Family Health Guy

Self-Evident

If you've ever had to work through even a slightly complicated encounter with our health care system - you know what it's like. You become a combination archaeologist, file cabinet and pack mule, begging providers for copies of your own images, lab results, medication lists, and encounter notes, then trying to make sure they're in front of the right people when decisions are made. Really, it's just nuts.

Tools like HealthVault help solve part of this problem - we are working hard to build connections to all of those places where your data lives, making it easier to create a comprehensive data asset and share it with all the members of your extended care team: providers, family members and, increasingly, innovative consumer services that use the power of software and social networks to create insight.

But in order for software to matter, our culture and attitudes need to change too. As I travel around the country working to help organizations share data with individuals, I consistently hear objections that reflect that challenge, even though HIPAA already says they are required to share on demand:

• People won't know what to do with this information; they need providers to filter it for them.
• If people see the raw data, they'll overwhelm providers with irrelevant questions.
• Sharing information could increase liability risk.
• Misuse of "their" information could damage a provider's brand.
• Sharing information gives away a competitive advantage to a provider's business.
• ... and more.

Right now, there are tons of policy "concrete" being poured into our healthcare system, thanks to ARRA and President Obama's push for healthcare reform. Before that concrete hardens, it is critical that we firmly establish complete access to one's own health data as an unassailable ethical and moral human right.

This is why I was so excited when I was invited to join the group of thought leaders across healthcare working to establish a Declaration of Health Data Rights at http://www.healthdatarights.org/. The text of the declaration is clear, appropriate and extraordinarily important to the advancement of effective care in our country and beyond:

A Declaration of Health Data Rights

In an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

1. Have the right to our own health data
2. Have the right to know the source of each health data element
3. Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; If data exist in computable form, they must be made available in that form
4. Have the right to share our health data with others as we see fit

These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

Microsoft and I wholeheartedly endorse this declaration and are proud to be part of a growing community that recognizes its importance. If you would like to add your voice to ours, you can get started by visiting http://www.healthdatarights.org/.

Self-evident indeed.

The Worst Idea Ever

One day when I was about fourteen years old, I bought a bunch of fireworks (rockets mostly) from that shady guy who roams the halls of every high school selling contraband. I went over to my friend Don's house in the afternoon and we really wanted to shoot some of them off - but it was raining outside, and we didn't want to stand outside getting wet.

"I have a great idea," I said. "We can open the windows of the dining room and launch the rockets from INSIDE the house - that way we'll stay dry." Pure adolescent genius, I tell you.

Now, you may have a sense of where this is going. Suffice to say that we spent a couple of hours desperately trying to get exhaust marks and the smell of sulphur out of Don's mom's super-fancy Oriental rug, and I was really glad that we tried this at his house, not mine. Looking back over the last forty years of my life, I have often referred to this as the Worst Idea Ever.

But today the great indoor fireworks episode has competition, in the form of a truly insane HIT bill up for consideration in the New Jersey State Legislature. Bill 3934 would make it ILLEGAL to sell any "health information technology product" that is not certified by CCHIT:

2.  (New section)  a.  No person or entity, either directly or indirectly, shall sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by the Certification Commission for Healthcare Information Technology.

As used in this section, "health information technology product" means a system, program, application, or other product that is based upon technology which is used to electronically collect, store, retrieve, and transfer clinical, administrative, and financial health information.

b.  A person or entity that violates the provisions of subsection a. of this section shall be liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.).

Frankly, I am just too stunned to really say much of anything about this disaster of a bill. It is actually difficult to think of another action that would be more effective at screwing up healthcare.

Look --- there are plenty of real debates to be had around HIT. I believe the evidence does not support the idea that CCHIT certification has or will stimulate adoption, but there are reasonable arguments on both sides. Happy to have that conversation. But there is simply no sensible position that would criminalize innovation in an industry that desperately --- desperately --- needs new ideas.

Please, New Jersey, do your citizens a favor and just make this go away.

We never were able to fix the carpet.

Continua in da house!

Thursday is the first full day of the 2009 Microsoft Connected Health Conference here in Bellevue ... there were a few events today, but things really get underway tomorrow at 9am with Peter's keynote and an opening panel including Uwe Reinhardt, David Kibbe and Mike Leavitt (Mike, not Mark, so we won't likely see an onstage rumble). I'll be wandering around all day, except for a presentation for our Amalga customers in the afternoon and a Q&A panel just after that. If you see me wandering around avoiding eye contact with strangers, say hello!

Anyway, I wanted to call out one session tomorrow that I'm particularly excited about:

Learn how Continua-compatible devices can work with HealthVault and what it might mean for your development efforts. ---Jesse St. Marie, Senior Program Manager, Microsoft Corp.

Jesse is our go-to guy for devices, and has been working on this for some time. At this session attendees will see a real, live, Continua Certified^TM fingertip pulse oximeter connect through a PC to HealthVault Connection Center and upload readings to a HealthVault record. It's not production-ready yet, but it's completely real.

Let's say that again, because it was really fun the first time.

We will show a Continua device sending data directly to HealthVault.

We've said again and again that what Continua is doing is complementary, not competitive, to what we're doing with HealthVault - and that integrating devices is the thing to focus on, not "joining Continua." Now that Continua certified products are entering the market, we're doing the work to get them hooked up, just like we promised.

We're simply not out to create and define standards - that is for other folks to do. We are about creating a connected ecosystem for health, embracing all of the standards that are important to making that a reality. Continua is on a path to be a meaningful part of that ecosystem.

This is great news for everybody --- HealthVault users will have more options; device manufacturers can choose to build products in whatever way works for them; and both Microsoft and Continua can (maybe) stop answering questions that just don't matter.

Good times.

You put your right HIPAA in…

Early last May, I posted an entry that described our position regarding the relationship of HealthVault to HIPAA. In short, our interpretation was that HealthVault did not fall under the definition of a Covered Entity or a Business Associate as defined by the legislation. Further, it seemed clear that HIPAA was simply not intended to cover services like HealthVault that provide tools to help individuals manage copies of their own health information. Pretty simple, really.

Fast forward about a year, and "pretty simple" just wasn't good enough for the well-meaning folks in Washington, DC. When they sat down to reform healthcare with the ARRA bill, things got a bit muddled up. Did anything really change that would affect our position? Unfortunately, the answer is really "nobody knows."

You simply cannot imagine how many hours I have spent in small conference rooms with no windows listening to experts argue this back and forth. Really.

Here's the thing:  this renewed atmosphere of ambiguity and uncertainty risks slowing down the important work we all are trying to get done - helping individuals get and stay healthier by collecting, sharing and leveraging their own personal health information - connected to their trusted providers.

So we decided to take a new look at the legislation. And when we did that, we realized that it really didn't matter how we are technically defined. As we have said from day one, we operate the HealthVault systems far beyond the baseline privacy and security measures required by HIPAA anyways. And further, we can sign "Business Associate Agreements" with covered entities that want to interact with HealthVault, without in any way restricting our ability to put consumers in control of their information. To be clear --- we can and will, without modification or compromise, continue to stand behind our privacy statement and service agreement.

Which brings me to the real point here. We are now prepared to sign a Business Associate Agreement with any covered entity that feels it is an important part of their responsibility under the HIPAA legislation. We have worked hard to create the text of that BAA, and are committed to being open and transparent about exactly what it contains. In fact, it is posted online for anybody to review here.

To date we have spent far too much time explaining to covered entities why we did not need a BAA between us. Going forward, we just don't need to have that discussion. This is a really, really Good Thing.

Onward!

Sweet Opportunity for Health Devices

As I posted about a few days ago, we're gearing up for the Connected Health Conference, happening here in Bellevue from June 10^th through 12^th. It looks like a really strong event, with an eclectic mix of participants and speakers showing off real-world evidence that the future of healthcare is well on its way. If you'd like to join us, just use the code "CHCREG" to register online.

I learned yesterday evening about another fantastic program we've got going at the conference - the HealthVaultDevices@BestBuy "side event." We've teamed up with Best Buy to invite anybody building connected health or wellness-related devices to pitch them to a panel of executives from both companies. The panel will select the most promising devices to discuss collaboration opportunities with Best Buy - the largest consumer electronics retailer in the United States. Not too shabby!

I understand that we've got a bunch of really cool companies signed up already - are we going to see yours? Having an existing connection to HealthVault is an advantage for sure, but not required. I'm going to try to sneak in and watch.

Full information and the signup form can be found here.

Another promise delivered

I am super-excited to say that, as of last week, we have officially released the HealthVault service specification under the Community Promise. This means that anybody who wishes to create and operate their own version of the HealthVault service is free to do so. We have documented the interface at a level sufficient for re-implementation, and we grant an irrevocable, compensation-free license to use any Microsoft patents required to execute the specification.

This is a big deal -- the last of three key initiatives we undertook more than a year ago to ensure that developers who build on top of HealthVault can be confident in their investment. We are not going away. But even if we did, or if for any reason a developer decided they no longer wanted to connect to "our" HealthVault, there is a realistic path to run against another implementation, with just a configuration change.

Will there be other implementations? That's up to the market - we've made it possible.

When we first announced our intent to release the specification last April, we thought it would be published a lot sooner. As we've followed the long path to get it done, I've learned a ton about the internal processes and gates here at Microsoft that help protect our intellectual property. The company takes this incredibly seriously - and rightly so, as IP is our only real asset - so releasing it so freely is a huge step that required explicit approval at the highest levels of the company. It speaks volumes about our approach to the health market and our ecosystem partners.

We also originally planned to use the Open Specification Promise, and ended up using the similar Community Promise instead. Why? Because the CP allows us to limit the license to the healthcare domain, which seemed to make a bunch of sense. Other than that, basically the same deal.

So whether you need an open source library to work with HealthVault, want to see or build upon the complete source code tree for our .NET SDK, or want to go all-in and create your own version of the HealthVault service, it's all good.

Yet another barrier knocked down, and yet another proof point that Microsoft is committed to do what is necessary to help spur real, fundamental change in our healthcare system.

Sitting in a random hotel in Albany at 2am - having missed seeing my son turn two double plays in one game because I was on the plane to get here - this healthcare thing can seem like a long slog. It is just awesome to have things like this to get excited about and be a part of. Wooooo hoo!

I love it when a plan comes together

You know, I'm starting to think we just may be onto something with this whole HealthVault idea. This afternoon I was talking with a guy who's writing a pretty broad piece on consumer-driven healthcare, and as I was running through all of the accomplishments of just the last few weeks ... I managed to get myself all worked up and excited:

• April 7, New York, NY: New York Presbyterian hospital launches mynyp.org, a robust patient portal powered by HealthVault and Amalga - real patients receiving rich visit summaries they can share with primary and referring providers.
  
  
• April 21, Rochester, MN: The Mayo Clinic launches Mayo Clinic Health Manager powered by HealthVault - extending the reach of Mayo's clinical expertise to family health managers across the country.
  
  
• May 6, Toronto, ON: TELUS announces they have licensed the HealthVault platform to provide a consumer-centric health service across Canada - proving that what we are doing is meaningful not just in the US, but around the world.
  
  

And of course, these don't even touch on our enterprise progress, where since HIMSS 2009 we have launched not only Amalga UIS 2009, a major revision of our data aggregation toolkit for healthcare, but Amalga Life Sciences 2009, a brand new product targeted at bioscience research.

Peter doesn't generally talk much about our products on his blog - but I'm too much of a proud papa to do the same over here. Woo hoo, go HealthVault and Amalga!

Which brings me to the real point of the day. Next month, from June 10^th through the 12^th, we will be hosting the third annual Microsoft Connected Health Conference here at the Meydenbauer Center in Bellevue, and I really hope you'll join us.

Now, I'm not generally a "conference guy" - for one thing I'm just way too much of a social hermit to be comfortable in the crowd, but I also get frustrated listening to what often seem like the same speeches at event after event. From the planning I've seen so far, I'm confident that this isn't going to be an issue at the CHC. The team is working super-hard to put together a program that talks about REAL traction - focusing on how REAL organizations are making progress by using technologies like HealthVault and Amalga. And they're setting up a bunch of formal and informal networking and Q&A time where folks can have real, in-depth discussions around the issues that are helping or hindering that progress - the kind of discussions that you can take back home with you and apply directly to your piece of the puzzle.

My understanding is that I'm on the hook for at least one session and a couple of Q&A panels --- I think it's going to be really useful and a ton of fun. I hope that you will choose to come out and spend some time with us. And if you are there, make sure to say hey if you see me hiding in the corner trying to look inconspicuous.

You can sign up for the conference at the CHC web site, or feel free to use the "email" form at the top right of this page to ask me any questions about the event.  

This just in: sharing health data is hard.

The folks at Google Health have been taking it on the chin this week, after the Boston Globe ran an article about a super-engaged patient named Dave who found a number of pretty nasty surprises when he imported his health information from Beth Israel into Google. From what I have read there were really three key issues at play:

1. BIDMC is sending condition information based on billing codes. Inferring good clinical data from billing codes is a notoriously tough thing to do - the codes are vague and dated, and it's just assumed that people will jam whatever seems kind of close in order to keep the dollars moving. And at a more basic level, things that get billed are often exploratory - just because I got an HIV test doesn't mean I have HIV.
   
   
2. A lack of proper date tagging resulted in data mush. For example, he received warnings about "critical" medication/condition interactions where the problematic condition was resolved years ago.
   
   
3. Only a small subset of the record was actually transferred. BIDMC has only implemented sharing of conditions, meds and allergies --- so Dave didn't get everything he expected/wanted in the exchange. 

People are having a grand time drawing conclusions from all from this, mostly trying to decide "who sucks" --- is it Google, or BIDMC, or the insurance companies, or lousy doctors, or all PHRs? Maybe the government? One guy actually suggests, seemingly in seriousness, that we should all just give up.

Jeez --- settle down, Beavis.

Yes, there is great learning here as to what can be done better --- Dr. Halamka has already posted about steps they're taking at BIDMC to make things better (as an aside, how many other medical institutions out there display this kind of transparency? Kudos are deserved here.). But the reality is, there is a bunch of dirty data out there in the world, and it is being used not just for billing but to make clinical decisions. Providing transparency and letting people see the mess inside --- that is the first real step to getting it fixed.

Anyways, the question I keep getting asked is --- is HealthVault vulnerable to this as well? As is all too often the case, the answer is yes and no. I think we are in a much better position than Google, but we are definitely not completely immune.

The bottom line is, if I authorize a provider to add data to my record, and they add an item that says "Sean has cancer," then indeed my record will say just that. There is no magic truth detector in HealthVault that knows that I actually don't have cancer (nobody would question our business model if we could do that!). And sometimes the data coming from providers --- especially those that rely on billing codes for clinical information --- will be wrong. So what can we do about it?

This is where our approach to data really helps. When we accept information from hospitals and other providers, we almost always get it in the form of a "package" --- either a CCD or CCR document. Within these documents can be many different individual data elements, all bound together as a snapshot of what that source believes to be true at a given point in time. These snapshots remain in HealthVault as distinct items, and can be digitally signed by the creator so recipients can trust where they came from and that they have not been tampered with in any way.

The user then has another choice - they can "reconcile" the package by looking at the individual items and choosing which ones should be extracted into their record. Only those items that the user chooses to copy out become part of their canonical list of conditions, allergies, medications, and so forth.  There are a few really nice things about this approach:

• Users have a well-defined place to make decisions about what elements they want to accept and which they believe are wrong. Right now our "reconciliation" process is pretty manual, but as we go forward we expect to do smarter things. One great idea that William Crawford put forth was --- in an interface like this, call out conditions that are associated with billing codes with a special warning icon --- to suggest that the user may want to take a closer look at these.
  
  
• It puts a fence around the "dirty data" problem so that users can benefit from all sources without worrying that their records are going to become polluted with errors.
  
  
• It turns out that retaining both the individual items and the package can be really useful - for some use cases the package itself is what a recipient really wants. For example, a referring doctor that wants to see the results of a surgery at NYP probably wants the digitally-signed CCR from that visit, not the user's all-up history.

You can see some screenshots and more detail on our reconciliation interface as part of the HealthVault Nickel Tour ... look for the "integrating information" part of the post.

No matter how you slice it, building and maintaining a quality health record is just a tough problem. I spend a lot of time with hospitals and other providers trying to help them figure out how to start sharing data with patients. So I can't help it --- I have to put in another plug here for New York Presbyterian, which launched their new patient portal at HIMSS last week (I am now officially two days late on my tech details follow-up post about NYP ... working on it!).

NYP uses our Amalga UIS toolkit to create a comprehensive, quality "data asset" that is the foundation driving the visit summaries they send to HealthVault in CCR form. Amalga is a really, really neat piece of software --- its sole purpose in life is to collect data from wherever it is in the institution, aggregate it together, and use it to perform real-time or retrospective analysis, drive internal workflows, or (as in the case of their patient portal) share it with other people or systems. Because they put in so much work up front to create a great data asset --- the information that NYP patients receive in their visit summary is really, really impressive and useful.

All up, I am super-glad that we have folks like Dave out there pushing the envelope. I know that the issues he uncovered are only the first ones we'll have to deal with. I think that with HealthVault we've done a good job laying a foundation that has the right fundamentals to help get us through successfully ... but it will take commitment from everybody involved to really make it work. The good news is, the payoff really matters and will totally be worth it.

 

A Little Imagineering at NYP

This last week while most of our industry was fighting the good fight through the snow at HIMMS in Chicago, I was taking a break with my family in the sunny climes of - no surprise to anybody who knows me at all - Disneyland, USA. Despite my daughter's cold and heavy spring break crowds, Lara's FastPass skills were in mid-season form, Club 33 was a special treat, I got Roz to talk to me in the Monsters, Inc. ride, and all up we had a great time.

One thing that was really cool was our visit to Blue Sky Cellar, a preview center for the changes that Imagineering is making to California Adventure over the next few years. To me, the stuff that goes into creating park experiences like Peter Pan, Midway Mania and Indiana Jones is simply incredible. Imagination is great - translating those ideas on a 2D movie screen is even better - but being able to render them as experiences in real space is just mind-boggling. Executing on great vision within all the constraints of the real world - that is special.

Back in HSG-land, the two big pieces of news were the release of Amalga UIS 2009 (way to go guys!) and the launch of New York Presbyterian's mynyp.org - a patient portal that combines HealthVault and Amalga to deliver a compelling showcase of what world-class service from a hospital is going to look like over the coming years. NYP is leading the way, and there have already been some great write-ups, particular in the New York Times and on the Chilmark blog.

We've talked about this kind of connectivity for a long time now. I've personally spent a good part of the last two years painting the vision of what could be -our team has spent that time building the infrastructure and tools that can help bring that vision to life. But the launch of mynyp.org is an enormous leap forward --- NYP has now rendered those ideas in real space and for real patients. The marketing ramp is conservative, but the site is open to everyone. If you get treated at NYP tomorrow, you can go home, create an account at mynyp.org and receive a detailed summary of your visit: discharge notes, medications prescribed, labs performed, images taken. All electronic and digitally signed, ready to share with your specialists, primary care doctors and family members.

I need to settle down here before I get too excited. The point is --- this is awesome, and it's really starting to happen. And what we have done with NYP, we will replicate and with others. We are going to have a real impact on the quality and continuity of care. "Meaningful use" folks, are you listening?

Later this weekend I'm going to post again - with some more technical detail about how HealthVault and Amalga are powering mynyp.org under the covers. In particular I'm going to talk about NYP's "data asset" - a term that only an engineer could love, but the concept that makes it all come together. Stay tuned.

FIRST Robotics == totally wicked

Fair warning, this isn't really a note about healthcare -- except inasmuch as any conversation about innovation and technology in our culture impacts our capacity to actually improve health and wellness over the long term.

I took the day off today - this evening is the first tournament game for my son's new baseball team --- but during the day I am camped out here at Seattle's Key Arena, watching high school teams compete in qualifying rounds for Dean Kamen's FIRST Robotics competition.

Truth is, I've been feeling a bit worn down lately. We're making great progress with HealthVault and Amalga, but it is slow going. All too often, I find our industry paralyzed over silly things like certification and old conventional wisdom, when with just a little action we could do really great things quickly --- and improve them over time.

Anyways, with that context I made a really great choice coming here today. The optimistic atmosphere, the attitude and enthusiasm of the kids participating, the genius behind the design of the challenge, the crowd and venue that makes rock stars out of technologists --- it is incredibly energizing.

Each year the FIRST organization creates a sport to be played by a combination of robotic and human participants. This year the game is "Lunacy." Lunacy is played on a field (the "crater") about the size of a tennis court, with two competing alliances each made up of three teams - so six robots on the field at once. Each robot pulls a trailer, and the goal is for robots and humans to deposit "moon rocks" about the size of playground balls into the opposing teams' trailers. Robots can collect and deposit rocks themselves, and can also deliver them back to humans at the edges of the crater -the humans can then shoot baskets into opposing trailers from the sidelines. In the first twenty seconds of the game the robots run autonomously, and then for the rest of the game they are guided by remote control.

There's a lot more to it than that - but you get the idea. What is really special about FIRST is the way the events are run - this is the big time. The jumbo screens at the Key are all running, music is blasting, the teams have mascots and flags and crazy costumes, and the announcing is done like it's the Seattle Seahawks out there rather than a bunch of engineers.  They have filled a good third of the Key on this first day of qualifications, on a school day. I've seen teams not just from Washington, but New Hampshire, Florida, California, Montana, British Columbia and Istanbul. This is an environment that says --- science matters, this is how you make your mark on the world, and by the way it is really, really fun.

Right now it's lunch break, and from my seat I can see teams in the pits making last minute adjustments to their robots, a bunch of modified Roombas cleaning the "crater" floor, groups of kids hanging around recapping the morning, and jumbotrons cycling quotes from people like Thomas Edison, Esther Dyson, Albert Einstein, Alan Fromme and Dean Kamen. This is what America (often through our immigrants!) has to offer the world --- innovation.

I don't have a lot of patience for cultural or political luddites that blame technology and human advancement for our problems. Sure, we screw things up all the time - but we achieve incredible, amazing things as well. In order to survive and thrive in the world we have to keep innovating - and we can only do that by teaching our kids that science and technology matter. That using their brain to create new things and solve real problems is one of the greatest things a person can do. That we can protect and embrace the natural world without giving up on the idea that we can make the world even better. And most importantly, that our society needs to reward innovation and individual creativity.

What a great day --- and now, back to your regularly scheduled programming: stimulus, hipaa, cchit, ccr, ccd, blah blah blah.... :)

   

Disappointed.

I thought a lot about whether I should write this one or not. For sure there's a set of people who are going to write it off to competitive jealousy - very possibly starting with the guy I'm writing about. But I think it's a real issue, so we'll just see how it goes.

A couple of days ago, Google launched a few new features at Google Health - the key one being a sharing function that lets users invite others to see a read-only view of a health profile. Let me be clear: this is great to see. I am really glad that Google is in the game. They do some things better than us, and the reverse is true as well. I enjoy my interactions with the super-smart folks there, and hope they'd say the same about me. So --- woo hoo, great news --- really!

My problem is not with Google, but with Matthew Holt, a guy who hangs his hat and his consulting business on being a broad expert in "anything to do with eHealth," including "consumers and how they're changing health care." Matthew is the founder of The Health Care Blog, which is indeed one of the best read blogs in health care.

Matthew felt that this new feature at Google was important enough to dedicate a post to, suggesting that it may be a "killer app" and has the "potential to be really disruptive." We agree. Which is why we implemented sharing of HealthVault profiles in October 2007 --- a year and a half ago --- on the day we launched. And why we allow read/write access, and why we allow you to pick which parts of the record to share. On the other hand, Google's interface takes two clicks, we do it in three. I guess that's the killer part? Come on.

Sour grapes? Perhaps --- I do take what we do very personally. But let's look a bit deeper.

A few weeks before Matthew's Health 2.0 conference last year, we had just launched a bunch of new HealthVault functionality. At this time, he had never written in any meaningful way about HealthVault, while there was a permanent area on the home page dedicated to Google Health. After speaking with Matthew, our PR folks asked me to put together a page-by-page tour of the HealthVault interface to give him a complete overview, which I did on my blog as our Nickel Tour. Both at that time and in a post after our demo issues at the conference, Matthew indicated that he would review the tour and do a detailed analysis. Still waiting. Oh, and the tour includes user sharing.

Am I reaching? Let's do some searches on THCB:

• Google: 2,100 hits
• Microsoft: 222
• HealthVault: 87

This just doesn't add up. We are working with pretty much every major health system in the country at some level. We continue to release functionality, add to our partner list, push the envelope on privacy and security, engage in the debates over standards and stimulus, and little by little are making this stuff really meaningful to consumers. Unfortunately, Matthew's readers don't get to see this progress. Good thing we're working with most of them anyways.

One of these two things is true: either Matthew is harboring some weird hidden agenda to shill for Google over Microsoft, or he simply does not understand the reality of how consumers are changing health care. Either option is just disappointing - because Matthew has an enviable and important pulpit to speak from - and the world needs him to use it responsibly.

Ah well. Things are good --- maybe I am just being too sensitive. I'll just sit back, tear up a bit over our new HealthVault video and then get set for a weekend with the World Baseball Classic.

Walk This Way

This is a fun one --- one story with two super-cool angles to it.

First --- a few days ago we launched a great new HealthVault application. It's called "Walk Me" and the idea is simple. Just start counting your steps - a little thing that research says can add up to a lot of positive change.  You can use a fancy HealthVault-connected pedometer, but it's certainly not required. I use an old one I had hanging around - passable units are available for just a few dollars.

The real hook behind Walk Me is the connections it makes with other people. You're automatically placed into groups organized by location, age and BMI, and can see how your progress stacks up (still first in my BMI group, folks!). Even better, you can create Walk Me "widgets" to place on your own blog (look over on the right side of this page), Facebook or MySpace page, even in your email signature. And of course, the steps you track with Walk Me are available in any HealthVault application - so if you want to spice things up with a virtual trip in RouteTracker - it all just works. Pretty sweet.

Here's the other thing, though, that's really an even bigger deal. Walk Me is actually the first application to be featured in the new "Sandbox for HealthVault" - an environment we've created to showcase innovative applications created by Microsoft employees. Walk Me is the result of a few guys (primarily Rocky, Vaibhav, Eric and Chris - although a bunch of others contributed as well) here on the HealthVault team who decided that the world needed a good walking app - so they built one.

It's hard for me to describe how completely over-the-top excited and proud this makes me. First, that we have folks here at HealthVault who care enough about what we're doing to sit down and build polished apps like this on their own time. Second, that a huge company like Microsoft recognizes the value of this kind of innovation, and is able to see beyond bureaucracy to create a place for it to thrive. And last, that I know things like this actually work and will have a positive health impact on real people.

I have a pretty cool job.

A quick note about oxygen

We've spent a lot of time over the last couple of weeks talking about moving data around - making it easy for providers, patients and their caregivers to get the right information at the right time to make critical care decisions, correlate effect to cause to improve outcomes, do important research, and just save money. It's a big deal and we care about it a lot.

Much of this movement happens within institutions and is bound by HIPAA regulation. But I was surprised during one such conversation to be asked - does this mean you're backing off of your commitment to patient privacy in HealthVault? My initial reaction was one of confusion - I just didn't get the relation of the question to the discussion at hand (however, in retrospect my response  --- "are you nuts?" --- could have been more measured).

Consumer privacy --- enabled by real transparency, awareness, consent and security --- is a foundational component of any kind of real and scalable data liquidity, especially beyond the walls of any given institution. Individuals must have access to their information; they must be confident that it can be shared and used in ways they understand and value; and just as importantly that it cannot be shared and used in ways they object to.

It's important to note that this approach does not prevent any particular use of health information - even mining, aggregation and monetization. As long as individuals understand and accept that use, it is certainly not up to Microsoft to say they cannot participate.

Real privacy is essential to consumer-centric healthcare. As my friend Michael Stokes says, this is the oxygen we breathe. Just to be clear.

Stay on target...

It's clear that Microsoft is buckling down to weather a potentially extended economic storm. This is a first time for the Microsoft community, and it has a lot of folks freaked out, especially here in Redmond where friends and coworkers are directly affected. At the same time, it's pretty clear that it is the right business choice for the company, and it's likely to have a positive impact on the organization overall. Not easy, not fun, but the responsible thing to do.

But what about our little Health Solutions Group? I've had a number of people contact me in the last two days asking what this news means for Amalga, for HealthVault, and broadly for our commitment to Healthcare. After all, we aren't Windows over here; we are still in the investment phase of our business.

The short answer is - we're fine, we're strong and we're more optimistic than ever about the great things we are doing and the business we are building in health.

The longer answer is - this is exactly why we started this business at Microsoft. This is a unique company, with a leadership team that knows how to make a good bet and stick with it. It took fourteen years for Word to become the world's dominant word processor. We know how to stay on target.

When we entered this business, we didn't know we'd run square into a worldwide economic crisis. But we did know that solving problems in health was going to take time, and we knew we had to create an environment where partners could get comfortable making their bets on us. We've been saying this since we launched, but recent events illustrate the point in a dramatic way - Microsoft is one of a very, very few organizations in the position to deliver the kind of infrastructure that the healthcare industry needs to move forward.

So what has changed? For the health of our industry, our partners, our country and the world - we believe a higher sense of urgency about our mission is essential. It is time to set aside the ridiculous arguments about standards and the crazy idea that data lock-in is a strategy for customer retention. We are marshalling our resources to deliver users and use cases --- real instances of real value that we can all point to and say, "Do more of that!"

If you are a hospital or doctor --- Join or start an HIE, especially one that gets data into emergency rooms. Give your patients a copy of their chart and discharge notes, electronically if you can but on paper if you can't. ePrescribe!

If you are a citizen --- Get your family's medical information online where it can be used in an emergency or natural disaster. Make a real attempt to get healthier --- lose a few pounds, stop smoking, check your blood pressure, exercise your heart.

If you are an entrepreneur --- Find new ways to use data to make things more efficient, more accurate, more effective. We need more reasons to build data assets, both inside and outside of institutional walls. Lean on free infrastructure services like HealthVault and Google Health to get to market quickly and efficiently.

If you make policy --- Don't slow us down with endless debate and forced standards. Reward outcomes, however they happen. Require and facilitate data exchange and transparency. Invest in programs to make citizens healthy.

Microsoft has made its bet. We are in. I hope you are too.

How about a REALLY better way to detect drug risks?

Jacob Goldstein at the WSJ just wrote a piece about a pilot program that Pfizer is funding to try and help track adverse reactions to drugs once they've hit the market. This is a real problem --- right now, once the clinical trials are done we pretty much have a black hole. The pilot attempts to fix this by making it super-easy for a doctor to report side effects while they are documenting a visit. Not a bad idea --- assuming you can wire enough systems to create reports, and impact doc behavior sufficiently that you get a good sample.

I think there's a better, cheaper and quicker way - why not just ask the folks that are actually taking the drugs?

Imagine that when you pick up a new drug, the pharmacist points out that the package insert contains a URL where you can learn more about your condition and sign up to automatically receive notice of any warnings or recalls. Given the hit-or-miss way this information is currently handled in the market - this would be an easy recommendation for the pharmacist to make.

Now what if that URL pointed to a simple HealthVault application ... and that the patient could be prompted each month with a quick survey of their progress with the medication, any perceived side effects or new conditions, hospital visits, and so on ... all powered by the health record that the patient is building up anyways.

The end result is a near real-time, aggregated view of the performance of the drug in the market - coupled with an efficient channel to alert patients to issues when necessary. Yes, at some level the patient information will be "messy" and some folks will even lie --- but that is the magic of statistics and the sample sizes available through the Internet --- at the end of the day, it will all wash out to useful information.

This is why we built HealthVault in the first place --- to enable really disruptive solutions that change the way healthcare happens. Of course there is a ton of heavy lifting still to do just getting data pipes hooked up - we are working on that every day. But the real magic will happen when companies like Pfizer start thinking about how to involve patients, not just providers, to solve problems like this.

Let's go already!