A Health 2.0 Overview, Through the Eyes of a New Diabetic

Written by Richard MacManus / November 26, 2007 7:36 PM /

Last Monday I found out from my doctor that I have Diabetes (probably Type 1; I need more tests to confirm), which basically means high blood sugar. It was quite a surprise, as I have no family history of diabetes and it is relatively uncommon to get Type 1 diabetes in your 30's. However, I soon discovered that diabetes affects more than 240 million people worldwide. So it is something a lot of people have. Indeed, chances are you know of someone with it or you may even have it yourself. Because it is so widespread, there is a lot of web data, social networking options and even web apps that cater to people with diabetes.

In this post, I'm somewhat selfishly going to review the diabetes sites and apps I found across the Web. But this post also serves, I hope, as an introduction to the more general topic of 'Health 2.0' - a.k.a. healthcare that uses the Internet. Over the weekend, Frank Gruber posted an excellent round-up of health 2.0 resources on the Web. Frank pointed out that the big sites, like Web MD and HealthLine, are the resources most used. But there are a lot of newer sites and apps that offer a more modern, Web 2.0 approach. He also noted that both Microsoft and Google are making moves in health 2.0. For example see our story earlier this year on Microsoft acquiring MedStory.

Defining Health 2.0

As with Web 2.0, there is a lot of debate about the meaning of the term 'health 2.0'. According to the Health 2.0 conference blog, their definition "is currently focusing on user-generated aspects of Web2.0 within health care but not directly interacting with the mainstream health care system." This means things like search, communities, and tools. As yet Health 2.0 user-generated content has not been connnected to the wider health care system - which, according to the Health 2.0 conference organizers, hasn't even adopted Web 1.0 yet!

Search

The first thing you might do if you discover you have diabetes, is do some Web searches on it. In my case my doctor and specialist had already explained the basics of the condition to me: it is fairly easily managed, via testing your blood a few times a day and injecting insulin maybe a couple of times a day (it varies by person). Also you must drastically cut your sugar intake in food and drink, and exercise moderately. There is no cure at this point for diabetes, so this routine must be followed indefinitely. So I was told all that, but still I was curious to find out everything I could... so, to the Web search engines I went!

A Google search is where I started; and at the top of the first page of results is the Wikipedia definition. This is a very thorough and long page, explaining what diabetes is and pointing to over 50 external references. A lot of people still complain about the Wikipedia as a source of reliable information, but as a starting point on diabetes it is exemplary.

My next port of call was a specialist health search engine. Frank mentioned Healia in his post, a health search engine that gives you filtering options. In my tests, it didn't really throw up much new info that I needed. WebMD had better info, but it wasn't presented very attractively.

Healia

Another 'vertical search' option for health is Kosmix, which has a kind of search-portal for many different verticals - one of which is diabetes. Now this is more like it! There are guides, images, Q&A, videos, "trusted sources", news, a forum, and more - all very nicely presented and easy to access. Even the ads were relevant to diabetes. There are a lot of areas to explore in this portal from Kosmix, making it the best search resource I found on the subject. But it will depend on what you're looking for - in my case, variety and good presentation are key factors to help me explore this new condition I have.

Kosmix Health

For more info on health search engines, see of course our network blog AltSearchEngines. Editor Charles Knight wrote a post in June reviewing health search engines (including a list of them) - his conclusion was that WebMD was best, but he also recommended revolutionhealth , CognitionSearch , Healthline , among others. TauMed is another one I've come across that I like. Finally, check out the Great Debate on health search engines on ASE.

Health 2.0 Blogs

Search is all very well for finding information, but what if you're after a more personal connection - or social groups.

The Health 2.0 Blog is a great starting point for healthcare on the Internet. It's a community blog that started in November. There's also an accompanying wiki and Facebook group.

The Diabetes Mine blog is a more personal day-to-day reflections blog about diabetes, by Amy Tenderich. The most recent post is very relevant to me - it's about being diagnosed with Type 1 in your mid-30's!

Another great site for diabetics is dLife, an attractive portal of info and forum options. It recently launched an aggregator for diabetes blogs, Blogabetes [via ScienceRoll].

dLife

There are many more blogs related to health and technology - check out the blogrolls of the above sites, or a list such as this one.

Social Networks

So what can social networks provide for diabetics? As to be expected, there are a number of Facebook groups about Diabetes - over 500 of them in fact! The biggest is 'Find a Cure for Juvenile Diabetes', which has 5,470 members. I joined up to a few of these groups, but I wanted something more.

I eventually found Tu Diabetes, an online community for people with diabetes that was created in March 2007 by Manny Hernandez using Ning. Manny describes it as a place "where the members help each other out, educate ourselves and share the steps we take every day to stay healthy while living with this very serious condition." One person described Tu Diabetes as "like 'MySpace' on insulin"! The site recently reached 1,400 members and it is a great example of a niche social network, as the below introductory video from Manny explains:

Diabetes Web Apps

SugarStats is an app that allows you to track, monitor and share your blood sugar levels "and other key statistics" online. It is based out of Hawaii and was founded by Marston Alfred, who was diagnosed with Type 1 Diabetes over 15 years ago. Normally diabetics have a paper journal in which they log the blood tests we are required to carry out 3-4 times a day. SugarStats has potentially very useful aggregation, graphing and trending tools, plus you can share your stats with relatives or other diabetics. SugarStats also has a mobile version - even Twitter integration!! For more reasons why online diabetes tracking is better than the paper-based version, see this post on the SugarStats blog.

SugarStats

There is a free and premium version from $8.29 per month (with extra features such as Food/Carb Tracking & Graphs, and SSL security). I've signed up to the free version to try it out, but I can see myself upgrading if it works well for me. Overall, SugarStats is an excellent use of web 2.0 to enhance healthcare treatment.

Health 2.0 Events

Getting back to health 2.0 in general, in recent years health 2.0 conferences and events have sprung up. There was a BarCamp-like event called HealthCamp at the end of last year (no sign of a follow-up event though). The Health 2.0 Conference was held on September 20th, 2007 in San Francisco. There's some good coverage of this event on the Diabetes Mine blog.

The next Health 2.0 conference is 3-4 March, 2008 in San Diego, and the topic is "Connecting Consumers & Providers". For more information see www.health2con.com.

Conclusion

This is a pretty indulgent post really - basically I needed to do research into diabetes management for my own purposes, and I have blogged what I discovered. But beyond that, I hope this post gives you a good idea of what is available on the Web when it comes to healthcare.

There are a lot of people much worse off than me, both in terms of diabetes (it's much tougher for children to cope with) and other health problems that people endure. Also it's still early stages in "health 2.0" - i.e. for some the Web may be of little use. But the Web is increasingly enhancing healthcare - certainly it is very useful with a condition such as diabetes, which is common worldwide and is something that can be managed on a daily basis.

I'm sure I've missed some health 2.0 and/or diabetes resources, so please add in the comments. Also if you want to discuss how the Web has helped you (or not) with a health issue you've experienced, then feel free to leave a comment.

Source: ReadWriteWeb
http://www.readwriteweb.com/archives/health_20_overview_diabetes_web.php

Google makes health service publicly available

By RACHEL METZ, AP Business Writer
Mon May 19, 10:24 PM ET

NEW YORK - Google's online filing cabinet for medical records opened to the public Monday, giving users instant electronic access to their health histories while reigniting privacy concerns.

Called Google Health, the service lets users link information from a handful of pharmacies and care providers, including Quest Diagnostics labs. Google plans to add more.

Similar offerings include Microsoft Corp.'s HealthVault and Revolution Health, which is backed by AOL co-founder Steve Case.

Google Health differentiates itself from the pack through its user interface and things like the public availability of its application program interface, or API, said Marissa Mayer, the Google executive overseeing the service.

Mary Adams, 45, a Cleveland Clinic patient who participated in the Google Health pilot, said that she was initially concerned about the privacy of her medical information.

Still, she felt safe enough to enroll and has been using the service for about six months, linking it with an online health management tool from the Cleveland Clinic and adding information on prescriptions and doctors to her online profile.

"I hate pieces of paper lying around my house, so I love the fact that i can log on with my normal Google login info and see everything at a glance," she said, adding that with its public availability she'll try to get her sister to use it.

The service, still a non-final "beta" version, does not include ads. But Mayer said Google doesn't plan to start placing them to support the site. A search box on Google Health pages leads to standard Google search results pages, where there are advertisements.

Besides importing records from providers, users can enhance their password-protected profiles with details such as allergies and medications, they can search for doctors and they can locate Web-based health-related tools.

Mountain View-based Google Inc. views its expansion into health records management as logical because its search engine already processes millions of requests from people trying to find information about injuries, illnesses and recommended treatments.

Before this public launch, Google stored medical records for a few thousand patient volunteers at the nonprofit Cleveland Clinic.

The health venture provides fodder for privacy watchdogs who believe Google already has too much about the interests and habits of its users in its logs of search requests and its vaults of e-mail archives.

Pam Dixon, executive director of the World Privacy Forum, said services like Google Health are troublesome because they aren't covered by the Health Insurance Portability and Accountability Act, or HIPAA.

Dixon's group issued a cautionary report on the topic in February on such third-party services.

Passed in 1996, HIPAA set strict standards for the security of medical records. Among other things, the law requires anyone seeking a patient's records by subpoena to notify the patient and give the patient an opportunity to fight the request.

By transferring records to an external service, patients could unwittingly make it easier for the government, a legal adversary or a marketing concern to obtain private information, Dixon said.

"We are in uncharted territory here. A privacy policy, I don't think, is enough to protect what needs to be protected in a doctor-patient record," Dixon said.

Mayer said, however, that users medical records "are generally speaking as safe with Google as they would be with a HIPAA-regulated entity."

During a webcast Monday, she said users' health information is stored at Google's "highest level of security" on computers that are more secure than those used for the company's search functions.

Mayer said in an interview with The Associated Press that Google will not aggregate users' health information across services so activity on the health service will not show up in search results.


Source: Yahoo News
On the Net:http://www.google.com/health

Getting grandpa wired

By Linda Marsa
Published: October 12 2007

Although Carol Roberts’s 77-year-old mother is active and mentally sharp, she suffers from a seizure disorder that requires close monitoring. Many people in her position would move in with family or into an assisted living facility. “But she didn’t want to lose her independence”, Roberts says.

Luckily, there is an alternative: the GrandCare System, which uses strategically placed sensors to record motion in key spots of the older woman’s home, such as the bathroom, kitchen, entryway and bedroom. Roberts can then check the information on her personal computer, keeping tabs on her mother around the clock.

“This way, she can live in her own space and I don’t worry,” she says.

The system, which costs $2,395 plus $49 a month, is just one of many innovative technologies developed in recent years to help a new generation of seniors. These range from remote-controlled lighting and floor sensors to more elaborate set-ups integrating webcams and videoconferencing systems with the internet. Scientists at universities and corporate research labs are meanwhile experimenting with the next wave of gadgets to track whether seniors are taking their medicine, to help with simple household tasks, such as cooking, and to detect mobility problems and medical emergencies.

The goal is to enable the elderly to live safely and independently at home for longer. For their adult children, the point is peace of mind.

The movement even has a name: “ageing in place”. And it is gathering momentum thanks to some important demographic trends. Over the next two decades the ranks of the “oldest old”, those aged 85 and up, are expected to balloon and, in 2011, the oldest members of the baby boom generation will turn 65. This advancing age wave will place an enormous burden on healthcare systems at a time when there are growing shortages of doctors, nurses and careworkers. Assisted living and skilled nursing facilities can’t be built fast enough to accommodate everyone and, even if they could, the costs would be astronomical.

“Corporations and government policy makers realise that as the boomers age, the costs won’t be sustainable if we continue to do business the way we’re doing it right now,” says Majd Alwan, director of the Center for Ageing Services Technologies in Washington, DC.

He and other observers think the solution is to create an entirely new paradigm of care, making it possible for seniors to remain in familiar surroundings until they die. “There is an intrinsic value to the home, where the individual has a sense of accomplishment and a level of comfort that they will never replicate by moving,” says Peter Bell, executive director of the US’s National Ageing in Place Council.

New technology is paving the way and we’ve come a long way from the electronic pendants with panic buttons the elderly can press in case of an emergency. Home automation, from specialist companies such as UK-based ABB, is one area of growth. “To date, the technology has mainly been associated with high-end audio-visual systems but, for the elderly or those with disabilities, smart controls offer massive benefits,” says ABB’s Gareth Rowlands. Tasks such as running bath water to the right temperature can be controlled via voice memos or remote “clickers” and dangerous scenarios, such as water over-flowing from a bath or sink, can be prevented with alarms.

There are also several monitoring and videoconferencing systems now on the market, including not only GrandCare but also AttentiveCare, AT&T’s Remote Monitor, Quiet Care and Home Guardian. Costs are reasonable, ranging from about $200 for a no-frills sensor network to about $2,000 for more complex systems. Because these products have come on the market within the past two years, their use isn’t widespread. “But they should become more popular, especially as the systems become more integrated,” Alwan says.

Deirdre and Steve Downham are early adopters, having installed an AtteniveCare system in the home of her 87-year-old mother, Olga Zaffos. A webcam hooked up to a PC with a flat panel television monitor in Zaffos’s living room transmits images through a broadband internet connection to a dedicated computer set up in her daughter and son-in-law’s nearby home. They can tell when she’s accidentally left the front door open and, whenever she wants to chat, she simply sits down in front of the camera. The computer is set up to flash reminders about taking medication and to receive messages, including family photos, the arrival of which is signalled by a distinctive ring recognisable even to people suffering from severe dementia.

“I check on her several times a day just to make sure she’s okay,” Steve Downham says.

The system, which costs $200 to set up, plus $600-$800 for off-the-shelf equipment and $60 for the monthly subscription, was devised by three brothers after their mother, who lived hundreds of miles away, was diagnosed with Alzheimer’s disease. The family stepped up in-home care as her condition deteriorated but the monitoring and videoconferencing system allowed her to continue living on the family farm in rural Arkansas until she died of cancer in 2003 at age 86.

“I had coffee with her every morning and got her day started,” says Ken Nixon, one of the brothers and now chief executive of the Oklahoma City-based Caregiver Technologies, which makes AttentiveCare. “It made such a difference in my life and in the life of my mom because it kept her engaged and made her feel valuable.”

Remote Monitor ($199 for a starter kit, plus $9.95 a month) also uses webcams to watch over various rooms as well as motion sensors that register when certain doors open. It can even turn house lights on and off and check if someone left a coffee pot on the stove.

Quiet Care ($199 for a basic package, plus $99.95 a month for monitoring) uses five to 10 sensors positioned throughout the home – near the bedroom door, bathroom, refrigerator door or family room – to track movement. The results are input into a computer programme that maps behaviour patterns. If there is any change in daily habits, such as when a person gets out of bed or how much time he or she spends in the kitchen or bathroom, the system will send out an alarm.

And Home Guardian, developed at the University of Virginia and set to be released next year, works in a similar way, analysing footstep patterns to detect problems. Inside a book-sized box, which sits on the floor, is a sensor that measures tiny vibrations, a microprocessor that learns a person’s normal walking habits and a software programme that can spot changes. If a person falls, or begins limping or shuffling, both possible symptoms of Parkinson’s disease or arthritis, the device fires off an electronic message to a PC, which is then transmitted to a monitoring service or the caregiver.

The systems aren’t foolproof: experts worry that they can provide a false sense of security. There are privacy concerns too. “Some seniors have used a hanky to cover the camera,” Alwan says.

Still, he and others think they are better than the alternatives. “Privacy is relative and most feel it’s an acceptable price to pay to avoid being institutionalised.”

Researchers are now hard at work on even more high-tech tools to help the elderly at home. From the Aware House laboratory at the Georgia Institute of Technology, there is the Digital Family Portrait, a monitoring system that keeps family members informed about their elderly relative’s activities, health status and possible problems by creating a “visualisation” of the person’s day as they move through the house. Dude’s Magic Box is meanwhile designed to help seniors keep in contact with their grandchildren. Youngsters put an item, such as a pet hamster, in the box, where a photo is taken. Dude, a cartoon character, pops up on the screen and asks if he should send the picture, then transmits the image to a computer screen at grandma or grandpa’s home. “Both of these devices are designed to make the senior who is living alone feel less isolated and reassure their children that they’re okay,” says Elizabeth D. Mynatt, a computer scientist at Georgia Tech.

Intel’s Health Research and Innovation Group is also working on new devices, such as “presence lamps”, which are set up in the homes of seniors and caregivers and light up when either person is home. “It comforts people to know that someone is around if they need help,” says lab director Eric Dishman. Another gadget, dubbed “caller ID on steroids”, is a computer plugged into a telephone, which holds information about the key people in an elderly person’s social network; when they call, a name pops up on-screen, along with a photo and a word or two to say who they are, helping jog the memories of those with dementia. “This gives people enough confidence to answer the phone and engage in a conversation,” Dishman says.

While all the new technologies are still in their infancy, they are important first steps toward coping effectively with an aging population. “The overall thrust is to increase the quality of life and of care that seniors receive in their home and ease the burdens on their families and on society in general,” Alwan says.

This is an edited version of an article that first appeared in the Los Angeles Times

Source: Financial Times
http://www.ft.com/cms/s/0/1845a4cc-778b-11dc-9de8-0000779fd2ac.html

Microsoft Acquires Hospital IT Software From GCS

By Paul McDougall , InformationWeek
October 29, 2007

GCS offers several health-care IT products that run on Windows, including software that automates patient record keeping, billing, regulatory compliance, and clinical workflows.

Continuing its push into systems and software that promise to modernize the provisioning of health care, Microsoft (NSDQ: MSFT) said Monday that it has acquired a number of assets from Global Care Solutions -- a Bangkok-based developer of computer software used in hospitals.

Microsoft said it would take on an unspecified number of GCS employees as a result of the deal. Financial terms were not disclosed.

GCS offers several health-care IT products that run in the Microsoft Windows environment, including software that automates patient record keeping, billing, regulatory compliance, and clinical workflows. The software is designed to run atop Windows Server 2003 and SQL Server 2005.

GCS developed its software in cooperation with Bangkok's Bumrungrad hospital, which treats more than 1.2 million patients per year. In a statement, Bumrungrad CEO Mack Banner said the use of GCS technology has helped the hospital reduce average patient waiting times to just 17 minutes.

"The GCS software is a key to our service delivery, medical quality, and financial performance," said Banner.

Microsoft sees as an opportunity the fact that a growing number of health-care organizations around the world are turning to IT to reduce costs and comply with increasingly complex government regulations.

Earlier this year, the company acquired Medstory Inc. -- a developer of search engines that provide health information over the Web -- with an eye to building out its recently formed Health Solutions Group. Last year, Microsoft bought out clinical software maker Assyxxi.

Not only does health care represent a lucrative market for Microsoft, it fits with chairman Bill Gates' growing interest in tackling issues beyond computer technology. The Bill & Melinda Gates Foundation has to date contributed millions of dollars to the fights against AIDs, malaria and other diseases.

Doctors click to networking

By Christopher Bowe in New York
Published: October 14 2007,

US doctors may not have time to be out of the office with colleagues playing golf anymore, but they might be found clicking away online (on a social networking site) instead.

And the demise of doctors’ weekday golf availability and their time on Sermo.com, the US social networking site for physicians, are very much related.

As the structure of medicine changes and more treatment is done in physician’s offices, allowing patients to avoid hospital stays – so-called outpatient treatment – doctors can spend more time there, and much less time than before interacting with peers.

Dr Daniel Palestrant, founder and chief executive of Sermo, says doctors’ increasing sense of isolation was one of the most unexpected findings after launching his social networking site a year ago.

“Golf is a thing of the past; even doctors’ lounges are things of the past. What was shocking to me was these doctors described themselves as ‘lonely’.”

But that is changing as doctors are now linking themselves and their practice of medicine in new ways with technology more often associated with teenagers than surgeons.

This shift is highlighted in the current collective discussion among Sermo’s online community of more than 30,000 physician members on what to call themselves. So far, they prefer “Sermoans”.

The Sermoans are medicine in the MySpace age. And it’s not just the younger set fresh from medical school. The attraction of belonging and the ability to publish or broadcast personal professional pursuits to a distinct and interactive online social community and receive feedback is grabbing the older, busiest doctors the most.

Dr Palestrant says he expected Sermo’s users to be dominated by younger doctors like himself at age 33. But instead, Sermo member doctors 45 years of age and older outnumber by three-to-one those under 45.

Sermo, which verifies each member’s credentials, is free to join for doctors, whose profiles can range from minimal biographical information to photos and personal details. Its business model rests on two fundamentals: no advertising and open, unedited interactions between members.

For instance, a doctor posts a medical case, and others help to work the problem. Other discussions can expose conflicts of interest in doctors, seek emotional support, or ask for guidance on hiring and firing office employees. “The wisdom of crowds dictates these things. It’s startling how effective this happens,” Dr Palestrant says.

Nevertheless, it was the prohibition of marketing and branding that at first left the pharmaceutical companies wondering how they could ever work on such a new frontier. Dr Palestrant estimates that nine months ago about 90 per cent of drugmakers he approached either thought Sermo was a joke, or looked for reasons why it would not work.

Pfizer was interested nine months ago, as the company struggling and in transition with Jeff Kindler, its new chief executive, sought fresh ideas.

Pfizer sees the technology as potentially helpful, efficient and a dynamic way of letting doctors obtain information on its drugs, learning more about its own drugs, improving relations with the medical community, and getting new ideas and feedback on clinical trials.

Dr Michael Berelowitz, global medical chief at Pfizer, said: “The most interesting thing for us about Sermo is in many ways it represents a future direction for physician discourse.

“The physicians at Pfizer would like to become part of the social fabric and learn to work with the physicians’ social network in ways they feel comfortable working with us.

“We in turn learn from them and learn how best our medicines may be used, and how best that knowledge of our medicines may be generated.”

Timing is always important, and Pfizer’s interest coincides with the company’s rigorous self-examination and search for change to reignite growth and prepare for a changing drug market.

Similarly, physicians have been seen as fragmented, disorganised and resistant to new technology, thus making them a formidable obstacle to healthcare cost reform, particularly in the US. Uniting them with a technology platform could bring many more important changes in the future.

Source: Financial Times
http://www.ft.com/cms/s/0/5ea58fd4-7a7b-11dc-9bee-0000779fd2ac.html

Microsoft launches HealthVault - platform for the people

By Diana Manos, Senior Editor

10/04/07, Healthcare IT News

WASHNGTON – Microsoft today launched a new technology platform it bills as the answer to how consumers can best get a handle on their healthcare information – and share it.

Called Microsoft HealthVault, the technology not only has the support of healthcare providers, patient activists and device manufacturers, it also passes muster with one of the industry’s toughest privacy rights advocate Deborah Peel, MD, founder of the Patient Privacy Rights Foundation, one of 50 organizations that comprise the Coalition for Patient Privacy.

The company also unveiled a new search engine called Microsoft HealthVault Search.

The promise of HealthVault is that it will bring the health and technology industries together to create new applications, services and connected devices, said Peter Neupert, corporate vice president of Microsoft’s Health Solutions Group. People will be empowered to monitor anything from weight loss to diabetes, he said.

“People are concerned to find themselves at the center of the healthcare ecosystem today,” Neupert said, because they must navigate a complex web of disconnected interactions between providers, hospitals, insurance companies and even government agencies. Neupert added. “Our focus is simple: to empower people to lead healthy lives.”

He said the launch of HealthVault makes it possible for people to collect their private health information on their terms. Also, companies across the healthcare industry will be able to develop compatible tools and services built on the HealthVault platform.

Addressing concerns over privacy and security was critical to development and launch of HealthVault, Microsoft executives said. Peel said Microsoft is leading the way for the rest of the industry.

“Their model is that consumers truly should control the information and that’s the direction they want to take as a company,” said Peel. “We really think that because they are the industry leader that the rest of industry will have to follow or be left behind.”

“Microsoft has agreed to adhere to all of the privacy principles that the coalition developed in 2007, ” Peel said. “Not only adhere to them in terms of contracts but to be audited on these principles. We think they’re setting a new amazingly high bar and frankly, we think what they’re doing is really the best practice that the entire industry needs to follow.”

A Who’s Who of healthcare IT industry leaders seemed to have joined Microsoft for the hoopla in the nation’s capital. Microsoft announced 40 partners for HealthVault. Among them are the American Heart Association, Johnson & Johnson, Polar, maker of heart rate monitors, MedStar Health, a healthcare system that serves the Baltimore and Washington region, and Chicago-based Allscripts, developer of electronic health records.

According to Allscripts CEO Glen Tullman, Allscripts will be first to connect with HealthVault with its eRx Now, the Web-based electronic prescribing solution offered at no cost to physicians across the country as part of the National ePrescribing Patient Initiative, or NEPSI. HealthVault lets patients of eRx NOW physician users receive an electronic copy of their medication history, conditions, and allergies, which they can then transfer to their own personal health record or other HealthVault-enabled consumer health application.

Frank Opelka, MD, CEO of LSU Healthcare Network in New Orleans, said HealthVault was one more reason why doctors “should run, not walk, to embrace electronic prescribing through NEPSI and, on a broader scale, electronic health records.”

“What we are really talking about is connecting healthcare,” said Tullman. “It’s not enough to have good software, it’s got to be connected.”

Microsoft Launches 'HealthVault' Records-Storage Site

10.04.07
http://www.pcmag.com/article2/0,1759,2191920,00.asp

At a gathering of healthcare providers in Washington D.C on Thursday morning, Microsoft is expected to launch HealthVault, an online repository where users can store health-related information.

As the name suggests, the HealthVault site is designed to be an online, encrypted vault, where U.S. users can store and manage their health records without paying a fee. The site will also serve as a repository for health-related articles and other information, Microsoft said.

HealthVault will also allow users to upload data from a small number of HealthVault-compatible devices, and allow users to send, receive and store their own medical records and information from doctors and healthcare providers. The information that could be stored in the vault includes data from fitness-related and health activities, according to Microsoft. Examples include aerobic sessions, measurements such as blood glucose and blood pressure, discharge summaries from hospitalizations, lab results, medications, and health history.

Microsoft's effort also won an endorsement from the Patient Privacy Rights Foundation, which praised Microsoft's privacy policy, which allows users to control which information they provide to other services through an opt-in program. In its privacy page, Microsoft says "We do not use your health information for commercial purposes unless we ask and you clearly tell us we may."

The site will operate in conjunction with the improvements to Windows Live Search, especially the heath-specific search engine that Microsoft debuted last week. The HealthVault site went live briefly on Wednesday, before Microsoft restricted the site to the health-related search engine.

The question, however, is what legal liability Microsoft will end up accepting as the operator of the HealthVault site. Furthermore, it is unclear what role the site will play inside the chain of agencies covered by the Health Insurance Portability and Accountability Act (HIPAA), which was enacted in 1996 and governs the transmission of confidential healthcare information. HIPAA covers "health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with transactions for which the Secretary of HHS has adopted standards under HIPAA," according to the act. It also covers "business associates" in certain cases, which includes "specified written safeguards" as data passes from one entity to another.

Reached before the official launch, a Microsoft spokeswoman said that the HealthVault site was covered by "HIPAA considerations," but she did not know the extent.

Microsoft: security is a top concern

Users can be granted access to other records, and manage them, as in the case of a sick mother's records managed by her son. Users have different levels of access privileges, with the highest being "custodial" access, with free privileges to add, modify or delete data, as well as grant or deny others access. The second tier is a "view-and-modify" access, and there is a time-limited, view-only access tier as well.

However, the site has made extra efforts to boost security. In some cases, users will be required to increase the complexity of their password until Microsoft's algorithms classify it as a "strong" password, based upon a PC Magazine examination of the site. (The definition of "strong"appears to include a password with a minimum number of characters, numbers, and some capitalization or special characters.)

Searches for medical information aren't identified by person or username, although logs of the searches are saved for 90 days, the Microsoft spokeswoman said. In addition, accesses and changes to health records are logged and viewable to the user.

Finally, Microsoft said the company isolated traffic onto a virtually separate network and located its servers in physically separate, locked cages.

"All data that moves among our systems are encrypted, including all traffic to and from HealthVault, its users and its partners," Microsoft said in a statement. "Access to HealthVault data by Microsoft employees is tightly controlled and extremely limited to a small group of personnel necessary to perform essential operations. All of our back up data is encrypted, and every stage of its transportation is logged. We also log every time records are created, changed, or read, leaving a clear audit trail."

However, the site's partners and their programs appear to only be answerable to Microsoft, who will serve as arbiter in any disputes. "In order to make a Program available through the Service, the Program provider must commit to protecting the privacy of your health data," the privacy policy states. "Microsoft can revoke a Program provider's access to the Service if a Program does not meet its privacy commitments to Microsoft. We encourage you to contact us if you believe a Program is not protecting the privacy or security of your health data.

Records can be instantly discarded, but Microsoft will hold them in a private cache for 90 days as a foil against malicious deletion, the site's privacy policy says.

Much of the site's expected health-related information was absent before the official launch, although users could log in and conceivably begin uploading data. Microsoft has made available special drivers so that users of certain blood pressure monitors can upload the information directly to the site. How that information will be maintained – as discrete pieces of information or data that can be crosslinked to ongoing exercise, weight, and blood pressure logs, for example – was not specified.

However, the site's partners are expected to shoulder some of the burden, the Microsoft spokeswoman said. For example, one partner application will provide doctors with a virtual fax number that will take the faxed document and automatically add it to the HealthVault account, she said.

Microsoft said approximately forty applications and devices are either available or planned for the HealthVault platform, with contributions from ActiveHealth Management, Allscripts, American Diabetes Association, American Heart Association and American Stroke Association, American Lung Association, Eclipsys Corporation, Home Diagnostics, Johnson & Johnson's LifeScan, Microlife USA, Nexcura, US Wellness, and WorldDoc, among others.