The Cusp of Consumer Engagement


When Chilmark Research was founded, the primary area of focus was healthcare IT that was consumer facing, consumer enabling – tools that would help consumers better manage their health and the health of loved ones. This led to our first major study on Personal Health Records (PHRs) published in May 2008. But alas, I was idealistic in the belief that there was enough interest in this area, enough of a market to sustain and grow this young company. Sure, there are loads of small companies trying to make a consumer health play and there is certainly plenty of hype surrounding it but at the end of the day when one takes a close look at this market one finds a multitude of small companies struggling to break through. Exceedingly few companies have been able to really capture the consumer market potential and scale to a size that would support the kinds of services that Chilmark Research offers. This led to a rethinking of what Chilmark Research would focus upon.

Stepping back and looking at the market one sees several critical technical gaps:

  1. Lack of Data: Despite all of the incredible medical advances taking place and the amazing technologies that are being used today to practice medicine, the industry as a whole is a laggard in adoption of IT. One can point the finger in many directions but the bottom line is that there is simply not a lot of clinical, personal health information (PHI) in a readily computable digital format that a consumer can tap into.
  2. Data Liquidity:  A consumer’s PHI, even when it is in digital form is most often scattered across a multitude of silo’d applications making it virtually impossible for a consumer to readily and securely access and manage their complete health records using the data contained therein to personally guide them to make better health decisions. There are a number of contributing factors at play here, primary among them lack of clear standards & terminology as well as reluctance of healthcare organizations to release data to the consumer.
  3. Ease of Access: Providing the consumer with “on-the-go” access to their health information allowing them to easily call up or input data to their personal health system, via a mobile device. Today, most mHealth apps in this category are rudimentary and it is not necessarily the fault of the app developer but often the lack of good data as a result of points 1 & 2.

Effectively combining the above can lead to “actionable knowledge,” the ability of a consumer to make informed decisions regarding their health, or that of a loved one, at the point of need – when it matters most. Now whether or not consumers actually use such technology remains to be seen. Yes, according to Pew Charitable Trust over 80% of consumers have used the Internet to search on a health topic but it is one thing to do a search on say a symptom and quite another to actively manage your health. There are examples of deep consumer engagement, such as the one we profiled at Howard University, but these remain more the exception than the rule.

Addressing the three critical gaps above will take time and it will begin within healthcare organizations of all sizes. It is for this reason that Chilmark Research re-directed its research to have a primary focus on technology adoption among providers. (Note: We will continue to address other areas such as employer views of health & wellness initiatives, consumer adoption, etc., it just will not be primary to our research). This new focus has resulted in two recent reports: mHealth in the Enterprise and HIE Market Report. Over the course of the coming year Chilmark will continue its focus on these two critical areas for ultimately they will lead back to addressing the critical gaps mentioned above.

Circling back to the title of this post, despite our rather pessimistic view of consumer adoption of health and wellness applications we are encouraged by a couple of recent initiatives.

First is the Blue Button initiative that was developed by the VA and CMS. This simple concept allows one to easily download their records has received the support of a number of organizations including both Google Health and Microsoft’s HealthVault. Now if one were to apply the Blue Button to State HIE initiatives a consumer could theoretically be able to aggregate their full longitudinal record from all the hospitals and physicians they may have seen in their region, their State, download it via a State HIE’s Blue Button to their desktop, their PHR, their Google Health or HealthVault account.

Second is the Direct Project. Unlike its predecessor, NHIN CONNECT, the Direct Project was from the outset charged to do one simple thing, replace the ubiquitous fax machine in physicians’ offices by providing a secure means for physicians to share clinical information via the Internet. Nothing fancy, nothing slick, just simple, secure email combined with a physician directory service. While this is fairly simple, what is exceedingly cool and potentially quite powerful is a featured now built into Microsoft’s HealthVault wherein a HealthVault user gets a secure assigned email address that they can share with their doctor. When that doctor goes to use Direct Project to send records to another physician as part of a referral process, he can also cc the patient and the records will also be sent to the consumer’s HealthVault account. Beth Israel Deaconess’s CIO John Halamka has already implemented this at his institution and we look forward to the day when this will become common practice across the healthcare sector.

Both of these initiatives have been released in the last six months but their broader adoption across the healthcare sector is not assured. It is our hope that future Meaningful Use requirements that are released for Stages 2 & 3 encourage physicians and healthcare organizations to adopt and use both the Blue Button and Direct Project in their day-to-day practice to ultimately make the consumer a more active participant in their health. This could indeed finally bring us to the cusp of a groundswell in consumer adoption and use of more advanced tools to better self-manage their health and the health of those they hold dear.

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