Family Health Guy

In which Sean talks about HealthVault and other cool ideas in Personal Health

The HealthVault Nickel Tour

The HealthVault Nickel Tour

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A couple of weeks ago now we shipped a bunch of new HealthVault stuff --- in particular, we've significantly enhanced the tools available directly on healthvault.com. We had a bunch of our best designers rework the site's content, styling and navigation, and added editing and graphing capability for a set of core data types. This stuff is really exciting to me because I believe it helps users answer the question, "How do I get started?" And most importantly, the investments we've made in controls for viewing, editing and graphing HealthVault data will ultimately make their way into our SDK (Software Development Kit) --- reinforcing again our commitment to making it easier and easier for our partners to build great HealthVault applications.

I told our PR team that, once we had this release in the bag, I would put together a "nickel tour" of HealthVault ... walking through the key functionality from start to finish. The goal is to really be able to give users, reviewers, industry folks, etc. a sense of what the product and platform are all about. Of course I won't hit everything - but here goes my best shot.

Welcome to HealthVault

The first thing we ask when you visit http://healthvault.com/ is whether you're somebody who wants to actually use the product as a consumer, or somebody who is trying to figure out how to work with us as a partner developing applications, services or devices. Both audiences are super-important to us, and being explicit up front helps us do a good job for both of them.

Probably the most important thing to take note of here is our privacy policy. We've tried to be crystal clear - you control your information, not us. There is of course the long version, but here's how we boil it down:

You control your health information. You decide who can share it, and what they can share. We always ask for consent before allowing another person or Web site to access health information.

There's actually a lot of good information here, so I'd encourage you to spend a few minutes and check it out. But frankly I'm as impatient as you are to get to the good parts, so when you're ready go ahead and click the Sign in or Create a free HealthVault account links (they go to the same place).

Setting up your account

It's important that you keep your health information secure in a way that makes sense for you, so we offer a choice: you can use a Windows Live ID to sign in, or you can use an account from a number of OpenID providers. You can use a traditional username/password combination, or add extra security to your account by using Information Cards, client-side certificates or physical tokens. If that sounds like technology soup --- it does to me too. But the point is that by partnering with the best identity services on the web, we will always be able to offer state-of-the-art security features to HealthVault users. Way better than being locked in to one system.

If you don't have a LiveID or OpenID, you'll be asked to create one. You can always choose to change the identity system you use at any time, so don't worry that you're making a once-in-a-lifetime decision.

 After you sign in, you're presented with a screen where we collect some basic information to start putting together your own personal health record: name, birth date, zip code, gender, and some optional stuff. We also need some of this to verify that you should get access to the system (HealthVault is currently offered only in the United States and to users 14 years or older).

Once you get through this, we land you on the HealthVault account page - you're in!

Account "Home"

The account home page shows a snapshot of the records in your HealthVault account. On the left side, you'll see a folder icon with the currently selected record, and a list of the other records you have access to, if any (this will be empty if you just created your account). In the body of the page, you'll see links to work with information in the record, a quick list of recent changes, and information on other applications and devices that you can use.

Right now, your account is pretty sad and empty. Sharing and working with health data is only interesting if you actually have some data ... so let's start working on that. Our first stop will be the basic viewing and editing tools available directly on healthvault.com - just click on the Add, view or edit information link.

Add, edit and view

There are already a lot of great applications available for working with HealthVault information ... we expect that most folks will find a fully-featured PHR application to be their "health home." But we heard loud and clear that our users really wanted a place to get started.

Our most recent release contains just that ---simple tools like the "notepad" that comes with Windows that make it super-easy to start building out a record and tracking basic information. The "Health info" tab has two lists. The first one shows all the types of information already in your record - just click a link to see what's there. The second one allows you to easily add new information; we've enabled editing for 16 core data types). Let's start by adding a weight measurement.

This one is quite a simple little dialog --- just enter a date and weight and you're off to the races. Other data types, like medications or lab tests are considerably more complex, but we've done our best to make a distinction between what is really important to track vs. what is optional and tucked away in an "advanced" pane.

For the information geeks in the room, this is an interesting challenge - because HealthVault data can come from so many places and with such differing degrees of structure, building a really good editor is quite a task. You have to be able to represent all the complexity when it is present, but not make things overwhelming when it is not.

That's actually what is really great about these tools, though. We built them to be reusable so that everybody doesn't have to suffer the way we did! They're not quite ready yet, but we're working on making them part of our public SDK, so that anybody building ASP.NET applications has a rich set of controls to start from. The whole point of the HealthVault platform is to make it easy for partners to build powerful applications - I am really looking forward to seeing how a great control library will accelerate the emergence of cool new stuff.

Once you've added your weight, you'll be taken to a list showing all your weight measurements. I've been working on losing weight lately, so my record has a bunch of items. You can also create basic charts right on the page, or export the list to Excel where you can really go to town.

More ways to populate a record

Hand-entering data is ok for some things, but one of the reasons we believe traditional "PHR" applications have failed to really gain traction is that the burden of keeping health records up to date manually is simply too high. One of the key things that makes HealthVault special is that we offer a whole bunch of ways to collect data into that lifetime record; it's something we have spent a lot of time on, and expect to continue to be working on for a number of years.

Provider Connections

Ultimately, you'll be able to expect that your healthcare providers will be connected electronically to your HealthVault record - automatically populating "the clipboard" from HealthVault when you show up at the office, and sending a visit summary with updates back to your record when you leave. We've got some early adopters live now, a number of vendors providing HealthVault-connected systems, and a slew of big-ticket partners (Kaiser, Mayo Clinic, New York Presbyterian, etc.) hard at work building connectivity that will keep rolling out over the course of the year (and beyond).

And it's not just about doctors. We've recently signed agreements with all of the major pharmacies in the country to share prescription information, and many forward-looking insurance companies are starting to pay attention as well.

It's a long road, but we will get folks connected - frankly that's one of the key reasons I came back to solve this problem at Microsoft. This is a company that has proven it has the patience and commitment to stick with great ideas, even if it takes awhile to get everybody together and on board. We are continually making it easier and easier for providers and applications to connect; check out a few of them here or here.

Files and Faxes

While I'm looking forward to that fully-connected nirvana, the reality is that most health information today is on paper. We have a philosophy --- better to be complete than perfect --- and that means making sure that all that paper can get into your record as well. For example, you can upload pretty much any file (text, html, Microsoft Office, PDF, images, etc.) directly into your record.

Even more interesting, you can sign up ($9 annually) with our partner MaxEmail and get a personalized fax number just for a HealthVault record (we haven't done a great job making this visible - go to the bottom of the record profile page for a link to get more information). Easy as pie to have an immunization record, lab results, etc. faxed directly into a HealthVault record. What I really like about this feature is that you get your own number, not a special coversheet or barcode ... so it's easy to get providers to actually use it.

Connected Devices

A big part of improving care is keeping people out of provider offices in the first place - and in many cases that means doing a better job of tracking and monitoring conditions at home. We've put together a full device driver model (based on the same "Windows for Portable Devices" standard that is used for cameras and media players) to support collecting information from a bunch of different device types:

  • Blood pressure monitors
  • Blood glucose meters
  • Heart rate monitors
  • Weight scales
  • Pedometers
  • Peak flow meters
  • Pulse Oximeters

You can find the whole list at our device directory. To get started, you'll need to download our Connection Center software that serves as the "store and forward" agent, collecting data from your devices and shuttling it seamlessly up to HealthVault. When you install Connection Center, it will walk you through an authorization step that grants the application access to send data into your HealthVault record.

Once this is all set up, it's pretty great. Connection Center will automatically detect when you connect a device, copy over any new readings you've taken, and send them right up to HealthVault. If your PC isn't connected to the Internet, it will hold them and send them the next time you go online.

If you use Windows Vista, you don't need to buy a fancy device to try out Connection Center. Go ahead and install the software, and then add in our weight tracking gadget for your desktop. Simple and sweet - and convenient, which is what really matters to get folks to stick with it.

This is pretty exciting stuff - the doctors all tell us that simple measurements can really make a difference. People who weigh themselves regularly after a diet have a 50% better chance of keeping the weight off. Even better, tracking trends in blood pressure, glucose, and other health measurements can play a key role in keeping patients with chronic conditions under control and out of the emergency room. A whole bunch of our Be Well Fund grantees are doing neat things with home monitoring.

Integrating information from external "snapshots"

There are two standards for exchanging personal health information that are really starting to take hold: the Continuity of Care Record, created by the ASTM, and the Continuity of Care Document, created by HL7. The two formats are pretty much functional equivalents, although when you look inside you can clearly see the divergent philosophies of their creators. Each contains core information such as conditions, allergies, medications, advance directives and so on.

Many of our key partners are choosing to send data to HealthVault as CCRs or CCDs, often with an attached digital signature so that recipients can verify the authenticity of the creator. This is a great pattern, because the "snapshot" contained in these formats provides a great history of what each provider saw as "truth" at a given point in time.

You can see how these work for yourself by uploading this sample file to your HealthVault record. (A quick tip --- create a "test" record attached to your account when you're experimenting with things like this ... otherwise it can get confusing as to what is really information about you!)

Of course, once you start to receive these items, you also need to extract the individual data elements so that you can maintain a single list of current medications, allergies, and so on. Our "reconciliation" tool makes it easy to do that - when providers add CCR or CCD information into your account, you'll be given a link that starts the reconciliation process.

The tool simply shows you what is in the snapshot on the left, and a composite on the right of what your record will look like after reconciliation. You can choose to add items to your record, ignore them, or overwrite existing items in cases where you receive updates in a snapshot.

I'm excited about this because it "closes the loop" -- getting information out of provider systems and reliably merging it into your HealthVault record in a useful way. Over the upcoming months and years, we will continue to improve the reconciliation process, for example detecting duplicate items automatically - and we can do all the work on our side so the providers and users benefit without doing any new work themselves.

Multiple Records and Sharing

So far, we've been working with just one record - the one that was automatically created for you when you created your HealthVault account. But we know that most of our users are responsible for a whole crowd - kids, pets, parents and spouses. We specifically built HealthVault to represent the complicated and changing relationships we all have.

For example, I may want to create a record for my daughter. I can do that by clicking the Add a new record link on the records tab and entering a bit of basic information.

Your new record will show up on the "Records" tab, and on the left side of the page in other tabs. When you choose to use a third-party application (we'll talk more about these later), you will be asked to choose which record(s) you want to use with the application.

You're also automatically made a "custodian" of any record you create - which means you get to decide who else can see and work with the record. For example, I may want to grant my wife access to my daughter's record, since either one of us may end up taking her to the doctor. I do that by going to the "Sharing" tab  and clicking the Send a new sharing invitation link.

On this page, I can choose what kind of access she should have (read only, read write, custodian) and what data she should be able to access (from "all" to any limited set of types I select). She will then receive an email with a special code she can use to accept the access.

In the case of our child, it makes sense for both my wife and me to be "custodians" of the record. Custodians get to decide who else can see the record, can see all audit/history information in the record, and they can mark items as "private" so that they are hidden from everybody but other custodians.

Custodianship is a key concept that enables HealthVault records to truly be valuable for an entire lifetime. When my daughter turns 18 and leaves home, I will simply transfer custodianship from my wife and myself to my daughter - so the same record we've been building for her all these years can follow her into adulthood and independence. And when she gets to an age where she needs her own children to help take care of her - she can pass on custodianship to them.

This kind of lifetime record has the potential to transform the personalization and consistency of care we receive over the course of our lives -- it's a wonderful, powerful model that we are very proud of.

Tracking history with audit information

A critical part of delivering on our "complete control" promise is keeping comprehensive and clear records of exactly who has been accessing a record and what they've been doing. HealthVault tracks all of this activity and makes it available to custodians on the History tab. On this page, you can see changes by date, by person, by application, you name it. Here is one view; all changes made in the last 30 days:

We also keep full copies of all past versions of items ... so when somebody makes an update, you can review the "before" and "after" to see exactly what was changed.

Audit information is important not only as a sanity check on sharing, but as a way for recipients of HealthVault information to decide how much they "trust" items. For example, a CCR item that has been altered from its original state will clearly show that it has been touched - and who touched it.

The Big Idea - 3rd Party Applications

We've looked at a lot of features delivered by HealthVault itself, but we haven't even gotten to the really good part yet. Fundamentally, HealthVault is not a "PHR Application" -- it's a personal health platform that serves as infrastructure supporting a growing ecosystem of innovative partner applications and services.

There is no shortage of smart, motivated people and companies with great ideas about how to innovate around health - helping people lose weight and get fit, manage chronic diseases, streamline interactions with doctors and nurses, manage medical expenses, provide convenient second opinion services, connect people with exciting clinical trials, analyze genetics to create personalized wellness plans - the list is endless.

But until now, much of this innovation pretty much died on the vine - because there was no unifying system that could pull together a comprehensive health record to start from ... not to mention the challenges of building out secure systems and privacy models that people could understand.

This is why we're here --- to unleash all of that innovation by providing infrastructure and glue that makes it easy for developers to create applications, and easy for individuals to take advantage of them. We've got dozens of applications live today, and scores more in the pipeline.

Whenever you use an application for the first time, you'll be asked to choose the records you want to work with, and to approve access to the application. Each application pre-registered with us exactly what data types it needs access to, and these are clearly shown on the approval page, along with the application's terms of use and privacy statement.

The application cannot do anything with your record until you give your OK, and even then it is restricted tightly to the data types it requires. At any time, you can review, edit or revoke your application sharing preferences on the Sharing tab at healthvault.com.

There isn't space here to introduce you to all of our partner applications, but to give you a flavor of the kinds of scenarios available I've just called out a few:

  • NoMoreClipboard uses information in your HealthVault record to fill out your doctor's "clipboard" form before you get to the doctor - so you don't have to waste time and try to remember years of health history while sitting in the waiting room.
  • Podfitness uses information in your HealthVault record to create customized audio workouts - combining your favorite music with expert personal training sessions based on your health profile.
  • MyVitalData helps you prepare for an emergency by integrating directly with hospital emergency departments and first responders to ensure your critical health information is available when you need it most.
  • TrialX automatically matches participants to relevant clinical trials based on information in your HealthVault record.

So that's what you get for your nickel

Almost a year after we first launched HealthVault, we are still super-early along the path we'll need to follow to really turn the potential into reality. We've added a boatload of new features and improved a lot of what was already there, but we won't be done for a long time.

Still, what is there today is pretty exciting. From the basic tools at healthvault.com, to data collection options ranging from fax to automated exchange, to integration tools, sharing and auditing, to our growing ecosystem of devices and applications - it has been a busy twelve months.

My hope is that this quick overview will inspire you to get involved with us, as a user, partner, or just a critical reviewer ready to tell us what we're doing right and what we're doing wrong. I'm always up for a good discussion on my blog at http://blogs.msdn.com/familyhealthguy --- see you there!

---S

 

 

 

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  • PingBack from http://chilmarkresearch.com/2008/09/29/healthvault-surges-google-flounders/

  • Sean -

    I've been following healthvault for some time.  We're just about to launch facetofacehealth.com - I recently read your post about matching people to others based upon clinical trials.  This is essentially what facetofacehealth is all about - we built HealthMatch which will automatically match people together based upon condition/medication/treatments/etc. You can also build custom searches/etc.  

    I would like to figure out how to programatically integrate the site with HealthVault/Live Search so users can search for health content.  

    my email: noutlaw@facetofacehealth.org

    Regards,

    Nowell Outlaw

    President/CEO FacetoFaceHealth

  • The HealthVault Nickel Tour , from HealthVault architect Sean Nolan.

  • Last two years brought unprecedented interest in Personal Health Records (PHRs). Started in healthcare industry outlets the excitement crossed over into traditional media and the expectations are high. Over the last year I have written a few pieces abou

  • HealthVault appears to have potential. However, I don't believe physicians will tap into this unless we can interface it with our existing electronic health records for free. I'd love to be able to upload immunization records, past medical history, meds, etc, and would likewise appreciate the download from patient entry from this portal.The costs of maintaining a ehr are already prohibitive, and without a free interface with major vendors, it will seldom be used by docs. I can pay an additional fee on top of my approx 2 grand a year renewal to get a web portal with my e-md software, but as a solo doc this is tapping me out financially. Additionally having to open seperate applications, and re-enter data, copy/paste or print up and scan data etc is inefficient and will decrease usership as well.

    I'm hopeful that microsoft will partner with most ehr's to create a bridge that is secure, free and easy to use for providers and patients. Quicken financial does it pretty well for online personal banking, but I'd want it to be even cleaner and more efficient than their process. I haven't been too impressed with the interfaces of labs (ie labcorp and quest) so I worry about how well more complex info over hl7 will transfer from webbased independent platform to ehr. just a few thoughts!

    Thanks,

    Fred

    fgroverjr@yahoo.com

  • Fred, thanks for your thoughts here ... I completely agree that in order to get used the interfaces have to (a) be integrated in with your existing tools, and (b) be priced in a way that allows them to be ubiquitous.

    We're working hard on both counts. We have active engagements with most of the big EMR vendors who are integrating into their products. This takes awhile to get done, but it is happening.

    As for costs --- we made HealthVault connectivity free for specifically the reason you bring up... taking a "toll" on communications between patients and doctors is neither useful or realistic at this point in time. As vendors implement connectivity, I assume they will take different approaches to getting it out there --- some making it part of their base product, and others using an upsell model. At the end of the day --- those features that aren't free from vendors will have to stand up on their own from a return-on-investment perspective, and as a good capitalist I'm confident that the market (YOU!) will tell them what works and what doesn't. :)

    It is certainly a lot of fun. I very much appreciate getting your perspective and hope you'll continue to let me/us know what you're thinking.

    ---S

  • It's been a classic good/bad day. On the good side --- we announced our relationship with Aetna , which

  • I thought a lot about whether I should write this one or not. For sure there's a set of people who are

  • The folks at Google Health have been taking it on the chin this week, after the Boston Globe ran an article

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