By Stephen Barlas

Sept. 23, 2008 | Normally talk about “new ecosystems” might be heard at a wildlife conference, but it dominated the presentations given in Washington on September 17 during a conference on “New Frontiers in Personal Health Records” sponsored by the Robert Wood Johnson Foundation (RWJF).

In the PHR context, these new ecosystems are essentially electronic applications for actively managing one’s health, which are consumer-activated—as opposed to physician office-centered electronic medical records (EMRs)—and allow a patient to control his or her chronic illness. “The current understanding of a PHR is of an online repository of all of the information in your medical record—and that is way too limiting,” said Stephen Downs, senior program officer and deputy director of the RWJF’s Health Group. “We want to stretch the vision so that technology designers and policy-makers see PHRs as resources that don’t just allow patients to review their medical information, but instead enable them to make more informed decisions because of it.”

Of course, the development of these kinds of applications raise the visibility of consumer-centered platforms such as Google Health and Microsoft’s HealthVault, whose representatives, at an afternoon session, expressed mostly “peace and love” toward one another and diffused a question about whether they are now at one another’s throats, competing to be the repository of choice for the kind of data consumers may be generating as a result of the growth of this new PHR ecosystem. Vince Kuraitis, the principal and founder of Better Health Technologies, moderated an afternoon session titled “Where Is This Headed” which included Neil Ramshaw, senior user experience designer at Google and Keith Toussaint, senior program manager, HealthVault.

Kuraitis referenced all the talk about “ecosystems” and asked whether their growth portended a “battle to the death” between Google and Microsoft. Toussaint argued that the arrival of Google Health actually has buttressed HealthVault’s viability. “Before there was a Google Health, I got questions about whether Microsoft HealthVault would survive,” he explained. “I don’t get that question anymore. The biggest battle is getting beyond paper medical records.”

In fact, Toussaint pointed out that Microsoft “has made a very clear statement” that it is committed to “an integrated platform” for exchange of PHRs, implying Microsoft will work together with Google. He went on to mention that Beth Israel Deaconess Medical Center (BIDMC) in Boston has signed agreements with both consumer platforms tying them into its “PatientSite” portal.

Ramshaw had earlier cited its first agreement in June with a health insurer— Blue Cross Blue Shield of Massachusetts (BCBSMA)—as evidence that health care providers, traditionally concerned about the cost of EHRs and the absence of a return on investment (ROI) with regard to computer and software costs, starting to get religion. “We are starting to see a shift and a lot of providers are starting to see the benefit of putting health information in the hands of their patients,” he stated.

It was that goal which led the RWJF to establish Project HealthDesign in December 2006, which then provided seed money to nine teams of health care, design, and technology “pioneers” who developed new, innovative PHR applications, whose prototypes were displayed in public for the first time at the September 17 conference. It was these new applications that reflect the new PHR ecosystem: for example, a MySpace-type prototype for teens ages 14-18 called Living Profiles which helps them manage juvenile arthritis, systemic lupus, and hemophilia.

In the prior session Anna-Lisa Silvestre, vice president, online services, Kaiser Permanente, stated the consumer concerns about use of their personal health data dissipated when Kaiser proved itself a trustworthy guarantor of that data’s sanctity. “You have their trust until you break it,” she said. She said the fact that 2.5 million of KP’s 8.7 members use the KP personal health manager at www.kp.org puts its acceptance in the range of online shopping services.