Project Health Design Blog

Google Health Joins the Fray

Posted on February 29, 2008 by Lygeia Ricciardi

As you may have heard, Google formally unveiled Google Health yesterday at the Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, following an announcement last week that it was participating in a pilot with the Cleveland Clinic. Google CEO Eric Schmidt described Google Health as a secure web based service that allows consumers to compile and store their health information remotely and make decisions about who has access to it. It is not yet available to the public.

Google Health has generated a lot of discussions about privacy, partly because some people are concerned that Google already knows too much about users from their general search activities, and partly because Google, like most non-traditional entrants into the consumer health market, is not covered by the HIPAA privacy regulation.

Google will offer its product free to consumers and plans to make money indirectly, through advertising revenues generated by consumers’ follow up searches on google.com. For a description of what GoogleHealth is and isn’t, see Chillmark Research’s analysis and the comparison with Microsoft's HealthVault by Vince Kuraitis.

On the Official Google Blog, Marissa Mayer, VP, Search & User Products, lays out the characteristics that the company thinks set Google Health apart: emphasis on privacy and security, use of a platform, portability, and a user focus. While Google’s service may not be unique in any of these dimensions, they’re betting that it may provide the greatest relative value in the area of usability. As Mayer says, “We aren't doctors or healthcare experts, but one thing Google can create is a clean, easy-to-use user experience that makes managing your health information straightforward and easy.” This emphasis on the “front end” as opposed to the “back end” appears to be one of the salient differences between Google Health and Microsoft’s HealthVault platform, launched last fall.  That said, Google will encourage third-party developers to build direct-to-consumer applications, such as medication tables or immunizations reminders, that will be delivered over its open platform.  Coincidence? Probably not. Though the grand entrance of powerful outsiders like Google and Microsoft may not totally transform health IT, it does bring capitol, innovation, and attention to the field. Now all we need is consumers!

On the topic of Microsoft, the company announced earlier this week (also at HIMSS) its $3 million HealthVault Be Well Fund, designed to spur development of PHRs and similar applications that improve health (and are, of course, compatible with HealthVault).

Project HealthDesign Releases Functional Requirements for PHR “Building Blocks”

Posted February 25, 2008 by Lygeia Ricciardi

Over the past 14 months, Project HealthDesign (PHD) has been working to support the development of an innovative array of PHR applications that address the specific needs of diverse health care consumers. Despite the differences in PHRs designed for, say, adults managing chronic pain, caretakers of children with cystic fibrosis, or sedentary adults wanting to increase their activity, there are numerous basic functions that PHRs have in common, like documenting observations of their illness experiences or helping patients to remember to take medications or scheduling appointments with a health care provider.

Today, Project HealthDesign announced the release of functional requirements for a set of software “building blocks” or “platform components” that are common to many PHR applications. The requirements are intended to inform and support the PHR development community generally, not to favor any particular existing model, product, or approach.

Walter Sujansky of Sujansky & Associates, LLC, who led the team that developed the requirements, informed me that, “These requirements were derived from the needs of the nine PHD applications, but, given the diversity of these projects we think that the requirements could have broad applicability across the field.”

The Project HealthDesign team is encouraging interested parties to use the comment form provided on the program’s Web site to send feedback on the functional requirements directly to the Project HealthDesign team, and also to comment on them publicly via this blog.

Project HealthDesign Director Patti Brennan said, “We are hoping that the functional requirements will catalyze PHR development broadly by providing an organizing structure—a little bit of structure can unleash a lot of creativity.”

What do the functional requirements cover?

Since Project HealthDesign was launched in 2006 it was anticipated that a few key functions would emerge as essential to all most PHR applications. Indeed they have. The functional requirements are an identification and description of those key functions or “core services.” This is not a comprehensive list, but an initial set, based on the experience of the project teams, that is expected to evolve with time:

• Medication list management—Record, manage, share, and provide advice to consumers based on a list of the specific medications they are taking.
• Calendaring—Track, share, and remind consumers of scheduled events relevant to the management of their health and their lives.
• Observations captured in the course of daily living—Manage health-related information captured outside of the health care system. For example, acknowledging the important fact that your blood pressure measurement may be very different at home than at the doctor’s office; the idea is to track information where people are…at home, work, or school, in transit, at the park, etc.
• Identity management—Manage user authorization and authentication and allow consumers to monitor and control access to their own health data.

Why are functional requirements needed?

Articulating functional requirements is a first step toward developing “common platform components” – the actual software modules that provide common services and a functional platform for PHR applications.

In addition, common platform components support interoperability. They may comprise, in effect, a shared infrastructure that facilitates the seamless exchange of information among consumers, caregivers, and physicians who may interact with multiple PHRs and related applications.

Steve Downs of the Robert Wood Johnson Foundation talked with me about how the functional requirements help realize the Project HealthDesign vision – to stimulate the field to develop more user-centered PHR applications and provide tools to facilitate their work.

“Since the beginning of Project HealthDesign, we've argued that innovation in personal health applications would most likely result if developers could build applications on top of open platforms that provided access to medical records, other relevant data, and core services.  The reasoning is quite simple -- with access to a platform, PHR application developers don’t have to reinvent the wheel. Instead they can focus on the ‘front end’ applications unique to specific groups of users, not the ‘back end’ coding that has already been done by others.  Our project teams have been designing and prototyping applications—to meet a wide range of possible users and health management needs—that assume access to such a common platform.  One of our goals has been to use the design process to identify the core services that a platform would need to offer.  Releasing these functional requirements serves two purposes:  1) it can inform the providers of PHR platforms of potential services they can offer to enable more 3rd party application development; and 2) it provides an opportunity for PHR application developers to join the discussion and by adding their perspective on what core services are needed to support their applications.”

Additionally, Project HealthDesign Director Patti Brennan points out that the development of functional requirements has helped several of the grantee teams by providing a framework that helps to shape the applications they are building.

How were they developed?

Project HealthDesign enlisted a team led by Walter Sujansky of Sujansky & Associates LLC to help develop the functional requirements and common platform components through an in-depth process of interviews with the nine grantee teams and analysis of their work to date.

As Patti Brennan underscored, “The teams ‘backed into’ an articulation of the functional requirements from their work, rather than imagining hypothetically what they might look like at the outset. We believe that this approach is the most practical because it’s grounded in real life experience.”

What’s next?

Project HealthDesign hopes the release of the functional requirements will complement and inform existing and future PHR development and related efforts, and that it will stimulate a broader discussion about the standardization and modularization of platform services.

Later this year, Project HealthDesign will release prototype versions of the actual code—the common platform components that correspond to the functional requirements released today. Those common platform components are being developed to support the prototyping work of the nine Project HealthDesign teams and will be made available to the public for vetting and integration into other efforts.

Report on Privacy and PHRs Released

Posted February 20, 2008 by Lygeia Ricciardi

FYI today the World Privacy Forum released a new legal and policy analysis examining Personal Health Records and the privacy issues associated with them. This analysis, Personal Health Records: Why Many PHRs Threaten Privacy, was prepared by Robert Gellman for the World Privacy Forum. The analysis finds that significant, serious threats to privacy exist in some PHRs.

Consumer Health Informatics Course in CA in April

Posted February 11, 2008 by Lygeia Ricciardi

FYI -- Claremont Graduate University is offering a 2.5 day educational workshop on research, systems, and practice in Consumer Health Informatics starting April 11, 2008. A description from the course website is as follows: This course provides dialogue between you and those most respected in the field of Consumer Health Informatics. Through presentations, panel discussions, and case study analyses participants will explore:

* PHR uses across diverse communities
* Consumer options for PHRs
* The role of consumer informatics in practice
* PHRs in times of emergency
* Educating the consumer on HIT
* The effect of policy on consumer adoption of HIT
* Consumer use of HIT

This two and a half day intensive learning session will serve to educate professionals on the gaps and needs of the consumer as a springboard for considering and enacting exciting new ideas for using e-health systems to provide benefits throughout society. This course will also provide an opportunity for educators to share their interests and experiences in providing a consumer health informatics perspective in the classroom.

Instructors and Guest Faculty include:
** Thomas A. Horan, PhD; Claremont Graduate University

** Karen Bell, MD; Office of the National Coordinator for Health Information Technology
** Blackford Middleton, MD, MPH, MSc; Center for Information Technology Leadership (CITL)

** Susan Daniels, PhD, Former Deputy Commissioner for Disability and Income Security Programs, Washington, DC
** Bill Hersh, MD, Oregon Health & Science University
** Don Detmer, MD, Professor of Medical Education at the University of Virginia, President AMIA
** Ted Shortliffe, MD, PhD, University of Arizona
** Holly Jimison, PhD, Oregon Health & Science University
** Paul Torrens, MD, UCLA
** Robert Jenders, MD, Cedars-Sinai Medical Center, UCLA
** Kim Nazi, Veterans Administration
** Will Crawford, Boston Children’s Hospital

For more information and to register see: http://kaycentersymposium.cgu.edu

Smart (and chic) clothing monitors vital signs

Posted February 7, 2008 by Lygeia Ricciardi

There's an interesting post by Susan Promislo today on our "sister blog"--Pioneering Ideas--about clothing made with smart fabrics that can read and report on the vital signs of the wearer. As the post points out, several Project HealthDesign teams have considered integrating such fabrics with PHRs. An intriguing combination of funcitonality and (Italian!) fashion.

Nurses’ Workgroup on Consumer Empowerment/PHRs

Posted February 6, 2008 by Lygeia Ricciardi

FYI -- The Technology Informatics Guiding Education Reform (TIGER) Initiative is focused on helping the nursing profession to adopt informatics tools, principles, theories and practices that make healthcare safer and more effective, efficient, patient-centered and equitable for all stakeholders.

At the TIGER Summit in 2006, participants defined action steps that the nursing profession can take to better prepare its workforce to use technology and informatics to improve the delivery of patient care.  Nine workgroups grew out of that effort – one on Consumer Empowerment and PHRs. The Consumer Empowerment and PHRs workgroup has set up a wiki and will be holding a webinar on February 21^st. The group is still fairly early in defining its work. You can sign up to participate here.

Congratulations, Paul Tang!

Posted February 1, 2008 by Lygeia Ricciardi

Dr. Paul Tang, the Chair of Project HealthDesign, is profiled as an "IT Visionary" by Health Care's Most Wired Magazine online. Paul is Vice President and CMIO at Palo Alto (Calif.) Medical Foundation.