Mayo Clinic and Microsoft are today launching a combined product called the Mayo Clinic Health Manager (and they’ll be showing it Thursday 23rd at the Health 2.0 Meets Ix conference). What this product does is essentially combine the care guidelines and rules that Mayo has developed over the years with an individual’s data in their HealthVault account to trigger recommendations about care.
This might be a series of simple recommendations that someone of a particular age and race should get a particular diagnostic test (e.g. mammograms for women over 50). But the program can go suck up data from Microsoft Healthvault, so that includes device data that, say, a diabetic might have in that system. Which means that much more complicated guidelines and prompts can be delivered to patients based on exactly what’s known about their current status. The first ones include pediatric wellness (immunizations to you!), pregnancy and asthma, with diabetes coming soon.
So at the moment it’s a management tool for patients, with the stamp of America’s best known health care brand on it. However, it also allows the patient to prepare for a physician visit.
It doesn’t take too much of an imaginative stretch to expect that soon, instead of preparing for an office visit with your local doctor, Mayo will be offering online and offline services for which this might become a front end. So if you can have Mayo guidelines and best practices anywhere using this tool, why wouldn’t you want Mayo services too? OK, so Mayo and Microsoft aren’t saying this now and maybe they aren’t thinking it. But if I’m a local health services provider knowing that I provide services that aren’t up to Mayo’s quality at probably more than Mayo’s prices, this would start to concentrate my mind a little.
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Yes – this is a big story, but I think the idea that this will somehow supplant face to face interaction with the person’s physician is missing a bigger point. The true power here is in the interaction between the patient and the physician when the patient realizes that they are not being given the “standard” of care. The ensuing interaction is an incredibly important piece of dialogue missing from today’s interactions.
I think Matthew highlights an important issue in that we are not very far from Mayo/Microsoft or HelloHealth or American Well/Google disrupting face-to-face physician office visits in a significant way. I imagine that most of us that read this blog embrace the concept of online visits, as do many patients, so it is not hard to imagine that for a patient who does not feel a connection with a personal physician, they may eagerly seek care online from a trusted source who will deliever the care in a convenient way that the patient wants. I have heard it discussed that online care could be a way for hospitals and other physician employers to deal with the coming primary care shortage. Or a physician group may not be busy enough to justify hiring another FTE for their office, perhaps they develop a relationship with such a site where they make referrals to a site which will provide online care for their patients.
One other thought one how to leverage this technology for the improvement of patient access to care would be for practices, or even call groups, to sign up with American Well, or similar site, and that group could provide online care to their own patients (and others) on nights and weekends. It would be moonlighting while taking call.
I agree with Matthew and David: this is a big deal. In the near term, it is a big deal in the PHR market space. In the longer term, it might be a big deal in the (nascent but exploding) market for remote/online health care.
I don’t see many providers eager to recommend this to their patients, for precisely the reasons Matthew mentions.
Individuals on their own are also not going to flock to this in large numbers anytime soon. Even with the advantages, HealthVault and particularly the Connection Center are still too cumbersome and confusing during registration and set up. I’ve spent several hours on it and only feel like I have a tenuous grasp of how to use it. I still can’t get my USB-equipped pedometer to upload data properly, and haven’t been able to find real customer support to help. If I’m struggling with one relatively simple device for data uploading, I don’t have a good feeling about how others are faring with multiple chronic conditions.
On the other hand, once someone has navigated HV, the Mayo PHR is well-done and easy to set up and use in comparison. But you have to get to that far first, and until HV improves the set-up process (or really, processes) participation is going to be very low among individuals doing this on their own.
It may seem like heresy to some, but I think the catalyst here might be health plans. I think that any small or mid-sized health plan has to take this HV/Mayo combo seriously as an option for its members: it’s free, it allows data aggregation and data portability at no extra cost to the plan, it has (or will have) sophisticated decision support logic, and it has one of the best brands in medicine.
Health plans have a lot of incentive to get their members to use a PHR with real decision support and data aggregation. They also have some money to try to direct the traffic, but there are a couple of major issues that must be addressed before health plans can use/promote this in place of their current tethered PHRs:
1) Co-branding. I’m guessing Mayo will be reluctant to co-brand or customize.
2) Since HV is set up on a direct-to-consumer model, it’s not clear how customization would work. Right now, everyone on HV has access to the exact same version of Mayo PHR. Is there any room in this business model for a particular health plan that wants to spring for its members to have an enhanced version of the Mayo PHR (or any other)?
3) Even with a push from the health plan, the hurdles in signing up individually for HealthVault and the Connection Center are significant. I know that HV has to keep it all voluntary, so that it is all opt-in rather than opt-out. But as anyone who has read Nudge (or is a good student of human psychology) knows, opt-in gets you a fraction of the participation rate as opt-out. So, what innovative things can be done to smooth the path to getting an individual HV account set up?
Combining Healthcare records is a daunting task. The current stimulus plan will accelerate electronic Health Records. But if we do not aim for a single EHR now, then trying to combine them at the other end later will be even more daunting. Just like it is easier to start a new medical office with EHR rather than converting a paper chart office into a paperless one.
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Dear Matthew: I think this is a big story. It combines data liquidity (the ability of health information to be transferred across networks, at the will of the individual patient/consumer), with data in computable formats (data that a sending and receiving computer application both know how to interpret, and therefore can compute upon), with guidelines and advisory algorithms that come from a recognized brand name medical provider. Presumably, people will trust the folks at Mayo to provide evidence-based advice in language that are patient-understandable.
This idea has been around for some time, as you know. I think that Microsoft and Mayo do a lot to help legitimize and lend credibility to the idea that patients/consumers can use the Internet to retrieve advice that is of high quality. And that’s an important advance.
Of course, the devil is in the details. As e-Patient Dave and the Parable of the Wicked EMR (http://e-patients.net ) dramatically demonstrates, most hospitals and medical practice information systems are not up to the task of supplying a verified accurate and up-to-date summary data set that includes a person’s demographics, problems and diagnoses, medications and allergies, procedures and immunizations, and so on, in computable format….yet. But the demand for this is starting to accumulate.
Kind regards, DCK