paid at all.

For now, the company expects doctors to mainly use the service to fill their spare time, though he said that he can imagine a day where a new medical school graduate might choose to set up an online-only practice.

Roy Schoenberg, the CEO of American Well, said that making better use of physicians' downtime fills a critical need. "There are not enough primary care physicians," he said. "It really allows us to capture 'care opportunities' out of the same number of physicians that were out there."

In stark contrast to the many businesses beating a path to Washington to beg for money, Microsoft is urging caution as the government looks to spend billions on digitizing health care.

Peter Neupert, the former Drugstore.com CEO, who now heads Microsoft's health care unit, said investment is a "necessary, but not sufficient" condition for improvement and said that spending money on computer technology may not even be the right first step.

"I'm trying to transform the discussion just a little bit," he said in an interview on Wednesday. "Don't focus on spending money on tech per se. Focus on what outcomes do we want."

Neupert

Neupert, who is due to testify before a congressional committee on Thursday, likens it to when the government set out to put a man on the moon.

"When we decided to go to the moon, we didn't say let's build a great...rocket," Neupert said. "We said let's go to the moon...I feel a little bit of the conversation is lets build a great rocket and hope we get to the moon."

The hearing, to be chaired by Senator Barbara A. Mikulski (D-Md.) is titled "Investing in Health IT: A Stimulus for a Healthier America." Even the title suggests that the spending itself is a main priority, although background information also talks about the need to reduce medical errors and give health care providers quicker access to patient data.

It's not that Microsoft doesn't want to see spending on health care technology. Far from it. With the recession putting a crimp on business technology spending, Neupert would love to see some government dollars.

"We know technology is an important part of it," he said, adding that one of the big reasons past efforts to spur digital health records went nowhere was that there weren't dollars to back up the talk.

But, he's worried that in a rush to spend money to boost the economy, political and other leaders may be losing focus on the goal.

"If the country is going to invest $50 (billion) in incremental health IT--we all want it to be invested wisely, Neupert said in a blog posting earlier this week. "We should be building an asset with this investment--and the asset is not an application...but a health data asset that can be used to improve both individual outcomes and the performance of the institutions and the system overall."

That's the message he hopes to deliver in person to the Senate committee Thursday, as he joins others in the industry, including Health Leadership Council President Mary Grealy, Permanente Federation Executive Director Jack Cochran and Valerie Melvin, director of information technology for the Government Accounting Office.

There's already been considerable effort made in the e-health space, though from a variety of different angles, without much in the way of standards and interoperability. Microsoft and Google have been pushing for consumer access to health records, while other companies have helped specific parts of the industry--such as hospitals and pharmacies--to digitize their processes.

One of the things that's needed is room for experimentation, he said.

"I'd rather have five people trying to do it than have somebody in an office in Washington with one way how to do it...even though I'd get the money faster," Neupert said.

The problem, he said, is complex. It's not just government that needs to be willing to experiment. Insurance companies--those that pay many of the country's health care bills--also need to be willing to try new things.

He points to chronic care management, an area that governments and insurance companies spend billions on. Currently, most plans reimburse a doctor when a patient comes into the office, but not when the patient and doctor exchange e-mails about care done at home and other steps critical to managing long-term illnesses like diabetes.

By contrast, Neupert says veterinary offices are much further along in terms of things like e-mail reminders and preventative care because theirs is a cash business.

"The reimbursement system has to also be adjusted," Neupert said, referring to how doctors are compensated. "If they don't get paid for it they can't innovate."

Ultimately, said he'd like to see something like what happened with online banking, where there was strong security, privacy and interoperability. While that exists today, he notes that Intuit did not exactly get a warm embrace when it asked those that held financial data to make it easy for consumers to access via Quicken.

"The banks weren't very cooperative for the first five years," he said.