This seminar had a variety of people, anything from late teens to elderly with long term conditions, and some without any kind of chronic illness. After an initial discussion on what access to patient record provides you, which was received quite well, an overall theme came out – what’s in it for me? The group was quite ‘suspicious’ on why patient access to record by 2015 was pushed as a goal by the Government, is it just because the NHS can’t handle it or are there real benefits to us citizens?

The famous JFK quote comes to mind – “Ask not what your country can do for you – ask what you can do for your country“. It perhaps comes down to being very clear and transparent about it, yes NHS can’t cope, we need to as collective citizens do our bit to keep our healthcare system working with the ethos ‘care for all’. However, besides the financial benefits, there are citizen benefits, which of course need to be articulated much better than we have done today.

There were three main categories for people in this seminar (very simplified segmentation): under 25’s, adults with little interaction with the NHS and adults with frequent interactions with the NHS. Common to all was ‘saving time’ as a key driver for. This could be anything from appointment bookings to viewing blood results online. The group which had frequent interactions with the NHS, and were on some sort of rehab saw the benefits of uploading your own data, like blood pressure etc., the younger group didn’t at all, in fact they did not see any benefits of having access to their records. The adults with little interaction with the NHS were sitting on the fence and trying to find benefits for themselves.

A very useful session and above is a very small snippet out of a long session. This is however a good indication of some of the challenges of making citizens engaged in their own health. Whilst the patient access to records by 2015 is a great initiative, its not an end, just the means to an end. Our platform strategy with HealthVault is about driving behavioural change, the platform is ready to consume the record, but the record is used to drive the interactions. Above summary also shows that different segments have different motivational drivers, and a platform like HealthVault enables us to create different experiences suited to each segment without creating information silos.

There was one patient in the group who had a significant experience of the healthcare system, and repeated several times the need to have both primary and secondary information available to us (not just the letter sent to the GP). Not a topic I can address right now in its entire, but have a look at what we are doing with SLaM. We are fortunate to be working with Mike Denis (Director of IS at SLaM), who very early realised the need for patient empowerment and integrated care, and initiated several initiatives to enable efficiencies and better health outcomes.

The article discusses the role of Amalga in this solution, and identifying the at-risk patient is a fundamental step in delivering the benefits, but I will of course beat the HealthVault drum a bit louder . Once you have identified the patients at-risk, the question will always be – so what? The customised care pathway is mentioned as a step after the identification of patients, and the ‘not so new’ challenge has been: how do you manage this pathway using a cost efficient model including social care. The answer is to use a patient centric platform like HealthVault, which not only enables the PHR element, but also the tools needed to deliver and interact with this pathway and self help -  the other side of the coin.

Exciting stuff and will keep you updated on the progress.

The beginning of this year also saw the launch of Fitbit in the UK (video), a great non-intrusive device that indeed helps you to change behaviour – love it! A slight word of caution though, it allows you to ‘share stats’ and one option is to share with HealthVault, but this is unfortunately only HealthVault in the US and will not work with UK accounts. I can guess what the next question would be for anyone reading this, and the answer would be WIP!

The absence of HealthVault of course sparked many debates (and wild speculations), and I received several emails asking me how about HealthVault? There is a great blog entry by Sean Nolan, our chief architect discussing this, and don’t want to repeat all of it but key points are that HealthVault is an open platform and a neutral ground for interoperability. Open platform and Open data are our key drivers and keeping HealthVault with Microsoft is the right thing to do. Our commitment is the same, and in fact, it will increase in 2012!

Going back to the WSD announcement, the core headline findings are very encouraging, not surprising considering various HealthVault based trials in the US and what we anticipated, but two other points stand out for me in this initial report:

1. It mentions service transformation by putting the citizen in the centre

2. Plans to work with the industry to deliver the 3 Million Lives campaign.

HealthVault is what I do, so no surprise to anyone if I promote it as the ‘perfect’ platform to deliver this campaign. More interestingly, however, as my good colleague Paul Thomas pointed out as well, it talks about Public-Private partnership, and I have been long waiting for this moment. I know this is just the beginning, but a recognition that private companies can play important role as a partner, not just supplier, is a good start, and using this approach will drive down costs. As explained previously, HealthVault is a platform and we take very similar approach, we are good at platforms but we don’t deliver healthcare apps, let the healthcare providers do that by partnering.

Interesting times ahead, HealthVault has the potential of bringing together an eco-system where patients/citizens have a choice of telehealth and same time not creating silos of data.

Lastly, Andy and I have pretty much been running around the country past 5 months to meet potential customers and app providers. Besides needing a break, we are looking forward to a great 2012 where much of our work this year will become a reality on HealthVault, anything from devices to applications

Happy Christmas and a New Year!

A comparison often made is with banks, they hold my financials (data and money) and HealthVault holds health data. The strange thing is that with online banking, I have not challenged or asked my bank where they are holding my data, what the security is etc., not sure why I decided to trust them without any evidence. As a side point, the thought of losing my financial data is far more scary than losing my health data, so why wouldn’t we want to put our health data in the cloud? That’s just me and others may have a different view. In fact, banks have gone one step further, not losing our data but they have lost our money…and we still seem to have an implicit trust to them. A debate for another time.

So in keeping the electronic ‘vault’ (banking or health) secure we need to look at 3 pillars: Technology, People and Processes. I am by no means expert on these things (my colleague Andy is, and here is another nudge to start his long awaited blog!), but let’s look at them:

Technology: Well, that’s what we do, our approach to secure technology is fundamental in how we develop code. Many financial institutions use Microsoft technology which is a great endorsement. The Help section of HealthVault even outlines some some of the measures we take to safeguard the data including the use of ‘white hat hackers’.

People and Processes: This is where things often go wrong, but our experience in delivering large (and I mean large) scale online solutions by GFS has enabled us to build up the resources and processes (e.g. MOF) to manage an environment like this.

Privacy is quite simple, it is the citizen’s data. No one can access it without their consent, and the citizen decides what they want to store and who they want to share with (and what part of the record). The obvious question is ‘what about Microsoft?’ Well, we can’t access it either unless the citizen gives us access. An extract from the Help section:

“Microsoft won’t use your information in HealthVault to personalize ads or services without explicit permission”

There it is, plain and simple and reason why I can confidently talk about HealthVault as a service that truly puts the citizen at the centre. Many Information Governance issues are circumvented by using a consent model HealthVault uses.

We have already established that HealthVault is a platform, and with that comes the opportunity to build pretty much any app (‘use case’) you like. This concept needs to be brought to life and we often demo different apps to show the possibilities of the platform. This generally drives a lively debate and discussions on what can be done – exactly the outcome we want.

We then move the conversation a bit further by explaining that the healthcare problem (as we see it) is not just the ‘illness’ bit; it needs to include wellbeing and fitness if we are to make a fundamental change to health outcomes. HealthVault, by taking the platform approach (with devices), is in great position to enable that ecosystem. We can use the diagram below to show it, but I don’t want to misrepresent HealthVault by implying that it can only hold limited information; it can hold anything you want, but the point here is what is useful to the citizen.

The conversation often includes how we see our competitors and the interesting thing is that in many cases where the competitors see us as competition, we don’t! We are a platform and we can integrate with anyone wanting to integrate with us. The idea is to unlock data, not creating ‘just another silo’ and we are keen to ensure that we integrate systems.

We had one conversation with a healthcare provider that wanted to create a roadmap of citizen services, starting from maternity and child wellness and then to long-term conditions. It didn’t take long for them to figure out that the platform approach would allow them that, with the freedom to build/select their own user experience on the same platform.

It’s all about choice. You would want to use a common platform that allows you to choose the application experience that is right for your citizens/patients and for your organisation. HealthVault provides that!

HealthVault holds fitness/wellness/medical information, as stated previously, but what will this mean to individuals and healthcare providers? There are many answers to this question, but the fundamental principles that I subscribe to are: a) quality of care will be improved by correct and relevant information and b) citizen/patient engagement.

Part of the healthcare challenge is the fragmented view of our fitness/wellbeing/medical information. The question is what outcome would we have if that information was stored in one place and available at point and decision of care? A blog post by Adam Roberts at Nuffield Trust touches upon the issue of a single record and asks the question if we will still be discussing these issues five years from now. I do understand that these are difficult challenges but I strongly believe that a system like HealthVault overcomes many of the issues, delivering the single patient-centric (owned) view at low cost and without the need to majorly overhaul existing systems. It’s worth mentioning that is also possible to provide clinicians with a single view of the patient with our solution Microsoft Amalga.

There are many reasons why citizen/patient engagement is important; one of them is driving behavioural change. This is not an easy thing as most of you know, especially changing health behaviours, but the point is that if you make information available to the citizen, you stand a better chance. That’s why health (risk) assessments and the ability to understand the impact of how certain changes in habits can impact our future health are an important part of the engagement. However, what I have found useful is also to “see” the effects of my current health behaviours. The obvious example is the impact of smoking. If I can see the impact on my lungs and heart on a regular basis, I am pretty sure I would think twice before lighting up my shisha. The article on NHS Choices does a good job of describing what teenage smoking will do, but still we human beings have a tendency to say ‘not me’. Sharing and allowing the citizen to see the impact would surely have a better outcome.

Then there is the question of long term vs. short term reward, but that’s a discussion for another time.

However, looking closely at how they have achieved this, I found some interesting similarities.

The National Electronic Health Record is a patient-centric view of the medical record. They have a patient portal where patients can log in and view their data and also control access to it. But here is the trick – it’s not a classic centralised system. They have core information stored in it, but it then contains links to local systems containing the detailed records, very much like how distributed name resolution works on the Internet. This allows for local innovation and there’s no need to replace existing systems as long as they can integrate with the national system.

HealthVault would have been perfect for Estonia (if it had been available for them several years ago) as this is one of the main use cases of HealthVault. The only difference is that rather than linking to other systems, HealthVault would store the information from other systems in a Read-Only or Sync scenario. However, thinking more about it, the linking system adopted by Estonia could probably work with HealthVault as well…

The bottom line is that centralisation is not a bad thing and two main lessons have been learned:

• Centralise around the patient/citizen, not around the care provider. The patient is, after all, the reason for the existence of all care providers, so why not create systems with patient in the middle?
• Centralise smartly, allow local innovation but let them be open systems that allow platforms like HealthVault to consume the distributed data easily.

Any fitness, wellbeing and health provider who wants to engage citizens/patients in an online programme with actionable and measurable outcomes will need a store into which they (both citizen and provider) can put information. This store should be UK-based, secure, reliable and owned by the citizen, where they decide who should be able to see their wellbeing and health data – this, in its simplest form, is HealthVault.

Ok, so we have established what HealthVault is, but that’s not the most exciting part – it’s what we can do with it. I called it ‘online programme’ above but the word ‘apps’ is more appropriate to use and a concept that most of us are familiar with on our smartphones. So think of HealthVault as the smartphone and the wellbeing and health organisations as the app providers – the point being that Microsoft is not a healthcare provider but develops technology that can be used by the organisations to achieve better health outcomes. One of my favourite examples is the Mayo Clinic Health Manager in the US, where Mayo has used HealthVault to deliver a great app for their patients. Have a look at the branding – it is Mayo across the board with HealthVault referenced as ‘powered by’ or ‘connects to’.

How many apps do we have in the UK? Well, we already have these right now with more coming soon. It’s a great time to get involved.

To learn more about how to develop apps on HealthVault, have a look at our MSDN resources and also the blog from our Chief Architect’s (Sean Nolan) blog, a fantastic read.

2009 was interesting year with elections coming up and plenty of discussions on how we can better make use of public private partnerships to drive efficiencies and cost savings (public services reform). HealthVault, which was launched in US in 2007, had been on my mind for a long time – the trick was to find the right time to bring it over to the UK and we believed this was it.

The responsibility for bringing it over, everything from the smallest logistical task to establishing the Consumer Health strategy, fell in my lap – well actually I wanted it, so I harassed my manager to give it to me! What followed was 6 months of hard, hard work together with Alex (the PM for the project) and a colleague from Microsoft Corp (Beny), who not only was critical to the project, but became a very good friend of mine. We came across issues no one had ever heard of. We were, after all, establishing a secure service to store personal health data. We did it though. With the right people around us, and the determination, we delivered on quality, time and budget in June 2010.

I’m now Director of HealthVault UK, working on what I passionately believe in – using web technologies to change health behaviour. I know it will take time for people to get used to the concept of online health, just like it took time to get used to online banking.  But I do believe that it will become second nature in the very near future as healthcare organisations are looking to transform and we the citizens want better information and care. In fact, thinking about, what choice do we have?

So, a little bit of history and plenty to talk about in my next blog entries – where we are, where we want to go and your feedback.

Arif