Mobihealthnews recently caught up with HealthVault's Senior Global Strategist George Scriban to discuss how HealthVault fits into the wireless health discussion. Can mobile application developers synch their apps directly to HealthVault? Will Windows Mobile create apps that integrate to HealthVault? How does a medical device maker enable its users to send information to HealthVault? Scriban answered these questions and more in a wide-ranging interview that also covered whether HealthVault could be offered as a bare bones EHR for physicians, how HealthVault drives revenue within the health solutions group at Microsoft and hints at the global health market as the key opportunity for wireless in healthcare.
Mobihealthnews: At various events, many times I've heard Microsoft executives stress that HealthVault is a "platform" and not a personal health record (PHR). Can you provide a brief overview of HealthVault to start as a reference point?
Scriban: The problem that HealthVault is designed to address is one that we have heard from consumers for a long, long time: The information that they need to manage their healthcare and their families' healthcare is fragmented. There was no one place to connect it all. HealthVault addresses that issue specifically by being able to connect to clinical systems, devices and application so that you have a single place to collect, store and share your personal health information. It's also a platform for action around your healthcare. Since it is a platform it has these interfaces that allow third parties like the Mayo Clinic, American Heart Association, American Cancer Society and a number of other third party solutions providers to deliver services that really allow you to act on your specific health information. [Mayo Clinic] Health Manager gives you guidance, for example, based on your specific condition like your blood pressure instead of just general guidance information that might include an average range. That's where HealthVault plays as a platform. It's a platform for applications and it's a platform where consumers can store all their health information.
I noted you said HealthVault is a consumer play -- how does Microsoft reach consumers? I know HealthVault's partner AllOne Mobile works through payers and another PHR provider, Dossia, works to offer its PHR through employers. How does Microsoft reach out to potential HealthVault users? Employers? Payers? Direct-to-consumer?
One of the things that Microsoft has always been really good at is allowing the people with the domain expertise to use the platform to make those kinds of vertical market or domain expertise based business decisions. For example, someone like Mayo Clinic with a mandate like MayoClinic.com to go after consumers directly or to deliver on their care mission to deliver to consumers health information directly, they would use HealthVault to develop applications for personal healthcare guidance and go directly after the consumer. A company like AllOne's model is to have their services subsidized by payers. They can still use exactly the same platform to reach that particular market. From our perspective it's not necessarily about Microsoft going after employers or employees at large corporations and getting them to try to use HealthVault, but it's more about determining who is delivering services already in the employee and health benefits space and then determining how they could benefit from re-architecting their applications, making their applications compatible or making new applications that run on top of something like HealthVault.
Another partner of ours, Vital Data Technologies, is an ideal example. They have a service generally sold through the employer market that enables you to prepare for emergencies. Microsoft employees can get a subsidized version of this service that is HealthVault compatible. This is one way for HealthVault to work together with a company going after a specific market without vertical-izing or isolating ourselves.
Clearly there is a focus then on the consumer-side. As I said, HealthVault is often referred to as a Personal Health Record (PHR), however, is there any inclination to offer HealthVault to doctors, too? Perhaps HealthVault could be offered to doctors who cannot afford an electronic health record (EHR). This question comes from someone via Twitter: Is there any strategy to roll out a bare-bones EHR, provider-side product based on HealthVault?
We get that question a lot in the United States because of the dismal numbers around EMR adoption particularly in smaller practices. We are really, really clear about who HealthVault is for -- who it is defined for and who we have in mind as our user: This is the consumer. We don't want to muddy that picture by saying that it is also a tool for physicians, except in the case that it is a tool that consumers can use to convey information to physicians. That said, we do work with partners like Covisint and the American Medical Association and the two of them have collaborated to offer a hosted, light-weight EMR to AMA members that is, incidentally, HealthVault compatible. There are a number of ways we think that HealthVault can play a role both in creating a certain amount of demand on the patient/consumer side for digital medicine and at the same time it can be a more effective tool for physicians. Physicians can now see that their follow-up care instructions are transmitted directly to the user via HealthVault or they can get more accurate information from their patient online before the patient even sets foot in their office.
Some of that information that physicians might be looking at through HealthVault has been transmitted from patients' medical peripheral devices. Can you highlight some of the ways HealthVault is working with medical device makers to enable patients to port health data from these devices into HealthVault? I noticed that HealthVault only has a few wireless-enabled devices in their directory like those devices offered by MedApps.
It all stems from the idea that whether you are well or ill you really do not spend the majority of your time in your physician's office. For the most part, 90 percent of your day is spent managing your condition, health or wellness by yourself. Devices can be an important part of that whether it's a pedometer keeping track of the number of steps you take, or a blood pressure cuff that helps you manage your hypertension, or even a weight scale -- something a lot of us use even if we don't think of ourselves as managing a condition. Right now you are correct in that a lot of these devices are not IP addressable wirelessly connected to the cloud. As a consequence they don't have a direct relationship with HealthVault.
[However], understanding the home health space, we have built-in the ability to get the data off of these devices and into your HealthVault record so that the physician can use that data, for example. There is a trial we are running with Cleveland Clinic where they are issuing patients managing hypertension and other heart disease a set of devices so that they can manage and monitor their condition at home. The data is being uploaded to HealthVault through HealthVault Connection Center, which is the software that sits on your Windows Vista or Windows 7 PC. The data itself is also being transmitted -- with the patient's permission and full consent -- to the clinicians at Cleveland Clinic and they can case manage individual patients. They can say that this patient is normal, he is not gaining weight so we don't have to worry about him right now or they might see some rapid weight gain and high blood pressures with this patient. So they then can focus their resources on the patient who is at risk before he shows up in acute care some place. There is definitely a role that HealthVault plays in connecting two previously very separate domains of healthcare management.
Wireless is an extremely interesting and obviously developing angle to all this: What happens when you can almost do this telemetry in real-time? The problem is that a lot of the companies playing in the wireless health space have previously thought of themselves as wireless companies. A lot of the wireless companies out there don't have a ton of domain expertise in the healthcare device space. As those two industries converge and as standards emerge for sensors to be connected to wireless hubs, either personal ones or ones in the home, as they solution architectures sort themselves out, HealthVault will of course be there. You still need a place to sort out all this data to make it useful, available in applications or to transmit it to care givers instead of locking yourself into a vertical, siloed solution.
Right, and in the mean time, while the sensor standards are being worked out, a lot of the action in wireless health today is in mobile applications. A quick search of the iPhone AppStore for HealthVault comes back with three applications developed by AllOne Mobile that connect to HealthVault and one app from Ringful that promises to connect to HealthVault soon. Does HealthVault work with developers to encourage that kind of connectivity to the HealthVault platform?
The funny thing about mobile platforms is that the architecture can be such that really the app on the device, on the smartphone, is a conduit to a separate Web app or service, so the developer's app is usually talking to their own service. As long as they do that the service as a Web application can easily communicate to HealthVault via XML over HTTP, which is the way we communicate with any other HealthVault-enabled service. Client-side, whether it is on a PC or on a mobile device, direct connectivity to the platform is a little trickier in that the security model has to be tightened up a little bit. We are used to communicating via XML over HTTP and so there are very few client-side sets of bits like HealthVault Connection Center that actually talk directly to the platform.
We are still working on how we incorporate native mobile applications, if you will, to speak directly from an individual phone straight to the cloud as opposed to through a service and then to the cloud. At the same time, it really depends on the business model of the application provider. If a company's business involves an ongoing service that is constantly connected to a client that is on the phone, say, one that synchronizes a Web version of their service with the phone version of their service, we don't want to have to step in the middle and say that the phone has to talk directly to HealthVault. I think we will be open and very permissive whether it is direct client-side development or client-through-Web-app. We worked closely with AllOne Mobile with their integration of their service with HealthVault and the wrinkle there is that because it all terminates in a Web service on the back end, it was much more like traditional HealthVault Web apps.
So just to follow-up with a question I received after I sent out a request for questions for this interview on Twitter -- Does HealthVault have a roadmap for integrating with the various mobile platforms out there, including Windows Mobile, iPhone, BlackBerry, Palm Pre, Android and so on? Given your previous explanation we may have covered this.
Yes, I think that's right -- for mobile the platform itself isn't really the point of integration for our service. This is how companies like AllOne Mobile, which can support so many different types of devices on the client end, but then have just one point of integration with HealthVault. It's not the device talking directly to us, it's the device talking to the AllOne service and then AllOne's service talking to HealthVault. We recognize that we will not make an impact on better engaging consumers with their health information unless we are everywhere, so we know we have to be platform agnostic in terms of who can communicate with HealthVault. We want every possible device to communicate to HealthVault, but in terms of a tight roadmap like when will there be an iPhone developer's kit or an extension to our SDK? I couldn't say. Obviously Windows Mobile is pretty close to home because we can walk down to the other side of the street and talk to those guys.
Yes, that was my next question -- do you work closely with the Windows Mobile team and is a HealthVault app something we can expect for the Windows Mobile application store?
I wouldn't say we work any more closely with them than we do anyone else. There are definitely conversations, though. Dealing with other parts of other Microsoft is sometimes like dealing with other companies altogether. [Windows Mobile] has its own goals and obviously has a much broader perspective on the market. They are not a wireless health play. It's a little bit like dealing with any other mobile OS or platform vendor. We are speaking with them about how they can support applications developers who want to create interesting and valuable healthcare applications on top of their platform. For [HealthVault] though, our interest is in supporting that effort regardless which mobile platform that developer is working on.
How does a device maker, say a wireless telemonitor device company like MedApps, become a partner with HealthVault and ensure that their device can send data into HealthVault?
It's very straightforward. Our [software development kit] and all of the other information required to become a member is wide open and available on the HealthVault developer center on MSDN. Anyone can visit that site to learn how they can get started creating a HealthVault enabled solution. For device manufacturers this can go a couple of different directions. If you are trying to connect your device to HealthVault via PC, there is a device driver kit and we have a certification process that makes sure device drivers are up to our quality standards. That process is really similar to the process any device manufacturer might go through whether they are making a digital camera that connects to Windows. We have tried to emulate or duplicate that process for health devices. For companies with bigger problems and bigger plans we have a full developer support program where you get partnered up with a program manager who would provide assistance during development.
That costs money to be a part of that program?
It depends on the scope of the partnership. If you are OK with asynchronous email support, that's not going to cost you anything. If you need to escalate it, then there might be a cost to the support call. It could be a longterm strategic relationship between the two partners where the company might want to have its entire suite of devices all HealthVault certified. That moves more into a business development relationship. Those pathways open up pretty quickly. We are a nimble organization within Microsoft.
You mentioned some costs for certain support, that relates to another question I received from Twitter: Revenue. If HealthVault is truly to become an "OS for Healthcare" then when and how will it generate revenue?
One thing to understand about the health solutions group at Microsoft, is that we are broader than just HealthVault. Most of our business and a huge percentage of our activities are around the products under the Amalga brand name. These are information solutions for large healthcare enterprises, ranging from life sciences, providers and healthcare systems. HealthVault is definitely part of the story to our Amalga customers. HealthVault in the United States is free, will always be free and that's for adoption purposes, but it definitely opens up doors when we talk to Mayo Clinic, Johns Hopkins or New York Presbyterian Hospital or any of the other leading edge care providers who are also Amalga customers.
There are, of course, other ways we monetize HealthVault -- we license it internationally. In Canada we have licensed the HealthVault technology to Telus, which is a major wireless player in Canada but they also run most of the healthcare transactions in Canada. They are going to deploy a service called Health Space that will be powered by HealthVault. They pay a license fee to us for the HealthVault technology so we monetize directly internationally. Also, for other Microsoft properties like MSN Health and Fitness, HealthVault allows them to deploy applications like Food Tracker or MSN Wellness Center that they monetize their own way through advertising. Since they can build HealthVault compatible applications we gave them a platform to build on so consumers could have high value applications that allow them to manage their health and wellness.
You mentioned before two things and I wonder if they are at all contradictory. You said to whatever extent possible HealthVault will be as agnostic in terms of access platforms, but at the same time in order to port the data from some of these devices a user needs a Windows Vista or Windows 7 PC for HealthVault Connection Center. Is that going to change at some point or is it always going to be Windows PC only?
No, and just to be clear the only thing that is PC only is the HealthVault Connection Center and the drivers. We [at HealthVault and Microsoft] have no plans, for example, to build a HealthVault Connection Center equivalent for any other platform like a Linux desktop or a Mac OS X. That said, should somebody want to develop that we certainly wouldn't stand in the way of it. Currently, though if you have data from a blood pressure cuff that you want to connect to HealthVault, you have to connect it to a PC and upload the data. If there is a demand among Mac users for some way to get data off their devices and into HealthVault then, for sure, we'll support someone who wants to create that. It's the same way we support Safari on Windows. We are not interested in cutting people off from a tool like HealthVault.
OK, any closing thoughts on the wireless angle for HealthVault?
Well, it is kind of interesting because this is not the first time I have had a discussion about devices. When it comes right down to it, including the wireless play in the consumer health space, whether you are talking about the healthcare home or remote monitoring of patients, what's interesting to me is that it's so unsettled whether or not the integration points will be through a Qualcomm scenario where they run and operate a network on behalf of a service and are also interested in supplying the chipsets to device manufacturers or if it's going to be more of an AppStore scenario where people will develop apps for all the various platforms and the applications will speak directly to the cloud. The point is, ultimately people will want to make use of this data and they don't want it to go someplace else where it's isolated. That's where HealthVault plays. Regardless of how the wireless device space in healthcare shakes out, HealthVault will always be open as an integration point to pull all this data together so users have a unified personal health database.
Thanks for your time today, George. Be sure to keep us up to date on any wireless initiatives going on at HealthVault.
Absolutely, particularly as we expand on our international foot print, because that's where wireless becomes a much more important gateway to health information for a lot of people.
